Nutrition

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Nutrition Self -Perception

• Dianna Spies Sorenson, PhD, RN, CNS

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My Body

• What do you look like?

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My Body

• What do you look like?
• What do you like? List it.

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My Body

• What do you look like?
• What do you like? List it.
• What dont you like? List it.

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My Body

• What do you look like?
• What do you like? List it.
• What dont you like? List it.
• Draw your body as it is

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My Body

• What do you look like?
• What do you like? List it.
• What dont you like? List it.
• Draw your body as it is
• Draw your body how youd like it to be

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My Body

• What do you look like?
• What do you like? List it.
• What dont you like? List it.
• Draw your body as it is.
• Draw your body how youd like it to be.
• What did you discover?

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Definitions

• Self concept "concept of oneself through
  description rather than evaluative judgments."
  Reber, 1985
• "an organized configuration of perceptions of the
  self which are admissible to awareness."
  (Somstroem, 1998).
• Self esteem the evaluation affect one holds
  for this personal picture competence self
  acceptance/satisfaction. (Somstroem, 1998)
• Body Image "one's view of his/her body, state
  of health, physical appearance, skills
  sexuality." (Roid and Fifts, 1994).
• Self concept might be related to a persons
  overall personality and mental health and may
  affect a person's behavior. A study done by
  Stower's and Durm to confirm correlations for
  both men and women between physical self and
  over-all self concept and examine the gender
  differences in those relationships to test the
  hypothesis that women have a more diminished body
  image than men. results showed that there was a
  significant relationship between body image and
  over-all self concept for both men women and woen
  had significantly lower body image scores than
  men. therefore, body image and over-all self
  image are related,

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Physical Self-Concept

• process of separating self from the environment
  others discovering personal causation
• environmental testing and learning from the
  response of others
• Cooley's "Looking glass theory
• observing comparing selves to our perceptions
  of others strengths weaknesses

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Ideal Vs. Real

• The Ideal American Woman
• Height 57 weight 110 lbs

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Ideal Vs. Real

• The Ideal American Woman
• Height 57 Weight 110 lbs
• The Actual American Woman
• Height 54 Weight 144 lbs

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Cultural/Economic Value Influence on Womens Size

• Amt. of body fat considered attractive in a
  culture is inversely correlated with
• the value of women's work
• degree of political power
• control over economic resources
• Body fat is more prized in subsistence economies
  than in advanced industrial ones.

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Historical View of Body Distortion Influence on
Children

• 1950s Lilli cartoon appeared in West German
  Tabloid Bild Zeitung
• featured as a sex idol
• became prototype for American Barbie doll

• Barbie as a real woman
• long neck
• 38 bust
• 18 waist
• 34 hips
• 510 tall
• extra long legs

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Changes in Body Attractiveness Standards

• curvaceousness ? over time from 1901-1993 (U.S.)
  
• ? economic prosperity
• ? womens participation in the economy
• Higher education among women
• ? Proportion of single women to men (20-24 y/o)
• Birth rate declined

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Body Image in Middle Older Age Women

• women 65 years
• 62 wanted to lose wt, when 65 were normal
  weight
• ?? wt dissatisfaction with higher educ.
• 42 dieted for wt control including 67 who were
  nl wt. Within past 5 vs.

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Body Image and Men

• Androgenic-anabolic steroids and body dysmorphia
  in young men is a manifestation of body
  dissatisfaction
• Societal trends Muscular mesomorphic physique
• Attractive body success
• Media presentation Schwarzenegger Stallone
• Male athletes have higher risk for eating
  disorders

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Nutrition and Adolescent Females

• college students with the greatest body
  dissatisfaction reported the lowest frequency of
  recent sexual activity
• healthiest eating attitudes associated with a
  positive self-esteem low levels of anxiety

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Diet/Eating Patterns General Statistics

• 90 H.S. Jr/Sr. girls regularly diet when only
  10-15 are over weight via ht/wt standards

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General Statistics on Older Adults (U.S.)

• 40 men 30 women 75 yr. are at least 10
  under weight
• 50 65 yr. are clinically malnourished at
  hospital admission 66 are malnourished at
  discharge.

• weight loss can be an independent predictor of
  increased mortality
• 31 males 61 females 65 yr. make food budget

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Factors R/T Development of Body Image
Preoccupation

• teasing
• social comparisons
• socially rx perfectionism
• discrepancy between perception actual self
• low self esteem
• image used to "fit in"

• body used for romantic sexual attractiveness
• over est. leanness as attractive to men

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Development of a Negative Body Image
Historical Causes
Socialization by Culture
InterpersonalExperiences
PersonalityCharacteristics
Current Causes
ActivatingEvents Situations
Assumptions, Interpretations, Thoughts on
Appearance
Body ImageEmotions
Self-Defensive Actions
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Socialization by Culture

• Media
• Rewards (money, power, position)
• Sexuality Definitions
• Food Industry
• Plastic Surgeons
• Dieting Industry
• Gender Role Prescription

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Interpersonal Experiences

• Discrimination
• Oppression
• Criticism
• Jokes
• Family Beliefs/Values

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Personality Characteristics

• Perfectionistic
• Sensitive
• Enmeshed
• Unhappy
• Low Self-Esteem
• Inability to have express emotions

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Activating Events Situations

• Humiliation
• Shame-inducing
• Powerless
• Vulnerability
• Rebuke
• Teasing

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Assumptions, Interpretations, Thoughts on
Appearance

• Magnification (e.g. Distortion of size)
• Overgeneralization (e.g. everyone is thinner
  than me)
• Polarization (Concrete all or nothing
  classification of good/bad, e.g. Fat is bad
• Competition against others/world (e.g. Im only
  important if I am thinner than the rest)
• Mind-Body Division
• Magical thinking (e.g. Everything -sex, love,
  friends, luck- would be better if I were thin
• Personalization (e.g. this only happened to me
  because Im fat)

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Body Image Emotions

• Unacceptability
• Self-Hatred
• Weakness
• Anxiety
• Depression
• Guilt Shame
• Humiliation

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Self-Defensive Actions

• Avoidance (persons, places, situations, foods,
  photos, physical contact)
• Food Restriction (diet)
• Indulgence (binge)
• Continual attempts to control eating behaviors

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Body Image of Eating Disordered

• Body image concerns are largely r/t the pursuit
  of beauty attractiveness
• Thinness associated with personal
  accomplishments, attractiveness, higher social
  status

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Continuum of Eating Patterns

• Healthy Eating
• Hungry/Eat
• No guilt
• No over/under eating
• Flexibility in food, time, location, etc
• Varied intake

• Disordered Eating
• Worried
• Body wrong
• Better if thinner
• Food avoidance
• Count cal, gm., etc
• Diets
• Restrictions
• ? exercise

• Eating Disorder
• Pathologic// destructive eating
• Eat to express emotional
• Disconnected from body needs
• Rigid eating patterns
• Invariable intake

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Definition Anorexia Nervosa

• Self- imposed food restriction starvation in an
  obsessive effort to lose weight achieve an
  unrealistic ideal of thinness
• DSMIV

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Definition Bulimia Nervosa

• An episodic pattern of binge eating where large
  amounts of food are eaten quickly, followed by
  some form of purging (I.e. vomiting, laxative,
  exercise) in an effort to avoid weight gain.
• DSMIV

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Anorexia Bulimia Comparison/Contrast
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Anorexia/Bulimia Prevalence In U.S.

• 5 million Americans
• 70 all women struggle with wt/body image
• 1 all adolescent girls develop anorexia
• 2-5 develop bulimia
• 10 anorectic/ bulimic are men

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Anorexia/Bulimia Prevalence International

• Fijian girls
• vomiting to control weight
• 1995 3
• 1999 15
• 1998
• 74 felt too fat/too big
• 62 dieted in past mo.
• 5 x ? in 4 yr.. since TV introduced

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Causes of Anorexia/Bulimia

• Hereditary - anxiety disorder (serotonin)
• Socio/cultural
• Intergenerational transmission process
• learned behavior
• Capitalism
• advertising/ product promotion
• Media portrayals

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Gender Differences

• 90-95 of eating disorders occur in females

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Cognitive View of Bulimia Nervosa Maintenance
Negative self-evaluation
Characteristic extreme concerns about shape wt
Perfectionism dichotomous thinking
Intense rigid dieting
Perfectionism dichotomous thinking
Binge Eating
Negative affect
Purging
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Definition of Hunger

• Hunger A strong desire or need for food
  discomfort, weakness or pain caused by prolonged
  lack of food

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Definition of Appetite

• Appetite An instinctive physical desire,
  especially for food or drink strong wish or urge

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Definition of Satiety

• Satiety The condition of being full or
  gratified the power of foods to stop eating at
  the end of a meal suppress eating between meals

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Disruption of Appetite Control - Infants to Adults

• Physiologic Regulation
• Eats preferred food
• Eats when hungry
• Regulates calories within/ between meals

• Appetite Disruption
• Parental Control of food
• Socialization of eatingeating schedules
• Food as a reward for comfort

• Psychologic Regulation
• Uses food for pleasure or reward
• Disregards physical hunger perceives feelings as
  hunger
• Responds to social environ. Vs. internal cues

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Relationships Among Hunger, Appetite Satiety
Hunger is there anything to eat?
Appetite What do I want to eat?
Satiety
Satiety
Food Intake
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Rate Your Fat Oppression Behaviors

• NEVER
  DAILY
• 1 2 3 4
  5

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Over-Weight/Obesity Prevalence In U.S.

• Obese (BMI 30)
• 22
• 1962 12.8
• 1980 14
• 1999 22.3
• Obesity ? 1963-1980
• Overall 20 ?
• 54 ? children
• 39 ? adolescents

• Overweight (BMII25- 30)
• 34 total population are over wt or obese
• 27 children (6-11)
• 15 adolescents
• 27 women (20-74)
• 24 men

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Obesity Prevalence International

• Fiji
• 74 girls obese
• 84 obese in studied villages (highest in the
  world)

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Causes of Obesity

• Caloric intake exceeds energy needed
• Genetic Factors
• Environmental Factors
• Lifestyle Behaviors
• Psychological Factors
• Rare illnesses
• Drugs

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Health Risks of Obesity

• diabetes
• heart disease, high blood pressure, stroke
• cancer
• men colon, rectum, prostate
• women gallbladder, breast, gynecologic
• gallbladder/gallstones
• osteoarthritis gout
• pulmonary problems
• sleep apnea

• 2 x ? premature death If 40 overweight

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Costs of Obesity

• Direct Costs to US annual economy
• DM, stroke, CHD 238 billion
• CHD alone costs 50 billion
• 5 billion spent on home exercise/ weight-loss
  equipment

• Indirect Costs US annual economy
• depression
• premature death
• quality of life

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• Dieting is a normative but non-benign
  developmental phenomenon with negative physical,
  psychological, and behavioral effects
• Michael Levine, 1994

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Feeling Fat
Self-Punishment
Stringent Diet
Shame
Depression,
Guilt
Compulsive Eating
Incompetent, Out of Control
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• Dieting worsens the problems--overeating, food
  obsessions body shame--that it purports to
  solve. And it wreaks havoc on moods, lives
  emotions
• -L.Fraser. 1977

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Warning Signs Meal Behaviors

• Hiding food
• Caloric restriction
• Dissecting food
• Arranging food
• Over-seasoning
• Improper use of utensils
• Stauned conversation
• Slow meal pace
• Tense body language

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Warning Signs

• Chronic Dieting
• Caloric Restriction
• Binge Activities
• Preoccupation with food (prep, eating, fretting
  about what was eaten)
• Preoccupation with body shape or weight

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Warning Signs, cont.

• Abuse of laxatives, enemas, ipecac, diet pills
• Inordinate exercise
• Generalized depression
• Continuous social comparison
• Eliminates bad (forbidden) foods

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Warning Signs, cont.

• Eating when not hungry
• C/o overeating
• Guilt/remorse/ depression after eating
• Secretive eating /sneaking foods
• Food used to calm self

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Warning Signs, cont.

• Menstrual irregularities
• Hair loss
• Perfectionism
• Avoidance (pictures, people, places, situations,
  physical contact)

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Warning Signs, cont.

• Dental decay
• Constipation/diarrhea
• Muscle weakness
• Chemical imbalances (dehydration, edema, cardiac
  irregularities, etc)
• esophageal stomach irritation

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Assessments

• Determine
• Target weight
• Nutritional status
• Dietary patterns
• Family processes
• Medical Stability
• Degree of cognitive impairment

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Nutrition Risk Assessment Tools
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General Interventions

• Be aware of own beliefs, attitudes behaviors
  how they affect your life the lives of others
• Role model regular, balanced, nutritious meals
• Dont avoid clothes, activities, situations that
  display your body

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General Interventions, cont.

• Emphasize moderation in all aspects of living
  (exercise, eating, sleeping, etc.)
• Eat and encourage eating for the right reasons,
  I.e. energy restoration, health, strength
• Resist media distortions (power, excitement,
  sexuality)

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Specific Interventions

• Nutritional Rehabilitation
• Psychotherapy
• Cognitive-behavioral
• Interpersonal
• Psychoeducational
• Education
• Group Therapy

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Outcomes Measurement

• Self-management of eating pattern
• Maintenance of medically safe wt.
• Resumption of menstruation
• Acceptance of body wt/shape
• Non-destructive emotional expression
• General health measures

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Prevention

• Primary
• Eliminate or reduce personal, social, cultural
  factors
• Develop individual social strengths

• Secondary
• ID warning signs
• recognize
• reach out
• collaborate
• Develop systems within schools, workplace,
  communities to TX support

• Tertiary
• prevent progression to chronic debilitation
• Arrange for community support for continuing TX