BED-head and Obesity – Food for Thought

It’s no wonder many of us make New Year’s resolutions having to do with exercise. After all, starting around Halloween time (one can’t let the leftover candy go to waste, right?), blurring through Thanksgiving, and continuing on through Hanukkah/Christmas/Kwanza and New Year’s Day, most Americans excuse themselves from their normal eating habits to allow for at least a little holiday splurge-eating each year. For some, however, binge-eating behaviors (characterized as consuming large quantities of food in a short period of time until an individual is uncomfortably full) doesn’t stop on January 2nd.

To understand why emerging research about the diagnosis of binge eating disorder (BED) is increasingly being recognized in the psychiatric community, it is first critical to understand the behavioral phenomenon that is BED. Because of its close relationship to the better-understood (or at least more widely researched) condition of bulimia nervosa, it might be more effective for the purpose of an overview to describe how BED is distinguishable from bulimia. There appear to be notable differences that compel researchers to more thoroughly explore BED since it is closely linked to a pervasive issue in the US that doesn’t seem to be going anywhere anytime soon — obesity.

Though they examined slightly different diagnostic nuances, in recent years, research groups led by Striegel-Moore and Barry both compared women meeting criteria for purging bulimia nervosa and for BED. According to authors, data supports the view that BED is a disorder distinct from purging bulimia. Barry and colleagues found that there were some similarities between the groups (for example, body dissatisfaction) but that the significant differences noticed between women with bulimia and BED were associated with obesity status. Women with the BED were overwhelmingly found to be medically obese (having a body mass index of greater than thirty) compared with those women with bulimia. Also, bulimia sufferers scored higher on five personality disorder scales than BED patients.

Additionally distinguishing the two eating disorders involving binge-eating behaviors, a study was conducted comparing two community-based cohorts of young woman — one with bulimia and the other with BED — over a five-year period. At the five-year follow-up, the majority of women with BED had made a full recovery despite not having received any formalized treatment while results were much less promising for the group with bulimia. The study suggests an interestingly temporary component to BED.

The implications? To highlight a few: many statistically “normal” folks are affected by BED. In the US, the CDC reported in 2008 that 33.9% of adults age 20 years and over who are obese. In the general population, the prevalence of BED is between 1-3%. However, the prevalence of BED amongst obese individuals as well as in patients seeking help for weight loss is staggeringly greater (>25%). Therefore, the likelihood that those reading this article know someone meeting criteria for BED at some point in their life cycle is fairly great.

As for treatment, Charles Pull with the Department of Neuroscience at Luxembourg Hospital summarizes an in-depth examination of literature by suggesting that a combination of pharmacotherapy with psychotherapy is most efficacious in treating the disorder. He is clear, however, that more needs to be known to better determine appropriate treatment course.

If such a significant number of individuals in the US are touched by BED, that alone may be reason to better understand (and therefore further research) the disorder. What recent research is beginning to more firmly contribute regarding the previously less-understood of the eating disorders is that BED may largely be determined by genetic factors, racial and ethnic influences, and personality/character traits. If we continue to look at the factors that cause BED, along with effective ways to treat the disorder, we may well be on our way to addressing the elephant in the room in American culture –- obesity — in more substantive ways.

References

Barry DT, Grilo CM, & Masheb RM (2003). Comparison of patients with bulimia nervosa, obese patients with binge eating disorder, and nonobese patients with binge eating disorder. The Journal of nervous and mental disease, 191 (9), 589-94 PMID: 14504568

Brewerton T. Binge Eating Disorder: Recognition, Diagnosis, and Treatment. Medscape Psychiatry & Mental Health eJournal, 1997;2(3).

CDC. Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960–1962 Through 2007–2008. Division of Health and Nutrition Examination Surveys, 2010.

Pull CB. Binge Eating Disorder. Current Opinion in Psychiatry, 2004;17(1).

Striegel-Moore RH, & Franko DL (2003). Epidemiology of binge eating disorder. The International journal of eating disorders, 34 Suppl PMID: 12900983

Image via Amore / Shutterstock.