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Eating Behaviors:

Dysfunctional Eating Behaviors

Dysfunctional eating behaviors can be categorized as maladaptive eating, disordered eating or as eating disorders. While some of these behaviors may have more or less serious impact on a person’s health, they all require assessment and intervention to limit unhealthy outcomes.

See also:

 

 

Maladaptive Eating Behaviors

Maladaptive eating behaviors are those that lead to unhealthy food intake but do not meet the criteria of serious dysfunctional eating. Maladaptive eating can be “normal” when engaged infrequently enough to have no significant impact on one’s health. Or the eating pattern and behavior can have serious consequences. The impact of these behaviors may lack direct serious consequences in the short run, but nevertheless may lead to failure to lose weight despite concerted efforts to do so or to greater risk for developing diabetes.  As such the downstream, long-term impact of maladaptive eating may still result in harmful physical, psychological and emotional conditions.

 

Examples of maladaptive eating behaviors/syndromes:

  • Hedonic Eating – Driven mostly by anticipation of the pleasure in doing so
  • Emotional Eating – Driven in response to emotion rather than hunger
  • External Eating – Driven by cues that stimulate desire to eat outside that of hunger
  • Night Eating – Excessive eating at night, driven by anxiety or inappropriate need

 

Disordered Eating vs. Eating Disorder

Disordered eating is used to describe a range of irregular eating behaviors that may or may not warrant a diagnosis of a specific eating disorder. The term “disordered eating” is a descriptive phrase, not a diagnosis. The most significant difference between an eating disorder and disordered eating is whether or not a person’s symptoms and experiences align with the criteria defined by the American Psychiatric Association.

Many people with disordered eating symptoms are diagnosed with Eating Disorder Not Otherwise Specified, or EDNOS. However, similar to eating disorders, EDNOS has specific criteria that must be met in order for the patient to receive this diagnosis,

Thus, while many people who have disordered eating patterns may fit the criteria for EDNOS, it also is possible to have disordered eating patterns that do not fit within the current confines of an eating disorder diagnosis. However, eating concerns falling short of a diagnosis require attention and treatment as they may turn into more problematic eating disorders and put individuals at risk of serious health problems.

 

Symptoms of Disordered Eating

Signs and symptoms of disordered eating may include, but are not limited to:

    • Frequent dieting, anxiety associated with specific foods or meal skipping
    • Chronic weight fluctuations
    • Rigid rituals and routines surrounding food and exercise
    • Feelings of guilt and shame associated with eating
    • Preoccupation with food, weight and body image that negatively impacts quality of life
    • A feeling of loss of control around food, including compulsive eating habits
    • Using exercise, food restriction, fasting or purging to “make up for bad foods” consumed

 

Harm Caused by Disordered Eating

It is not uncommon for people with disordered eating patterns to either minimize or not fully recognize the impact it has on their mental and physical health. This lack of understanding can worsen the harm of disordered eating. Harmful consequences can include a greater risk of obesity and eating disorders, bone loss, gastrointestinal disturbances, low blood pressure as well as increased anxiety, depression and social isolation.

Disordered eating is a serious health concern because it can be difficult to detect and can lead to significant physical, emotional and mental stress.

What are Eating Disorders?

First, eating disorders are not lifestyle choices. Eating disorders are often serious and sometimes fatal illnesses characterized by severe disturbances in people’s eating behaviors and related thoughts and emotions. Those afflicted with eating disorders often have a preoccupation with food, body weight and/or shape. Common eating disorders include binge-eating disorder, bulimia nervosa, and anorexia nervosa.

Eating disorders can be differentiated from maladaptive eating behaviors such as emotional eating, external eating, night time or nocturnal eating and disordered eating. These patterns of eating are seldom fatal but should be considered serious due to their consequent association with obesity and increased risk for the metabolic syndrome conditions of diabetes, hypertension and elevated blood cholesterol as well as their psychological impacts including depression and anxiety, loss of self-esteem etc.

 

What are Some of the Eating Disorders?

1. Binge-eating disorder (BED)

In Binge-Eating Disorder (BED), people lose control over their eating and have reoccurring episodes of eating very large amounts of food. Unlike bulimia nervosa, episodes of binge-eating are not followed by self-induced vomiting (purging), excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Symptoms include:

    • Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
    • Eating even when you’re full or not hungry
    • Eating fast during binge episodes
    • Eating until you’re uncomfortably full
    • Eating alone or in secret to avoid embarrassment
    • Feeling distressed, ashamed, or guilty about your eating
    • Frequently dieting, possibly without weight loss

 

2. Bulimia nervosa

In Bulimia nervosa, people have recurrent and frequent episodes of eating very large amounts of food wwhile feeling a lack of control over these episodes. This excessive eating is followed by a behavior that compensates for the overeating such as forced vomiting (purging), excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or over overweight.

Symptoms include:

    • Chronically inflamed and sore throat
    • Swollen salivary glands in the neck and jaw area
    • Worn tooth enamel and sensitive or decaying teeth as a result of repeated exposure to stomach acid
    • Acid reflux disorder and other gastrointestinal problems
    • Intestinal distress and irritation from laxative abuse
    • Severe dehydration from purging of fluids
    • Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack

 

3. Anorexia nervosa

Anorexia nervosa is a condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight.

There are two subtypes of anorexia nervosa: a “restrictive“ and “binge-purge“

  • Restrictive subtype: people severely limit the amount and type of food they consume.
  • Binge-Purge subtype: people also severely limit the amount and type of food they consume. However, they may also binge-eat followed by purging or use of laxatives or diuretics to eliminate what was consumed.

Anorexia nervosa has an extremely high death (mortality) rate compared with other mental disorders. People with anorexia suffer from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.

Symptoms include:

    • Extremely restricted eating
    • Extreme thinness and emaciation
    • A relentless drive to pursue thinness with unwillingness to maintain a normal weight
    • Intense fear of gaining weight
    • Distorted body image, with poor self-esteem based on inappropriate  perceptions of body weight and shape
    • Denial of the seriousness of their low body weight

Other symptoms may develop over time, including:

    • Thinning of the bones (osteopenia or osteoporosis)
    • Mild anemia and muscle wasting and weakness
    • Brittle hair and nails
    • Dry and yellowish skin
    • Growth of fine hair all over the body
    • Severe constipation
    • Low blood pressure
    • Slowed breathing and pulse
    • Damage to the structure and function of the heart
    • Brain damage
    • Multi-organ failure
    • Drop in internal body temperature, causing a person to feel cold all the time
    • Lethargy, sluggishness, or feeling tired all the time
    • Infertility

Risk Factors for Eating Disorders

People of all ages, racial/ethnic backgrounds, body weights, and genders can suffer from Eating Disorders. They frequently appear during the teen years or young adulthood but may also develop during childhood or later in life.

Research suggests that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Eating disorders run in families so they may gave genetic risks.

 

Treatment of Eating Disorders

People with eating disorders often have depression, anxiety or problems with substance use. It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. It is important to stress that complete recovery is possible.

Treatment plans should be tailored to the individual needs and may include one or more of the following:

  • Individual, group, and/or family psychotherapy
  • Medical care and monitoring
  • Nutritional counseling
  • Medications

Psychotherapies

Family-based therapy, a type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, can be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

 

Medication

Medications such as antidepressants, antipsychotics, or mood stabilizers may be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression. The Food and Drug Administration’s (FDA) website  has the latest information on medication approvals, warnings, and patient information guides.

 

Resources

The following list includes resources that may be helpful in coping with being overweight as well as facilitating weight loss.

www.nutrition.gov

Nutrition.gov provides easy access to vetted food and nutrition information from across the federal government. It serves as a gateway to reliable information on nutrition, healthy eating, physical activity, and food safety for consumers.

Providing science-based dietary guidance is critical to enhance the public’s ability to make healthy choices in the effort to reduce obesity and other food related diseases. Since dietary needs change throughout the lifespan, specialized nutrition information is provided about infants, children, teens, adult women and men, and seniors.

Users can find practical information on healthy eating, dietary supplements, fitness and how to keep food safe. The site is kept fresh with the latest news and features links to interesting sites.

 

www.naafa.org – National Association to Advance Fat Acceptance

Founded in 1969, the National Association to Advance Fat Acceptance (NAAFA) is a non-profit, all volunteer, civil rights organization dedicated to protecting the rights and improving the quality of life for fat people. NAAFA works to eliminate discrimination based on body size and provide fat people with the tools for self-empowerment through advocacy, public education, and support.

 

www.obesityaction.org

The Obesity Action Coalition (OAC) was born with the goal that the organization could create needed change for those who are living with and/or are affected by the disease of obesity. The OAC is a more than 85,000 member-strong 501(c) national nonprofit organization dedicated to serving the needs of every individual affected by obesity.

 

List of Weight Loss Programs

 

Phone Apps

 

Other Resources for Help

 

References

NEW ARTICLES

  1. Association of Obesity With Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US – PMC – 2020
  2. Chronic pain management in the obese patient- a focused review of key challenges and potential exercise solutions – 2015
  3. Chronic Stress, Cortisol Dysfunction, and Pain_ A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation – PMC – 2014
  4. Clinically Combating Reward Deficiency Syndrome (RDS) with Dopamine Agonist Therapy as a Paradigm Shift- Dopamine for Dinner? – 2015
  5. Effects of changes in sleeping behavior on skeletal muscle and fat mass- a retrospective cohort study – 2023 Leptin and Inflammation – 2008
  6. Sleep Deprivation_ Effects on Weight Loss and Weight Loss Maintenance – 2022
  7. The role of insufficient sleep and circadian misalignment in obesity – 2023

 

Obesity – Visceral Fat

Visceral Fat – Overviews

  1. Pathophysiology of Human Visceral Obesity – An Update

Visceral Fat – Biomarkers

Biomarkers – Adinopectin

    1. The role of fat topology in the risk of disease. – PubMed – NCBI

Biomarkers – IL-6

    1. Metabolic obesity: the paradox between visceral and subcutaneous fat. – PubMed – NCBI

Biomarkers – Hypertriglyceridemia

    1. Hypertriglyceridemic waist – a useful screening phenotype in preventive cardiology? – 2007

Visceral Fat – Exercise

  1. Effect of exercise training intensity on abdominal visceral fat and body composition

Visceral Fat – Genetics

  1. Genetic and behavioral influences on body fat distribution. – PubMed – NCBI
  2. The genetics of fat distribution – 2014

Visceral Fat – Stress

  1. Interleukin-1 beta – a potential link between stress and the development of visceral obesity – 2012

 

Obesity – Comorbid Conditions

Obesity – Fatty Liver

    1. The role of visceral and subcutaneous adipose tissue fatty acid composition in liver pathophysiology associated with NAFLD. – PubMed – NCBI
    2. What non-alcoholic fatty liver disease has got to do with obstructive sleep apnoea syndrome and viceversa? – PubMed – NCBI

Obesity – Kidney Disease

    1. Association of visceral fat area with chronic kidney disease and metabolic syndrome risk in the general population

 

Obesity – Metabolic Syndrome

    1. Association of visceral fat area with chronic kidney disease and metabolic syndrome risk in the general population
    2. Abdominal Obesity and the Metabolic Syndrome – Contribution to Global Cardiometabolic Risk – 2008
    3. Metabolic syndrome and adipose tissue: new clinical aspects and therapeutic targets. – PubMed – NCBI
    4. Subcutaneous and Visceral Adipose Tissue: Their Relation to the Metabolic Syndrome: Endocrine Reviews: Vol 21, No 6

Obesity – Oxidative Stress

    1. Oxidative stress drivers and modulators in obesity and cardiovascular disease: from biomarkers to therapeutic approach. – PubMed – NCBI

Obesity – Sleep Apnea

    1. Visceral fat and respiratory complications – 2004
    2. What non-alcoholic fatty liver disease has got to do with obstructive sleep apnoea syndrome and viceversa? – PubMed – NCBI

Wt Loss Program

Wt Loss Program – Body Composition Analysis (BCA)

  1. Body Composition Analysis – Patient Preparation handout
  2. Measurement of visceral fat by abdominal bioelectrical impedance analysis is beneficial in medical checkup. – PubMed – NCBI
  3. The clinical importance of visceral adiposity – a critical review of methods for visceral adipose tissue analysis – 2012
  4. The use of bioelectrical impedance to detect excess visceral and subcutaneous fat – 2007

 

Wt Loss Program – Appetite Suppressants

Appetite Suppressants – Prescription Medication List

  1. Adipex (Phentermine)
  2. Belviq (Lorcaserin)
  3. Bupropion
  4. Contrave (Bupropion/Naltrexone)
  5. Invokana (Canagliflozin)
  6. Naltrexone
  7. Orlistat (Xenical, Alli)
  8. Qsymia (Phentermine and Topiramate)
  9. Saxenda (Liraglutide)
  10. Topamax (Topiramate)
  11. GLP-1 Receptor Agonists
  12. Wegovy (Semaglutide)

 

Appetite Suppressants (Rx) –  Semaglutide

    1. Semaglutide Medications – Information
    2. Ozempic Information
    3. RYBELSUS Information
    4. Wegovy Information
    5. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity – PMC – 2021
    6. Review Wegovy (semaglutide)- a new weight loss drug for chronic weight management – 2022
    7. Once-Weekly Semaglutide in Adults with Overweight or Obesity – 2021
    8. Once-Weekly Semaglutide in Adults with Overweight or Obesity – PubMed – 2021
    9. Effect of semaglutide and liraglutide in individuals with obesity or overweight without diabetes- a systematic review – 2022
    10. GLP-1-Medications-Article-References-and-PubMed-Links
    11. Sublingual Semaglutide Supportive deposition
    12. The Impact of GLP1 Agonists on Bone Metabolism: A Systematic Review.- 2022
    13. Efficacy and safety of dulaglutide 3.0 and 4.5 mg in patients aged younger than 65 and 65 years or older: Post hoc analysis of the AWARD‐11 trial – 2021
    14. Safety of Semaglutide – 2021
    15. Semaglutide for the treatment of overweight and obesity_ A review – 2023
    16. Two-year effects of semaglutide in adults with overweight or obesity_ the STEP 5 trial 2022
    17. Semaglutide for the Treatment of Obesity – 2021

 

Appetite Suppressants (Rx) – Wegovy (Semaglutide)

    1.  Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity – PMC – 2021
    2. Singh G, et al. J Investig Med 2022;70-5–13. doi-10.1136 jim-2021-0019525 Review Wegovy (semaglutide)- a new weight loss drug for chronic weight management – 2022
    3. Once-Weekly Semaglutide in Adults with Overweight or Obesity – 2021
    4. Once-Weekly Semaglutide in Adults with Overweight or Obesity – PubMed – 2021

Appetite Suppressants –  CAM

    1. Appe-control and Hunger Block

 

 

Wt Loss Program – Diet

Diet – Guidelines

 

Diet – Fasting

  1. Calorie restriction increases life span: a molecular mechanism. – PubMed – NCBICalorie restriction increases muscle mitochondrial biogenesis in healthy humans. – 2007
  2. A double-blind, placebo-controlled test of 2 d of calorie deprivation – effects on cognition, activity, sleep, and interstitial glucose concentrations – 2008
  3. Fasting and refeeding differentially regulate NLRP3 inflammasome activation in human subjects – 2015

Diet – Foods

  1. Chia Seeds
  2. Pistachios
  3. Fiber

 

Diet – Supplements

Supplements – Vitamins

Vitamins – Overviews

    1. Vitamin status in morbidly obese patients – a cross-sectional study – 2008

Vitamin C

Vitamin D

    1. Decreased bioavailability of vitamin D in obesity – 2000
    2. Higher visceral fat area increases the risk of vitamin D insufficiency and defic
      iency in Chinese adults – 2015
    3. Obesity and vitamin D 2004
    4. Rising serum 25-hydroxy-vitamin D levels after weight loss in obese women correlate with improvement in insulin resistance. – PubMed – NCBI
    5. The Effect Of Vitamin D Supplementation On Serum 25OHD In Thin And Obese Women – 2012
    6. The Longitudinal Association of Vitamin D Serum Concentrations & Adiposity Phenotype – 2013
    7. Vitamin D and Its Relationship with Obesity and Muscle – 2014
    8. Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markers – 2009
    9. Update on vitamin D – pros and cons – 2015

Diet – CAM Supplements

  1. Multi-Nutrient Supplements
  2. NRF2 Activators
  3. CoQ10
  4. Nicotinamide Riboside (NR)

 

 

Wt Loss Program – NLAL Lipolysis

NLAL Lipolysis – Handouts

  1. NLAL Lipolysis
  2. NLAL – Patient Treatment Info

NLAL Lipolysis – References

  1. Fat Liquefaction – Effect of Low-Level Laser Energy on Adipose Tissue
  2. Application of low-level laser therapy for noninvasive body contouring. – PubMed – NCBI
  3. Body contouring using 635-nm low level laser therapy. – PubMed – NCBI
  4. Efficacy of low-level laser therapy for body contouring and spot fat reduction. – PubMed – NCBI
  5. Independent evaluation of low-level laser therapy at 635 nm for non-invasive body contouring of the waist, hips, and thighs. – PubMed – NCBI
  6. Low-level laser therapy as a non-invasive approach for body contouring: a randomized, controlled study. – PubMed – NCBI

 

 

Maladaptive Eating

Eating Behavior – Emotional Eating

  1. Emotional Eating

Eating Behavior – External Eating Cues

  1. External Eating Cues

 

Eating Behavior – Cravings

  1. Food craving – new contributions on its assessment, moderators, and consequences – 2015
  2. Pickles and ice cream! Food cravings in pregnancy – 2014
  3. Relationship of cravings with weight loss and hunger – Results from a 6 month worksite weight loss intervention – 2013
  4. How Relevant is Food Craving to Obesity and Its Treatment? – 2014

Cravings – Treatment

Cravings Treatment –  CAM Supplements

    1. Quercetin
    1. Synaptamine

Eating Behavior – Binging  (BED)

BED – Overview

    1. Binge Eating Disorder – Recognition, Diagnosis, and Treatment

BED – Dopamine </sp an>

    1. Binge eating disorder and the dopamine D2 receptor: genotypes and sub-phenotypes. – PubMed – NCBI
    2. Dopamine for “Wanting” and Opioids for “Liking” – A Comparison of Obese Adults With and Without Binge Eating-2009

 

BED – Treatment

BED – Treatment, Overview

    1. Current and Emerging Drug Treatments for Binge Eating Disorder – 2014
    2. Pharmacological management of binge eating disorder – current and emerging treatment options

BED -Treatment, Bupropion

    1. Bupropion for Overweight Women with Binge Eating Disorder – Randomized Double-blind Placebo-controlled Trial – 2013

BED -Treatment, Chromium

    1. Chromium Picolinate – Summary
    2. A Double-blind, Randomized Pilot Trial of Chromium Picolinate for Binge Eating Disorder – Results of the Binge Eating and Chromium (BEACh) Study – 2013
    3. Dietary chromium supplementation for targeted treatment of diabetes patients with comorbid depression and binge eating. – PubMed – NCBI

BED -Treatment, Contrave

    1. Treatment of Binge Eating Disorder in Obesity: Naltrexone: Bupropion Combination Versus Placebo – Full Text View – ClinicalTrials.gov

 

Maladaptive Eating – Reward Deficiency Syndrome

  1. Clinically Combating Reward Deficiency Syndrome (RDS) with Dopamine Agonist Therapy as a Paradigm Shift- Dopamine for Dinner? – 2015

“Dopamine for Dinner” by Joan Borsten, 2014

Avaliable online at Amazon.com: Kindle subscriber: free;  Kindle book: $9.95  Paperback: $149.00

“Dopamine for Dinner,” is the first Malibu Beach Recovery Diet Cookbook, based on their famous low-glycemic diet. The recipes developed by four accomplished chefs are both pleasant eating as well as healthy. Based on the use of low glycemic index foods, the recipes emphasize nutritious eating in a manner that promotes maintaining high brain levels of dopamine and serotonin as a means of supporting healthy brain chemistry.

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thous
ands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

 

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