Page 65 Complete Your CE Test Online - Click Here EBP alert! Research shows that 50% of males with muscle dysmorphia abuse steroids in attempts to add muscle mass to their bodies. In addition to using injectable steroids, some males use what are advertised as “natural” protein powders and supplements as well. These powders and supplements are not regulated by the food and Drug Administration (FDA), may contain unhealthy and even dangerous ingredients, and may also cause adverse side effects[6] . Nurses and other healthcare professionals must be alert to steroid use and ask about such use when evaluating nutritional status. Nursing consideration: Some members of not only the general public but also of the healthcare provider community may not recognize how the problem of eating disorders among males has increased. Nurses have a serious obligation to educate clients, families, and professional colleagues about the existence of these types of disorders in both males and females. Statistics pertaining to eating disorders show the incidence, prevalence, and some of the dangers of these diseases[5,6,7] : ● ● 95% of all eating disorders begin at adolescence. ● ● The rate of new cases of eating disorders has been increasing since 1950. ● ● It is common for eating disorders to occur in conjunction with other mental health disorders: ○ ○ Alcohol and other substance abuse disorders are four time more common in persons with eating disorders than in the general population. ○ ○ Depression and other mood disorders are often found to co-exist in persons with eating disorders. ○ ○ There is a significant increase in risk for persons with eating disorders to develop obsessive-compulsive disorder. ● ● The incidence of anorexia in young women ages 15-19 has increased in each decade since 1930. ● ● By the age of six, girls in particular express worries about their own weight or body shape, and 40 to 60% of elementary school girls are worried about their weight or about becoming too fat. ● ● One in 200 American women suffers from anorexia nervosa. ● ● Two to three in 100 American women suffer from bulimia nervosa. ● ● 35% of “normal dieters” progress to pathological dieting, with 20- 25% of these people progressing to partial or full-syndrome eating disorders. ● ● One in four eating disorders now occurs in males. ● ● 38% of teen males report that they would sacrifice at least a year of their life for a perfect body. ● ● 31% of male teens report binge eating, purging or overeating. Adolescents are particularly vulnerable to the development of eating disorders. Physical appearances, as well as being popular and attractive are especially important to this age group. Eating disorders may start with the belief that dieting and losing weight will make them popular, attractive, and happy. As weight loss occurs and they receive compliments about their slimmer appearance, susceptible adolescents may be tempted to carry weight loss to extremes. Still other adolescents may turn to food as a means of compensation for feelings of inadequacy, resulting in weight gain and even obesity[2,3,4] . The statistics pertaining to treatment and mortality are very disturbing. Anorexia has the highest mortality rate of any mental illness. Research shows that 5-10% of people with anorexia nervosa die within 10 years of developing the disease, and 18 to 20% will be dead within 20 years of developing the disease[5] . Statistics regarding recovery from eating disorders indicate that only 30 to 40% of persons with anorexia nervosa ever fully recover from the disease. Additionally[5] : ● ● Only one in 10 people with an eating disorder receive treatment for the disorder. ● ● The mortality rate among people with anorexia nervosa has been estimated at 0.56% annually, or about 5.6% per decade. ● ● The death rate for anorexia nervosa is approximately 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population. ● ● Without treatment, as many as 20% of people with serious eating disorders will die. With treatment the mortality rate decreases to 2 to 3%. What causes eating disorders? There is no simple answer to this question. Researchers believe that eating disorders are the result of a complex combination of factors including genetic, biological, behavioral, psychological, and social issues[3] . Researchers are investigating the following factors that may contribute to the development of eating disorders[8] : ● ● Biological factors: Specific chemicals in the brain control hunger, appetite, and digestion. In persons with eating disorders these chemicals may be imbalanced. ● ● Genetics: Eating disorders are often found to run in families. Evidence indicates that there are major genetic contributions to eating disorders. ● ● Psychological factors: Stress, loneliness, depression, anxiety, anger, low self-esteem, and/or feelings of lack of control or inadequacy contribute to eating disorders. ● ● Social factors: Society glorifies thinness in women and muscularity in men. The media helps to perpetuate this glorification to the point that even young children are consumed with worry about their weights. Eating disorders have some commonalties. But it is important to study each disorder for those issues that are specific to development, recognition, and treatment. ANOREXIA NERVOSA Cathy is 17 years old and a junior in high school. She is a star on the girls’basketball team and hopes to earn an athletic scholarship that will pay her college expenses and allow her to continue her athletic career. Despite her active lifestyle Cathy is a few pounds overweight and admits to a love of desserts. One day after practice her coach casually remarked, “You might want to lose a few pounds, Cathy. That may help you to pick up some speed on the court.” Cathy takes this suggestion seriously. She begins a strict diet and quickly loses 10 pounds. Her running speed does improve, and her friends and family tell her she looks “fantastic.” Convinced that if she continues to lose weight her game will improve even more, Cathy continues to diet. She monitors everything she eats and makes sure to eat no more than 600 calories per day. This meager nutritional intake, compounded by the calories burned during practice and basketball games, leads to a dangerous weight loss. Cathy denies that she is hungry and becomes obsessed with what she eats. She stops menstruating and has trouble sleeping. Her family, friends, teammates, and coach all try to convince her to eat “normally.” Cathy, however, believes that she is “fat” and needs to continue to lose weight, no matter what anyone else tells her. Cathy is displaying signs and symptoms of anorexia nervosa (commonly referred to as anorexia), characterized by a loss of weight greater than 15% of minimally normal weight for age and height[2] . The essential feature of anorexia nervosa is self-induced starvation due to a distorted body image and an extreme, irrational fear of gaining weight[2] . The word “anorexia” may suggest to some people that the client’s weight loss is linked to a loss of appetite. This, however, is quite rare[9] . Anorexia is characterized by clients having[1,2,9] : ● ● A distorted body image. Despite an obviously gaunt, emaciated appearance, the clients still perceive themselves to be fat and unattractive. Even though family, friends, teachers and/or co- workers try to convince clients otherwise, they firmly believe that they must continue to lose weight. They have an unshakable belief that they are fat and see themselves as such no matter what evidence to the contrary is presented to them. ● ● An extreme, irrational fear of gaining weight. This fear makes clients go to extremes to lose weight and to avoid gaining weight. Such extremes include literally starving themselves and, possibly, exercising to the point of exhaustion.