Ment ental al Hea ealth lth Series eries Todays topic: The - PowerPoint PPT Presentation

child & youth Ment ental al Hea ealth lth Series eries Today’s topic: The Culture of Weight Promoting Health and Preventing Eating Disorders Speaker: Dr. Clare Roscoe Date: May 17, 2018

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Promoting Health and Preventing Eating Disorders Dr. Clare Roscoe Child & Adolescent Psychiatrist Children’s Hospital of Eastern Ontario

Case 1 – Libby 14 year old female referred for an Eating Disorder assessment by family MD for severe restriction and rapid weight loss (50lbs):  Six month history of progressive food restriction down to 500 – 600 calories/day  Food rituals: eating every 2 hours, drinking green tea 30 minutes after eating; taking cold showers, putting ice packs on her stomach to ‘shrink her fat cells’  Further history – likely 2 – 3 years of cutting out food types (carbs, becoming pescatarian)  Physical symptoms: cold intolerance, dizzyness, decreased concentration, constipation, premenarchal, bradycardia

Further history...  Co-morbidities:  Severe bullying due to weight since grade 4, limited social circle  Undiagnosed Obsessive Compulsive Disorder, starting around grade 3  History of major depressive episode in grade 6  School avoidance in the last year due to anxiety, involved with a Robert Smart worker  Family history:  Mother with previous Anorexia Nervosa then Binge Eating disorder; 12 year old sister with obesity  Significant depression/anxiety

Treatment  Admission  Medically stabilized, meal plan  Request to leave unit – profound fear of being “fat again”  Quick decompensation, showing extreme rigidity and OCD symptoms  Kicking people out of kitchen for 30 – 45 min. to make her meals; has fear of calories ‘travelling through the air’  Not eating anything mother makes as ‘afraid to catch her fat’  Started skipping outpatient appointments  Eventual readmission

 What is a healthy weight for her?  A.c.t. patient: She is too big  Reinforced by culture  Reinforced by medicine  What is our culture and what are the facts?

Outline Look at our culture – history and present day 1. 2. What are the facts 3. What messages should be sending to all our children and youth about weight and health?

We live in a culture where… • 80% of 10 year old girls are afraid to be fat • The number one “magic wish”, of girls between the ages of 10-14 is to lose weight.

We live in a culture where..  50% of Ontario teenagers feel unhappy about their weight  Fasting, skipping meals, crash diets are frequent  (22-46%)  Vomiting: 5-12% adolescent girls  Diet pill use 3-10%  Smoking to loose weight: 12-18%

We live in a culture where… THIN, THIN, THIN

We live in a culture where…  We as a health care providers are not immune to these messages

Twiggy – Why now?  1967- baby boomers as teenagers  30 million teenage girls eager to spend their allowance  Beginning of the “billion dollar brainwash”:  Industries use an ideal person that is unachievable to society to maintain profits  Create a culture where women are insecure about their bodies, and they will be more likely to buy beauty product, new clothes and diet aids

Women’s liberation movement  Second wave feminism  Bra burning, abortion, gay rights, equal pay

Impact on youth  Encourages young people to focus on the immediate and the superficial rather than the personal and the profound. – what is important is how we look  From an early age, we must spend time and energy to achieve this look  We must feel guilty and ashamed if we fail  Failure is inevitable….

 Obesity simplified - eating too much  Culture of vigilance in schools:  good and bad foods  shaming for a cookie in the lunch  calorie counting in health class  Public weighing and feedback

 Profound shaming

Direct or Implied messages  Any one who is overweight is:  Lazy  Eats poorly  Unhealthy / going to die  Should be on a diet

Dieting / Disordered Eating Hazardous weight loss Severe Body Dissatisfaction Weight Pre- occupation

Impact of these messages  Paralyses women and girls  Culture of self-deprication and self-hatred  Leads to high levels of:  Size discrimination  Anxiety and stress  Depression

Impact on Youth  Severe bullying and teasing  This is sanctioned

Risk Factors for Anorexia Nervosa Cultural Family Individual Idealization of Family History of ED / Female Gender thinness, “normative Anxiety / Mood disorder discontent” for female / OCPD body image Gay males Early life Perfectionism / “overprotective / high Obsessionality concern parenting” Activity where thinness Low self-esteem / = success e.g. Sense of modeling / acting ineffectiveness Competitive sports Eagerness to please / with emphasis on High sensitivity thinness: e.g.. gymnastics / ballet Puberty

Canary in the Mines  Sensitive to the world  perfectionistic, anxious, does things “110%”, compulsive by nature

Facts C auses for obesity are complex 1. 2. There is limited correlation between weight & health 3. Dieting should never be prescribed

Impact of Genetics  50 – 90% of our risk for obesity comes from our genes  Some people are at greater risk for developing obesity and some are at less risk  Biologic influences:  Gut microbiome/exposure to antibiotics

Obesity  Poverty, low SES  Trauma  Intra-uterine malnutrition  High levels of parental control over eating

Facts C auses for obesity are complex 1. 2. There is limited correlation between weight and health 3. Dieting should never be prescribed

Set Point  BMI 18.5 – 25  Body Mass Index kg/m²

Health and Weight  Limited direct correlation between health and weight  Weight associated with lowest mortality: All ages >55 yr Caucasian 24.5 26.5 African 27 29.8 American  Health is much more predicted by genetics and activity level

Olympic athletes with 3 different body types

Dieting:  95% of those who diet to lose weight regain the weight lost within one year  What other product or strategy would we keep using if it had a 95% failure rate?

Effects of dieting  Increase weight over time

Statistics on Weight Behaviours in Youth...  95% of all dieters regain their lost weight within one to five years  Adolescent girls who diet are at 324% greater risk of becoming overweight or obese

 So if weight does not tell us about health…  Obesity is a complex process  And dieting should never be recommended….

They are the same for obesity as well as the prevention of Eating Disorders

Young people who feel better about their bodies, are more likely to engage in healthier behaviours, e.g. Physical activity and normalized eating, and thus have better mental and physical outcomes + Body image ↑ Physical activity Normalized Eating ↑ Health

Teach that healthy, strong and happy bodies come in all shapes and sizes  Our shoe size is genetically predetermined ….as is our body height, size, shape and weight  Encourage youth to accept all body sizes, Just as we accept all races and colours

Help a child focus on what their body can do well!

How to have exercise improve body image…  Exercise for the joy of feeling your body move and be strong  Exercise to enjoy the social time with friends and family (skating, skiing, swimming)  Separate exercise from weight loss; we don’t want our kids to think of exercise as a way to make up for eating a piece of cake..

In the Office: Fostering Positive Body Image  Refrain from criticizing your own appearance or clothes in front of youth  Help make home and office ‘appearance safe’ zones • No glossy diet fitness and fashion magazines • No diet foods

Focus on Healthy Behaviours (not #’s or BMI)  How you move ( Physical activity )  How you cope ( Emotional health )  What and how you eat ( Nutrition )