Binge eating disorder: the next generation of research

Enablers and barriers to prevent weight-regain post bariatric surgery - A qualitative enquiry

BACKGROUND

Weight-regain is commonly experienced after bariatric surgery. This qualitative enquiry aimed to explore participants' self-reported enablers and barriers to prevent future weight-regain post-surgery.

METHODS

Eligible adults were recruited at 12-months post-bariatric-surgery at Counties Manukau, Auckland. Participants were invited to attend data collection at their 18-month group nutrition-education session, and to participate in a focus group at 21-months post-surgery. Thematic analysis was used to evaluate patient experiences.

RESULTS

Participants (n = 28) were mostly female (73.2 %), New Zealand European (41.5 %), and had gastric sleeve surgery (92.3 %). Five key themes emerged from the analysis: A Life Changing Health Journey - participants experienced a decrease in obesity-related comorbidities and a subsequent decrease in medications. Weight change and food intolerances impacted quality of life. Challenge of managing a New Healthy Lifestyle - financial stress, buying healthier foods and social events were new challenges, often centred on food. Changing Eating Behavior - all participants struggled managing eating behaviors. Mindset Changes - post-surgery most participants had a positive mindset, increased confidence, and feelings of happiness. However, many struggled with mindset around weight and food. A need for On-going Support - most felt under-supported and expressed a need for longer, specific follow-up care.

CONCLUSION

Post-surgery group education sessions provided participants with increased support from both health professionals and peers on the same journey, to overcome struggles such as binge eating or identifying new coping strategies. Findings provide important insights into the challenges patients with bariatric surgery face and key learnings to develop specific supports for future care practices.

Eating disorder behaviors and treatment seeking in self-identified military personnel and veterans: Results of the National Eating Disorders Association online screening

OBJECTIVE

To characterize disordered eating behaviors, eating disorder (ED) risk and diagnosis, and treatment seeking behaviors in active-duty military personnel/veterans compared with civilians.

METHOD

Self-selecting participants (n = 113,388; 1744 were military personnel/veterans) 18+ years old completed the National Eating Disorders Association's online screen. Engagement in and frequencies of disordered eating behaviors were compared across military/veteran and civilian groups and were stratified by gender. ED risk and diagnosis and treatment seeking behaviors were also compared.

RESULTS

Individuals in the military/veteran group were more likely to engage in diuretic/laxative use and excessive exercise compared with civilians. Compared with civilians, the military/veteran group had a lower percentage who screened "at risk for an ED" and a higher percentage who screened for "no risk". Females in the military/veteran group were more likely to engage in diuretic/laxative use, excessive exercise, and fasting compared with female civilians; males in the military/veteran group were more likely to engage in excessive exercise and less likely to engage in vomiting than male civilians. Of the self-identified military personnel/veterans who screened positive for any ED, 86% had never received treatment, which did not differ significantly from civilians. Notably, 56.7% of those (54.1% of military/veteran group; 56.7% of civilians) who completed an optional item on intention to seek treatment (n = 5312) indicated they would not seek treatment.

CONCLUSIONS

Disordered eating and ED profiles, but not treatment seeking, may differ between military personnel/veterans and civilians who complete an online ED screen. Future work should emphasize treatment options and connecting respondents directly to tailored resources.

Differential Expression of DeltaFosB in Reward Processing Regions Between Binge Eating Prone and Resistant Female Rats

Binge eating (BE) is characterized by the consumption of large amounts of palatable food in a discrete period and compulsivity. Even though BE is a common symptom in bulimia nervosa (BN), binge eating disorder (BED), and some cases of other specified feeding or eating disorders, little is known about its pathophysiology. We aimed to identify brain regions and neuron subtypes implicated in the development of binge-like eating in a female rat model. We separated rats into binge eating prone (BEP) and binge eating resistant (BER) phenotypes based on the amount of sucrose they consumed following foot-shock stress. We quantified deltaFosB (ΔFosB) expression, a stably expressed Fos family member, in different brain regions involved in reward, taste, or stress processing, to assess their involvement in the development of the phenotype. The number of ΔFosB-expressing neurons was: (1) higher in BEP than BER rats in reward processing areas [medial prefrontal cortex (mPFC), nucleus accumbens (Acb), and ventral tegmental area (VTA)]; (2) similar in taste processing areas [insular cortex, IC and parabrachial nucleus (PBN)]; and (3) higher in the paraventricular nucleus of BEP than BER rats, but not different in the locus coeruleus (LC), which are stress processing structures. To study subtypes of ΔFosB-expressing neurons in the reward system, we performed in situ hybridization for glutamate decarboxylase 65 and tyrosine hydroxylase (TH) mRNA after ΔFosB immunohistochemistry. In the mPFC and Acb, the proportions of γ-aminobutyric acidergic (GABAergic) and non-GABAergic ΔFosB-expressing neurons were similar in BER and BEP rats. In the VTA, while the proportion of dopaminergic ΔFosB-expressing neurons was similar in both phenotypes, the proportion of GABAergic ΔFosB-expressing neurons was higher in BER than BEP rats. Our results suggest that reward processing brain regions, particularly the VTA, are important for the development of binge-like eating.

Driving better intervention outcomes in eating disorders: A systematic synthesis of research priority setting and the involvement of consumer input

OBJECTIVE

Setting specific research priorities and involving consumers in this process is one pathway to driving better intervention outcomes in eating disorders (EDs). We reviewed research priority setting in the field and the involvement of consumers in this priority setting.

METHOD

A systematic review following the PRSIMA statement was conducted and eight studies were identified for inclusion; four included substantial input from consumers, and four were researcher led. Similarities and differences across the types of studies were examined.

RESULTS

Research priorities informed by consumers were primarily concerned with producing better interventions and outcomes. A large degree of overlap with researcher-led priorities was present. The former studies had a greater focus on early intervention, bridging the research-practice gap, and recovery, while the latter were more likely to address diagnosis, genetic factors, brain circuitry, and pharmacotherapy. Priorities endorsed across more than one consumer-informed study included: the role of self-harm, working with health care professionals to increase early detection, supporting transition between services, and six issues about improved treatments.

CONCLUSIONS

The ED field needs to engage in more meaningful involvement of co-design across consumers, clinicians and researchers along the entire research journey, not just research priority setting. An integrated research strategy incorporating a co-design perspective has the potential to drive better outcomes.

Binge eating and binge-eating disorder in Black women: A systematic review

OBJECTIVE

Although several effective behavioral treatments for binge-eating disorder (BED) exist, there are racial disparities in treatment access, with African-Americans and/or Black individuals having some of the lowest rates of access to care. Little is known about the experience and treatment of binge eating (BE) and BED among Black women.

METHOD

This systematic review, conducted according to PRISMA guidelines, synthesizes information related to BE and BED in Black women.

RESULTS

A total of N = 38 studies met our eligibility criteria. We did not identify any systematic risk of bias across studies. The majority of included studies used cross-sectional survey methodology, and relied on interview (EDE) and self-report measures (particularly the Binge Eating Scale, BES) for the assessment of BE. Outcomes were inconsistently measured across trials, and there are limited data on the results of evidence-based treatments for BE/BED in Black women.

DISCUSSION

Although Black women have similar or higher rates of BE than White women, most research on BE and BED has focused on White women, with Black individuals underrepresented in clinical trials. Future research should examine evidence-based treatments to prevent and treat BED in this population.

OBJETIVO

Aunque existen varios tratamientos conductuales que son efectivos para el Trastorno de Atracones (BED, por sus siglas en inglés), existen disparidades raciales en el acceso a tratamiento, con individuos Afroamericanos y/o personas de color teniendo algunas de las tasas más bajas de acceso al cuidado de la salud. Se sabe muy poco acerca de la experiencia y tratamiento del comer en atracones (BE, por sus siglas en inglés) y BED entre mujeres afroamericanas y/o de color. MÉTODO: Esta revisión sistemática, realizada bajo lineamientos de las guías PRISMA, sintetiza información relacionada con BE y BED en mujeres afroamericanas y/o de color.

RESULTADOS

Un total de N = 38 estudios cumplieron con nuestros criterios de elegibilidad. No identificamos ningún riesgo sistemático de sesgo entre los estudios. La mayoría de los estudios incluidos utilizaron una metodología de encuesta transversal y se basaron en la entrevista (EDE) y las medidas de autoinforme (en particular, la Binge Eating Scale, BES) para la evaluación de BE. Los resultados se midieron de manera inconsistente entre los ensayos, y hay datos limitados sobre los resultados de los tratamientos basados en la evidencia para BE/BED en mujeres afroamericanas y/o de color. DISCUSIÓN: Aunque las mujeres afroamericanas y/o de color tienen tasas similares o más altas de BE que las mujeres blancas, la mayoría de las investigaciones sobre BE y BED se han centrado en las mujeres blancas, con individuos afroamericanos y/o de color subrepresentados en ensayos clínicos. La investigación futura debería examinar los tratamientos basados en la evidencia para prevenir y tratar el BED en esta población.

Identifying research priorities in eating disorders: A Delphi study building consensus across clinicians, researchers, consumers, and carers in Australia

OBJECTIVE

Eating disorders are underrepresented among successful applications for medical research funding. Developing agreement on the top research priorities may assist in fostering collaborations, innovation, and meaningful consumer and carer involvement. This study aimed to develop consensus among Australian clinicians, researchers, consumers, carers, and interested members of affiliated industries, on the priorities for eating disorders research.

METHOD

The Delphi expert consensus method was used. Participants were 291 members of the Australia New Zealand Academy for Eating Disorders (ANZAED) or the National Eating Disorders Collaboration (NEDC). Three panels were formed based on participant expertise: "ED Specialists," Consumers/Carers, and Affiliates. A total of 32 potential research areas (29 in Survey 1, 3 in Survey 2) were rated on a 5-point scale of importance, with 80% agreement across all three panels required for endorsement as a priority. Participants also ranked 7 broad research domains in order of priority.

RESULTS

Research areas describing early intervention and evidence-based treatments were the most highly rated, with more than 90% endorsement from each of the three panels. The research domains of accessible evidence-based treatments, early intervention and detection, and origins of eating disorders, were the most highly ranked. The ED specialists and Consumers/Carers panels had very similar patterns of responding, while the Affiliates panel showed small differences.

DISCUSSION

Using the Delphi expert consensus method resulted in a collaborative consensus driven eating disorders research agenda for the Australian context and forms a model upon which other countries may also develop their funding priorities.

Emotional eating and cognitive conflicts as predictors of binge eating disorder in patients with obesity

Background/Objectives: Binge Eating Disorder (BED) is often associated with obesity. In order to identify the variables that allow to better detect the presence of BED, people with overnutrition were compared with and without BED in the presence of cognitive conflicts, eating symptoms and anxious-depressive symptoms. The inclusion of cognitive conflicts had been relevant in bulimia studies but had not been investigated with respect to BED. Method: Two groups with obesity were evaluated, one without BED (OB, n = 54) and the other with BED (OB-BED, n = 48), using a social-demographic questionnaire as well as a semi-structured interview to assess BED, questionnaires (DASS-21, EDE-Q, EEQ) and the Repertory Grid Technique. Results: Overall, the OB-BED group presented more conflicts and more symptoms. The model that best differentiated between the groups included emotional eating and level of cognitive conflicts, correctly classifying 91.4% of the sample. Conclusion: These results highlight the role played by cognitive conflicts and emotional eating as differentiating elements between OB and OB-BED, with a high level of predictive accuracy.

Eating disorders

Twenty years have passed from the International Classification of Diseases, Tenth Revision (ICD-10) to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and, in the meanwhile, a lot of research data about eating disorders has been published. This article reviews the main modifications to the classification of eating disorders reported in the "Feeding and Eating Disorders" chapter of the DSM-5, and compares them with the ICD-10 diagnostic guidelines. Particularly, we will show that DSM-5 criteria widened the diagnoses of anorexia and bulimia nervosa to less severe forms (so decreasing the frequency of Eating Disorders, Not Otherwise Specified (EDNOS) diagnoses), introduced the new category of Binge Eating Disorder, and incorporated several feeding disorders that were first diagnosed in infancy, childhood, or adolescence. On the whole, the DSM-5 revision should allow the clinician to make more reliable and timely diagnoses for eating disorders.

[Validation of the French version of the Binge Eating Scale: Examination of its factor structure, internal consistency and construct validity in a non-clinical and a clinical population]

OBJECTIVE

The Binge Eating Scale is a widely used scale to assess binge eating disorder in obese patients. Until now, this scale has not been validated on a French population, and no psychometrically sound tool assesses binge eating disorder in the French. This study aimed to test the psychometric properties of a French version of the Binge Eating Scale by establishing its factor structure, internal consistency, and construct validity in both a non-clinical population and a clinical population (obese patients who are candidates for bariatric surgery).

METHODS

A total of 553 non-clinical subjects and 63 morbidly obese patients who were candidates for bariatric surgery were assessed with the BES and the Bulimic Investigatory Test, Edinburgh or BITE (which assesses both binge eating behaviours and use of inappropriate compensatory behaviours). We tested the factor structure of the instrument, its internal consistency, its construct validity with measures of binge eating, and its construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In 47 out of the 63 obese patients, we assessed binge eating disorder (SCID).

RESULTS

In the non-clinical population, the BES had a one-factor structure (which accounted for 61% of the variance), excellent internal consistency (α=0.93), and high construct validity with measures of binge eating. In this population, construct validity with measures of inappropriate compensatory behaviours was confirmed in overweight and obese subjects (P=0.42), but not in underweight and optimal weight subjects (P<0.001). In obese patients candidates for bariatric surgery, we demonstrated that the BES had a one-factor structure (which accounted for 46% of the variance), had high internal consistency (α=0.88) and high construct validity with measures of binge eating and good construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In the subpopulation of 47 obese patients, sensitivity, specificity, positive predictive value and negative predictive value were respectively 75%, 88.4%, 37.5% and 97.4% (BES threshold=18).

DISCUSSION

In this study, we validated a psychometrically sound French version of the Binge Eating Scale, both in a non-clinical and a clinical sample. The psychometric properties of the French version of the BES are comparable to its original version with a one-factor structure. The BES is a useful tool to assess binge eating disorder in obese patients (e.g., bariatric surgery candidates), but might not differentiate between binge eating disorder and bulimia nervosa in underweight and optimal weight subjects.

Binge Eating among Women Veterans in Primary Care: Comorbidities and Treatment Priorities

BACKGROUND

Little is known about the clinical profile and treatment priorities of women with binge eating disorder (BED), a diagnosis new to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. We identified comorbidities and patients' treatment priorities, because these may inform implementation of clinical services.

METHODS

Data were collected from women veteran primary care patients. Analyses compared those who screened positive for BED (BED+), and those without any binge eating symptoms (BED-).

RESULTS

Frequencies of comorbid medical and psychological disorders were high in the BED+ group. The BED+ group's self-identified most common treatment priorities were mood concerns (72.2%), weight loss (66.7%), and body image/food issues (50%). Among those with obesity, a greater proportion of the BED+ group indicated body image/food issues was their top treatment priority (12.9% vs. 2.8%; p < .01), suggesting that these patients may be more apt to seek treatment beyond weight management for their problematic eating patterns.

CONCLUSIONS

Women primary care patients with BED demonstrate high medical and psychological complexity; their subjective treatment priorities often match objective needs. These findings may inform the development of targeted BED screening practices for women with obesity in primary care settings, and the eventual adoption of patient-centered BED treatment resources.

Medical comorbidity and medical complications associated with binge-eating disorder

OBJECTIVE

The purpose of this review is to provide an overview of possible medical complications of binge-eating disorder (BED).

METHOD

Literature on BED, both in obese and nonobese patients, was reviewed.

RESULTS

A growing literature suggests that BED independently may increase the likelihood of developing components of the metabolic syndrome, and that LOC eating in children may contribute to weight gain and metabolic disturbances. Limited evidence suggests that other organ systems may be affected by BED as well.

DISCUSSION

Additional prospective studies are needed. Although the results of the available studies are not definitive and provide somewhat mixed results, there does appear to be a clear suggestion of an increased risk for the development of components of the metabolic syndrome in adults and children.

High-frequency binge eating predicts weight gain among veterans receiving behavioral weight loss treatments

OBJECTIVE

To assess for the frequency of binge eating behavior and its association with weight loss in an overweight/obese sample of veterans.

METHODS

This study is a secondary analysis of data from the ASPIRE study, a randomized effectiveness trial of weight loss among veterans. Of the 481 enrolled veterans with overweight/obesity, binge eating frequency was obtained by survey for 392 (82%).

RESULTS

The majority (77.6%) reported binge eating, and 6.1% reported high-frequency binge eating. Those reporting any binge eating lost 1.4% of body weight, decreased waist circumference by 2.0 cm, and had significantly worse outcomes than those reporting never binge eating who lost about double the weight (2.7%) and reduced waist circumference by twice as much (4.2 cm). The high-frequency binge group gained 1.4% of body weight and increased waist circumference by 0.3 cm.

CONCLUSIONS

High rates of binge eating were observed in an overweight/obese sample of veterans enrolled in weight loss treatment. The presence of binge eating predicted poorer weight loss outcomes. Furthermore, high-frequency binge eating was associated with weight gain. These findings have operational and policy implications for developing effective strategies to address binge eating in the context of behavioral weight loss programs for veterans.

Disordered eating in obese individuals

PURPOSE OF REVIEW

This article provides an overview of current thinking about the association between disordered eating and obesity, emphasizing binge eating, binge eating disorder and food addiction as useful conceptual models.

RECENT FINDINGS

Binge eating, recurrent and persistent episodes of overeating coupled with a lack of control over eating, and binge eating disorder, the Diagnostic and Statistical Manual-5 mental disorder, have been a major focus of work to clarify the relationship between disordered eating and obesity. A second focus has been the addiction model of aberrant eating, which posits that recurrent overeating of palatable food is similar to addictive behavior and characterized by dysregulation of the dopaminergic reward system. We describe efforts to integrate these models by focusing on binge eating phenotypes as the subgroup of obese individuals characterized by disordered eating. Examples of empirical work based on these models are provided, as well as selected studies that reflect the burgeoning literature focusing on addictive and feeding behaviors across multiple domains and levels of analysis.

SUMMARY

Research evidence to explain similarities and differences across levels of BMI and varying aspects of feeding behavior may promote the identification of novel interventions that address weight and eating problems.

A narrative review of binge eating and addictive behaviors: shared associations with seasonality and personality factors

Binge-eating disorder and seasonal affective disorder were first described as clinically relevant conditions in very close temporal proximity a few decades ago. Both disorders have a higher prevalence rate in woman than in men, are characterized by a high proneness-to-stress and manifest heightened responsiveness to high-calorie, hyper-palatable foods. In recent years, a compelling body of evidence suggests that foods high in sugar and fat have the potential to alter brain reward circuitry in a manner similar to that seen when addictive drugs like alcohol and heroin are consumed in excess. These findings have led to suggestions that some cases of compulsive overeating may be understood as an addiction to sweet, fatty, and salty foods. In this paper, it is proposed that high seasonality is a risk factor for binge eating, especially in those characterized by anxious and impulsive personality traits - associations that could only occur in an environment with a superfluity of, and easy access to, rich and tasty foods. Given the well-established links between binge eating and addiction disorders [Ref. (1-3) for reviews], it is also suggested that seasonality, together with the same high-risk psychological profile, exacerbates the likelihood of engaging in a broad range of addictive behaviors. Data from a community sample (n = 412) of adults tested these models using linear regression procedures. Results confirmed that symptoms of binge eating and other addictive behaviors were significantly inter-correlated, and that seasonality, gender, and addictive personality traits were strong statistical predictors of the variance in binge-eating scores. Seasonality and addictive personality traits also accounted for a significant proportion of the variance in the measure of addictive behaviors. Conclusions are discussed in the context of brain reward mechanisms, motivational alternations in response to chronic over-consumption, and their relevance for the treatment of excessive appetitive behaviors.

Longitudinal predictors of dieting and disordered eating among young adults in the U.S

OBJECTIVE

To assess longitudinal associations between cognitive and behavioral characteristics in adolescence and dieting and eating pathology in young adulthood.

METHOD

Data from the National Longitudinal Study of Adolescent Health and multivariate logistic regressions were used to examine the unique and cumulative effects of adolescent behavior and cognition on four weight-related health indicators in young adulthood: dieting, extreme weight loss behaviors (EWLB), binge eating, and eating disorder (ED) diagnosis (N = 14,322).

RESULTS

Early dieting, depression, and body image distortion (BID) prospectively predicted dieting or EWLB at Wave 3. In addition, early depression and dieting were associated with binge eating in young adulthood, and early BID was associated with ED diagnosis. Gender differences were observed. In the prospective models, the effect of depression on the onset of EWLB was stronger for women than men; while association between early depression and ED diagnosis was significantly stronger for men than women. Findings supported a cumulative risk effect. Among women, each additional correlate was associated with greater odds of eating pathology in young adulthood; among men, each additional correlate was associated with greater odds of ever reporting ED diagnosis. Overall prevalence of dieting and eating pathology among young adults was higher among women than men and increased over time for both sexes.

DISCUSSION

Early weight control behavior and cognition affect long term eating patterns and are salient for both young adult men and women. Transition to young adulthood is a critical period for assessing and preventing weight and eating-related health problems.

The overlap between binge eating disorder and substance use disorders: Diagnosis and neurobiology

BACKGROUND AND AIMS

Binge eating disorder (BED) is a relatively common condition, especially in young adult females, and is characterized by chronic over-consumption of food resulting in embarrassment, distress, and potential health problems. It is formally included as a disorder in DSM-5 for the first time, an acknowledgement to its debilitating nature. This article explores the overlap between binge eating disorder and substance use disorders (SUD).

METHODS

The bibliographic search was a computerized screen of PubMed databases from January 1990 to the present. Binge eating disorder, substance use disorder, binging, obesity, food addiction, comorbidity, dopamine, opioid, serotonin, glutamate, and pharmacological treatment were the keywords used in searching.

RESULTS

BED shares similar phenomenology to SUD, including significant urges to engage in binging episodes, resulting in distress and impairment. Similar neurobiological pathways are found in both BED and SUD and medications based on similar neurobiology have been examined for both disorders. A subset of individuals with BED may have a "food addiction", but there is no clinical agreement on the meaning of "food addiction". Exploring the relationship between BED and obesity may also shed light on the extent to which BED can be viewed as an addiction.

CONCLUSIONS

Overall, nascent research regarding BED and SUD suggests an overlap between these disorders, but there are discrepancies between these two disorders that need further exploration.

Psychological treatments for eating disorders

PURPOSE OF REVIEW

This review summarizes recent evidence on psychological treatments for eating disorders.

RECENT FINDINGS

Eating disorders are serious psychiatric conditions requiring evidence-based intervention. Treatments have been evaluated within each eating disorder diagnosis and across diagnoses. For adults with anorexia nervosa, no one specialist treatment has been shown to be superior. Cognitive behavioral therapy and interpersonal psychotherapy remain the most established treatments for bulimia nervosa and binge eating disorder, with stepped-care approaches showing promise and new behavioral treatments under study. Enhanced cognitive behavioral therapy has improved symptoms in adults and youth. Maudsley family-based therapy is the most established treatment for youth with anorexia nervosa and may be efficacious for youth with bulimia nervosa. Interpersonal psychotherapy for the prevention of excess weight gain may be efficacious for reducing loss of control eating and weight gain in overweight youth.

SUMMARY

Significant advances in treatments have been made, including evaluation of long-term outcomes, novel approaches, and tailored extension for specific patient profiles. However, widespread access to effective eating disorder treatments remains limited. Increasing the potency and expanding the implementation of psychological treatments beyond research settings into clinical practice has strong potential to increase access to care, thereby reducing the burden of eating disorders.