Nutrition & Eating
Disorders
Dionne Bose
• Teenagers need to have a healthy diet. Make healthy
foods, snacks and fluids available: fruits, vegetables, low-
fat dairy products, lean proteins, water and sugar-free
drinks.
• Dieting is a common concern during adolescent years.
Diet trends can lead to unhealthy behaviors such as
restricting intake, skipping meals, taking diet pills or
purging after a meal. Contact your child’s healthcare
provider if you have concerns about these or other eating
behaviors.
A balanced diet in adolescence
• A balanced diet is one that provides all nutrients
(carbohydrates, proteins, fats, vitamins and minerals) in
required amounts and proportions for maintaining health
and general well being and also makes a small provision
for extra nutrients to withstand short duration of
leanness. It can be achieved through a blend of four basic
food groups, i.e. carbohydrates, proteins, fats, vitamins
and minerals. As these are present in different types of
food items like dals, chapati or rice, green vegetables,
easily available fruits and milk it is important to eat these
food items in the right mix everyday.
Major components of food
• Major components of food include protein, fats, carbohydrates, minerals
and vitamins which perform different functions.
• Function of various food components
• Proteins are of greatest importance in nutrition. Proteins are required
for bodybuilding and help in repair and maintenance of body tissues.
• Fats are high-energy foods and a source of energy. They also make the
food more palatable and provide fat-soluble vitamins.
• Carbohydrates form the major component of most diets and are the main
source of energy.
• Vitamins and minerals are required in small quantities. They do not yield
energy but enable the body to use other nutrients and also play in important
role in growth, repair and regulation of vital body functions.
• Requirements for iron and calcium are particularly increased in adolescence,
due to rapid physical growth during adolescence.
• Calcium needs during adolescence are greater than they are in either
childhood or adulthood because of rapid increase in lean body mass and
skeletal growth
• Zinc is especially important in adolescence because of its role in growth and
sexual maturation. Some sources of zinc are grains, nuts, meat, cheese and
milk.
Eating Disorders in Adolescence
• These include anorexia nervosa, bulimia nervosa,
avoidant/restrictive food intake disorder, and binge eating
disorder.
• Anorexia nervosa (AN) is an eating disorder that is
difficult to treat, and relapse is common. This article
addresses management strategies and nursing
interventions for adolescents diagnosed with AN.
• According to The Diagnostic and Statistical Manual of Mental
Health Disorders, 5th edition (DSM-5), an AN diagnosis requires
each of the following three key features:5
• persistent self-restriction of energy intake, leading to significant
weight loss
• an intense fear of gaining weight, or persistent behavior that
interferes with weight gain
• a disturbance in self-perceived weight or shape.
• Determining a BMI percentage according to patient age is important in
assessing adolescents for AN. Patients under the 5% margin for BMI with age
are considered underweight. One study suggested a BMI below the 10th
percentile may result in the malnourishment associated with AN.
• The DSM-5 describes two subtypes of AN: the restricting type and the binge-
eating or purging type.5 Both are characterized by a 3-month time frame.
• In restricting type, patients achieve weight loss primarily through dieting,
fasting, and/or excessive exercise.8
• Patients diagnosed with binge-eating or purging type have engaged in
recurrent episodes of self-induced vomiting or the misuse of laxatives,
diuretics, or enemas.
What is bulimia nervosa?
• Bulimia nervosa is an eating disorder in which a person eats
excessive amounts of food in a short period of time (binge
eating), with a sense of lack of control over eating, and then
engages in compensatory behaviors to prevent weight gain,
such as vomiting, use of laxatives, diuretics, other medications,
fasting or excessive exercise.
• Bulimia usually begins in adolescence or young adulthood and
is more likely to affect girls than boys.
DSM 5 CRITERIA
• Recurring binge eating episodes characterized by the following:
• Eating large amounts of food within a 2-hour period and sense of
lack of control
• Recurring inappropriate compensatory behavior (vomiting,
laxatives, exercise, diet pills)
• Binge eating and compensatory behaviors occur, on average, at
least once a week for three months
• Self-evaluation is unduly influenced by body shape and weight
Causes
• Bulimia is a complex condition that may involve genetic,
biological, behavioral, psychological and social factors.
Avoidant/Restrictive Food Intake
Disorder
• An eating or feeding disturbance (e.g., apparent lack of interest in
eating or food; avoidance based on the sensory characteristics of
food; concern about aversive consequences of eating) as manifested
by persistent failure to meet appropriate nutritional and/or energy
needs associated with one (or more) of the following:
• Significant weight loss (or failure to achieve expected weight gain
or faltering growth in children)
• Significant nutritional deficiency.
• Dependence on enteral feeding or oral nutritional supplements.
• Marked interference with psychosocial functioning.
Binge Eating Disorder
• DSM-5 Criteria for Binge Eating Disorder Diagnosis
• Recurrent episodes of binge eating. An episode of binge eating is
characterized by both of the following:
• Eating, in a discrete period of time (for example, within any two-hour period),
an amount of food that is definitely larger than most people would eat in a
similar period of time under similar circumstances
• A sense of lack of control over eating during the episode (for example, a
feeling that one cannot stop eating or control what or how much one is eating)
• The binge-eating episodes are associated with three (or more) of the
following:
• Eating much more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amounts of food when not feeling physically hungry
• Eating alone because of feeling embarrassed by how much one is eating
• Feeling disgusted with oneself, depressed, or very guilty afterwards
• Marked distress regarding binge eating is present.
• The binge eating occurs, on average, at least once a week for three months.
• The binge eating is not associated with the recurrent use of inappropriate
compensatory behavior (for example, purging) and does not occur
exclusively during the course of anorexia nervosa, bulimia nervosa, or
avoidant/restrictive food intake disorder.
• It is extremely important to note that weight or appearance is not part of
the diagnostic criteria for binge eating disorder.
