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1. I want a conceptual map (concept diagram) that represents the most relevant criteria or factors of the article that I have provided. 2. References Image transcription text Machine Translated by Google Nutr Hosp. 2012;27(2):391-401 Nutricion ISSN 0212-1611 . CODEN NUHOEQ SVR 318 Hos… Show more abbreviations ED: Eating Behavior Disorder. AN: Anorexia Nervosa. BN: Bulimia Nervosa. EAT: Eating Disorder Not Otherwise Specified. DSM-IV: Statistical Diagnostic Classification of Mental Disorders-IV. ICD-10: International Classification of Disease des-10. BMI: Body Mass Index. Introduction Eating disorders (ED) are serious psychiatric illnesses, marked by changes in behavior, attitudes, and ingestion of food usually accompanied by intense preoccupation with weight or body shape body1 . They are difficult to treat and harmful to the health and nutrition, predispose individuals to malnutrition or obesity2 and are associated with low quality of life, high rates of psychosocial comorbidity and premature mortality3 . TCAs, anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder specified (TANE)1 . AN is characterized by a distorted image of the body, the individual rejects maintain a weight above the healthy weight for your height, which motivates the adoption of inappropriate strategies to prevent weight gain, namely: vigorous physical activity and drastic restriction of eating of food. In addition, AN may also be associated with binge eating and/or behaviors purging, called AN of the bulimic type1,3. The other category, BN, is manifested by episodes of excessive food consumption followed by compensatory behaviors in order to minimize or eliminate the effects of the excess through purging, fasting or exercise. Finally, the TANE, include the disorder due to binge eating and other eating disorders that do not meet the clinical criteria for AN or BN. people with disorder by binge have episodes of food intake in the large amounts of food are consumed in a short period, along with the absence of behaviors Inadequate compensatory responses and feelings of anxiety, depression, and guilt after overeating1 . The appearance of AN and BN and, especially, the syndromes partial, it is greater in adolescence4,5, given the magnitude of the biological and psychological changes and the redefinition of the social role in this stage , associated of life6with concern for the cult of beauty7 .Mostly, adolescents and young adults are among the groups with higher prevalence of TCA8 , although the occurrence it is not negligible among male adolescents5,9, nor among school-age children4,9,10 . Scientific evidence indicates that factors of Causal risk of eating disorders are multifactorial. These disorders result from the complex interaction of factors psychological, physical and socio-cultural factors that interfere in the behavior of the individual, making it difficult to understanding of its etiology . In addition to this complexity in the etiology of eating disorders, we must consider the adolescence, a period characterized by major biological and psychosocial changes that can be compromised by the appearance of these disorders, producing potentially serious consequences for adolescent health3,6. Thus, this review aims to address current and relevant issues about the Epidemiology and risk factors of eating disorders, especially AN and BN, in adolescence. Method A non-systematic review of the literature was carried out, using a bibliographic review of the databases as a search strategy: MEDLINE, SciELO and LILACS. To select the studies, the articles on prevalence, incidence and risk factors for AN and BN in adolescence, published in English, Portuguese or Spanish, in the period between 2005 and 2011. However, we felt that studies should provide clarity on some methodological aspects, namely: 1) the study sample should include the adolescent phase, 2) the design must be specified methodological and theoretical approach used to collect and analyze data. Regarding the database search, the following strategies were used: one of the keywords the descriptors “eating disorder”, “anorexia nervosa” “bulimia nervosa”, disordered eating” and “adolescent” combined with at least one of the keywords “epidemiology”, “prevalence”, “incidence”, “risk factors”, “body dissatisfaction”, “obesity”, “dieting”, “psychological factors”, “genetics”, “sociocultural factors” and their equivalents in other languages. The references of the retrieved articles were also evaluated in order to locate the articles that they had not been found by electronic search. I know excluded book chapters, theses and dissertations, as well as studies whose main objective was other psychiatric disorders other than eating disorders. The prevalence and incidence of anorexia nervosa and bulimia nervosa Eating disorders are considered infrequent events, so it is difficult establish the prevalence/incidence in the population In general, moreover, many studies focus only on one single sample selected, present the results of data originating from health services, which increases the methodological problems of studies of Image transcription text Machine Translated by Google incidence4 . It is also noteworthy that, although the DSM-IV diagnosis of BN. Currin et al.5 in … Show more need to clarify the mechanisms by which they occur the genetic contribution in this complex process20. It is estimated that during adolescence, variations genetics are responsible for 50% to 85% of the risk factors for eating disorder symptoms24,25,26 and for concern with the weight and shape of the body27, thereby indicating These factors are much more important in determining the etiology of eating disorders, which environmental factors. However, Klump et al.26 understand that little or no environmental influence shared environment in eating disorders identified in these studies, does not exclude the participation of factors socio-cultural in this process. Evidence suggests that the type of genetic risk for binge eating may be gender-mediated and estimates of heritability of ED symptoms are shared in a small proportion by both genders28. The desire to be thin and body dissatisfaction29 , intentional weight loss and behavior abnormal eating30 were significantly more lower among boys compared to girls. Without However, high estimates of heritability of the Index of Body Mass (BMI) above normal were similar between the sexes (80% for women and 76% for men)30. Twin studies suggest that the magnitude of genetic and environmental effects on symptoms TCA varies significantly at different ages25,27 following a trajectory similar to the influence of these effects during sexual maturation24,31 . Klump et al.25 reported large environmental effects shared environment (40%) and non-shared (54%) among adolescents at 11 years of age on the risk of developing eating disorder symptoms, while Genetic effects accounted for only 6%. For other part, there was a significant increase in the contribution genetics (46%) at the age of 14 who remained constant until the age of 18. Other studies still highlight that the genetic effects on the symptoms of TCA showed a significant increase in the estimation of heritability, with no influence genetics before puberty but with significant levels at puberty and after puberty (44% at 60%)28,31. It is suggested that with the activation of ovarian hormones (mostly estradiol) at the beginning of the puberty, an increase in genetic factors is also recorded24,31,32. However, estradiol, which regulates transcription of genes between the neurotransmitters that control the appetite and mood, like serotonin, can influence the genetic predisposition of eating disorders in the puberty31,32. Some researchers suggest that motivations for weight loss are more significant in girls homozygous for the polymorphism in the serotonin transporter gene associated with a increased activity of platelet monoamine oxidase33. On the other hand, no significant interaction was detected between the restrictive diet, impulsivity and the Serotonin genes for binge eating34. The role of puberty The onset of puberty is caused by the release of hormones through the hypothalamic-pituitary gonadal axis, this phase being characterized by the development and maturation of secondary sexual characteristics in adolescents, as well as by linear growth accelerated, the dynamics of weight gain and the development of identity (the desire to learn and develop) of the adolescent32. The action of steroid hormones is remarkable in the psychology of eating behaviors and in the anxiety, as well as in the organizational alteration of psychological and behavioral traits35 and in the physical changes, such as an increase in the amount of body fat in girls24. According to Bearman et al.36, this new body structure in girls opposes what established as an ideal of beauty for women, exposing them to pressure to be thin in their interpersonal relationships, which contributes to less body image satisfaction. Another important event is early puberty37, that places the individual at risk of suffering from eating disorder symptoms, anxiety35, acting impulsively in response to a situation of suffering38, worry by weight control or loss39, which suggests that physical and psychosocial mechanisms are affected by early sexual maturity35. Importantly, there is strong evidence that the occurrence of childhood obesity in girls precedes precocious puberty40, differentially in children, high BMI is associated with late maturity41 . Rosenfield et al.37 found that girls who are overweight, compared to those with a Adequate BMI, had a prevalence of maturity sexual intercourse at an early age and onset of menarche a younger age. Also, these girls are exposed to a condition that requires a maturity also anticipated of their identity, which could lead to conflict and contribute to further dissatisfaction and poor body image, with consequent inappropriate eating behaviors and possible appearance of TCA39. overweight and obesity Obesity is a major health problem in childhood and adolescence, especially in developed countries42, however, it does not exclude those developing43. In the contemporary world in which we live in a environment that promotes the development of obesity, characterized by many factors, such as the easy access to low-cost, high-calorie foods and pleasing to the palate, pressure from the media through the imposition of a body image ideal, and on the other hand, the consumption of unhealthy foods44. of 28 hours per week) was the strongest predictor of body image dissatisfaction, specifically in the group of girls who often and they indiscriminately watched television programs. In the other research, Becker et al.6 identified that only social media exposure networks were associated with indications of TCA. In the United States, girls who tried to look like the women who were in the media62 and the boys and girls who were exposed to magazines on weight loss54, presented a higher risk of binge eating and use of extreme strategies to control weight. Findings consistent with those found in Western countries 61,66. In addition, studies show an association between a greater effect of media on body dissatisfaction and ideal muscle tone development among adolescent males7,55,67, however, results are contradictory, indicating that interpersonal relationships between them are more important in the determination of these conditions that the means of communication68. The influences of interpersonal relationships The influence of the cycle of proximal relationships, parents and friends, can reinforce the pressures exerted on the adolescent as they Socio-cultural pressures to have a body “ideal” promote a greater appreciation of appearance, being able to generate in the adolescent, especially those with obesity, greater body dissatisfaction and as a consequence significant risk of severely negative eating behaviors7,45. It is important to highlight that, while overweight and obesity tend to be more frequent among boys compared to girls16,46, dissatisfaction with body image7,47 , unhealthy eating behavior48 and eating disorders5,8,17 are more frequent among girls. Furthermore, underweight children seem to be more concerned with muscle tone, while negative body image in girls increases with increase in BMI49. Obesity in adolescence is a condition of high risk of developing eating disorders50,51, inappropriate eating attitudes and behaviors for the loss of weight48,52, dissatisfaction with body image7 , being a victim of “criticism/teasing” by the family and/or their peers49 , anxiety46 , worrying, depression53 it is and, even more the possibility that adolescents experience same time several problems related to the weight, a condition that can perpetuate the alteration54. In a longitudinal study it was found that 40% of girls and 20% of boys who were overweight, were involved in at least one altered eating behavior and, respectively, 13.4% and 4.7% had more than one related behavior54. Other research suggests that a high BMI, blood pressure sociocultural to reduce weight, and the comparison of the body were risk factors for carrying out weight loss behaviors55. However, it is important to note that the excess weight gain in pre-puberty can lead to early onset of sexual maturation40 and altogether probably contribute to the appearance of BN56 and dissatisfaction with body image. Being dissatisfied with the body predicts the use of extreme strategies to control or promote power loss57, which that can put teens at risk for weight gain54,57,58 and other harm to your health57. Socio-cultural factorsSocio-cultural pressures on weight Recent literature indicates that dissatisfaction with body image and the occurrence of eating disorders are influenced by sociocultural pressures, for example from media and interpersonal relationships, centered on an ideal of unattainable beauty for many adolescents59,60,61. However, few studies have investigated the effects of these pressures in relation to with age or stage of life. The results indicate that, above all, the family exerts influence on the boys/girls and in the youngest adolescents, due to the On the contrary, friends and the media on those who are in intermediate phases and late adolescence. The influence of the media In today’s globalized society, the ideal of beauty disseminated in different social contexts, economic and cultural through the media impose and value the figure of “thinness of the body” for adolescent men and women54,62 and on the other hand, they stigmatize obesity63. Paradoxically, the media show messages that being thin is beautiful, they encourage the use of strategies to reach the established level of beauty, and therefore On the other hand, children and adolescents are bombarded with images of attractive and desirable foods, but unhealthy. In this context, from very early on, boys and girls who are still in the process of forming the body image, receive conflicting information from means of communication that can be configured in very unfavorable conditions in the process of formation of body image, eating behavior and health of adolescents54. The study developed by Schooler and Trinh64 recorded, among girls, than the profile of television use (see television programs approve of the image of the ideal body determined by the media, increasing the person’s risk of developing problems related to eating and measurements and body figure60,66,69, but the results Two about who plays the main role in determining these problems are inconsistent. Mellor et al.69 highlight the influence of parents on children as the greatest risk factor for body dissatisfaction and weight loss adolescents of both sexes, suggesting that the family plays a much more important role among the adolescents than friends and the media. On the contrary, Shroff and Thompson45 indicated than peer influences, but not peer influences parents, were associated with the internalization of the ideal of thinness and with social comparison among girls. For On the other hand, Muris et al.55, Jackson and Chen66 and Shomaker and Furman70 indicated similar pressures on the appearance of adolescents of both sexes. Considering these contradictory results, Blodgett, Salafia and Gondoli59 highlight the need to to evaluate the importance of the role of socio-cultural pressures in determining eating disorders during the process of transition to adolescence, due to the specific characteristics of this period of life, marked due to instabilities. These researchers followed four years to girls from 10 years to 12 years of age and found that in the separate evaluation, the Parents and friends have a significant effect on body image dissatisfaction and bulimic symptoms. however, when examining the role of parents and friends Together, friends have more influence than parents59. In addition, studies have found that individuals who maintain proximal relationships of the same gender than the adolescent, are important in determining the occurrence of binge eating62 and the use of strategies both for weight loss and to increase the muscle tone 60. Also, the behavior of the parents with too much control over feeding their children, along with pressure from parents and friends to that they are thin, contribute to the development of a negative body image of oneself71 and the consequent subsequent health risk behaviors. However, in relation to muscle tone, researchers found that boys and girls did not differed in the report of pressure to be muscular in relationships with their mothers, fathers or friends, however, the boys were more pressured by their romantic partners to be muscular and had higher scores than girls on the desire and concern for the musculature70. Another important issue in determining the existence of dissatisfaction with body image and eating disorders it’s teasing from family and friends about weight. It has been identified an increased risk of binge eating, inappropriate behaviors to control weight72 and overweight54 among children and restrictive diets72, binge eating and extreme weight loss behaviors among girls who have been provoked because of their physical appearance, compared to their peers54. It is also suggested that the behavior of friends can influence the level of satisfaction with the body image and behaviors related todiet, since these aspects are shared within the group relationship73,74 . Some studies have observed that dieting by peers reference group was a risk factor for behaviors related to eating disorders in males and females54,74. The cross-cultural aspects Eating disorders are not occur uniformly in all cultures and in some cases manifest with different characteristics of the disease9,75. Although there are few studies on risk behaviors76 and eating disorders in other cultures, there are evidence that the appearance of these problems is not restricted to Western countries, with similar rates of TCA to those recorded in Caucasian samples15,77,78. Immigrants residing in Western countries of the first world and the ethnic minorities in those countries, seem to compose a risk group for the appearance of TCA, according to the acculturation process78. girls American Indian and Latino Americans and American Indian, Hispanic, and Black children had higher rates of behaviors associated with inappropriate weight loss practices that their white peers did not Hispanics48. A similar situation was observed by Jennings et al.78, who identified significantly higher scores in psychopathology in the Asian group. of eating disorders, compared to Caucasians. Another study with adolescent girls in Australia and Fiji, it was identified that both adolescents had dissatisfaction with their body image, wanted to be thinner than their current weight and valued the presence of muscle tone, however, it appears that Australian girls were less concerned with image than their fellow Fijians. The researchers justify these results in light of the “modernization” that it has occurred in the culture of Emphasis should be given to the TCA cases described in many cultures, in which the morbid fear of gain weight and/or body image disorders9 or compensatory behaviors9,15 are not present as symptom of the disease, or cases where concern is centered on facial appearance, such as in China75. These findings suggest that TCAs among adolescents in different cultures may come from a series of conditions unrelated to compensatory behaviors or weight, but to the way of the body or part thereof Psychological factorsWeight concern, internalization of the ideal of thinness Weight concern is reflected in the desire to girls and boys with an ideal body, thin and/or muscular Image transcription text Machine Translated by Google assed The fear of gaining weight was present in 71% of children and adolescents. 6?% o… Show more Image transcription text Machine Translated by Google assed The fear of gaining weight was present in 71% body gene than their healthy weight p… Show more Image transcription text Machine Translated by Google among malesBB and extreme loss behavior weight in girl554. In turn. Stice et al.87 sho… Show more

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