1. 11-Eating disorder
Nutrition and fitness
Dr. Siham Gritly

2. Objectives
• At the end of this lecture students should be able
to identify and understand the following concepts;
• Hunger, Satiation, and Satiety
• The Female Athlete Triad
• Anorexia Nervosa,
• Bulimia,
• Compulsive Exercise
• The Binge-Purge Cycle
• Dietary strategies to combat those disorders
Dr. Siham Gritly

3. Terms to be understood
• appetite: the integrated response to the sight,
smell, thought, or taste of food that initiates or
delays eating.
• hunger: the painful sensation caused by a lack
of food that initiates food-seeking behavior
• hypothalamus: a brain center that controls
activities such as maintenance of water balance,
regulation of body temperature, and control of
appetite.
Dr. Siham Gritly

4. • satiation: the feeling of satisfaction and fullness
that occurs during a meal and halt (stop) eating.
Satiation determines how much food is consumed
during a meal.
• satiety: the feeling of fullness and satisfaction
that occurs after a meal and inhibits eating until
the next meal. Satiety determines how much time
passes between meals.
Dr. Siham Gritly

5. • binge-eating disorder: an eating disorder with
criteria similar to those of bulimia nervosa,
excluding purging or other compensatory
behaviors.
• Bulimia nervosa: an eating disorder
characterized by repeated episodes of binge eating
usually followed by self induced vomiting, misuse
of laxatives or diuretics, fasting, or excessive
exercise.
Dr. Siham Gritly

6. Hunger, Satiation, and Satiety
• hunger is the physiological response to a need
for food caused by nerve signals and chemical
messengers originating and acting in the brain,
primarily in the hypothalamus. Hormones of
hypothalamus promotes thoughts of eating
• hunger: the painful sensation caused by a
lack of food that initiates food-seeking
behavior
Dr. Siham Gritly

7. Exercise 1
• Look for the hypothalamus gland
Dr. Siham Gritly

8. • Hunger can be influenced by;
• * the presence or absence of nutrients in the
bloodstream,
• * the size and composition of the previous meal,
• * usual eating patterns,
• *climate, exercise,
• * hormones,
• * physical and mental illnesses.
Hunger determines what to eat, when to eat, and
how much to eat.
Dr. Siham Gritly

9. • Satiation or (to stop eating): the feeling of
satisfaction and fullness that occurs during a meal and
stop eating.
• Satiation determines how much food is consumed
during a meal.
• During the course of a meal, as food enters the GI tract
and hunger diminishes, satiation develops.
• As receptors in the stomach stretch and hormones such
as cholecystokinin become active, the person begins to
feel full. The response: satiation occurs and the
person stops eating
Dr. Siham Gritly

10. • Satiety; the feeling of fullness and
satisfaction that occurs after a meal and
inhibits eating until the next meal.
• Satiety determines how much time passes
between meals
• After a meal, the feeling of satiety continues to
suppress hunger and allows a person to not eat
again for a while.
Dr. Siham Gritly

11. Relation between Hunger, Satiation, and
Satiety
• Hunger
• 1-Physiological influences
• Empty stomach
• Gastric contractions
• Absence of nutrients in small intestine GI
• hormones
• Endorphins (the brain’s pleasure chemicals) are
caused by the smell, sight, or taste of foods,
enhancing the desire for them
Dr. Siham Gritly

12. • Seek food and start meal
• 2-Sensory influences
• Thought, sight, smell,
sound, taste of food
Ellie Whitney and Sharon Rady Rolfes; Under standing
Nutrition, Twelfth Edition. 2011
Dr. Siham Gritly

13. Keep eating
3-Cognitive influences
• Presence of others,
social stimulation
• Perception of hunger, Adapted from; Ellie Whitney and Sharon Rady
Rolfes; Under standing Nutrition, Twelfth Edition.
awareness of fullness 2011
• Favorite foods, foods with special meanings
• Time of day
• Abundance of available food
Dr. Siham Gritly

14. • Satiation: End meal
• 4-Postingestive influences (after food enters
the digestive tract)
• Food in stomach activates stretch receptors
• Nutrients in small intestine elicit hormones
(for example, fat elicit cholecystokinin, which slows
gastric emptying)
Dr. Siham Gritly

15. • Satiety: Several hours later
• 5-Postabsorptive influences (after nutrients
enter the blood)
• Nutrients in the blood signal the brain (via
nerves and hormones) about their availability,
use, and storage
• As nutrients decrease, satiety diminishes
• Hunger develops
Dr. Siham Gritly

16. The healthy eating cycle
Dr. Siham Gritly

17. The Female Athlete Triad
• The Female Athlete Triad; (fatal combination of
disordered eating, amenorrhea, and osteoporosis)
Women athletes with eating disorders often fit into a
condition called the female athlete triad, a
combination of:
• Low energy availability (eating disorder)
• menstrual irregularities (amenorrhea)
• Weak bones (increased risk of stress fractures and
osteoporosis)
Dr. Siham Gritly

18. • Amenorrhea (menstrual irregularities)
• is characterized by low blood estrogen,
infertility, and often bone mineral losses.
• Risk factors;-Excessive training,
• depleted body fat,
• low body weight,
• inadequate nutrition.
Dr. Siham Gritly

19. Eating disorders
• Eating disorders are most common in athletes that
participate in the following sports:
• ballet and other dance
• skating
• gymnastics
• running
• swimming
• rowing
• horse racing
• wrestle (fight)
Dr. Siham Gritly

20. • Both men and women are susceptible to eating
disorders, although a greater percent of eating
disorders are found in women.
• The three most common eating disorders found
in athletes are:
• 1-Anorexia Nervosa,
• 2-Bulimia,
• 3-Compulsive Exercise
Dr. Siham Gritly

21. Warning Signs of an Eating Disorder
• be troubled with food and weight
• concerns about being fat
• Increasing criticism of one's body
• Frequent eating alone
• Use of laxatives
• Trips to the bathroom during or following meals
• Continuous drinking of diet soda or water
• Compulsive, excessive exercise
• Complaining of always being cold
Dr. Siham Gritly

22. 1-Anorexia nervosa
• Anorexia nervosa: an eating disorder
*characterized by a refusal to maintain a
minimally normal body weight and a distortion
in perception of body
.
Adapted from Ellie Whitney
shape and weight. and Sharon Rady Rolfes;
Under standing Nutrition,
Twelfth Edition. 2011
*may lose 15 to 60 percent
of their normal body weight
by severely restricting their
food intake or exercising excessively.
Dr. Siham Gritly

23. Anorexia nervosa of Two types:
• 1- Restricting type: During the episode of
anorexia nervosa, the person does not regularly
engage in binge eating or purging behavior (i.e.,
self-induced vomiting or the misuse of laxatives,
diuretics, or enemas).
• 2- Binge eating/purging type: During the episode
of anorexia nervosa, the person regularly engages
in binge (lacking control of over eating) eating or
purging behavior (i.e., self induced vomiting or
the misuse of laxatives, diuretics).
Dr. Siham Gritly

24. Health Complications from Anorexia
• Anorexia poses life-threatening complications for
athletes, these complications including:
• malnutrition
• Abnormal Heart Rhythms
• low blood pressure
• Dehydration
• electrolyte imbalance
• amenorrhea (interruption of the menstrual cycle)
• osteoporosis (decreased bone mass)
• sleep disorder
Dr. Siham Gritly

25. Signs and Symptoms of Anorexia
• Excessive weight loss
• Always thinking about food, calories, and
body weight
• Wearing layered clothing
• Mood swings or depression
• Inappropriate use of laxatives, or diuretics in
order to lose weight
• Avoiding activities that involve food
Dr. Siham Gritly

26. Diet Strategies for Anorexia nervosa
• Appropriate diet is vital to recovery and must be
according to each individual’s needs. Experts
classified anorexia as BEM
• *first food intake may be only 1200 kcalories per day.
• *A variety of foods and foods with a higher energy
density should be eaten
• *athletes with anorexia should gradually increase his
or her energy intake as soon as eating become easy.
Dr. Siham Gritly

27. 2-Bulimia
• Bulimia is one such eating disorder
that describes a cycle of binging
and purging
• Like anorexia nervosa, the person
Adapted from . Ellie Whitney and
• with bulimia nervosa spends much Sharon Rady Rolfes; Under
standing Nutrition, Twelfth
Edition. 2011
• time thinking about body weight and food
• Bulimia can begin when the feeling of hunger
associated with reduced calorie intake leads to
reduce eating.
Dr. Siham Gritly

28. • In response to the binge, an athlete may feel
guilty and purge by vomiting or taking
laxatives, diet pills, and drugs to reduce fluids.
Dr. Siham Gritly

29. Bulimia is of Two types:
• 1-Purging type: The person
regularly engages in self-induced
vomiting or the misuse of laxatives,
diuretics.
• 2-Nonpurging type: The person uses other
compensatory behaviors, such as fasting or
excessive exercise, but does not regularly engage
in self-induced vomiting or the misuse of
laxatives, diuretics,
Dr. Siham Gritly

30. • binge is characterized by a sense of lacking
control over eating, usually progress through
several emotional stages:
• anticipation
• planning,
• Anxiety
• urgency to begin ,
• rapid and uncontrollable consumption of food,
• relief and relaxation,
• disappointment,
• finally shame or disgust.
Dr. Siham Gritly

31. The Binge-Purge Cycle has no beginning or end, Bulimia is an
addictive cycle on both physical and emotional levels
Dr. Siham Gritly

32. Signs and Symptoms of Bulimia
• Excessive weight loss
• Visiting the bathroom after meals
• Depression
• Excessive dieting, followed by binge eating
• Always criticizing one's body
Dr. Siham Gritly

33. Diet Strategies for Combating
Bulimia Nervosa
• Planning Principles
• Plan meals and snacks;
• record plans in a food diary prior to eating.
• Plan meals and snacks that require eating at
the table and using utensils.
• avoid doing finger foods.
• Refrain from “dieting” or skipping meals
Dr. Siham Gritly

34. • Nutrition Principles
• Eat a well-balanced diet and regularly timed
meals consisting of a variety of foods.
• Include raw vegetables, salad, or raw fruit at
meals to prolong eating times.
• Choose whole-grain, high-fiber breads, pasta,
rice, and cereals to increase bulk.
• Consume adequate fluid, particularly water.
Dr. Siham Gritly

35. 3-Compulsive Exercise
• compulsive exercise is a form of eating disorder
that results in excessive and addictive exercise in
an attempt to control or lose weight.
• Addictive exercisers may use extreme training as
one way to expend calories and maintain or lose
body weight in the attempt to improve
performance or achieve a desired body shape or
weight.
Dr. Siham Gritly

36. Warning Signs of a Compulsive Exercise
• Force to exercise even if you don't feel well.
• almost never exercise for fun
• Every time you exercise, you go as fast or hard as
you can.
• experience severe stress and anxiety if he or she
miss a workout.
• You can't relax because you think you're not
burning calories.
• You worry that you'll gain weight if you skip
exercising for one day.
Dr. Siham Gritly

37. Unspecified Eating Disorders,
Binge-Eating Disorder
• People with binge eating disorder exert less
self control during eating
• Such an eating disorder does not meet the
criteria for either anorexia nervosa or bulimia
nervosa
• Obesity alone is not an eating disorder
Dr. Siham Gritly

38. • There are also differences between obese binge
eaters and obese people who do not binge.
• Obese binge eaters tend to consume more
kcalories and more dessert
Dr. Siham Gritly

39. Criteria for Diagnosis of Binge-Eating
Disorder
• *Eating, in a separate period of time (e.g.,
within any two-hour period) an amount of food
that is larger than most people would eat
• *lack of control over eating during the episode
(e.g., a feeling that one cannot stop eating or
control what or how much one is eating).
Dr. Siham Gritly

40. • *Eating much more rapidly than normal and
eating until feeling uncomfortably full.
• *Eating large amounts of food when not
feeling physically hungry and usually eating
alone
• *Feeling disgusted or very guilty after
overeating.
Dr. Siham Gritly

41. References
• Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition.
2011, 2008 Wadsworth, Cengage Learning.
• Sareen Gropper, Jack Smith and James Groff, Advanced Nutrition and Human
Metabolism, fifth ed. WADSWORTH
• Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. 9th ed, McGraw
Hill
• Heymsfield, SB.; Baumgartner N.; Richard and Sheau-Fang P. 1999. Modern
Nutrition in Health and Disease; Shils E Maurice, Olson A. James, Shike Moshe and
Ross A. Catharine eds. 9th edition
• Guyton, C. Arthur. 1985. Textbook of Medical Physiology. 6th edition, W.B.
Company
The American College of Sports Medicine
Dr. Siham Gritly