S-1 Prevalence of Chronic disease in India S-2 Percentage of Hypertension in Indians S-3 Percentage of Hypertension in Indians S-4 Percentage of overweight Indians S-6 Chronic diseases share common risk factors and conditions S-7 Major Factors Influence Our Eating Behavior S-8 Portion sizes S-9 Informational Eating Norms S-10 Family and Social Determinants S-11 Environmental Influences on eating Behaviour S-12 Parental Influences on on children's Eating pattern and Food Choices S-13 Eating Disorders S-14 Types of Eating Disorders S-15 Health Effects of Different Types of Eating Disorders S-16-18 Diagnostic Consideration for Different types of Eating Disorders S-23 Different Treatment Options for eating Disorders S-24-27 Nutritional Assessment, Intervention and Nutrition Monitoring and Evaluation

1. Determinants of Eating Behavior
and its Impact on Chronic Diseases
Presented to Dr Charul Jha
Assistant Professor Institute of Nutrition and
Dietetics Nims University Jaipur Rajasthan India
Presented by Wajid H Rather
PhD scholar, Institute of Nutrition and Dietetics
Nims University Jaipur Rajasthan India

2. Prevalence of Chronic disease in India
38
31
23
9
4.5
2
1
0
5
10
15
20
25
30
35
40
Hypertension Diabetes obesity Heart Disease Osteoprosis COPD some Types of cancers

3. Percentage of Hypertension in Indians
Source: National Family Health Survey (NFHS-5), 2019-21
21.1
24
8.8
13.5
NHFS-5 (2019-21) NHFs-4 (2015-16)
Men
For men and women age cohort of 15-49 years is considered
Women

4. Percentage of overweight Indians
Source: National Family Health Survey (NFHS-5), 2019-21

5. Chronic diseases share
common risk factors and conditions
Non-Modifiable
Risk Factors
Behavioral Risk Factors
Cultural and
Environmental
Conditions
Intermediate
Conditions :
High Blood
Pressure (HTN)
Elevated Blood
Lipids
(hyperlipidemia)
Overweight/Obe
sity
Pre-diabetes
Disease endpoints:
CVDs
Diabetes
Arthritis
Chronic respiratory
diseases
Several cancers

6. Major Factors Influence Our Eating Behavior
Eating
Behavior
Genetic
• Hunger
• Taste
• Pleasure
Psychological
• Mood
• Stress
Social
• Cultural norms
• Social norms
Environmental
• Cost
• Accessibility
• Advertising
Individual
• Beliefs
• knowledge
• Perceptions
• Values
Experiences
with Food
• Preferences
• Familiarity
• Aversions
Scientific American nutrition for Changing world 2016 W H Freeman and company

7. When we are served
larger portion sizes, we
tend to eat more

8. What Everyone Else is Eating: A Systematic Review and
Meta-Analysis of the Effect of Informational Eating
Norms on Eating Behavior
Informed Eating Choices Social Influences Social Identity
Journal of the Academy of Nutrition and Dietetics 114.3 (2014): 414-429.

9. Family and Social Determinants of children
Eating Patterns and Diet Quality: A Review
• Eating Patterns are strongly influenced by characteristic of both physical and social
environment.
• Children are likely to eat that are available and easily accessible and eat greater quantities
when large portions are provided.
• Various socioeconomic and sociocultural factors such as parents, education, time, constraints
and ethnicity influence the type of foods children eat.
• Parents play a direct role in eating pattern through their behaviors, attitudes and feeding style
• Mealtime structure is also important factor related to children eating patterns like whether
families eat together, mealtime screening, sources of food like food delivering applications
(FDA).
Patrick, Heather, and Theresa A. Nicklas. Journal of the American college of nutrition 24.2 (2005): 83-92.

10. Environmental Influence on Children’s Eating and Food choices
• The earlier and boarded the experiences with food are, the healthier the
child diet is.
• The more fruits and vegetables that are available at home, the more
fruits and vegetables the child will consume.
• The more fruit juice and breakfast bars are available at home, the less
actual fruits and vegetables the child can consume.
• the greater the frequency of meals in front of the television and / or the
lesser the frequency of family meals and / or the greater the use of food
as reward , the higher the child’s intake of sugar –sweetened beverages.

11. Parental Influence on Children Eating and Food
Choices
• The more consistent parents are with their eating schedules or serves
healthy vs unhealthy foods, the greater the children’s eating behavior are
disinhibited.
• The presence of at least one parent during the evening meal is associated
with lower risk of poor consumption of fruit, vegetables and dairy foods and
lower risk of skipping breakfast.
• Girls who are overweight at 5 years of age and received higher levels of
restriction had the highest tendency to eat in absence of hunger.

12. Eating Disorders - The Silent killer

13. Eating Disorders
• Eating disorders are serious mental conditions marked by
persistent disturbances in eating or behavioral patterns that
considerably impair overall physical and mental health.
• Anyone, regardless of age, gender, ethnicity, or socioeconomic
status, can be affected by any of these disorders.

14. Anorexia Nervosa (AN)
• A severe restriction in food consumption, a distorted body image,
and a crippling dread of gaining weight are all characteristics of
this form of the eating disorder.
• Anorexic people may weigh abnormally less, often lower than
what is thought to be healthy for someone their age and height.

15. Health effects of Anorexia Nervosa (AN)
• Osteoporosis
• Hypothermia and Hypotension
• Arrhythmias that can lead to cardiac arrest
• Menstrual period Stops

16. Diagnostic Consideration for Anorexia Nervosa
• Exaggerated drive for thinness
• Refusal to maintain a body weight above the standard minimum (e.g;85%
of expected weight)
• Intense fear of becoming fat with self-worth based on weight or shape
• Evidence of an endocrine disorder
Proposed for DSM V
• Restricted energy intake relative to requirements leading to a markedly low body weight
• Intense fear of gaining weight or becoming fat or persistent behavior to avoid weight gain,
even though at a markedly low weight
• Disturbance in the way in which one’s body weight or shape is experienced

17. Bulimia Nervosa (BN)
• This eating disorder is characterized by binge eating, followed
by compensatory measures that include fasting, excessive
exercise, or forced vomiting.
• Although people with bulimia may have a normal body weight,
their binging and purging behaviors can cause significant
weight changes.

18. Health effects of Bulimia Nervosa (BN)
• Gastrointestinal Issues like constipation and acid reflux.
• Electrolyte imbalances
• Tooth decay and cavities
• Esophagus inflammation (Esophagitis) and tears.
• Throat and stomach ulcers

19. Diagnostic Consideration for BN
• Overwhelming urges to overeat and inappropriate compensatory behaviors or purging that follow
the binge episodes (e.g., vomiting, excessive exercise, alternating periods of starvation, and abuse
of laxatives or drugs).
• Similar to anorexia nervosa, individuals with bulimia nervosa also display psychopathology, including
a fear of being overweight
Proposed for DSM V
• Recurrent episodes of binge eating with a sense of a lack of control with inappropriate
compensatory behavior..
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa.

20. Compulsive Over Eating(COE)/Binge Eating Disorder
(BED)
• Eating more rapidly than normal
• Eating until uncomfortably full
• Eating large amount when not hungry
• Eating alone due to embarrassment
• Feeling disgusted, depressed, guilty

21. Health effects of Binge Eating Disorder
• Hypertension
• Hyperlipidemia
• Insulin resistance
• Cardio vascular diseases
• Certain types of cancers
• Gastrointestinal problems

22. Diagnostic Consideration for COE/BED
• Caused Marked Distress
• Occurs at least once a month for 3 months
• Partial or full remission
• Severity determined by binge frequency

23. Treatment for Eating Disorders
Medical Management Psychological Therapy Nutritional Therapy

24. Nutrition Assessment
• Identify eating disorder symptoms and behaviors.
• Perform anthropometric measurements in younger patients (ages 20
years and younger).
• Evaluate biomedical assessment, eating pattern, core attitudes regarding
weight, shape, eating.
• Assess behavioral-environment symptoms food restriction, bingeing,
rituals secretive eating, affect and impulsive control,vomiting,or other
purging.
• Apply nutrition diagnosis and create a plan to resolve nutrition problems,
coordinate with other HCPs

25. Nutrition Intervention
• Ensure diet quality and regular eating pattern, increased amount and
variety of food consumed, normal perceptions of hunger and satiety
and suggestions about supplement use.
• Provide psychological support and positive reinforcement; structured
refeeding plan.
• Counsel individuals and other caregivers on food selection considering
individual preferences, health history, physical and psychological
factors and resources

26. Nutrition Monitoring and Evaluation
• Monitor nutrient intake and adjust as necessary.
• Monitor rate of weight gain, once weight restored, adjust food
intake to maintain weight.
• Communicate individual’s progress with team and make
adjustments to plan accordingly.

27. References
• Robinson, Eric, et al. "What everyone else is eating: a systematic review and meta-analysis of
the effect of informational eating norms on eating behavior." Journal of the Academy of
Nutrition and Dietetics 114.3 (2014): 414-429.
• Scaglioni, S., De Cosmi, V., Ciappolino, V., Parazzini, F., Brambilla, P., & Agostoni, C. (2018).
Factors influencing children’s eating behaviours. Nutrients, 10(6), 706.
• Patrick, H., & Nicklas, T. A. (2005). A review of family and social determinants of children’s
eating patterns and diet quality. Journal of the american college of nutrition, 24(2), 83-92.
• Herle, Moritz, et al. "A longitudinal study of eating behaviours in childhood and later eating
disorder behaviours and diagnoses." The British Journal of Psychiatry 216.2 (2020): 113-119.
• Research to Practice Series, No. 2 May 2006National Center for Chronic Disease Prevention
and Health Promotion Division of Nutrition and Physical Ac
• Eating Disorders: A Guide to Medical Care and Complications, 3rd Edition , Philip Mahler, MD,
FAED and Arnold Anderson, MD, Johns Hopkins University Press, 2017.)
• Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Eating Disorders ,
Treatment of Eating Disorders” published online at www.eatright.org/ positions. J Am Diet
Assoc. 2011;111: 1236-1241.

28. PhD Scholar, Institute of Nutrition and Dietetics,Nims
University Jaipur Rajasthan India
Thank you