The Nutrition Care Process for Binge Eating Disorder

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					   The Nutrition Care
Process for Binge Eating

      Leah Bekkerus
     Concordia College
      Moorhead, MN
  Be able to identify Binge Eating Disorder (BED)
  Identify the two types of binge eating disorder
  Identify the factors that contribute to binge
   eating disorder
  Understand the nutrition care process
   associated with binge eating disorder
  Understand motivational interviewing
  Be able to identify ethical issues associated
   with binge eating disorder

  1 in 142 people in the United States
   suffer from binge eating disorder
  Approximately 1.9 million people
  2% of United States population
  Has become the most
   common eating disorder
What is Binge Eating
  Binge Defined:
    An act of excessive or compulsive consumption
  Binge Eating Disorder Defined:
    An eating disorder characterized by recurring
     episodes of binge eating accompanied by a sense of
     lack of control and often negative feelings about
     oneself but without intervening periods of
     compensatory behavior.

                                       Merriam- Webster’s Medical Dictionary
What is Binge Eating
Disorder? (cont.)
  Frequent episodes of uncontrollable binge

  Feeling extremely distressed or upset during or
   after the binge

  No regular attempts to “make up” for the binge
       Vomiting
       Fasting
       Overexercising
Types of Binge Eating

  Objective Binge Eating (OBE)
    Loss of control over eating
    Large amount of food is consumed

  Subjective Binge Eating (SBE)
    Sense of out of control over eating
    Large amount of food not consumed
Binge Eating Disorder vs.
Objective Overeating
  Binge Eating Disorder
    Sense the loss of control
    Feel remorse
    Consume excess amounts of food

  Objective Overeating
    Do not sense the loss of control
    Consume excess amounts of food
Who is at Risk for Binge
Eating Disorder?
  Everyone
    2% of men
    3.5% of women
  Usually late onset (40’s)
  Can happen in younger years
  People who are over weight or obese
    Over weight: BMI 25-29.9
    Obese: BMI > 30
  People of a healthy weight
    BMI 18.5-24.9
Causes of Binge Eating
    Negative self image
    Depression
    Negative mood
    Sadness
    Emotional eating
    Boredom
    Worry
    Stress
    Anger
    Failed dieting
Psychological effects of
Binge Eating Disorder

    Can elevate negative self image
    Can enhance depression
    Becomes an addiction
    Begin to obsess over self control
Risk Factors of Binge Eating
  Binge eating causes
    Weight gain
    Results  obesity
  Obesity causes:
      Type 2 diabetes
      High cholesterol
      High blood pressure
      Heart disease
      Sleep apnea
Signs of Binge Eating
  Eating more rapidly than usual
  Eating until uncomfortably full
  Eating large amounts of food when not
  Eating alone to hide actual food intake
  Feelings of disgust, depression, or guilt
   after eating
The Cycle of Binge Eating
The Nutrition Care Process
  Assessment
    Collect and interpret laboratory values
  Diagnosis
    Determine illness or disorder
    Find contributing factors
  Intervention
    Care plan
  Monitor
    Evaluate the Nutrition Care Process
Nutrition Care Process:
 Assess the patients caloric intake
   Determine if it is within their acceptable range
   Record patient’s:
      Height (cm)
      Weight (kg)
      Ideal Body weight
         Males: 106 lbs./5 ft. + 6 lbs./ in.
         Females: 100 lbs./5 ft. + 5 lbs./in.
      Ideal Caloric intake (Mifflin- St. Jeor)
         Males: (9.9 x wt) +(6.25 x ht) – (4.92 x age) + (5 x SF)
         Females: (9.9 x wt) + (6.25 x ht) – (4.92 X age) – (161 x
         SF: Stress Factor 1.3-1.5
Nutrition Care Process:
  Determine why the over eating occurs
    Stress levels
    Emotional eating
    Depression
  Determine if the patient is overweight or obese
    BMI: Body Mass Index
       Weight (kg)
       Height (m squared)
    Overweight: BMI 25-29.9
    Obese: BMI > 30
Nutrition Care Process:
Nutrition Care Process:
  Binge eating disorder
  Overweight or obese
  Determine contributing factors to the
   binge eating disorder
Nutrition Care Process:
  Four common practices of treatment
    Psychotherapy
       Cognitive behavioral therapy
       Interpersonal therapy
       Dialectal behavior therapy
    Medication
       Antidepressants
       Anticonvulsants (Topamax)
       Anti-obesity medication (Meridia)
    Behavioral weight-loss programs
    Self help strategies
Nutrition Care Process:
Intervention (cont.)
  The Goal of the RD
   Help the patient
    Learn self monitoring skills
    Develop regular eating patterns
    Learn alternatives to binge eating
    Develop problem solving skills
    Reduce restrained eating
    Evaluate thoughts on eating and self control
Motivational Interviewing

  A method of communication with your
  Started as a tool for addiction counseling
  What can the RD do?
      Give   them   insight
      Give   them   knowledge
      Give   them   skills
      Give   them   a hard time
Motivational Interviewing
  The focus is where the patient is.
       Example: Tell me what you know…
  The Spirit of Motivational Interviewing:
    Collaboration- not confrontation
    Autonomy- not authority
    Evocation- Not education/ advice
       Example: What are you willing to try to do?
Motivational Interviewing
  Principles of Motivational Interviewing
      Express Empathy
      Self Efficacy
      Develop Discrepancy
      Role with Resistance
Motivational Interviewing
  Using Motivational Interviewing
    Must use different communication methods

      Open End Questions
      Affirm
      Reflective Listening (key skill!)
      Summarize
Motivational Interviewing
  Reach for change:
   Have the client
    Think about it
    Read about it
    Agree to talk about it at another session
    Take on a small step
    Follow up
Nutrition Care Process:
  Monitor the patient’s progress
      Encourage them to keep a journal
      Schedule future meetings
      Assess the progression of their recovery
      Evaluate the Nutrition care process
Ethical issues:
  Obesity and Binge Eating Disorder
    Which is treated first?
  Using Topomax (anticonvulsant medication)
    Binge eaters are not convulsing
    Do we risk the possible side effects?
    Are we doing more harm than good?
  Binge eating disorder is mainly a psychological
    Do we use autonomy or a surrogate decision
Binge eating self check:

  Do you:
      Feel out of control when you are eating?
      Think about food all the time?
      Eat in secret?
      Eat until you feel sick?
      Eat to escape from worries or to comfort yourself?
      Feel disgusted or ashamed after eating?
      Feel powerless to stop eating, even if you want to?

 Binge eating disorder sends people into
  episodes where they can not control the
  amount of food they are consuming.
 Binge eating can affect anyone
 There are many psychological factors to binge
  eating disorder
 Binge eating can result in obesity and other
  serious future complications.
Summary (cont.)

  There are definite signs of BED
  It is important as a RD to use the Nutrition
   Care Process when assessing BED.
  Motivational Interviewing is an intervention
   technique that helps you work with your
   patients to make progress.
  It is important to remain in contact with your
   patients to check their progress.
Summary (Cont.)
    Arbaizar, B., Gomez-Acebo, I., & Llorca, J. (2008). Efficacy of topiramate in bulimia
          nervosa and binge-eating disorder: A systematic review. General Hospital Psychiatry,
         30(5), 471-475.
    Binge eating disorder. Retrieved 10/2/2008, 2008, from
    Binge eating status influences pre-diet weight change and test meal intake in
          obese individuals.(2008). Appetite, 51(2), 408.
    Binge-eating disorder - Retrieved 10/2/2008, 2008, from
    Binge-eating disorder: What's the best treatment? Retrieved 10/2/2008, 2008,
    Bisaga, A., Danysz, W., & Foltin, R. W. (2008). Antagonism of glutamatergic
         NMDA and mGluR5 receptors decreases consumption of food in baboon model of binge-
         eating disorder. European Neuropsychopharmacology : The Journal of the European
         College of Neuropsychopharmacology,
    The contributions of weight problem perception, BMI, gender, mood, and smoking
         status to binge eating among college students☆.(2008). Eating Behaviors,
References (Cont.):
    Dingemans, A. E., Martijn, C., Jansen, A. T., & van Furth, E. F. (2008).
          The effect of suppressing negative emotions on eating behavior in binge eating disorder. Appetite,
    Laura Alderman, M. E. (2007). Motivational interviewing. Unpublished manuscript.
    Melinda Smith, M. A., Suzanne Barston, Robert Segal, M.A. & Jeanne Segal, P. D. (2008).
          Binge eating disorder. Retrieved September 25, 2008, from

    The onset and course of binge eating in 8- to 13-year-old healthy weight, overweight
          obese children.(2008). Eating Behaviors,
    Position of the american dietetic association nutrition intervention in the treatment of anorexia
          nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS).(2001). Journal of the
          American Dietetic Association, 101(7), 810.
    Raynor, H., & Zemel, P. (1996). Binge eating disorder and the dietitian's role.
          Journal of the American Dietetic Association, 96(9), 854.
    ScienceDirect - appetite : The effect of suppressing negative emotions on eating behavior
          in binge eating disorder. Retrieved 10/2/2008, 2008, from

    WIN - publication - binge eating disorder. Retrieved 10/2/2008, 2008, from

Photo References
  http://www.mhguidelines-