Eating Disorder Toolkit is a new 1-hour online continuing education (CE/CEU) course that provides an overview of the current research on the prevalence, treatment, and role of the RDN in the care of eating disorders.
Eating disorders (ED) are severe psychiatric disorders that are associated with increased levels of social, psychological, and physical impairment as well as high levels of morbidity and mortality. This toolkit will address the three main eating disorders as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Binge Eating Disorder (BED), Anorexia Nervosa (AN), and Bulimia Nervosa (BN). The previous catch-all category of Eating Disorder Not Otherwise Specified (EDNOS) has been replaced with Other Specified Feeding and Eating Disorder (OSFED) and will not be discussed in this course.
Goals of medical nutrition therapy for eating disorders will be discussed, along with steps in the Nutrition Care Process. Laboratory values to monitor, signs/symptoms and risk factors to consider, and treatment guidelines are provided. A final section includes a case study, resources for both clinicians and clients, and screening tools to assess the presence of an eating disorder. Course #11-27 | 2019 | 21 pages | 10 posttest questions
This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document).
Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more. Have a question? Contact us. We’re here to help!
ABOUT THE AUTHOR
Jen Ross, MSH, RDN, LDN, FAND, is an instructor in the College of Health at the University of North Florida (UNF), where she is currently completing her doctorate in clinical nutrition. Her areas of focus include counseling, intuitive and mindful eating, binge eating, impulsive & compulsive eating, eating disorders, weight concerns, recipe modification, insulin resistance, and maternal/infant nutrition. Jen received her BA in Human Services from Elon College, and BSH and MSH in Health Science/Nutrition from UNF.
Professional Development Resources is a CPE Accredited Provider with the Commission on Dietetic Registration (CDR #PR001). CPE accreditation does not constitute endorsement by CDR of provider programs or materials. Feedback for this activity can be sent directly to CDR. Professional Development Resources is also a provider with the Florida Council of Dietetics and Nutrition (#50-1635) and is CE Broker compliant (all courses are reported within a few days of completion).
You might be checking on what your friends are up to. You might be looking for a way to connect and communicate. Or you might just be looking for some entertainment.
Despite the reasons we engage in social media, researchers at the University Of Pittsburgh School Of Medicine say our social media use is predisposing us to body image concerns and the risk of developing an eating disorder (Sidani et al., 2016).
“We’ve long known that exposure to traditional forms of media, such as fashion magazines and television, is associated with the development of disordered eating and body image concerns, likely due to the positive portrayal of ‘thin’ models and celebrities,“ explains Jaime E. Sidani, PhD, MPH, assistant director of Pitt’s Center for Research on Media, Technology and Health. “Social media combines many of the visual aspects of traditional media with the opportunity for social media users to interact and propagate stereotypes that can lead to eating and body image concerns” (Sidani, 2016).
Sampling 1,765 U.S. adults age 19 through 32 in 2014, Dr. Sidani and her colleagues used questionnaires to determine use of 11 of the most popular social media platforms: Facebook, YouTube, Twitter, Google Plus, Instagram, Snapchat, Reddit, Tumblr, Pinterest, Vine and LinkedIn.
Then they cross-referenced those results with the results of another questionnaire that used established screening tools to assess eating disorder risk, including anorexia nervosa, bulimia nervosa, binge eating disorder and other clinical and mental health issues where people have a distorted body image and disordered eating.
Their findings should have us all putting our phones down. The participants who spent the most time on social media throughout the day had 2.2 times the risk of reporting eating and body image concerns, compared to their peers who spent less time on social media. And participants who reported most frequently checking social media throughout the week had 2.6 times the risk, compared with those who checked least frequently (Sidani et al., 2016).
While previous research has shown that people tend to post images online that present themselves in a more positive – rather than realistic – light, thereby exposing others to unrealistic expectations for their appearance, it is also possible, notes Brian A. Primack, MD, PhD, assistant vice chancellor for health and society in Pitt’s Schools of the Health Sciences, that people who have eating and body image concerns might then be turning to social media to connect with groups of people who also have these concerns” (Primack, 2016).
The concern, however, is that despite Instagram banning the hashtags ‘thinspiration’ and ‘thinspo,’ YouTube videos about anorexia nervosa that could be classified as “pro-anorexia” received higher viewer ratings than informative videos highlighting the health consequences of the eating disorder.
For Sidani, the answer is more research. Not just do we need to develop effective interventions to counter social media content that either intentionally or unintentionally increases the risk of eating disorders in users, she notes, we need to follow users over time to answer the cause-and-effect questions surrounding social media use and risk for eating and body image concerns.
Related Online Continuing Education (CE) Courses:
Ethics and Social Media is a 2-hour online continuing education (CE) course that examines the use of Social Networking Services (SNS) on both our personal and professional lives. Is it useful or appropriate (or ethical or therapeutic) for a therapist and a client to share the kinds of information that are routinely posted on SNS like Facebook, Twitter, and others? How are psychotherapists to handle “Friending” requests from clients? What are the threats to confidentiality and therapeutic boundaries that are posed by the use of social media sites, texts, or tweets in therapist-client communication?
The purpose of this course is to offer psychotherapists the opportunity to examine their practices in regard to the use of social networking services in their professional relationships and communications. Included are ethics topics such as privacy and confidentiality, boundaries and multiple relationships, competence, the phenomenon of friending, informed consent, and record keeping. A final section offers recommendations and resources for the ethical use of social networking and the development of a practice social media policy. Course #20-75 | 2016 | 32 pages | 15 posttest questions
Nutrition and Mental Health: Advanced Clinical Concepts is a 1-hour online continuing education (CE/CEU) course that examines how what we eat influences how we feel, both physically and mentally. While the role of adequate nutrition in maintaining mental health has been established for some time, just how clinicians go about providing the right nutritional information to the patient at the right time – to not just ensure good mental health, but actually optimize mood – has not been so clear. With myriad diets, weight loss supplements and programs, clients often find themselves reaching for the next best nutritional solution, all the while, unsure how they will feel, or even what to eat to feel better. On the other side of the equation, clinicians so often face not just a client’s emotional, situational, and relational concerns, but concerns that are clearly mired in how the client feels physically, and what impact his/her nutritional health may have on these concerns. For example, research into the role of blood sugar levels has demonstrated a clear crossover with client impulse control. Additionally, the gut microbiome, and its role in serotonin production and regulation has consistently made clear that without good gut health, mitigating anxiety and depression becomes close to impossible.
So if good mental health begins with good nutritional health, where should clinicians start? What advice should they give to a depressed client? An anxious client? A client with impulse control problems? This course will answer these questions and more. Comprised of three sections, the course will begin with an overview of macronutrient intake and mental health, examining recent popular movements such as intermittent fasting, carb cycling and ketogenic diets, and their impact on mental health. In section two, we will look specifically at the role of blood sugar on mental health, and research that implicates blood sugar as both an emotional and behavioral regulator. Gut health, and specifically the gut microbiome, and its influence on mood and behavior will then be explored. Lastly, specific diagnoses and the way they are impacted by specific vitamins and minerals will be considered. Section three will deliver specific tools, you, the clinician, can use with your clients to assess, improve and maximize nutrition to optimize mental health. Course #11-06 | 2017 | 21 pages | 10 posttest questions
Statistics report that Americans are an increasingly overweight population. Among the factors contributing to our struggle to stop tipping the scales is the component of “emotional eating” – or the use of food to attempt to fill emotional needs. Professionals in both the physical and emotional health fields encounter patients with emotional eating problems on a regular basis. Even clients who do not bring this as their presenting problem often have it on their list of unhealthy behaviors that contribute to or are intertwined with their priority concerns. While not an easy task, it is possible to learn methods for dismantling emotional eating habits. The goals of this course are to present information about the causes of emotional eating, and provide a body of cognitive and behavioral exercises that can help to eliminate the addictive pattern. Course #40-26 | 2011 | 44 pages | 30 posttest questions
Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Georgia State Board of Occupational Therapy; the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors (#MHC-0135); the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).
Binge eating, anxiety and depression are common symptoms in severely obese patients who are seeking and undergoing bariatric surgery, according to a recent study on mental health conditions.
Bariatric surgery is an accepted method of promoting weight loss in severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery; however, the prevalence of these conditions and whether they are associated with postoperative outcomes has not been known.
Aaron J. Dawes, M.D., of the David Geffen School of Medicine at UCLA, Los Angeles, and colleagues conducted a meta-analysis to determine the prevalence of mental health conditions among bariatric surgery candidates and recipients and the association between preoperative mental health conditions and health outcomes following bariatric surgery. The authors identified 68 publications meeting criteria for inclusion in the analysis: 59 reporting the prevalence of preoperative mental health conditions (65,363 patients) and 27 reporting associations between preoperative mental health conditions and postoperative outcomes (50,182 patients).
Results of the meta-analysis estimated that 23 percent of patients undergoing bariatric surgery reported a current mood disorder — most commonly depression (19 percent) — while 17 percent were diagnosed with an eating disorder. “Both estimates are higher than published rates for the general U.S. population, suggesting that special attention should be paid to these conditions among bariatric patients,” the researchers write. Another common mental health condition was anxiety (12 percent).
There was conflicting evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Neither depression nor binge eating disorder was consistently associated with differences in weight outcomes. Bariatric surgery was, however, consistently associated with postoperative decreases in the prevalence of depression (7 studies; 8 percent-74 percent decrease) and the severity of depressive symptoms (6 studies; 40 percent-70 percent decrease).
“Previous reviews have suggested that self-esteem, mental image, cognitive function, temperament, support networks, and socioeconomic stability play major roles in determining outcomes after bariatric surgery,” the authors write. “Future studies would benefit from including these characteristics as well as having clear eligibility criteria, standardized instruments, regular measurement intervals, and transparency with respect to time-specific follow-up rates. By addressing these methodological issues, future work can help to identify the optimal strategy for evaluating patients’ mental health prior to bariatric surgery.”
Karin Kratina, PhD, RD, LD/N; Michelle Albers, PhD, RD, LD/N Effective treatment of eating disorders requires multidimensional and individualized interventions. Education that addresses the normal nutritional needs and the physiologic effects of starvation and refeeding is a critical component of treatment. Management often requires long-term nutritional counseling of the patient which may extend several years. This course will describe the rationale and use of providing Medical Nutrition Therapy (MNT) for the treatment of Anorexia Nervosa, Bulimia Nervosa, Eating Disorder Not Otherwise Specified, and Binge Eating Disorder. Included are: Criteria for Diagnosing Eating Disorders; Role of Dieting in the Development of Eating Disorders; Symptomology; Treatment Overview; Nutrition Therapy; Reconnecting with Hunger and Satiety; Use of Exercise; Working with a Therapist; Pharmacotherapy; In-Patient versus Out-Patient Treatment; Refeeding; Establishing a Dietary/Eating Pattern; Comparing Traditional and Health at Every Size (HAES) Approaches to Health Enhancement; Recovery from Eating Disorders; Nutrition Care Process; and the Core Minimum Guide.
Susan Moyers, PhD, MPH, LD/N Overweight and obesity constitute one of the nation’s ten leading health indicators with nearly two-thirds of adults in the United States now classified as either overweight or obese. Before any diet and physical activity program can be personalized and implemented, a nutrition assessment is needed, along with an understanding of the individual’s readiness to change and motivation. This course was developed by the Florida Academy of Nutrition and Dietetics for their Manual of Medical Nutrition Therapy to provide Licensed and Registered Dietitian/Nutritionists (RDNs) and technicians with evidence-based, non-biased information on the prevention and treatment of obesity in adults. Topics covered include: obesity synopsis; reimbursement considerations; nutrition assessment (diagnosis, intervention, monitoring and evaluation); pharmacotherapy for weight-loss (prescription and OTC); and physical activity. Nutrition education handouts are included at the end of the course.
This course is a self-instructional module that “walks” readers through the process of replacing their self-defeating weight issues with healthy, positive, and productive life-style behaviors. It moves beyond the “burn more calories than you consume” concept to encompass the emotional aspects of eating and of gaining and losing weight. Through 16 included exercises, you will learn how to identify your self-defeating behaviors (SDBs), analyze and understand them, and then replace them with life-giving actions that lead to permanent behavioral change.* Please note – this course contains common material on eliminating SDBs with Living a Better Life with Chronic Pain: Eliminating Self-Defeating Behaviors
Statistics report that Americans are an increasingly overweight population. Among the factors contributing to our struggle to stop tipping the scales is the component of “emotional eating” – or the use of food to attempt to fill emotional needs. Professionals in both the physical and emotional health fields encounter patients with emotional eating problems on a regular basis. Even clients who do not bring this as their presenting problem often have it on their list of unhealthy behaviors that contribute to or are intertwined with their priority concerns. While not an easy task, it is possible to learn methods for dismantling emotional eating habits. The goals of this course are to present information about the causes of emotional eating, and provide a body of cognitive and behavioral exercises that can help to eliminate the addictive pattern.
This course is designed to help clinicians enhance their working knowledge of the etiology and treatment of obesity, including assessment skills, diagnostic issues, treatment planning, and current developments in pharmacological and surgical treatments. Case studies will elucidate different aspects of treatment. The information in this course will be especially helpful to clinicians who work with obese individuals and want to provide better psychological care.
Professional Development Resources is a CPE Accredited Provider with the Commission on Dietetic Registration (CDR #PR001). CPE accreditation does not constitute endorsement by CDR of provider programs or materials. Professional Development Resources is also a provider with the Florida Council of Dietetics and Nutrition (#50-1635).
Excessive dieting is associated with an increase in suicide attempts in people with body dysmorphic disorder, a new study finds.
Body dysmorphic disorder (BDD) is a dangerous condition characterized by excessive concern and preoccupation with how one’s body looks. People with BDD genuinely believe their bodies are flawed.
BDD is a common, often severe, and under-recognized body image disorder. People with BDD experience distressing or impairing preoccupations with perceived flaws in their appearance and are obsessed with the belief that something is wrong with how they look, when in reality they look normal.
More than 75 percent of people with BDD feel life is not worth living or think about suicide in their lifetime, and approximately 25 percent have a history of a suicide attempt.
Researchers from Rhode Island Hospital and Auburn University examined the association of suicide attempts with physically painful BDD-related behaviors, including restrictive food intake, excessive exercise, BDD-related cosmetic surgery, compulsive skin picking and physical self-mutilation.
The study found that BDD-related restrictive food intake was associated with more than double the number of suicide attempts, but was not associated with suicidal ideas; and that those with a history of BDD-related excessive exercise had less than half the number of suicide attempts as those without such a history.
The study also found that none of the other variables indicating exposure to painful and provocative experiences, such as BDD-related cosmetic surgery and compulsive skin picking, were significant predictors of suicide attempts.
Researchers focused their study on the acquired capability of suicide. The concept is based on the interpersonal-psychological theory of suicide and is comprised of physical pain tolerance and lowered fear of death.
The paper is published in the journal Suicide and Life-Threatening Behavior.
Because restriction of food intake can be physically painful, the researchers theorize that a person who is capable of enduring the physical discomfort of caloric restriction may be more capable of enduring the physical discomfort required in order to inflict self-harm.
They theorize that severe restriction of food intake that results in long-standing physical discomfort would predict capability for suicide, whereas more moderate dieting behaviors would have less of a relationship (if any). “Significantly limiting food intake can be physically painful,” says Katharine A. Phillips, M.D.
“It goes against our natural instincts to feed our bodies and respond to the physical pain that comes with extreme hunger. The results of this study suggest the importance of assessing individuals with BDD for restrictive eating behaviors to identify suicide risk, even if they have not previously been diagnosed with an eating disorder.”
During the study, researchers interviewed 200 individuals (68.5 percent women) between the ages of 14 and 64 who had a lifetime diagnosis of BDD.
The main criterion variable was the participants’ number of past suicide attempts, which ranged from 0 to 25 in the study group.
Additionally, 78 percent of the study group had a history of suicide-related ideation. The study only included examination of suicide attempts, not deaths by suicide.
“While some of the other BDD-related behaviors may seem outwardly more painful – such as undergoing repeated cosmetic procedures, or compulsive skin picking, the level of pain associated with excessive dieting could significantly increase a person’s pain tolerance,” says Elizabeth R. Didie, Ph.D.
“This study suggests that those who are capable of enduring such physical discomfort and pain from restrictive eating also may be capable of enduring the physical discomfort required to inflict self-harm.”
A big job that parents have to deal with, learn about, and work to prevent is eating disorders. In the United States as many as 10 million females and 1 million males are affected with an eating disorder. About 40% of eating disorder sufferers are between the ages of fifteen to twenty-one years old. Every decade since 1930, there has been a rise in anorexia. From 1988 to 1993 bulimia has tripled in women ages ten to thirty-nine. The mortality rate among women, who suffer from anorexia nervosa between the ages of fifteen to twenty four, is twelve times higher than the death rate of any other cause.
These are some scary statistics and everyday they are affecting young women and men. This article is to help educate about what eating disorders are, how to recognize the signs and symptoms of an eating disorder, and most of all how prevent eating disorders. Children are very influential, they pick up on everything. They see and hear everything we do and say. Next time you are looking in the mirror saying “I’m so fat” remind yourself that those little eyes and ears are watching you and learning from you.
What is an eating disorder? According to the National Eating Disorder Association, “An eating disorder is a serious, but treatable illness with medical and psychiatric aspects. People with an eating disorder often become obsessed with food, body image, and weight. The disorders can become very serious, chronic, and sometimes even life threatening if not recognized and treated appropriately. Treatment requires a multidisciplinary approach with an experienced care team.”
Who is at risk for getting an eating disorder? In today’s society almost anyone is at risk now for developing an eating disorder. The previous stereotype that eating disorders only affect Caucasian, teenage girls who are perfectionist, people pleasers and from an upper class socioeconomic group, no longer holds true. Eating disorders are affecting children as young as 7 or 8 years old men and women well into their 30’s and 40’s. We are seeing a rise in eating disorders among men and young boys and eating disorders are affecting people in every socioeconomic and ethnic group.
What are the signs and symptoms of an eating disorder? Here are a few red flags that you child may be at risk for developing an eating disorder.
Is your child avoiding certain food groups because they are “fattening”? If your child suddenly proclaims he or she is now a vegetarian this could be a red flag for an eating disorder. For many eating disorder sufferers, especially young children and teenagers, proclaiming vegetarianism suddenly makes it okay and acceptable by family and peers to avoid whole food groups such as meat, eggs, fish, and dairy.
When in a social situation and around food does your child act differently? Either by shrinking away and refusing to eat anything or by losing sense of control and overeating?
Do you hear your young one constantly talking about weight loss, body size, and food? Always seeking reassurance from others about looks and referring to self as fat, gross, or ugly? Overestimating body size? Striving to create a “perfect” image? These are not healthy behaviors for anyone, especially young children and teens.
Have you seen a sudden change in weight? Either dramatic weight loss or big fluctuations in weight over a short period of time?
If you notice some of these signs and symptoms with a loved one, seek out support now. Getting the right help and support can prevent serious issues from developing later on.
Can I really work at preventing eating disorders? Yes. Listed below are a few tips of simple things that can help build the confidence of your child and prevent eating disorders.
Change dinner table talk. For many young people, struggling with an eating disorders can stem from parents own obsession with dieting, weight loss, calorie control, exercise, and looks. Instead of talking about the latest diet or weight loss plan that you may be following, use your time together to discuss other topics. Ask your child questions about school and social events, take up a hobby together that does not focus on looks.
Seek professional support. If your child wants to lose weight or adapt a specific lifestyle such as being a vegetarian make sure he or she is doing it for the right reasons. Schedule an appointment with a professional such as a registered dietitian who can help educate and ensure adequate nutrient intake.
Avoid being the food police. If you know your child is trying to lose weight, avoid commenting on everything he or she puts on the plate or into their mouth. Constantly watching and monitoring food intake only sets the tone for resentment, overeating or under eating, shame, and guilt; all which can lead to a serious eating disorder.
Encourage activities that promote a positive body image. Involve your child in activities that make him or her feel good. If your child is in an environment where he or she is constantly being ridiculed or made fun of by a coach or team mates, change the environment. Find positive outlets for your child to thrive in.
Limit exposure to trendy TV shows and magazines. These media sources are constantly bombarding young minds with how they are supposed to look. Remind your child that these “famous” people have been airbrushed and touched up with every computer program available to give the “perfect” look.
Remember, from a very early age children pick up from what is going on with parents. If you are constantly on a diet, always talking about either your own body size or other people’s body size, your child is hearing you. The first step you can take in preventing an eating disorder is to treat yourself and others with love and respect and not always focus on the “image.” If you or a loved one is struggling with an eating disorder, seek out professional support. Using a multi-facet approach by working with a doctor, therapist and registered dietitian can help treat and overcome this scary disease.