Calorie Restriction with Optimum Nutrition
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CRON and Eating Disorders

Day-to-day adherence to a calorie-restricted diet (CRON) requires deliberate concentration and chronic dedication. CR dieting may also require a particular, genetically-predisposed behavioral mind-set. If you have tried CRON for a week or two and find it too cumbersome, you are better off abandoning the regimen. Opt instead for a healthy, normal-calorie diet.

The following discussion is on eating disorders. Some CRONIes never experience them, others suffer them on an acute or more-regular basis. Be aware of the warning signs and know when to seek help -- or even abandon CRON dieting temporarily or altogether. Remember: CRON is not just dieting, but a lifestyle. You may ultimately find it is not for you.

Eating disorder are disorders characterized by abnormal eating behaviors and beliefs about eating, weight, and shape. The three major diagnoses are:

In addition, there are many cases of abnormal eating that have only some of the features required for an eating disorder diagnosis; these cases are classified as eating disorders not otherwise specified. Obesity is classified as a general medical condition and not as an eating disorder (a psychiatric condition) because it is not consistently associated with psychological or behavioral problems.

There are also three childhood eating disorders:

  1. Pica is a persistent pattern of eating nonnutritive substances in infants or young children.
  2. Rumination disorder involves repeated regurgitation and rechewing of food. This behavior is not the result of a gastrointestinal or medical condition; the partially digested food comes back into the mouth without any observable nausea, disgust, or attempt to vomit.
  3. Feeding disorder of infancy or early childhood is the persistent failure to eat adequately, as reflected in insufficient weight gain for age.

Pica and rumination disorder are thought to be uncommon and frequently associated with developmental delays and mental retardation. Perhaps half of the pediatric hospitalizations for inadequate weight gain (which constitute 1-5% of all pediatric hospitalizations) may be due to feeding disorder of infancy or early childhood.

Anorexia nervosa

Anorexia nervosa is characterized by a refusal to maintain a minimal normal body weight (defined as 15% below average weight for height), an intense fear of becoming fat, and, if female, amenorrhea for at least 3 months. The majority of cases of anorexia nervosa are classified as restricting type; these individuals achieve abnormally low weight by severely dieting, fasting, and often by exercising compulsively. In severe cases, patients refuse to eat and can die of starvation or severe medical complications. Another subtype of anorexia nervosa is binge-eating/purging type. Despite being emaciated or dangerously thin, persons with anorexia nervosa perceive themselves as overweight (distorted body image), deny the seriousness of their condition, and have an intense fear of becoming fat.

Anorexia nervosa occurs in roughly 1% of adolescent and young adult females. Most cases (90%) are female, and the majority are Caucasian and come from middle-class or higher socioeconomic groups. Anorexia nervosa is more prevalent in industrialized countries that share western views regarding thinness as an ideal. It develops most frequently during adolescence.

Persons with anorexia nervosa frequently manifest symptoms of depression and anxiety. The restricting type of anorexia nervosa is associated with obsessionality, rigidity, perfectionism, and overcontrol, whereas the binge/purge subtype is associated with greater mood instability and impulsivity across a wide ranges of areas, including substance abuse.

Although some cases of anorexia nervosa show no evidences medical problems, prolonged starvation affects most organ systems, and a wide array of medical problems tend to be present. Long-term mortality from anorexia nervosa is estimated at 5-10% with most deaths resulting from starvation, cardiac events or suicide.

The causes of anorexia nervosa are not yet understood but are likely to involve a complex combination of genetic, familial psychological, and sociocultural factors. The onset of anorexia nervosa tends to follow a period of dieting and is frequently triggered by stressful life events or transitions.

Since the starvation and weight loss can be life-threatening initial treatment efforts need to focus on weight gain and the reestablishment of regular eating patterns. Inpatient hospitalization is frequently necessary. Although significant psychological issues tend to be present, it is generally ineffective to address these until weight has been stabilized. Once weight gain is achieved, psychotherapies can become useful. Relapse rates are high.

Bulimia nervosa

Bulimia nervosa is characterized by recurrent episodes of binge eating (eating large amounts of food while experiencing a subjective sense of lack of control over the eating "drive"), the regular use of extreme weight-compensatory method (for example, self-induced vomiting), and dysfunctional belief about weight and shape that unduly influence self-evaluation or self-worth.

Bulimia nervosa occurs in roughly 2% of adolescents and adults. It is most common in females (90% of cases), Caucasians, and other middle-class or higher socioeconomic groups. The prevalence of bulimia has increased over the past few decades, and is also becoming more common in non-Caucasian groups.

Persons with bulimia nervosa have high rates of depression anxiety, and substance abuse problems. Although this condition is less dangerous than anorexia nervosa, medical complications can nevertheless occur. Dental erosion and periodontal problems are common. Electrolyte imbalance and dehydration can result in serious medical complications, including cardiac arrhythmias. In rare cases, esophageal bleeding and gastric ruptures occur.

Bulimia nervosa is likely to result from a combination of genetic, familial, psychological, and sociocultural factors. Although many persons have weight and diet concerns, the development of bulimia is thought to arise only in vulnerable individuals and usually after a stressful event. Bulimia nervosa is a self-maintaining vicious cycle.

Bulimia nervosa can often be treated successfully with out-patient therapies. Cognitive behavioral therapy and interpersonal psychotherapy have been found to be most effective for reducing binge eating and vomiting and improving associated concerns such as depression, self-esteem, and body image. These therapies also have the best results over the long term. Certain types of pharmacotherapy, notably antidepressant medications are also effective.

Binge-eating disorder

Binge-eating disorder is characterized by recurrent episodes of binge eating but, unlike bulimia nervosa, no extreme weight-control behaviors (purging, laxatives, fasting) are present. Persons with binge-eating disorder have chaotic eating patterns and frequently overeat as well as binge.

Although obesity is not required for the diagnosis, many people with binge-eating disorder are overweight. Binge-eating disorder is estimated to occur in 3% of the general population, but in roughly 30% of obese persons. Binge-eating disorder occurs most frequently in adulthood, affects men nearly as often as women, and occurs across different ethnic groups.

Obese binge eaters are characterized by higher levels of psychiatric problems (depression, anxiety, substance abuse) and psychological problems (poor self-esteem, body image dissatisfaction) than non-binge eaters and closely resemble persons with bulimia nervosa. Overweight persons with binge-eating disorder are at high risk for further weight gain and weight fluctuations and associated medical complications. The etiology of binge-eating disorder is unknown.

Cognitive-behavioral therapy is effective at reducing binge-eating and improving associated concerns such as depression, self-esteem and body image but does not seem to result in weight loss. There is some evidence that behavioral weight-control treatment can reduce binge-eating and facilitate weight loss. Antidepressant medications seem to reduce binge-eating but produce weight loss; relapse is rapid (and common) after discontinuation of the medication.


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