1. Prevention of Eating Addictions Maria Afordakos, Suzanne Ashley, & Abby Moncrief Summer 2010

2. Pre-presentation QuizTrue or False? Research has linked eating to the human’s brain reward system. Anorexia and Bulimia are the two most common eating disorders. Females are more likely to present eating disorders symptoms than males. Most teachers and school counselors do not feel equipped enough to properly discuss eating addictions. All who suffer from an eating addiction are overweight or obese. It is harder to treat someone with an eating addiction than someone who is addicted to alcohol or other substances. Prevention programs should focus on warning the public about signs, symptoms, and dangers of eating addictions.

3. CNN Health File How can eating act as an addiction? http://www.youtube.com/watch?v=ttW-KMQMv7Q Remember Jessica’s story throughout our presentation.

4. Overeating, Binge Eating, & Eating Disorders as Addictions Current evidence links pathological obesity and drug addiction through common brain characteristics. reward pathway in brain increased dopamine during ingestion of food has been reported result in similar behaviors and feeling states, such as loss of control, compulsive usage, chronic relapsing (Gold, Frost-Pineda, & Jacobs, 2003)

5. Overeating, Binge Eating, & Eating Disorders as Addictions Common associations shared between eating disorders & drug addictions: cravings preoccupation compulsive use/behavior despite adverse consequences denial of problem use of substance to relieve negative affect with guilt of use comorbidity genetic links common neurobiological pathways (Gold et al., 2003)

6. Recent, Relevant News on Eating June 1, 2010 on CNN Binge eating is recommended as a psychiatric diagnosis in the DSM Tends to run in families More common in males and older age Currently--Eating Disorder Not Otherwise Specified--EDNOS Bad because EDNOS patients have more severe medical needs but don't qualify for the level of care from insurance companies (http://www.cnn.com/2010/HEALTH/06/01/eating.disorders.bingeing.obesity/index.html?iref=allsearch)

7. Definition of Food Addiction A food addiction is any disorder characterized by a preoccupation with food. Among the disorders associated with food addiction are anorexia, bulimia, and compulsive eating. Food addicts gain pleasure from the anticipation, availability, and ingestion of food. (http://www.allaboutlifechallenges.org/food-addiction-symptoms-faq.htm)

8. Symptoms of Food Addiction Obsessed with thoughts about food. Eats to relieve worry or stress. Eats until they feel sick. Feels anxious while eating. Worries or feels anxious while eating which results in more eating. Overeats because the food is there. Eats too fast so they can eat more. Eats everything on the plate even when they feel full. Feels guilty when they overeat. Hides food so they can eat in secret away from other people. Goes on a food binge after dieting or after trying to cut back. Does not like the feeling of being hungry. Sees food as something to be avoided or as harmful. (http://www.allaboutlifechallenges.org/food-addiction-symptoms-faq.htm)

9. Food Addiction Cycle (Minirth, Sneed, Hemfelt, Meier, 1990)

10. Types of Eating Disorders Linked Eating Addictions Anorexia: starving self and weight loss Bulimia: binging and purging to control weight Eating Disorder Not Otherwise Specified—EDNOS Binge Eating Disorder: compulsively overeat and rapidly consume thousands of calories in a short period of time Most common food addiction in U.S. Overeating: consuming excessive amounts of food over a long period of time (www.helpguide.org)

11. Statistics Approximately 10 million females & one million males have eating disorders. Anorexia has the highest morality rate of any mental illness. Eating disorders are more expensive to treat than schizophrenia. Eating disorders are more common than Alzheimer's disease. (NEDA, 2010)

12. Statistics Anorexia: less than 1% Bulimia: 2%-3% EDNOS: 2%-5% (Lock & Fitzpatrick, 2009) Gender Differences Girls or women are either as likely as, or LESS likely than, boys or men to report: Binge eating Use of excessive exercise for weight control Girls or women are more likely than boys or men to report: Weight dissatisfaction Dieting for weight control Use of purging (Striegal-Moore , Rosselli, Perrin, DeBar, Wilson, May, & Kraemer, 2009)

14. Overeaters may subconsciously desire added pounds to protect themselves from love and intimacy

15. Overeaters may use food to satisfy their need for immediate gratification

16. Overeaters may eat to punish themselves or others

17. Overeaters may have a faulty perception of their body image

18. Overeaters eat to satisfy other “hungers”

19. Overeaters may have emotional feelings about food which were developed at their parents’ dinner table.

20. Overeaters may eat to control their circumstances

21. Overeaters may use food as a tranquilizer. (Minirth, Sneed, Hemfelt, Meier, 1990)

22. Warning Signs of an Eating Addiction Preoccupation with body or weight Obsession with calories, food, or nutrition Rapid weight loss or weight gain Compulsive exercising Eating alone or in secret Hoarding high-calorie food Constant dieting, even if thin Taking laxatives or diet pills Making excuses to get out of eating Avoiding social situations that involve food Going to bathroom right after meals (www.helpguide.org)

23. Prevention

24. Case Study Jessica from CNN Health File reported: One year ago, she lost 50 pounds. She has a new job and a new wedding. She has gained the weight back. “I feel bad so I eat. I feel bad so I eat. When I’ve had a bad day, I really crave something, say chocolate.” Jessica shared on the clip.

25. Basic Principles of Prevention Systematic approach to create change –Primary Prevention = designed to prevent the occurrence of eating addiction before they begin; promote healthy lifestyle –Secondary Prevention = designed to promote early identification; often called “targeted prevention” The earlier an eating disorder is discovered and addressed, the better the chance for recovery. (Levine & Maine, 2005)

26. Effective Principles of Prevention Should address: –Cultural obsession with slenderness –Roles of men and women in society –Development of people’s self-esteem & self-respect Should NOT solely focus on warning the public about signs, symptoms, and dangers of eating addictions School programs & community organizations should coordinated with eating disorder professionals. (Levine & Maine, 2005)

27. Primary Prevention Teachers, health educators, school nurses, school counselors, school psychologists, and sports coaches are NOT prepared to talk about eating addictions with students 40% of school counselors did not feel competent in helping students with eating addictions 49% reported they only felt moderately competent (Price, 1990 as cited in Yagar, 2005)

28. “A culture is formed by the stories its children are told.” (Kater, 2005)

29. Society's Statistics 80% of American women are dissatisfied with their appearance (Smolak, 1996). 42% of 1st-3rd grade girls want to be thinner (Collins, 1991). 81% of 10 year olds are afraid of being fat (Mellin et al., 1991). 46% of 9 to 11 year olds are "sometimes" or "very often" on diets (Gustafson-Larson & Terry, 1992). Americans spend over $40 billion on dieting and diet-related products each year (Smolak, 1996).

30. Bibliotherapy as Part of Prevention Shapeville By: Andy Mills & Becky Osborn Ages 3-8 “It’s not the size of your shape or the shape of your size, but what’s in your heart that deserves first prize.” Full Mouse Empty Mouse A Tale of Food and Feelings By: Dina Zeckhausen Ages 7-12 Highlights the importance of talking about feelings and finding comfort in healthy ways.

31. Toxic Cultural Myths Underling Body Image, Eating, Fitness, Nutrition, and Weight Problems(Kater, 2005)

32. Prevention for Adolescents Do not hesitate to approach child with your concerns about their eating attitudes and behaviors. Be attentive to all the changes in children’s lives as they grow and develop. Observe and monitor child’s home and school life. Have open communication with child. Did you know… -Research suggests that daughters of mothers who have a history of eating disorders may be at higher risk for developing an eating disorder. -In addition, children and adolescents may be more at risk for developing an eating disorder if their parents have psychiatric disorders or substance abuse disorders. (Katzman, Pinhas, 2005)

33. Prevention of Cultural Food Addiction American culture breeds overeaters with Fast Food Industry -> Supersize portions In the last 50 years, Americans went from eating once or less per month to at least once per day per family. Fast food has also allowed people to become “secret eaters” by allowing them to eat in the cars before driving to work or driving home. The American people are also consumed with “fad diets,” diet pills, laxatives, special weight-loss machines or clothing. (Minirth, Sneed, Hemfelt, Meier, 1990)

34. Relapse Prevention Have regularly scheduled follow-up visits with individuals who are treated successfully for bulimia None of the 30 subjects who relapsed during the follow-up period came back for treatment as instructed (Mitchell, Agras, Wilson, Halmi, Kraemer, & Crow, 2004)

35. Relapse Prevention Dr. Stephen F. Grinstead is a Relapse Prevention Expert on Eating Addiction and Coexisting Disorders. He has created a workbook for those in recovery of eating addictions to allow them to plan and map out their recovery -- A Healthy Living Plan. The following are chapters from Dr. Stephen Grinstead's The Eating Addiction Relapse Prevention Workbook: Exercise 1: Looking at the principles of a Healthy Living Plan from a Biopsychosocialspiritual perspective, then listing your personal triggers in each of those categories and creating your own Healthy Living Plan. Exercise 2: Learning how to develop your personalized definition of abstinence as an important component of your recovery and Healthy Living Plan. Exercise 3: Completing the Eating Addiction Problem Checklist to help determine your level of problem (past and/or present) with compulsive use of eating. Exercise 4: Looking at the pros and cons concerning the way you have used eating in the past and making a decision to stop using eating as a coping tool. Exercise 5: Creating a craving management plan and an early relapse intervention plan (www.recoverytoday.net)

36. Relapse Prevention The last five chapters of the workbook are in place to identify High Risk Factors and triggers of your eating addiction. Exercise 7: Defining high risk situations and picking your own personal high risk situation that you would like to learn to manage. Exercise 8: Mapping (exploring) past ineffectively managed and effectively managed high risk situations, then using that information to project and explore a future high risk situation. Exercise 9: Learning to identify and manage personal reactions to high risk situations by exploring your automatic thinking, feelings, urges, actions, and social reactions that drive the relapse process and are triggered when you encounter a high risk situation. Exercise 10: Developing a personalized recovery plan by selecting and scheduling recovery activities that will help you identify and manage future high risk situations. Exercise 11: Completing a final evaluation process that asks you to complete a check list to determine how well you believe you did completing this workbook. (www.recoverytoday.net)

37. Counseling Techniques & Support

38. Are you a Food Addict? 1. Have you ever wanted to stop eating and found you just couldn't? Do you think about food or your weight constantly? Do you find yourself attempting one diet or food plan after another, with no lasting success? Do you binge and then "get rid of the binge" through vomiting, exercise, laxatives, or other forms of purging? Do you eat differently in private than you do in front of other people? Has a doctor or family member ever approached you with concern about your eating habits or weight? Do you eat large quantities of food at one time (binge)? Is your weight problem due to your "nibbling" all day long? Do you eat to escape from your feelings? Do you eat when you're not hungry? Have you ever discarded food, only to retrieve and eat it later? Do you eat in secret? Do you fast or severely restrict your food intake? Have you ever stolen other people's food? Have you ever hidden food to make sure you have "enough?" Do you feel driven to exercise excessively to control your weight? Do you obsessively calculate the calories you've burned against the calories you've eaten? Do you frequently feel guilty or ashamed about what you've eaten? Are you waiting for your life to begin "when you lose the weight?" Do you feel hopeless about your relationship with food? (www.foodaddicts.org)

39. Screening CAGE questionnaire used in screening alcohol dependence modified for binge eating Have you ever felt the need to cut down on eating? Have you ever had guilty feelings about your eating? Have you ever gotten up in the middle of the night or early in the morning to eat? Several positive responses may indicate a problem. (Gold et al., 2003)

40. Assessment Self-reports may be more reliable than data gathered in client interviews. Eating Disorder Examination (EDE) is one diagnostic tool. Counselor should assess health-related quality of life factors, general psychological distress, and coping strategies. (Mond, Hay,, Darby, Paxton, Quirk, Buttner, ... Rodgers, 2009)

41. Diagnosis Evidence suggests that the majority of individuals with a lifetime eating disorder diagnosis DO NOT receive treatment. High Comorbidity Depression (Mondet. al, 2009)

42. Seeking Treatment Motivational Variables Clients with greater perceived inability to suppress emotional difficulties. Clients with greater perceived impairment in role functioning, such as unable to complete work or household responsibilities due to health problem (Mond et. al, 2009)

43. Potential Treatment Plan Long-Term Goal: Develop healthy cognitive patterns and beliefs about self that lead to alleviation and help prevent relapse. Short-Term Objective: 1. Identify and develop a hierarchy of high-risk situations for unhealthy eating or weight loss practices Therapeutic Interventions: Assess the nature of any external cues and internal cues that precipitate the client’s uncontrolled eating and/or compensatory weight management behaviors Direct and assist client in construction of hierarchy of high-risk internal and external triggers for uncontrolled eating. (Jongsma, Peterson, Bruce, 2006)

45. Interpersonal psychotherapy – will focus on relationship issues that may contribute to compulsive eating. Patient will begin to learn how to communicate more effectively and develop healthier relationships. This will allow the client to have the support that they need, satisfying relationships that will inevitably lead to less urges to binge and make them easier to resist.

46. Dialectical behavior therapy – This would teach the client to accept themselves, how to better manage stressful situations/issues in their life, and how to monitor and handle their emotions. This will allow the client and therapist to investigate and change any unhealthy thoughts about body image, food, eating, etc.(http://www.helpguide.org/mental/binge_eating_disorder.htm)

47. Family Counseling Benefits Allows counselor to uncover potential patterns that have been passed through the generations Counselor can see how these patterns may contribute to the development and continuation of the eating disorder in the family Provides a safe place where family members are able to explore and express their feelings If counselor offers educational information about societal influences to all family members and parents, parents will blame themselves less (Costin, 1999)

48. Support Groups Overeaters Anonymous Food Addicts in Recovery Anonymous Anorexics Anonymous Bulimics Anonymous Eating Disorders Anonymous Eating Addictions Anonymous

49. References Collins, M. E. (1991). Body figure perceptions and preferences among pre-adolescent children. International Journal of Eating Disorders, 199-208. Costin, C. (1999). The eating disorder sourcebook: A comprehensive guide to the causes, treatments, and prevention of eating disorders (2nd ed.). Los Angeles: Lowell House. Food Addicts In Recovery Anonymous. (2000) Are you a Food Addict?. Retrieved from www.foodaddicts.org. Gold, M. S., Frost-Pineda, K., & Jacobs, W. S. (2003). Overeating, binge eating, and eating disorders, as addictions. Psychiatric Annals, 33(2), 117-122. Retrieved June 2, 2010, from PsychINFO. Grinstead, Stephen F. Dr. (April 2009). Eating Addiction Relapse Prevention – Flourishing in Recovery. Retrieved from www.recoverytoday.net. Gustafson-Lawson, A. M., & Terry, R. D. (1992). Weight-related behaviors and concerns of fourth-grade children. Journal of American Dietetic Association, 818-822. Jongsma, A. E., Peterson, L. M., & Bruce, T. J. (2006). The complete adult psychotherapy treatment planner. Hoboken, N.J.: Wiley. Kater, K. J. (2005). Healthy body image: teaching kids to eat and love their bodies too! : promoting healthy body image, eating, fitness, nutrition and weight : a comprehensive resource manual and lesson guide with scripted-lessons and activities for grades four, five or six (2nd ed.). Seattle, WA: Eating Disorders Awareness and Prevention. Katzman, Debra, and LeoraPinhas. Help for Eating Disorders: a Parents' Guide to Symptoms, Causes & Treatments. Toronto: R. Rose, 2005. Print. Levine, M., & Maine, M. (2005). Eating disorders can be prevented! National Eating Disorders Association. Retrieved June 13, 2010, from http://www.nationaleatingdisorders.org Lock, J. & Fitzpatrick, K.K. (2009). Advances in Psychotherapy for children and adolescents with eating disorders. American Journal of Psychotherapy, 63(4), 287-303. Mellin, L., McNutt, S., Hu, Y., Schreiber, G. B., Crawford, P., & Obarzanek, E. (1991). A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollment: The NHLBI growth and health study. Journal of Adolescent Health, 27-37. Mills, A., & Osborn, B. (2003). Shapesville. Carlsbad, CA: Gurze Books. Minirth, Dr. Frank, Dr. Paul Meier, Dr. Robert Hemfelt, and Dr. Sharon Sneed. Love Hunger: Recovery from Food Addiction. Thomas Nelson, 1990. Print.

50. References Mitchell, J.E., Agras, W.S., Wilson, G.T., Halmi, K., Kraemer, H., & Crow, S. (2004). A trial of a relapse prevention strategy in women with bulimia nervosa who respond to cognitive- behavior therapy. doi: 10.1002/eat.10265 Mond, J. M., Hay, P. J., Darby, A., Paxton, S. J., Quirk, F., Buttner, P., ... Rodgers, B. (2009). Women with bulimic eating disorders: When do they receive treatment for an eating problem? Journal of Consulting and Clincial Psychology, 77(5), 835-844. doi: 10.1037/a0015336 National Eating Disorders Association. (n.d.). Retrieved June 13, 2010, from http://www.nationaleatingdisorders.org/ Park, M. (2010, June 1). Binge eating recommended as psychiatric diagnosis; obesity is not. CNN.com. Retrieved from www.cnn.com Smith, M. & Barston, S. (2008, February). Helping someone with an eating disorder: Advice for parents, family members, and friends. Retrieved from www.helpguide.org Smith, M. & Barston, S., Segal R. (2008, March). Binge Eating Disorder: Symptoms, Causes, Treatment, and Help. Retrieved from www.helpguide.org Striegel, R. H., Rosselli, F., Perrin, N., DeBar, L., Wilson, G. T., May, A., & Kraemer, H. C. (2009). Gender differences in the prevalence of eating disorder symptoms. International Journal of Eating Disorders, 42(5), 471-474. doi: 10.1002/eat.20625 Yager, Z. & O'Dea, J.A. (2005). The role of teachers and other educators in the prevention of eating disorders and child obesity: What are the issues? Eating Disorders, 13, 261-278. doi: 10.1080/10640260590932878 Zeckhausen, D., & Boyd, B. (2008). Full mouse, empty mouse: a tale of food and feelings. Washington, DC: Magination Press.

51. Additional Readings From the First Bite: A Complete Guide to Recovery from Food Addiction, By: Kay Sheppard Food Addiction: The Body Knows: Revised & Expanded Edition, By: Kay Sheppard Anatomy of a Food Addiction: The Brain Chemistry of Overeating: An Effective Program to Overcome Compulsive Eating, By: Anne Katherine Why Can't I Stop Eating?: Recognizing, Understanding, and Overcoming Food Addiction (Paperback), By: Debbie Danowski Conquer Your Food Addiction : The Ehrlich 8-Step Program for Permanent Weight Loss, By: CarylEhrlich Food for Thought: Daily Meditations For Overeaters, By: Elisabeth L. Breaking the Bonds of Food Addiction (a Psychology Today publication) By: Susan McQuillan The Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders. 2nd Edition, By: C. Costin

52. Pre-presentation QuizTrue or False? Research has linked eating to the human’s brain reward system. = TRUE Anorexia and Bulimia are the two most common eating disorders. = FALSE Females are more likely to present eating disorders symptoms than males. = FALSE Most teachers and school counselors do not feel equipped enough to properly discuss eating addictions. = TRUE All who suffer from an eating addiction are overweight or obese. = FALSE It is harder to treat someone with an eating addiction than someone who is addicted to alcohol or other substances. = TRUE Prevention programs should focus on warning the public about signs, symptoms, and dangers of eating addictions. = FALSE