SIGNIFICANCE OF THE ISSUE Anorexia nervosa is an eating disorder that involves aggressive control of food intake in order to have a low body weight. Personal control of food consumption generally involves a combination of strict dieting, vomiting and extreme conditions of physical exercising. This eating disorder is caused by the psychological condition of anxiety with regards to ones weight and body shape, which in turn, is derived from an extreme concern over gaining weight or from desperately wanting to be thin.
Anorexia nervosa is also considered a psychological illness because the patients generally perceive themselves differently, and often at an exact opposite as to what other people see. Individuals with anorexia nervosa consider their loss of weight as a good indicator for a gain in self-confidence and self-respect (Sullivan, 1995). Their total control over weight gain provides them a sense of power over their lives. Anorexia nervosa is a life-threatening medical condition because it may cause grave physical problems that are related to self-starvation (Hsu, 1996).
Prolonged malnourishment may lead of severe loss of muscle and bones tissues, resulting in a massive decline in bodily strength. This eating disorder is often observed among females, both young and adult. Aside from loss of bone and muscle mass, females with anorexia nervosa usually miss their monthly menstruation, also as a result of the self-inflicted undernourishment. This eating disorder not only affects the individual himself, but also affects his relationship with his family and friends because patients often find it easier to withdraw from social interactions.
The degree of severity of this psychological-physical illness if generally left unnoticed, resulting in a significant number of individuals with anorexia nervosa left undiagnosed (Zerbe, 1995). REVIEW OF LITERATURE Normal weight has been defined by the World Health Organization (WHO) as having a body mass index (BMI) of 18. 5 to 24. 9 kg/m2 (Deurenberg and Yap, 1999; Weisell, 2002). BMI is the ratio of an individuals weight in kilograms (kg) to his heights in meters squared (m2).
An individual with a BMI of 25 to 29 kg/m2 is classified as overweight, those with BMI greater than or equal to 30 kg/m2 are categorized as moderately obese, and people with BMI of 40 kg/m2 and above are identified as morbidly obese. Obesity was earlier considered as an imbalance between energy intake and energy expenditure. Today, obesity is regarded as a disease that is strongly influenced by genetic, physiologic and behavioral factors (Jequier and Tappy, 1999). The global estimate of overweight people is currently 1. 2 billion, of which at least 300 million are classified as obese.
Obesity has been identified as a preventable health risk, but unfortunately, the mortality rate of this disease is still high, contributing to approximately 300,000 deaths each year in the United States alone. Since the cases of overweight and obesity are continually increasing without any preference to economic status of a country, health governing bodies have put in a significant effort to promote awareness of this disease and intervention programs that would teach the public of the risks of being overweight and/or obese.
A major factor that influences such excessive weight gain is the poor lifestyle choices individuals make, in terms of their eating, exercising and physical activities. Fast food consumption and passive entertainment are two major lifestyle factors have been suggested to influence the significant increase in rates of obesity (Jeffery and French, 1997). There has been a general and significant increase in the amount of money spent towards food bought outside the home, and that the choices of the general public as food during work or travel are those that are easily accessible, quick to prepare and of very reasonable prices.
Hence, fast food restaurants have been the popular choice of the public, because these fast food restaurants are strategically located at almost every specific area in every city. Fast food restaurants offer items that are cheap and quick to serve, including French fries, hotdogs, burgers and soda. In addition, these fast food places have added the feature of drive-thru windows, where the consumer does not have to get out of his car to buy food, but only needs to bring the car over to the nearest functional window of the fast food restaurant.
The significant increase in television entertainment through the use of cable and DVD technology has also positioned the consumer in a very risky situation because he is exposed to different types of advertisements which present specific fast food restaurants as well as particular food items to be attractive to the palate. The most vulnerable group among the television viewers are the children, who are known to spend the most time in front of the television because the television is now considered the babysitter in modern homes.
The public should be aware that television programs can psychologically influence the public in terms of food choice, lifestyles, and attitudes and this will only be realized once problems of massive proportions are observed in the general public after a significant amount of time has passed. Studies have shown that children choose to eat what they see on television that seem to be delicious and very attractive, such as grilled burger sandwiches and oily pan pizzas served quick and hot. It is sad to know that there are not much advertisements on television that promote healthy and nutritious foods.
Anorexia nervosa is recognized in two forms- the restricting type and the binge-eating/purging types (APA, 1994). The restricting type of anorexia nervosa involves the absolute inhibition of food consumption and does not accompany any purging or binge-eating actions. The binge-eating type of anorexia nervosa is commonly characterized by cycles of binge-eating and purging. The classic symptom of anorexia nervosa is subjecting ones self to a starvation condition, with the main goal of preventing or avoiding gaining weight or sensing that any fat is deposited in the body.
The psychological angle with anorexia nervosa is that the individual perceives himself as overweight yet actually, their weight is already below normal. The extreme condition of anorexia nervosa usually involves death due to severe malnutrition. Anorexia nervosa involves self-limitation of food intake, resulting in an induced starvation, which directly denies the body of nutrients that are essential to the normal physiology of the body. This self-starvation causes a slowing down of most of the bodily processes, resulting in a conservation of energy.
Such decrease in physiological processes is closely associated with slower heart rate, lower blood pressure, osteoporosis, muscle loss, extreme dehydration and hair loss. The muscle loss is strongly correlated with patient weakness and fatigue. ISSUE RESOLUTIONS, PAST AND PRESENT The public should realize that the television is a very powerful influence on children and that they should be aware that a complete meal is always the best food that they can offer to children. In addition, it is still best that children spend more time playing outdoors instead of spending time glued to the television.
Should these factors be evaluated and modified in terms of usage time, a healthier generation of kids can be observed in a few years time and there will be a significant decrease in concern for public health in terms of body weight. In the paper by Powell et al. (2007) entitled Associations between access to food stores and adolescent body mass index, the influence of food stores to body weight is discussed with a surprising result. Food consumption and access to food stores are two major lifestyle factors have been suggested to influence the significant increase in rates of obesity.
Classically, there has been a general and significant increase in the amount of money spent towards food bought outside the home, and that the choices of the general public as food are those that are easily accessible, quick to prepare and of very reasonable prices. Hence, food stores have been the popular choice of the public, because these are strategically located at almost every specific area in every city. Food stores offer items that are cheap and quick to serve. The study conducted by Powell et al. (2007) involved survey data from high school students in relation to different kinds of food stores and restaurant establishments.
The number of food stores, as correlated with the prices of the food items, was analyzed in correspondence to the zip codes of the students participating in the study. BMI was estimated using the height and weight of the participants and categorized according to the growth chart of the Centers for Disease Control and Prevention (CDC). The survey showed an interesting result that access to chain supermarkets was negatively correlated to body mass index among adolescents. In contrast, the presence of food stores or convenience stores was positively correlated to higher body mass index and overweight conditions.
In addition, the correlation between access to food stores and body mass index varied among ethnic groups. The study revealed that there was a stronger correlation between access to supermarkets and increase in weight among African-American adolescents, in comparison to white or Hispanic adolescents. The same correlation was also observed among adolescents that come from families in which the mother was working on a full-time setting. IMPLICATIONS FOR NURSING The family physician and any other healthcare professionals play a key role in helping the individual with anorexia nervosa to recognize that he is suffering from this eating disorder.
Once the individual recognizes and accepts this psychological condition, treatment and care should be given to the patient. Anorexia nervosa generally affects not only the individual who controls his eating behavior, but also those individuals that are directly interacting with the affected individual. Healthcare practitioners have actively suggested that the concerned family member should seek help and support from related healthcare facilities or support groups. These groups may provide information that will help the family in understanding what is causing this eating disorder (LeGrange et al.
, 2005). These groups may also give methods on how to cope with such psychological illness. The most important action that must be initiated is for the family members to help the affected individual to accept the fact that he has an eating disorder. These members of the family should also know that they play a major role in facilitating the recovery of the patient (Lock et al. , 2005). There are also numerous specialist clinics that provide treatment programs for individuals with eating disorders.
A supportive and compassionate group of individuals will be helpful to a patient with anorexia nervosa, because most of the cases of this eating disorder involve psychological issues such as not being understood well by family and friends (Lock et al. , 2001). There are some patients that can not accept the option of seeking consult with healthcare professionals and this may result in a significant worsening of the physical and mental well-being of the patient. There are also self-help support groups that can assist a patient in coping and solving this eating disorder.
It is important that the patient be given sufficient information about anorexia nervosa and its associated treatment prior to subjecting ones self to treatment. RECOMMENDATIONS FOR NURSING RESEARCH It would be helpful to conduct research on patients diagnosed with anorexia nervosa, wherein they are subjected to psychological assessment with a healthcare professional, as well as with a group of patients also having the same illness. In some cases, the meetings may involve the patient and the members of his immediate family.
A professional nurse may be in a unique position in this type of disorder because they are provided with the best interaction with the patient and they are also trusted healthcare professionals. References American Psychiatric Association (1994): Diagnostic and Statistical Manual for Mental Disorders, 4th ed. APA: Washington D. C. Deurenberg, P and Yap M (1999): The assessment of obesity: methods for measuring body fat and global prevalence of obesity. Baillieres Best Pract. Res. Clin. Endocrinol. Metab. 13(1):1-11.
Eisler I, Dare C, Russell GFM, Szmukler GI, LeGrange D and Dodge E (1997): Family and individual therapy in anorexia nervosa: A five-year follow-up. Archiv. Gen. Psych. 54:1025-1030. Eisler I, Dare C, Hodes M, Russell G, Dodge E and Le Grange D (2000): Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. J. Child Psychol. Psych. 41:727-736. Hsu GLK (1996): Epidemiology of the Eating Disorders. Psych. Clin. North Amer. 19(4), 681-697. Jequier, E and Tappy L (1999): Regulation of body weight in humans. Physiol. Rev. 99(2):451-80.
LeGrange D and Lock J (2005): The dearth of psychological treatment studies for anorexia nervosa. Int. J. Eating Disord. 37:79-91. LeGrange D, Binford R and Loeb KL (2005): Manualized family-based treatment for anorexia nervosa: A case series. J. Am. Acad. Child Adolesc. Psych. 44:41-46. LeGrange D, Eisler I, Dare C and Russell G (1992): Evaluation of family treatments in adolescent anorexia nervosa: a pilot study. Int. J. Eating Disord. 12:347-357. Lock J, Agras WS, Bryson S and Kraemer H (2005): A comparison of short- and long-term family therapy for adolescent anorexia nervosa. J. Am. Acad. Child Adolesc. Psych. 44:632-639.