Dr. Gregory Jantz delivered this presentation "Whole Person Treatment of Eating Disorders" at the 2014 Lifestyle Intervention Conference in Las Vegas.
If you or a loved one is struggling with an eating disorder or associated issues of depression, anxiety, addiction, abuse or other concerns, contact The Center • A Place of HOPE today at 1.888.771.5166 to speak with a licensed specialist. It is a free, confidential call. We care and we can help.
This document provides a summary of the American Dietetic Association's position on weight management. It endorses lifelong commitment to healthful lifestyle behaviors through sustainable eating and daily physical activity for successful weight management. It discusses goals of weight management, which go beyond numbers to also include prevention of weight gain and improvements in health. It also covers assessment of obesity, which involves measuring BMI, waist circumference, medical history, psychological factors, and nutrition intake to develop a care plan.
This document provides an overview of nutrition therapy for eating disorders. It discusses how nutrition professionals are essential members of multidisciplinary clinical teams treating eating disorders, possessing knowledge of nutrition, physiology, and skills for promoting behavior change. The document reviews nutrition assessment, interventions, monitoring, and considerations regarding professional boundaries in the treatment of eating disorders. It emphasizes that training and experience in nutrition therapy specific to eating disorders can help achieve positive patient outcomes.
The document discusses the development and applications of the Edinburgh Feeding Evaluation in Dementia (EdFED) scale. It describes how the EdFED scale was developed through factor analysis and Mokken scaling to measure 6 items related to feeding behavioral problems in people with dementia. Studies have found the EdFED scale is stable across cultures and a good measure of feeding difficulty. Research has also shown that interventions like music during meals and Montessori-based activities can help alleviate feeding problems for those with dementia.
Eating disorders are often linked to weight concerns and body dissatisfaction that develop during adolescence. Additional research is needed to better understand the relationship between body dissatisfaction and eating disorder symptomatology. A study found that those concerned with their outward appearance were more likely to engage in harmful weight control behaviors if dissatisfied with their body, while those with internal focus were less likely to do so. Weight concerns have been shown to influence the development of eating disorders across several studies.
- Irritable bowel syndrome (IBS) affects 7-21% of the general population and is the most commonly diagnosed gastrointestinal condition. It is defined by abdominal pain or discomfort with altered bowel habits in the absence of underlying disease.
- Factors that contribute to IBS include alterations in the gut microbiome, intestinal permeability, immune function, motility, sensation, brain-gut interactions, and psychosocial status. Dietary triggers and a history of infection or antibiotics can also play a role.
- IBS substantially reduces quality of life and productivity. While some patients improve over time, it is generally a chronic relapsing condition. Diagnosis involves symptom evaluation and exclusion of other diseases through selected testing. Management
This document summarizes a workshop convened by the National Institutes of Health and Centers for Disease Control and Prevention to discuss the feasibility of conducting a randomized clinical trial to estimate the long-term health effects of intentional weight loss in obese individuals. While short-term studies show weight loss reduces disease risk factors, little is known about long-term health outcomes. Observational studies have limitations and results are inconclusive. Workshop participants agreed a well-designed randomized trial could provide clearer answers about long-term health risks and benefits of weight loss, informing clinical practice and policy.
Frequency of bulimia nervosa and binge eating disorder in obese females and t...Alexander Decker
This study examined the prevalence of bulimia nervosa (BN) and binge eating disorder (BED) among obese females in Iraq and compared individual characteristics between obese females with and without eating disorders. The study found that 21% of 190 obese females met criteria for BN or BED, with 16.84% having BED and 4.23% having BN. Obese females with eating disorders tended to be younger, live in cities, be married, and have higher education levels compared to obese females without eating disorders. They also reported greater body shape stress, history of diabetes, preferring fatty/mixed meals, and regular meal/snack consumption. The study aimed to better understand the relationship between obesity and eating disorders
This document provides a summary of the American Dietetic Association's position on weight management. It endorses lifelong commitment to healthful lifestyle behaviors through sustainable eating and daily physical activity for successful weight management. It discusses goals of weight management, which go beyond numbers to also include prevention of weight gain and improvements in health. It also covers assessment of obesity, which involves measuring BMI, waist circumference, medical history, psychological factors, and nutrition intake to develop a care plan.
This document provides an overview of nutrition therapy for eating disorders. It discusses how nutrition professionals are essential members of multidisciplinary clinical teams treating eating disorders, possessing knowledge of nutrition, physiology, and skills for promoting behavior change. The document reviews nutrition assessment, interventions, monitoring, and considerations regarding professional boundaries in the treatment of eating disorders. It emphasizes that training and experience in nutrition therapy specific to eating disorders can help achieve positive patient outcomes.
The document discusses the development and applications of the Edinburgh Feeding Evaluation in Dementia (EdFED) scale. It describes how the EdFED scale was developed through factor analysis and Mokken scaling to measure 6 items related to feeding behavioral problems in people with dementia. Studies have found the EdFED scale is stable across cultures and a good measure of feeding difficulty. Research has also shown that interventions like music during meals and Montessori-based activities can help alleviate feeding problems for those with dementia.
Eating disorders are often linked to weight concerns and body dissatisfaction that develop during adolescence. Additional research is needed to better understand the relationship between body dissatisfaction and eating disorder symptomatology. A study found that those concerned with their outward appearance were more likely to engage in harmful weight control behaviors if dissatisfied with their body, while those with internal focus were less likely to do so. Weight concerns have been shown to influence the development of eating disorders across several studies.
- Irritable bowel syndrome (IBS) affects 7-21% of the general population and is the most commonly diagnosed gastrointestinal condition. It is defined by abdominal pain or discomfort with altered bowel habits in the absence of underlying disease.
- Factors that contribute to IBS include alterations in the gut microbiome, intestinal permeability, immune function, motility, sensation, brain-gut interactions, and psychosocial status. Dietary triggers and a history of infection or antibiotics can also play a role.
- IBS substantially reduces quality of life and productivity. While some patients improve over time, it is generally a chronic relapsing condition. Diagnosis involves symptom evaluation and exclusion of other diseases through selected testing. Management
This document summarizes a workshop convened by the National Institutes of Health and Centers for Disease Control and Prevention to discuss the feasibility of conducting a randomized clinical trial to estimate the long-term health effects of intentional weight loss in obese individuals. While short-term studies show weight loss reduces disease risk factors, little is known about long-term health outcomes. Observational studies have limitations and results are inconclusive. Workshop participants agreed a well-designed randomized trial could provide clearer answers about long-term health risks and benefits of weight loss, informing clinical practice and policy.
Frequency of bulimia nervosa and binge eating disorder in obese females and t...Alexander Decker
This study examined the prevalence of bulimia nervosa (BN) and binge eating disorder (BED) among obese females in Iraq and compared individual characteristics between obese females with and without eating disorders. The study found that 21% of 190 obese females met criteria for BN or BED, with 16.84% having BED and 4.23% having BN. Obese females with eating disorders tended to be younger, live in cities, be married, and have higher education levels compared to obese females without eating disorders. They also reported greater body shape stress, history of diabetes, preferring fatty/mixed meals, and regular meal/snack consumption. The study aimed to better understand the relationship between obesity and eating disorders
Approach to Support Diabetes through Data Visualization DivyaBastola
Used Tableau to created a Geo-map by zip codes, Bar chart by sex and race, and another Bar chart by age to display the dense of diabetes prevalence in 17 zip codes of North Texas.
Literature Review is conducted to demonstrate the reduction of hyperglycemia events after the implementation of an inpatient multidisciplinary glucose control management program.
Created Info-graphic to exhibit the ways to manage diabetes through education, counseling, meal/diet, and exercise and potential comorbidities in the diabetic patient that undergoes surgeries.
1) No studies were found that measured quality of life as an outcome of interventions aimed at improving adherence in type 2 diabetes patients.
2) The interventions studied mainly included diabetes education, nurse-led interventions, and pharmacist-led interventions.
3) Nurse-led interventions were found to increase adherence to medication, diet, and glucose monitoring. Pharmacist-led interventions also increased medication adherence.
4) Patient education interventions were found to improve quality of life, though it was not directly measured as an outcome of improved adherence.
The document discusses the benefits, burdens and harms of artificial nutrition and hydration like tube feeding in patients with advanced dementia or who are near the end of life. It finds that tube feeding does not prevent aspiration pneumonia or malnutrition, does not decrease mortality rates, and does not prevent or hasten healing of pressure sores. Tube feeding is also not shown to improve patient comfort or functional status. Instead of tube feeding, the document recommends comfort feeding by hand for patients with advanced dementia.
This document is an honors thesis submitted by Shaquille Charles to the Psychology Department at Carnegie Mellon University. The thesis examines implications of the patient-physician relationship for people with diabetes. It reviews literature showing African Americans have poorer diabetes self-care and outcomes compared to Caucasians. The patient-physician relationship, including cultural competence, patient engagement, and shared decision-making, may influence these racial disparities. The thesis aims to study differences in patient satisfaction, expectations, and involvement between African American and Caucasian patients and how these relate to self-care behaviors.
Dietary Carbohydrate Restriction as the First Approach in Diabetes Management...May Forsyth
The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication.
The document describes the use of the Roy Adaptation Model in caring for a patient diagnosed with breast cancer who underwent breast-conserving surgery. The Roy Adaptation Model evaluates patients across four modes of adaptation: physiologic, self-concept, role function, and interdependence. The case study applies the nursing process based on the Roy Adaptation Model by assessing the patient in the four modes and identifying nursing diagnoses to develop a holistic care plan. The goal is to increase the patient's adaptation through meeting needs across the four modes of the model.
This document discusses health-related quality of life (HRQOL) and how it is measured. Some key points:
1. HRQOL assessments evaluate how medical treatments impact patients' overall well-being and ability to function, not just clinical outcomes like survival. It is a multidimensional concept.
2. Valid and reliable HRQOL instruments use standardized questions across domains to accurately capture patients' perceptions over time. Instruments must demonstrate properties like reliability, validity, and responsiveness to change.
3. Comparing HRQOL scores to appropriate comparison groups and clinically meaningful thresholds is important for interpreting results in research and clinical practice. Both general and disease-specific HRQOL instruments are used.
Nutritional Rehabilitation for Eating DisordersDavid Garner
This report describes our approach in sufficient detail to allow our outcomes to be replicated and compared with other programs. Our approach to meal planning has been referred to as “mechanical eating” and consists of a structured eating program in which quantity of food consumed, type of food consumed and spacing of meals, are all specified in advance. This report describes our approach in sufficient detail to allow our outcomes to be replicated and compared with other programs. We have anticipated potential criticisms of this
approach and have provided the theoretical and practical basis for our model.
This summary provides an overview of a research review on medical nutrition therapy for type 1 and type 2 diabetes in adults:
- The review examined evidence on carbohydrate intake, protein intake, weight management, physical activity, glucose monitoring and their effects on diabetes management.
- A total of 173 primary studies, 6 meta-analyses, and 2 reviews were analyzed to develop 17 summary statements, which then formed the basis for 29 diabetes nutrition practice recommendations.
- Key findings included that consistency in carbohydrate intake, moderate protein intake, physical activity, and glucose monitoring as part of a structured education program can improve glycemic control and reduce diabetes-related health risks. However, evidence on some topics like differing macronut
This study examined the correlation between stress levels and eating habits in undergraduate students. A survey was administered that included questions about typical food consumption and the Perceived Stress Scale. The study found no significant correlation between deviations from normal eating guidelines and increased stress levels, contrary to previous research. Limitations included a small, non-representative sample and potential issues with self-reported data. While the results did not support the hypothesis, improved methodology in future research could help determine if a relationship exists between stress and eating behaviors in college students.
The Eating Attitudes Test (EAT-26) is probably the most widely used and cited standardized measure of symptoms and concerns characteristic of eating disorders . The original EAT appeared as a Current Contents Citation Classic in 1993. The 26-item version is highly reliable and valid according to Wikipedia. Many studies have used the EAT-26 as an economical first step in a two-stage screening process.
This document discusses using lithium supplementation as a potential public health strategy to reduce antisocial behaviors. It notes that while some individuals are genetically predisposed to antisocial behaviors, environmental stimuli also play a role in whether those behaviors manifest. Those with certain genes related to neurotransmitters like serotonin are more susceptible. Lithium is known to impact these neurotransmitter systems and has shown success in treating conditions like bipolar disorder. The document proposes low-level lithium supplementation as a way to potentially help reduce antisocial behaviors in those genetically at risk who would not otherwise seek treatment due to lack of awareness of their condition.
This document discusses nutrition in elderly adults and the role of nurses. It describes a patient who has lost 10 pounds and is at risk of malnutrition due to factors like decreased activity and mild dementia. The nurse's role is to assess the patient's nutritional status using tools like the Mini Nutritional Assessment and develop interventions. These may include encouraging exercise, ensuring social eating environments, and monitoring lab values to guide increasing calorie, protein and nutrient intake through the diet and supplements. The goal is to maintain the patient's nutrition, health, and quality of life.
Elderly compliance to physical therapy programs is an important issue, as noncompliance can lead to negative health outcomes. Studies have found that one-third to two-thirds of patients are not fully compliant with prescribed exercises. The Health Belief Model and Self-Determination Theory can help explain factors influencing compliance. Key factors include a patient's perceived susceptibility, severity of their condition, barriers/benefits to treatment, and level of intrinsic motivation. Improving patient education and autonomy support can increase long-term compliance to physical therapy programs.
Families, Family Interaction and Health 2009 NIMH PresentionJames Coyne
The document summarizes critiques of past studies that claimed to find direct physiological links between family interactions and health outcomes like diabetes control or mortality. Some key criticisms included small sample sizes, overanalyzed data, ignoring obvious behavioral explanations like medication adherence, and findings that did not replicate or pass common sense tests. Later work found marital quality predicted survival through more plausible mechanisms like supporting complex medical regimens rather than direct physiological pathways. The takeaway is to be cautious of strong claims from weak evidence and avoid distractions from testable hypotheses about behavioral pathways.
Carle Palliative Care Journal Club 1/15/2020Mike Aref
A journal club review and criticism of J Natl Cancer Inst. 2019 Dec 17. pii: djz233. doi: 10.1093/jnci/djz233 Emergency Department Visits for Opioid Overdoses Among Patients with Cancer by Jairam V, Yang DX, Yu JB, Park HS.
The document discusses strategies for improving diabetes management programs to better serve racially and ethnically diverse patient populations. It emphasizes the importance of cultural competence and addressing health beliefs, alternative treatments, language barriers, and family roles that are specific to different ethnic groups. Effective programs elicit patients' cultural health beliefs, educate practitioners, provide language assistance, and address social factors like racism that can influence health outcomes.
This randomized study compared the effects of a Nordic diet versus a control diet high in refined wheat and butter on insulin sensitivity, lipid profiles, and inflammation markers in individuals with metabolic syndrome. 200 participants were randomized to either the Nordic diet rich in berries, root vegetables, fish, rye, and canola oil or the control diet for 18-24 weeks. The Nordic diet led to improvements in some lipid parameters and the inflammatory marker IL-1Ra compared to the control diet. However, there were no differences between the diets in terms of LDL, HDL cholesterol, insulin sensitivity, blood glucose, blood pressure, or other inflammation markers. The control diet was not representative of participants' usual diets and may have been
This document summarizes a literature review on perceived barriers to lifestyle changes among Hispanic Americans with type 2 diabetes. It finds that cultural, sociocultural, and psychobehavioral factors like familismo, diet/exercise barriers, and self-efficacy influence diabetes management. Barriers include lack of social support, high costs, and limited access to care or providers who understand patients' language and culture. Perceived barriers may differ between Hispanic subgroups and genders. Understanding these barriers can help tailor effective diabetes interventions for Hispanics.
The study examined the effects of a counseling intervention on cancer patients. Fifty female cancer patients participated, with 13 receiving 10 counseling sessions focused on developing coping skills like optimism, perceived control over illness, and future orientation. Quantitative measures found the intervention significantly improved optimism, perceived control, symptom reporting, future outlook, and quality of life. Case studies of counseled patients also showed benefits from developing active coping strategies with social support. The results suggest psychological counseling can help cancer patients better manage their illness.
This study examined weight loss strategies used by overweight adults with type 2 diabetes participating in the Look AHEAD clinical trial. Less than half of participants self-weighed at least weekly. Participants ate breakfast most days but also ate several meals and snacks per day and almost two fast food meals per week on average. The most common weight control practices involved increasing fruits and vegetables or reducing sweets or high-carbohydrate foods. Self-weighing less than weekly, eating more fast food meals, and fewer breakfast meals were associated with higher BMI after controlling for other factors. Regular self-weighing and breakfast consumption along with limiting fast food were related to lower BMI.
This document discusses lifestyle medicine as a solution for chronic disease prevention and treatment. It defines lifestyle medicine as involving therapeutic lifestyle approaches like nutrition, exercise, stress management and tobacco cessation to prevent and sometimes reverse chronic diseases. The document outlines tools of lifestyle medicine including motivational interviewing, group medical visits, intensive lifestyle treatment, and residential treatment. It promotes a whole food, plant-based diet as the optimal fuel for the body and discusses evidence that such a diet can prevent and treat chronic conditions like heart disease and diabetes.
Approach to Support Diabetes through Data Visualization DivyaBastola
Used Tableau to created a Geo-map by zip codes, Bar chart by sex and race, and another Bar chart by age to display the dense of diabetes prevalence in 17 zip codes of North Texas.
Literature Review is conducted to demonstrate the reduction of hyperglycemia events after the implementation of an inpatient multidisciplinary glucose control management program.
Created Info-graphic to exhibit the ways to manage diabetes through education, counseling, meal/diet, and exercise and potential comorbidities in the diabetic patient that undergoes surgeries.
1) No studies were found that measured quality of life as an outcome of interventions aimed at improving adherence in type 2 diabetes patients.
2) The interventions studied mainly included diabetes education, nurse-led interventions, and pharmacist-led interventions.
3) Nurse-led interventions were found to increase adherence to medication, diet, and glucose monitoring. Pharmacist-led interventions also increased medication adherence.
4) Patient education interventions were found to improve quality of life, though it was not directly measured as an outcome of improved adherence.
The document discusses the benefits, burdens and harms of artificial nutrition and hydration like tube feeding in patients with advanced dementia or who are near the end of life. It finds that tube feeding does not prevent aspiration pneumonia or malnutrition, does not decrease mortality rates, and does not prevent or hasten healing of pressure sores. Tube feeding is also not shown to improve patient comfort or functional status. Instead of tube feeding, the document recommends comfort feeding by hand for patients with advanced dementia.
This document is an honors thesis submitted by Shaquille Charles to the Psychology Department at Carnegie Mellon University. The thesis examines implications of the patient-physician relationship for people with diabetes. It reviews literature showing African Americans have poorer diabetes self-care and outcomes compared to Caucasians. The patient-physician relationship, including cultural competence, patient engagement, and shared decision-making, may influence these racial disparities. The thesis aims to study differences in patient satisfaction, expectations, and involvement between African American and Caucasian patients and how these relate to self-care behaviors.
Dietary Carbohydrate Restriction as the First Approach in Diabetes Management...May Forsyth
The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication.
The document describes the use of the Roy Adaptation Model in caring for a patient diagnosed with breast cancer who underwent breast-conserving surgery. The Roy Adaptation Model evaluates patients across four modes of adaptation: physiologic, self-concept, role function, and interdependence. The case study applies the nursing process based on the Roy Adaptation Model by assessing the patient in the four modes and identifying nursing diagnoses to develop a holistic care plan. The goal is to increase the patient's adaptation through meeting needs across the four modes of the model.
This document discusses health-related quality of life (HRQOL) and how it is measured. Some key points:
1. HRQOL assessments evaluate how medical treatments impact patients' overall well-being and ability to function, not just clinical outcomes like survival. It is a multidimensional concept.
2. Valid and reliable HRQOL instruments use standardized questions across domains to accurately capture patients' perceptions over time. Instruments must demonstrate properties like reliability, validity, and responsiveness to change.
3. Comparing HRQOL scores to appropriate comparison groups and clinically meaningful thresholds is important for interpreting results in research and clinical practice. Both general and disease-specific HRQOL instruments are used.
Nutritional Rehabilitation for Eating DisordersDavid Garner
This report describes our approach in sufficient detail to allow our outcomes to be replicated and compared with other programs. Our approach to meal planning has been referred to as “mechanical eating” and consists of a structured eating program in which quantity of food consumed, type of food consumed and spacing of meals, are all specified in advance. This report describes our approach in sufficient detail to allow our outcomes to be replicated and compared with other programs. We have anticipated potential criticisms of this
approach and have provided the theoretical and practical basis for our model.
This summary provides an overview of a research review on medical nutrition therapy for type 1 and type 2 diabetes in adults:
- The review examined evidence on carbohydrate intake, protein intake, weight management, physical activity, glucose monitoring and their effects on diabetes management.
- A total of 173 primary studies, 6 meta-analyses, and 2 reviews were analyzed to develop 17 summary statements, which then formed the basis for 29 diabetes nutrition practice recommendations.
- Key findings included that consistency in carbohydrate intake, moderate protein intake, physical activity, and glucose monitoring as part of a structured education program can improve glycemic control and reduce diabetes-related health risks. However, evidence on some topics like differing macronut
This study examined the correlation between stress levels and eating habits in undergraduate students. A survey was administered that included questions about typical food consumption and the Perceived Stress Scale. The study found no significant correlation between deviations from normal eating guidelines and increased stress levels, contrary to previous research. Limitations included a small, non-representative sample and potential issues with self-reported data. While the results did not support the hypothesis, improved methodology in future research could help determine if a relationship exists between stress and eating behaviors in college students.
The Eating Attitudes Test (EAT-26) is probably the most widely used and cited standardized measure of symptoms and concerns characteristic of eating disorders . The original EAT appeared as a Current Contents Citation Classic in 1993. The 26-item version is highly reliable and valid according to Wikipedia. Many studies have used the EAT-26 as an economical first step in a two-stage screening process.
This document discusses using lithium supplementation as a potential public health strategy to reduce antisocial behaviors. It notes that while some individuals are genetically predisposed to antisocial behaviors, environmental stimuli also play a role in whether those behaviors manifest. Those with certain genes related to neurotransmitters like serotonin are more susceptible. Lithium is known to impact these neurotransmitter systems and has shown success in treating conditions like bipolar disorder. The document proposes low-level lithium supplementation as a way to potentially help reduce antisocial behaviors in those genetically at risk who would not otherwise seek treatment due to lack of awareness of their condition.
This document discusses nutrition in elderly adults and the role of nurses. It describes a patient who has lost 10 pounds and is at risk of malnutrition due to factors like decreased activity and mild dementia. The nurse's role is to assess the patient's nutritional status using tools like the Mini Nutritional Assessment and develop interventions. These may include encouraging exercise, ensuring social eating environments, and monitoring lab values to guide increasing calorie, protein and nutrient intake through the diet and supplements. The goal is to maintain the patient's nutrition, health, and quality of life.
Elderly compliance to physical therapy programs is an important issue, as noncompliance can lead to negative health outcomes. Studies have found that one-third to two-thirds of patients are not fully compliant with prescribed exercises. The Health Belief Model and Self-Determination Theory can help explain factors influencing compliance. Key factors include a patient's perceived susceptibility, severity of their condition, barriers/benefits to treatment, and level of intrinsic motivation. Improving patient education and autonomy support can increase long-term compliance to physical therapy programs.
Families, Family Interaction and Health 2009 NIMH PresentionJames Coyne
The document summarizes critiques of past studies that claimed to find direct physiological links between family interactions and health outcomes like diabetes control or mortality. Some key criticisms included small sample sizes, overanalyzed data, ignoring obvious behavioral explanations like medication adherence, and findings that did not replicate or pass common sense tests. Later work found marital quality predicted survival through more plausible mechanisms like supporting complex medical regimens rather than direct physiological pathways. The takeaway is to be cautious of strong claims from weak evidence and avoid distractions from testable hypotheses about behavioral pathways.
Carle Palliative Care Journal Club 1/15/2020Mike Aref
A journal club review and criticism of J Natl Cancer Inst. 2019 Dec 17. pii: djz233. doi: 10.1093/jnci/djz233 Emergency Department Visits for Opioid Overdoses Among Patients with Cancer by Jairam V, Yang DX, Yu JB, Park HS.
The document discusses strategies for improving diabetes management programs to better serve racially and ethnically diverse patient populations. It emphasizes the importance of cultural competence and addressing health beliefs, alternative treatments, language barriers, and family roles that are specific to different ethnic groups. Effective programs elicit patients' cultural health beliefs, educate practitioners, provide language assistance, and address social factors like racism that can influence health outcomes.
This randomized study compared the effects of a Nordic diet versus a control diet high in refined wheat and butter on insulin sensitivity, lipid profiles, and inflammation markers in individuals with metabolic syndrome. 200 participants were randomized to either the Nordic diet rich in berries, root vegetables, fish, rye, and canola oil or the control diet for 18-24 weeks. The Nordic diet led to improvements in some lipid parameters and the inflammatory marker IL-1Ra compared to the control diet. However, there were no differences between the diets in terms of LDL, HDL cholesterol, insulin sensitivity, blood glucose, blood pressure, or other inflammation markers. The control diet was not representative of participants' usual diets and may have been
This document summarizes a literature review on perceived barriers to lifestyle changes among Hispanic Americans with type 2 diabetes. It finds that cultural, sociocultural, and psychobehavioral factors like familismo, diet/exercise barriers, and self-efficacy influence diabetes management. Barriers include lack of social support, high costs, and limited access to care or providers who understand patients' language and culture. Perceived barriers may differ between Hispanic subgroups and genders. Understanding these barriers can help tailor effective diabetes interventions for Hispanics.
The study examined the effects of a counseling intervention on cancer patients. Fifty female cancer patients participated, with 13 receiving 10 counseling sessions focused on developing coping skills like optimism, perceived control over illness, and future orientation. Quantitative measures found the intervention significantly improved optimism, perceived control, symptom reporting, future outlook, and quality of life. Case studies of counseled patients also showed benefits from developing active coping strategies with social support. The results suggest psychological counseling can help cancer patients better manage their illness.
This study examined weight loss strategies used by overweight adults with type 2 diabetes participating in the Look AHEAD clinical trial. Less than half of participants self-weighed at least weekly. Participants ate breakfast most days but also ate several meals and snacks per day and almost two fast food meals per week on average. The most common weight control practices involved increasing fruits and vegetables or reducing sweets or high-carbohydrate foods. Self-weighing less than weekly, eating more fast food meals, and fewer breakfast meals were associated with higher BMI after controlling for other factors. Regular self-weighing and breakfast consumption along with limiting fast food were related to lower BMI.
This document discusses lifestyle medicine as a solution for chronic disease prevention and treatment. It defines lifestyle medicine as involving therapeutic lifestyle approaches like nutrition, exercise, stress management and tobacco cessation to prevent and sometimes reverse chronic diseases. The document outlines tools of lifestyle medicine including motivational interviewing, group medical visits, intensive lifestyle treatment, and residential treatment. It promotes a whole food, plant-based diet as the optimal fuel for the body and discusses evidence that such a diet can prevent and treat chronic conditions like heart disease and diabetes.
Running head PROJECT MILESTONE TWO 1.PROJECT MILESTONE.docxtodd581
Running head: PROJECT MILESTONE TWO
1.
PROJECT MILESTONE TWO
6.
Running head: FINAL PROJECT MILESTONE
3.
Southern New Hampshire University
January 6th, 2019
Research question: “Does self-disclosure of the therapist improve eating disorder treatment.”
Hypothesis: Self-disclosure of the therapist improves eating disorder treatment.
Information On Research
The key variables for this research are self-disclosure of the therapist and eating disorder treatment. This research will focus on online research whereby participants will be recruited from an eating disorder charity database. The participants will be asked about the status of their condition and how they feel about having the disorder. The neutral condition will be that the therapists will disclose their sexuality and their feelings towards the patients’ conditions and personality (Marziliano, Pessin, Rosenfeld, & Breitbart, 2018).
Process of Study
The study will continue for two months with the therapists making contact with the participants once every week. These conditions will form the independent variables. The dependent variable would be participants continued to receive positive self-disclosures from the therapist leading to a greater level of patient self-disclosure, which lowered their shame, and encouraged the participants to continue with the treatment process. The participants will also be asked if they have been involved in any treatment before, and how they could describe their therapeutic alliance (Fuertes, Moore, & Ganley, 2018).
A longitudinal study and the rate of drop-out will be used to gather more information about the participants. The collected data will then be analyzed in relation to the independent variables by the end of the study. One of the ethical issues, which will be looked into while conducting the study, is informed consent. Participants will be informed about the purpose of the research and will have the right to participate or not participate in it. Secondly, the research will ensure the privacy and confidentiality of every participant.
Annotated Bibliography:
Secrecy and concealment are typical behaviors in individuals with eating problems. In the article titled “ Self-Disclosure in eating disorders,” researchers examined women with greater related eating issues and determined whether or not, these women would be willing to disclose information. In this study, different types of disclosure were calculated considering the body appearance of the individual and to restrained eating. This article would benefit my research because it provides great information that will confirm my theory and test my hypothesis.
Abstract 1.
Those who suffer from eating disorders are very emotional beings. Often times, some may not feel a need to express their need to not eat foods. Many women become self-conscious about their weight and find it hard to share th.
Diabetes Evidence Based Practice Paper.pdfsdfghj21
The document discusses using an evidence-based practice paper to improve population health outcomes for diabetes. It recommends explaining how evidence-based practices could better manage diabetes and provide a higher return on investment. The Health Belief Model is presented as a framework to help those with diabetes manage their condition through behavior change. Specifically, it could encourage self-care behaviors important for chronic disease management.
11 Feeding, Eating and Elimination DisordersThe diagnostic crite.docxjesusamckone
11 Feeding, Eating and Elimination Disorders
The diagnostic criteria for the Feeding and Eating Disorders in this chapter are categorized by recurrent disordered eating activities and attitudes that are mutually exclusive, with the exception of pica, which results in significant physical and/or psychosocial impairment (APA, 2013). Research demonstrates that eating disorders often originate in childhood or adolescence with the average age of onset between 8 and 21 years (Hudson, Hiripi, Pope, & Kessler, 2007). Approximately 20 million women and 10 million men in the United States suffer from a clinically significant eating disorder during their lifetime (Wade, Keski-Rahkonen, & Hudson, 2011). Despite this prevalence, only one in ten individuals with an eating disorder receives treatment (Noordenbox, 2002). It is estimated that over 90% of those diagnosed with an eating disorder are young females between the ages of 12 and 25 (SAMHSA, 2003), but adult males suffer significantly as well (EDC, 2007).
Data from the National Comorbidity Replication Survey (NCS-R) and the Adolescent Supplement (NCS-A) show that adults and children with eating disorders often have coexisting mental disorders such as depression, anxiety, and substance use; sadly, few seek treatment specific to their eating disorder. More distressing, this data demonstrates that eating disorders are often associated with functional impairment and suicidality (Hudson et al., 2007; Swanson, Crow, Le Grange, Swendsen & Merikangas, 2011).
The first three disorders were relocated to this category “Feeding and Eating Disorders” to highlight that although they are most often diagnosed in children, they can occur at any age, including adulthood. These disorders are distinguished by problems with the process of eating and retaining food, eating inappropriate food, or lack of interest in or avoidance of food. Among individuals with intellectual disabilities their presence appears to increase with the severity of the condition. Pica Disorder is the eating of nonfood items such as paint chips, string, hair, or newspaper. Although it may occur with other eating and mental disorders, symptoms must be severe enough to warrant an independent diagnosis. Rumination Disorder involves vomiting and re-eating food. Avoidant/Restrictive Food Intake Disorder was formerly feeding disorder of infancy or early childhood, but it has been expanded to capture a broader range of symptoms and age levels. This disruption in eating and feeding behavior is marked by continuous inability to meet appropriate sustenance and dietary needs. It is associated with a serious decrease in body weight, failure to grow, nutritional deterioration, reliance on enteral feeding and impairment in psychosocial functioning (APA, 2013). For any of these diagnoses, all three eating disorders should not develop solely during the course of another eating disorder and cannot be a culturally sanctioned practice or attributable to a medica.
11 Feeding, Eating and Elimination DisordersThe diagnostic crite.docxaulasnilda
The document discusses feeding and eating disorders as categorized in the DSM-5. It notes that eating disorders often develop in childhood/adolescence and are more prevalent in young females, though they can affect males as well. Common eating disorders discussed include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, pica, and rumination disorder. Assessment of eating disorders involves evaluating dietary habits, behaviors like restricting/purging, comorbid mental disorders, family factors, and medical monitoring. The Eating Disorder Examination and Eating Disorder Inventory are validated assessment tools.
- The document discusses the importance of nutrition counseling in primary care and barriers to its implementation. It provides an effective 5 step approach ("A5 Algorithm") for physicians to provide brief but effective nutritional counseling.
- Case studies demonstrate how the approach can be used to address different patient nutritional issues like metabolic syndrome, lipid levels, and weight management.
- Effective nutrition counseling in primary care has potential to improve health outcomes and prevent deaths from diseases like obesity, hypertension and stroke. Tools and a team approach are needed to successfully incorporate it into short patient visits.
A 52-year old woman with obesity, type 2 diabetes, and depression is seeking treatment. She has a 9-year history of type 2 diabetes and is overweight. Her diabetes is poorly controlled and she struggles with weight loss due to a sedentary lifestyle and lack of motivation from depression. The physician recommended weight loss and exercise but she has joint pain that limits exercise. Coordinated care is needed from a dietician, mental health professional, and physical trainer to help her safely lose weight and manage her chronic conditions through diet, exercise, and treatment of depression. Logistical challenges in rural areas include access to care, transportation, affordability, and personalized treatment plans.
The American College of Lifestyle Medicine (ACLM) is the medical professional society for physicians and other professionals dedicated to clinical and worksite practice of lifestyle medicine as the foundation of a transformed and sustainable health care system.
This document outlines information about eating disorders including definitions, health consequences, risk factors, prevalence, prevention, and treatment. It defines eating disorders as conditions characterized by abnormal eating habits caused by biological, psychological, and environmental influences. The document discusses specific eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder. It also provides statistics on the prevalence of eating disorders in the United States and risk factors. The document concludes by discussing evidence-based approaches to prevention and treatment of eating disorders.
Mediterranean-style eating can provide significant health benefits and reduce chronic disease according to extensive research. It can help prevent and manage diabetes, improve heart health by reducing risk of heart attacks and strokes, lower cancer risk, improve brain health, support weight loss and fertility, increase lifespan, lower blood pressure, and reduce environmental impacts like methane emissions. Adopting Mediterranean-style eating is recommended as a health policy approach to help address widespread chronic illness issues.
Dietary guidelines are accused to be the key reason for obesity and diabetes epidemic. This slide deck shows why they are not. Junk food diet is the key reason.
This document discusses the link between food allergies/intolerances and addiction, and the importance of nutrition in addiction recovery. It states that foods we crave can act like drugs by binding to receptor sites like endorphins. It also notes that failing to eat a nutritious diet can cause problems like fatigue and depression that make recovery more difficult. Several studies are cited showing that correcting biochemical imbalances through proper nutrition can positively impact behavior, recovery outcomes, and relapse prevention. The document advocates for allergy/intolerance testing through Allgenic to help patients identify and eliminate problem foods from their diets to aid the recovery process.
ALTERNATIVE MEDICINE.docx PTT. Slide shareKoudomJoycy
This document provides an overview of alternative and traditional medicine. It defines key terms like complementary medicine, alternative medicine, and integrative medicine. It describes the main categories of alternative medicine practices including natural products, mind-body medicine, manipulative practices, and energy or whole medical systems. Specific alternative therapies like herbal medicine, acupuncture, chiropractic, massage and meditation are discussed. The document contrasts alternative medicine with conventional Western medicine and notes alternative medicine focuses more on holism, spirituality and vital energy forces while conventional medicine is more materialistic.
The document discusses patient non-adherence to medical treatment plans. It summarizes research showing that healthcare providers and patients have differing views on adherence levels. The main reasons for non-adherence are identified as lack of education, forgetfulness, and cost/complexity of treatment plans. The document reports on surveys of healthcare providers and patients, finding that both groups agree responsibility for adherence is primarily on patients, but that doctors and other providers should better educate patients. Improving communication between providers and patients is seen as key to increasing treatment adherence.
A study found that exposing women to plus-size models in advertisements reduced their preference for extremely thin bodies, whereas exposing them to slim models increased their preference for thinness. The researchers argue that showing a more diverse range of body types in media could help promote healthier body attitudes among women. Increased exposure to larger-sized models may counteract the obsession with thinness perpetuated by the predominance of underweight celebrities and models currently featured. Addressing the narrow representation of female bodies could potentially help reduce eating disorder risk.
This document provides an overview of research on the health benefits of following a Mediterranean diet. It summarizes research showing that a Mediterranean diet can reduce the risk of chronic diseases like heart disease, diabetes, cancer, and Alzheimer's; promote weight loss and cognitive function; increase life expectancy; and benefit pregnancy outcomes and the environment. The Mediterranean diet emphasizes fruits, vegetables, whole grains, beans, nuts, olive oil, fish, and poultry while limiting red meat and dairy foods.
The document summarizes a study that evaluated the Emory Latino Diabetes Education Program (ELDEP), which provided culturally appropriate diabetes self-management education and support to 142 Latino patients over 5 years. The study found that after participating in ELDEP, patients had significant improvements in clinical indicators like A1C, blood pressure, and home blood glucose monitoring. Risk reduction examinations also increased. Predictors of continued participation included income, physical activity, and previous attendance. The program was effective at improving diabetes care for Latino patients.
Similar to Dr. Gregory Jantz Lifestyle Intervention Conference 2014 - Whole Person Treatment of Eating Disorders (20)
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
Emotional and Behavioural Problems in Children - Counselling and Family Thera...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath. ETCO2 levels reflect the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
Dr. Gregory Jantz Lifestyle Intervention Conference 2014 - Whole Person Treatment of Eating Disorders
1. Whole Person Treatment of
Eating Disorders
Gregory L. Jantz, PhD, CEDS
IAEDP-Certified Eating Disorder Specialist and Approved Supervisor
2. Anorexia Nervosa-Historical Perspective
14th Century – Catherine of Siena practiced an extreme form of
fasting and eventually died of starvation
1868 – Sir William W. Gull names the illness anorexia nervosa –
which means “nervous loss of appetite.”
1870 – Charles Lasègue, without the knowledge of Gull’s work,
described the condition as “L’anorexic hysterique.”
1947 – John Berkman: “Among adolescents the cause for the
psychic upset can often be traced to a parent.”
1973 – Hilde Bruch’s idea that an unhealthy pursuit of thinness
was caused by psychological or cultural factors became part of
the common consciousness.
Source: James Greenblatt, MD; Dietary Fats in the Prevention and Treatment of Eating Disorders, presented to IAEDP March 22,
2013; used by permission
Gregory L. Jantz, PhD, CEDS
3. Not Otherwise Specified?
Under DSM-IV-TR, the majority of
patients were given a diagnosis
without specified criteria.
Gregory L. Jantz, PhD, CEDS
5. Changes to Eating Disorder Criteria between DSM-IV-TR & DSM-V:
Gregory L. Jantz, PhD, CEDS
Anorexia Nervosa
•The core diagnostic criteria for anorexia nervosa are conceptually unchanged
from DSM-IV with one exception: the requirement for amenorrhea has been
eliminated. In DSM-IV, this requirement was waived in a number of situations
(e.g., for males, for females taking contraceptives). In addition, the clinical
characteristics and course of females meeting all DSM-IV criteria for anorexia
nervosa except amenorrhea closely resemble those of females meeting all DSM-IV
criteria. As in DSM-IV, individuals with this disorder are required by Criterion
A to be at a significantly low body weight for their developmental stage. The
wording of the criterion has been changed for clarity, and guidance regarding
how to judge whether an individual is at or below a significantly low weight is
now provided in the text. In DSM-5, Criterion B is expanded to include not only
overtly expressed fear of weight gain but also persistent behavior that interferes
with weight gain.
Source: Highlights of Changes from DSM-IV-TR to DSM-5 (2013) from the American Psychiatric
Association, page 12.
6. Changes to Eating Disorder Criteria between DSM-IV-TR & DSM-V:
Bulimia Nervosa
•The only change to the DSM-IV criteria for bulimia nervosa
is a reduction in the required minimum average frequency
of binge eating and inappropriate compensatory behavior
frequency from twice to once weekly. The clinical
characteristics and outcome of individuals meeting this
slightly lower threshold are similar to those meeting the
DSM-IV criterion.
Source: Highlights of Changes from DSM-IV-TR to DSM-5 (2013) from the American Psychiatric
Association, page 12.
Gregory L. Jantz, PhD, CEDS
7. Changes to Eating Disorder Criteria between DSM-IV-TR & DSM-V:
Binge-Eating Disorder
•Extensive research followed the promulgation of
preliminary criteria for binge eating disorder in Appendix B
of DSM-IV, and findings supported the clinical utility and
validity of binge-eating disorder. The only significant
difference from the preliminary DSM-IV criteria is that the
minimum average frequency of binge eating required for
diagnosis has been changed from at least twice weekly for 6
months to at least once weekly over the last 3 months,
which is identical to the DSM-5 frequency criterion for
bulimia nervosa.
Source: Highlights of Changes from DSM-IV-TR to DSM-5 (2013) from the American Psychiatric
Association, page 12.
Gregory L. Jantz, PhD, CEDS
8. Difficulties in Treating Patients with Eating Disorders
Greater than 30% of patients with AN become chronically ill over
10 years
Mortality rates: 10% at 10 years, 20% at 20 years
Highest risk for suicide among all psychiatric illnesses
Highest number of hospital days of any psychiatric illness
No Advances in the Biological Treatment of Anorexia Nervosa
in 50 years.
Source: James Greenblatt, MD; Dietary Fats in the Prevention and Treatment of Eating Disorders, presented to
IAEDP March 22, 2013; used by permission
Gregory L. Jantz, PhD, CEDS
9. What is the “Whole-Person” approach?
•Integration of multiple factors for long-term
recovery of eating disorders
•Emotional
•Relational
•Intellectual
•Medical/Brain-science
•Nutritional
•Chemical dependency/Substance Abuse
•Dental
•Spiritual/Faith-based
Gregory L. Jantz, PhD, CEDS
10. The TOMATO Effect:
Rejection of Highly Efficacious Therapies
Source: James S. Goodwin, MD, Jean M. Goodwin, MD, MHP
JAMA May 11, 1984, Vol. 251, No. 18
Gregory L. Jantz, PhD, CEDS
11. The TOMATO Effect:
Rejection of Highly Efficacious Therapies
•When an efficacious treatment for a certain disease is ignored
or rejected because it does not “make sense” in light of accepted
theories of disease
•Americans would not eat tomatoes for over 200 years even
though they were eaten since the 16th century in Europe
•In 1820, there was a public tasting that occurred without
consequences
Source: James Greenblatt, MD; Dietary Fats in the Prevention and Treatment
of Eating Disorders, presented to IAEDP March 22, 2013; used by permission
Gregory L. Jantz, PhD, CEDS
12. Whole-Person recovery requires an integrated
treatment team model
A treatment team approach is the recommended model, including
medical personnel (either a physician or a psychiatrist), a
registered dietitian or medical professional who is trained in
nutritional rehabilitation, and a mental health clinician. Dental
professionals may also be part of the team.
(From Key Elements to a Good Treatment Plan by Cris Haltom, Ph.D., June 26, 2006)
Gregory L. Jantz, PhD, CEDS
13. Whole-Person recovery requires an integrated
treatment team model
When a patient is managed by an inter-disciplinary team in an
outpatient setting, communication among the professionals is
essential to monitoring the patient’s progress, making
necessary adjustments to the treatment plan, and delineating
the specific roles and tasks of each team member.
American Psychiatric Association – Practice Guidelines for the Treatment of Patients with Eating Disorders, 3rd
Edition, 2006, Executive Summary (a) Coordinating care and collaborating with other clinicians
Gregory L. Jantz, PhD, CEDS
14. Whole-Person recovery requires an integrated
treatment team model
The authors of a textbook edited by Grilo and Mitchell (2010) describe
therapeutic approaches and reviews supporting evidence on all
aspects of eating disorder treatment, from assessment to nutritional
rehabilitation to managing the chronically ill. The authors state that
there is no single treatment for patients with eating disorders.
Rather, a diversity of approaches is recommended.
Source: American Psychiatric Association – Guideline Watch (August 2012): Practice Guidelines for the Treatment
of Patients with Eating Disorders, 3rd Edition (page 2); The Treatment of Eating Disorders: A Clinical Handbook,
edited by Carlos M. Grilo, PhD and James E. Mitchell, MD.
Gregory L. Jantz, PhD, CEDS
15. Whole-Person recovery requires an integrated
treatment team model
A team that includes professionals with experience in psychiatry and
psychology, internal medicine and nutrition, social work, nursing
and even recreation is needed to provide the full range of therapy
and treatment to help patients develop the skills necessary to gain
control of destructive eating disorder behavior, improve their
support system, increase self-esteem , and establish a foundation
for long-term recovery.
Source: A “Continuum of Care” Approach to Eating Disorders by Stuart Koman, Ph.D.;
http://www.waldenbehavioralcare.com/pdfs/ContinuumOfCare.pdf
Gregory L. Jantz, PhD, CEDS
16. Whole-Person recovery requires an integrated
treatment team model
•Approximately 50% of individuals with an eating disorder
(ED) abuse or are dependent on alcohol or illicit substances
compared with approximately 9% of the general population
Source: (Holderness et al., 1994; The National Center on Addiction and Substance Abuse
(CASA at Columbia University, 2003)
•Of individuals with a substance use disorder, more than 35%
report some form of an ED (CASA, 2003) compared to lifetime
prevalence estimates of approximately 5% for women in the
United States
(Hudson et al., 2007).
Source: From the Introduction to Patterns of Comorbidity of Eating Disorders and Substance Use
in Swedish Females, Root et al., 2009); http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788663.
Gregory L. Jantz, PhD, CEDS
17. Whole-Person recovery requires an integrated
treatment team model
It is the position of the American Dietetic Association that
nutritional intervention, including nutritional counseling, by a
registered dietitian (RD) is an essential component of the team
treatment of patients with anorexia nervosa, bulimia nervosa,
and other eating disorders during assessment and treatment
across the continuum of care.
Source: Position of the American Dietetic Association: Nutrition Intervention in the Treatment of
Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders (J Am Diet Assoc. 2006; 106:20773-
2082)
Gregory L. Jantz, PhD, CEDS
19. Whole-Person recovery requires an integrated
treatment team model
Eating disorders arise from a variety of physical,
emotional and social issues all of which need to
be addressed to help prevent and treat these
disorders . . . while eating disorders appear to
focus on body image, food and weight, they are
often related to many other issues. Referral to
healthcare professionals and encouragement to
seek treatment is critical as early diagnosis and
intervention greatly improve the opportunities
Gregory L. Jantz, PhD, CEDS
for recovery.
Source: American Dental Association, Oral Health Topics, Anorexia Nervosa (Eating
Disorders); http://www.ada.org/2582.aspx?currentTab=2
21. Standard of Care
There is no FDA-approved medication for Anorexia
Nervosa . . .
Source: WebMD August 25, 2011- http://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/
anorexia-nervosa-medications
. . . Yet, the majority of
patients treated are with
psychotropics
Polypharmacy is the norm
Gregory L. Jantz, PhD, CEDS
22. Benefits of a Multiple-Disciplinary Team Approach to
Treatment
Non-response to SSRI medication in ill AN
subjects could be a consequence of an
inadequate supply of nutrients, which are
essential to normal serotonin synthesis and
function. [These data suggest that a disturbed
serotonin activity may create a vulnerability for
the expression of a cluster of symptoms common
to both AN and BN and that nutritional factors
may affect SSRI response in depression and/or
obsessive-compulsive disorder.]
Source: Kaye W, Gendall K, Strober M Biol Psychiatry 1998 Nov 1; 44(9):825-38.
Gregory L. Jantz, PhD, CEDS
23. Benefits of a Multiple-Disciplinary Team Approach to
Treatment
Anorexics with low body weight, low BMI,
and low serum albumin (the main protein in
blood) levels are at increased risk for vitamin
and mineral deficiency. Vitamin
abnormalities may contribute to cognitive
difficulties such as poor judgment or
memory loss and other psychiatric
conditions. These deficiencies can often be
corrected with dietary interventions.
Source: From the University of Maryland Medical Center – “Anorexia
Nervosa”; http://www.umm.edu/altmed/articles/anorexia-nervosa-
000012.htm
Gregory L. Jantz, PhD, CEDS
24. A Medical Mystery?
Eating disorders are characterized by
severe weight loss from self-starvation
Gregory L. Jantz, PhD, CEDS
yet signs or symptoms of
vitamin, mineral and fat deficiencies
are rarely studied or integrated into
treatment.
Pellagra?
25. Incidence of Eating Disorders
A majority of young women diet at
some point in time yet only a small
fraction develop eating disorders.
Why?
Gregory L. Jantz, PhD, CEDS
26. Benefits of a Multiple-Disciplinary Team Approach to
Treatment
Research shows that many
nutrients, such as vitamin B12
and iron, are essential to human
Gregory L. Jantz, PhD, CEDS
brain function and that
deficiencies in these nutrients
and others can lead to impaired
cognitive function and impaired
memory and concentration.
28. Is This a Struggle for CONTROL?
Gregory L. Jantz, PhD, CEDS
You don’t
see what
I see!
29. Benefits of a Multiple-Disciplinary Team Approach to
Treatment
Nutritional deficiencies are also
directly related to:
• impaired emotional functioning,
i.e., irritability;
• apathy;
• withdrawn behavior;
• decreased ability to focus;
• decreased ability to listen;
• decreased ability to process
information;
• and fatigue.
Gregory L. Jantz, PhD, CEDS
30. Standard American Diet (SAD)
•50% of caloric intake of American children is obtained from
added fat and sugar
•20-24% of calories for 2-19 year-olds come from soft drinks!
•<15% of school children consume recommended servings of
fruit
•<20% of school children consume recommended servings of
vegetables
Source: James Greenblatt, MD; Dietary Fats in the Prevention and Treatment of Eating Disorders, presented to IAEDP March
22, 2013; used by permission
Gregory L. Jantz, PhD, CEDS
32. The majority of women with eating disorders are
vegetarian
The Journal of the Academy of Nutrition and Dietetics
published a study where they found that:
•53% of women with eating disorders were vegetarians
•12% of healthy women are vegetarians
Source: Jenny Sangler, August 30, 2012
Gregory L. Jantz, PhD, CEDS
33. Benefits of a Multiple-Disciplinary Team Approach to
Treatment
Decreased food intake, a cyclic pattern of eating,
and weight loss are major manifestations of zinc
deficiency. Patients with eating disorders may
develop zinc deficiencies for the following
reasons:
• lower dietary intake of zinc
• impaired zinc absorption
• vomiting
• diarrhea
• bingeing on low-zinc foods
Gregory L. Jantz, PhD, CEDS
34. Physical Symptoms of AN and Zinc Deficiency
Anorexia Nervosa
1. Decreased appetite and
meat avoidance
2. Decreased taste and smell
3. Nausea and bloating during
re-feeding
4. Insomnia and poor sleep
Gregory L. Jantz, PhD, CEDS
habits
5. Depression
6. Attention difficulties
Zinc Deficiency
1. Decreased appetite and
meat avoidance
2. Decreased taste and smell
3. Nausea and bloating during
re-feeding
4. Insomnia and poor sleep
habits
5. Depression
6. Attention difficulties
Source: Zinc deficiency and eating disorders. Humphries L, Vivian B, Stuart M, McClain CJ. J Clin Psychiatry 1989
Dec; 50(12):456-9
35. Recommended nutritional therapies for recovery
•Daily multivitamin
•Essential fatty acids, such as Omega 3’s
•Vitamin C
•Coenzyme Q10
•5-HTP
•Creatine
•Probiotic supplement (Lactobacillus acidophilus)
•L-glutamine
•DHEA
•Melatonin
From the University of Maryland Medical Center, accessed 7/8/13
Gregory L. Jantz, PhD, CEDS
37. Omega-3 Fatty Acids – Augmentation of
Antidepressants
•42 patients (40.% y/0) with dietary intake of Omega 3 < 3 gms/day
•DBPC 1.8 gms EPA .4 gms DDHA) Omega 3 supplements or placebo
BID x 8 weeks
•Celexa 20-40 mg
•Higher proportion of patients achieved full remission in Omego 3
group versus the placebo group - 44% verses 18%
Source: Gertsik, L, Poland, RE, Bresee, C, Rapaport, MH.
J Clin Psychpharmacol. 2012 Feb;32(1):61:4.
Gregory L. Jantz, PhD, CEDS
38. A pilot open case series of Ethyl-EPA supplementation
in the treatment of anorexia nervosa
AN patients received 1 g EPA/day for 3 months:
43% recovered
57% showed improved symptoms in:
Weight gain
Reversal of growth retardation
Improvement in mood
Improvement in general functioning
Source: Ayton, et al., Prostaglandins, Leukotrienes and Essential Fatty Acids; 2004;71:205-209
Gregory L. Jantz, PhD, CEDS
39. Omega-3s may have ability to delay or prevent
psychosis
Study participants: 81 adolescents or young adults with sub-threshold
psychosis
Supplementation: 1.2 g omega-3 fatty acids or placebo for 12
weeks
After 40 weeks:
5% (2 out of 41 individuals) in omega-3 group developed psychosis
28% (11 of 40 individuals) in placebo group developed psychosis
Source: Amminger, et al, Archives of General Psychiatry, 2010, 67(2):146-154
Gregory L. Jantz, PhD, CEDS
40. Fatty Acids for Prevention of Psychotic Disorders
Dietary intake and information on psychotic-like symptoms was
derived from a food frequency questionnaire among 33,623
women, aged 30-49 years-old
Participants were classified into three predefined levels: low,
middle and high frequency of symptoms
Findings raise a possibility that adult women with a high intake
of fish, omega-3 or omega-6 PUFA and vitamin D have a lower
rate of psychotic-like symptoms
Source: Hedelin et al. Dietary intake of fish, omega-3, omega-6 polyunsaturated fatty acids and vitamin D and
the prevalence of psychotic-like symptoms in a cohort of 33 000 women from the general population. BMC
Psychiatry 2010, 10:38.
Gregory L. Jantz, PhD, CEDS
41. Gregory L. Jantz, PhD, CEDS
It takes at least 10 weeks
for cerebral membranes’
highly unsaturated fatty
acid levels to recover
following chronic
deficiency.
Source: Bourre, et al., Prostaglandins Leukot
Essent Fatty Acids, 1993
Not a Quick Fix
43. Recommended nutritional therapies for recovery
From Complimentary and Alternative Medicine Treatments in Psychiatry; 2012; Stradford, Vickar, Berger, Cass
. . . there is a place for nutritional treatments in mental health
treatment. Some patients, due to poor diets or metabolic
abnormalities, have unusually high needs for some nutrients
– biochemicals that are required for normal physiological
function. Supplementation can sometimes fully or partially
restore neurological activity that has gone awry.
Additionally, some supplements – as lithium has for decades
– have a palliative effect on symptoms and, in moderate
doses, can improve the patient’s condition with few or no
side effects (page 45).
Gregory L. Jantz, PhD, CEDS
44. Recommended nutritional therapies for recovery
From Complimentary and Alternative Medicine Treatments in Psychiatry; 2012; Stradford, Vickar, Berger, Cass
(pg. 51)
Vitamin B6 Deficiencies
Gregory L. Jantz, PhD, CEDS
Nervousness
Irritability
Depression
Difficulty concentrating
Short-term memory loss
45. Recommended nutritional therapies for recovery
From Complimentary and Alternative Medicine Treatments in Psychiatry; 2012; Stradford, Vickar, Berger, Cass (pg. 50)
Vitamin B12 Deficiencies
Concentration difficulties
Confusion
Irritation
Impaired memory
Dementia
Irritability
Depression
Personality changes
Psychosis
Gregory L. Jantz, PhD, CEDS
46. Recommended nutritional therapies for recovery
From Complimentary and Alternative Medicine Treatments in Psychiatry; 2012; Stradford, Vickar, Berger, Cass
(pg. 55)
Vitamin D Deficiencies
Although clinical studies are few,
epidemiological studies show
remarkable associations between
low Vitamin D and psychiatric
disorders, including depression
and bipolar disorder.
Gregory L. Jantz, PhD, CEDS
47. Recommended nutritional therapies for recovery
From Complimentary and Alternative Medicine Treatments in Psychiatry; 2012; Stradford, Vickar, Berger, Cass
(pg. 57)
Calcium/Magnesium Deficiencies
Depressive symptoms
Gregory L. Jantz, PhD, CEDS
Confusion
Anxiety
Hallucinations
Nervousness
Apprehension
Numbness
48. Recommended nutritional therapies for recovery
From NIH Osteoporosis and Related Bone Diseases National Resource Center, “What People with Anorexia
Nervosa need to know about Osteoporosis”; January 2012;
http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Conditions_Behaviors/anorexia_nervosa.asp
Anorexia nervosa has significant physical consequences. Affected
individuals can experience nutritional and hormonal problems that
negatively impact bone density. Low body weight in females causes the
body to stop producing estrogen, resulting in a condition known as
amenorrhea, or absent menstrual periods. Low estrogen levels contribute to
significant losses in bone density.
In addition, individuals with anorexia often produce excessive amounts
of the adrenal hormone cortisol, which is known to trigger bone loss. Other
problems, such as a decrease in the production of growth hormone and
other growth factors, low body weight (apart from the estrogen loss it
causes), calcium deficiency, and malnutrition, contribute to bone loss in girls
and women with anorexia. Weight loss, restricted dietary intake, and
testosterone deficiency may be responsible for the low bone density found
in males with the disorder.
Gregory L. Jantz, PhD, CEDS
49. Medical Research
•The Japanese eat very little fat and
suffer fewer heart attacks than the
British or Americans.
•The French eat a lot of fat and also
suffer fewer heart attacks than the
British or Americans.
Gregory L. Jantz, PhD, CEDS
50. Medical Research
•The Japanese drink very little red wine and
suffer fewer heart attacks than the British or
Americans.
•The Italians drink excessive amounts of red
wine and also suffer fewer heart attacks than
the British or Americans.
•The Germans drink a lot of beer and eat lots of
sausages and fats and suffer fewer heart
attacks than the British or Americans.
Gregory L. Jantz, PhD, CEDS
51. Medical Research
Eat and drink what you like.
Speaking English is apparently what kills you.
Gregory L. Jantz, PhD, CEDS
52. Faith in the Treatment of Eating Disorders
Gregory L. Jantz, PhD, CEDS
53. My eating disorder
destroyed my relationship
with God. It blocked me from
God and I lost all faith and
trust in God. I became very
angry with God because I felt
like God had abandoned me.
Eventually, I just stopped
thinking about God. My
eating disorder became my
God and my body became
the Devil.
From Spirituality and Eating Disorders;
http://www.byui.edu/counseling-center/self-help/
eating-disorders
Gregory L. Jantz, PhD, CEDS
54. Beneficial effects of faith integration in recovery from
eating disorders
Faith assists patients to develop meaningful life goals
Patients who actively engage
in making decisions about their
care, and who are self-directed
toward meaningful life goals,
are far more likely to follow
through with treatment and
achieve lasting results.
From A Continuum of Care Approach to Eating
Disorders by Stuart Koman, Ph.D.
Gregory L. Jantz, PhD, CEDS
55. Beneficial effects of faith integration in recovery from
eating disorders
7 Common Spiritual Issues
1. Negative image of God who judges, is
unforgiving and punishing
2. Feelings of spiritual unworthiness and shame
resulting in a resistance to asking for God’s help
Many eating disorder patients attempt to compensate for their
feelings of unworthiness through perfectionism,
relentlessly striving to meet impossibly high standards –
physically, morally, religiously, academically and so forth.
Reference: Lack of Spiritual Well-Being as a Predictor of Eating Disorders Among College Students by Ghazala Saleem, Department
of Psychology, Missouri Western State University, page 265 – http://clearinghouse.missouriwestern.edu/manuscripts/809.asp
submitted May 6, 2006.
Gregory L. Jantz, PhD, CEDS
56. Beneficial effects of faith integration in recovery from
eating disorders
7 Common Spiritual Issues
3. Fear of abandonment by God, resulting in a distrust of God’s love
4. Guilt and shame about sexuality, sexual activity and promiscuity
5. Reduced capacity to love and serve others
6. Difficulty surrendering and having faith due to a belief that only
they are able to control their lives
7. Shame about the dishonesty and deception they practice due to
the secrecy of their eating disorder behaviors
Reference: Lack of Spiritual Well-Being as a Predictor of Eating Disorders Among College Students by Ghazala Saleem, Department
of Psychology, Missouri Western State University, page 265 – http://clearinghouse.missouriwestern.edu/manuscripts/809.asp
submitted May 6, 2006.
Gregory L. Jantz, PhD, CEDS
57. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
1. Their eating disorder will provide control.
Their eating disorder becomes their higher power.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
58. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
2. Their eating disorder is the only way they are able to
express their pain, suffering and feelings of not being
accepted.
Their eating disorder becomes their vindication.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
59. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
3. Their eating disorder makes them unique and
special.
Their eating disorder becomes their uniqueness.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
60. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
4. Their eating disorder is the evidence of their
unworthiness.
Their eating disorder becomes their “just”
punishment.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
61. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
5. Their eating disorder will result in perfection.
Their eating disorder becomes their source of hope.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
62. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
6. Their eating disorder will remove anxiety and stress
and result in comfort and safety.
Their eating disorder becomes their refuge.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
63. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
7. Their eating disorder will give them a sense of
recognition and identity.
Their eating disorder becomes their identity.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
64. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
8. Their eating disorder will make up for past
problems, trauma, abuse or personal mistakes.
Their eating disorder becomes their redemption.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
65. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
9. Their eating disorder is their justification for failing
to live an enriched and full life.
Their eating disorder becomes their justification.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
66. Beneficial effects of faith integration in recovery from
eating disorders
10 False Beliefs Hindering a Spiritual Connection
10. Their eating disorder will provide them with
other’s approval.
Their eating disorder becomes their affirmation.
Reference: Hardman, Berrett, and Richards (2003); Study at Center for Change
Gregory L. Jantz, PhD, CEDS
67. Integrated Whole-Person Treatment Team
Mental health counselors, including those familiar
and comfortable with spiritual issues
Chemical dependency professionals
Medical professionals, including dental
professionals
Nutritional professionals
Gregory L. Jantz, PhD, CEDS