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Cross Addiction: The Effects of Binge Eating Disorder on Weight Loss Surgery Outcome : 

Cross Addiction: The Effects of Binge Eating Disorder on Weight Loss Surgery Outcome Katie Polsky, Ph.D. Clinical Director, New Dawn Eating Disorder Recovery Centers

Slide 2: 

In the United States… 5 - 10% of girls/women (5 - 10 Million) 1% of boys/men (1 Million) Source: National Eating Disorder Association (NEDA)

HAVE AN EATING DISORDER : 

HAVE AN EATING DISORDER

Slide 4: 

What is an Eating Disorder?

PEOPLEWITH EATING DISORDERS COME IN ALL SHAPES AND SIZES! : 

PEOPLEWITH EATING DISORDERS COME IN ALL SHAPES AND SIZES!

Anorexia Nervosa : 

Anorexia Nervosa Weight at or below 85% of ideal for age and height Intense fear of gaining weight Disturbed body image Amenorrhea Subtypes: Restricting Type Binge/Purge Type

Bulimia Nervosa : 

Bulimia Nervosa Binge eating Compensatory behavior (on average 2 times per week for 3 months) Disturbed body image Subtypes: Purging Type Non-purging Type

Binge Eating Disorder (BED) : 

Binge Eating Disorder (BED) Recurrent episodes of binge eating - includes large amount & sense of “lack of control” No compensatory behavior following a binge Associated with 3 or more of following: Rapid eating Eating large amounts of food when not hungry Eating until uncomfortably full Eating alone/embarrassment Guilt/disgust after overeating Minimum of 2 times per week for 6 months

Prevalence Rates by Subtype : 

Prevalence Rates by Subtype 0.5% - 3.7% of females suffer from Anorexia Nervosa in their lifetime 1.1% - 4.2% of females suffer from Bulimia Nervosa in their lifetime 2% - 5% of the American population experience Binge Eating Disorder Source: National Eating Disorder Association

Eating Disorder Statistics…. : 

Eating Disorder Statistics…. Mortality Death rate is 12x greater than the general death rate for women aged 15-24 years 27% of the deaths associated with eating disorders come from suicide Mortality at 5 years is 5% and at 20 years it is 20% Long term health complications can lead to premature death later in life

Slide 11: 

Relative to other conditions… Individuals with Eating Disorders are estimated to be TRIPLE those living with AIDS Eating Disorders affect THREE TIMES as many people as schizophrenia Eating Disorders have the HIGHEST mortality rate of any mental illness - 10% of people with an eating disorder die

Age of Onset : 

Age of Onset 10% report onset at 10 years or younger 33% report onset between ages of 11-15 43% report onset between ages of 16-20 86% report onset of illness by the age of 20

Slide 13: 

42% of 1st- 3rd grade girls want to be “thinner” 81% of 10 year olds are “afraid” of being “fat” 51% of 9/10 year old girls “feel better” about themselves if they are on a “diet” 46% of 9 - 11 year olds are “sometimes/very often” on diets - as are 82% of their families Source: Association of Anorexia Nervosa & Associated Disorders

Slide 14: 

Eating Disorders are Biopsychosocial Diseases

Slide 15: 

Causation/Factors Genetics -Depression -OCD -Anxiety -Neurotransmitters (Serotonin and Dopamine implicated) Personality Traits -Perfectionist -People pleaser -Emotionally reserved -Poor coping skills -Avoids risks -Difficulty adapting to change -Low self-esteem Trauma/Loss Family Dynamics -Expectations -Stress Culture -Thin as the ideal -Media influence -Dieting

Psychology : 

Psychology

Psychological Disorders/Problems Associated with BED : 

Psychological Disorders/Problems Associated with BED Trauma/PTSD Depression/Mood Disorder Anxiety Obsessive Compulsive Disorder

Personality or other characteristics : 

Personality or other characteristics Difficulty expressing feelings and needs Need to be in “control” Avoids conflict, “tries to keep the peace” Social Isolation Feelings of worthlessness Impulsivity Inability to delay gratification Struggles with difficult emotions such as anger and sadness Rigid black or white thinking Teased about appearance

Slide 19: 

Sociocultural

Sociocultural : 

Sociocultural Women who viewed fashion magazines for 1 hour reported increased levels of depression and negative body image Negative body image has been found to be a precursor to eating disorder behavior

Sociocultural : 

Sociocultural Thin ideal--DIETING “Normative Discontent” Happiness Emotions Relationships Wealth and Fame We live in an environment that encourages and supports eating disorders and disordered eating

How does this relate to weight loss surgery? : 

How does this relate to weight loss surgery?

Binge Eating Disorder (BED) Rates Before and After Surgery : 

Binge Eating Disorder (BED) Rates Before and After Surgery Before Surgery Up to 64% engage in binge eating Up to 49% have BED After Surgery Up to 71% engage in binge eating Up to 32% have BED Mitchell and Steffen (2009)—Meta-analytic study University of North Dakota School of Medicine, Fargo

BED and Weight Loss Surgery Outcomes : 

BED and Weight Loss Surgery Outcomes Those that have BED prior to the surgery lose less weight and regain more, more quickly than those individuals who do not have BED. Those that have BED with histories of psychiatric illness including depression, anxiety, PTSD, OCD, and substance abuse problems (particularly alcoholism) have poorer prognoses after the surgery.

Risks of Eating Disorder Diagnosis Before Surgery : 

Risks of Eating Disorder Diagnosis Before Surgery Poor outcome of surgery or not sustaining weight loss Dangerous medical complications Loss of identity Increased Depression, Anxiety, PTSD symptoms Bulimia Nervosa Substance Abuse Gambling Sex Addiction Compulsive Spending ____Addiction

Why is this important? : 

Why is this important? If the underlying reasons (causes) people develop __________addiction (i.e., BED) are not examined and worked through or dealt with then CROSS ADDICTION or SYMPTOM SUBSTITUTION WILL OCCUR. Weight loss surgery is not appropriate or implicated for everyone who wants to or needs to lose weight.

What should you do? : 

What should you do? Examine why you eat, drink, do drugs, etc. Seek therapy around your addiction. Chances are there are environmental/social factors (trauma/abuse) that are involved in your addiction as well as biological factors. There is no quick fix.

CONTACT INFORMATION : 

CONTACT INFORMATION For an eating disorder assessment, please call New Dawn Eating Disorder Recovery Centers at: 415-331-1383 www.newdawnrecovery.com [email protected] For local outpatient referrals, you can call Katie Polsky, Ph.D. (916)284-1416 or email at [email protected]

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