Medical comorbidity of binge eating disorder

Behavioral weight loss treatment for adults with binge-eating disorder: A qualitative analysis of patients' perspectives and experiences

OBJECTIVE

Understanding the perspectives of behavioral weight loss (BWL) participants could inform whether, how, and for whom BWL should be offered.

METHOD

All 126 participants in a clinical trial of BWL for adults with binge-eating disorder (BED) and overweight/obesity were contacted about a qualitative study. 45 participants, 11 of whom had dropped out of the parent study, completed qualitative interviews. The interview guide was developed using data from a survey of providers who offer Health at Every Size and other weight-neutral lifestyle interventions. Questions were phrased to invite even the most negative responses. Questions focused on participants' experiences of weight stigma during treatment, perceptions of BWL's calorie and WL goals, and opinions of BWL and weight-neutral interventions.

RESULTS

We identified four themes using thematic analysis: (1) BWL did not perpetuate weight stigma. (2) Calorie and WL goals did not exacerbate participants' binge eating. (3) Patients should have the right to pursue any treatment that aligns with their personal goals. (4) BWL can improve participants' overall health.

DISCUSSION

BWL participants with BED and overweight/obesity want others to have access to a program that can reduce both weight and binge eating. Participants emphasized that no treatment works for everyone, and they all agreed that BWL had not perpetuated weight stigma. Fewer than 20% of participants considered the program's calorie and WL goals to be harmful; most participants viewed those goals as achievable and helpful, and many asserted that their participation in BWL had improved their overall health.

PUBLIC SIGNIFICANCE

We interviewed adults with binge-eating disorder and overweight/obesity who had participated in a behavioral weight loss (BWL) program. Our participants wanted others in their position to have access to BWL because it aims to reduce both weight and binge-eating frequency. Efforts should be made to provide patients, clinicians, and policymakers with the knowledge that supervised, evidence-based BWL is an effective and desired treatment choice for this population.

Treatment of Binge-Eating Disorder Across the Lifespan: An Updated Review of the Literature and Considerations for Future Research

PURPOSE OF REVIEW

The present review describes the recent literature on treatment for binge-eating disorder (BED) in adults and youth, with a particular focus on research gaps, emerging treatments, and future research directions.

RECENT FINDINGS

Evidence supports the efficacy of several treatment modalities in adults, including self-help treatment, clinician-led psychotherapy, and pharmacotherapy; the largest effect sizes have been found for psychotherapies, most of which were cognitive-behavioral in orientation. Adapted psychotherapies for youth also show promise but lack a robust body of evidence. Predictors, moderators, and mediators of treatment outcome remain poorly understood; individuals with BED continue to experience significant barriers to treatment; and research is needed to address suboptimal treatment response. Recent work has highlighted the potential of adaptive interventions and investigation of novel mechanisms to address these gaps. Research on BED treatment continues to grow, though critical questions must be answered to improve treatment efficacy across the lifespan.

Effectiveness of a Web-Based Cognitive Behavioral Self-Help Intervention for Binge Eating Disorder: A Randomized Clinical Trial

Importance

Binge eating disorder (BED) is one of the most frequent eating pathologies and imposes substantial emotional and physical distress, yet insufficient health care resources limit access to specialized treatment. Web-based self-help interventions emerge as a promising solution, offering more accessible care.

Objective

To examine the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BED.

Design, Setting, and Participants

This 2-arm, parallel-group randomized clinical trial conducted from January 15, 2021, to August 3, 2022, in Germany and other German-speaking countries enrolled patients aged 18 to 65 years who met the diagnostic criteria for BED (according to the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]). Data analysis occurred between January 27 and September 4, 2023, following our statistical analysis plan.

Interventions

Participants were randomized to a web-based self-help intervention or a waiting-list control condition.

Main Outcomes and Measures

The primary outcome was a change in objective binge eating episodes from baseline to after treatment. Secondary outcomes included global eating pathology, clinical impairment, work capacity, well-being, comorbid psychopathology, self-esteem, and emotion regulation.

Results

A total of 1602 patients were screened, of whom 154 (mean [SD] age, 35.93 [10.59] years; 148 female [96.10%]) fulfilled the criteria for BED and were randomized (77 each to the intervention and control groups). The web-based intervention led to significant improvements in binge eating episodes (Cohen d, -0.79 [95% CI, -1.17 to -0.42]; P < .001), global eating psychopathology (Cohen d, -0.71 [95% CI, -1.07 to -0.35]; P < .001), weekly binge eating (Cohen d, -0.49 [95% CI, -0.74 to -0.24]; P < .001), clinical impairment (Cohen d, -0.75 [95% CI, -1.13 to -0.37]; P < .001), well-being (Cohen d, 0.38 [95% CI, 0.01 to 0.75]; P = .047), depression (Cohen d, -0.49 [95% CI, -0.86 to -0.12]; P = .01), anxiety (Cohen d, -0.37 [95% CI, -0.67 to -0.07]; P = .02), self-esteem (Cohen d, 0.36 [95% CI, 0.13 to 0.59]; P = .003), and emotion regulation (difficulties: Cohen d, -0.36 [95% CI, -0.65 to -0.07]; P = .01 and repertoire: Cohen d, 0.52 [95% CI, 0.19 to 0.84]; P = .003).

Conclusion and Relevance

In this randomized clinical trial of a web-based self-help intervention for patients with BED, the findings confirmed its effectiveness in reducing binge eating episodes and improving various mental health outcomes, highlighting a scalable solution to bridge the treatment gap for this condition.

Trial Registration

ClinicalTrials.gov Identifier: NCT04876183.

Eating disorders and obesity: bridging clinical, neurobiological, and therapeutic perspectives

Eating disorders (EDs) and obesity are complex health conditions sharing various risk and maintenance factors, intensified in cases of comorbidity. This review explores the similarities and connections between these conditions, examining different facets from a multidisciplinary perspective, among them comorbidities, metabolic and psychological factors, neurobiological aspects, and management and therapy implications. We aim to investigate the common characteristics and complexities of weight and EDs and explore their interrelationships in individuals who experience both. The rising prevalence of EDs in people with obesity necessitates integrated approaches to study this comorbidity and to identify and analyze both common and distinct features of these conditions. This review may offer new opportunities for simultaneous prevention and management approaches, as well as future lines of research.

Outcomes in people with eating disorders: a transdiagnostic and disorder-specific systematic review, meta-analysis and multivariable meta-regression analysis

Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta-analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD-defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all-cause and ED-related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow-up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44-49, n=283, mean follow-up: 44.9±62.8 months, no significant ED-group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23-29, n=170, mean follow-up: 59.3±71.2 months, no significant ED-group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2-0.7, n=214, mean follow-up: 72.2±117.7 months, no significant ED-group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person-years (95% CI: 4.4-6.1, n=167, mean follow-up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18-36, n=18, mean follow-up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self-injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio-demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family-based therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self-help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.

Applying Stages of Change Model to Examine Online Peer Communication on Binge Eating

Despite the distress and disruption associated with eating disorder (ED), people struggling with EDs are often ambivalent about their eating issues and unmotivated for recovery. Rather than seek professional help, these people tend to turn to online ED groups for information and support. Using the stages of change model, this study investigates the characteristics of online peer communication around binging vis-à-vis participants' motivation and readiness for behavioral change. Our results illustrate how individuals with binging issues in different motivational stages discuss their problematic eating online and provides insights into their ambivalence toward treatment and relapses into binging. This study further clarifies how people with binging issues feel trapped in a cycle of dieting-binging, which is observed to be undergirded by unresolved weight-related issues, and how they cope with the stressful relationship between eating and body weight through their postings on social media. These findings suggest that healthcare providers should promote healthier methods of addressing the weight gain from binge eating and provide support tailored to individuals' motivational stage in breaking the dieting-binging cycle.

A network analysis of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults

OBJECTIVE

Previous studies have revealed associations between disordered eating symptoms, big-five personality traits, and psychological distress. However, limited research has explored these relationships as a network, including their interconnections, and even less has done so in non-Western populations. We employed network analysis to investigate the co-occurrence of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults.

METHOD

A sample of 500 Chinese adults (256 men) completed measures assessing big-five personality traits, psychological distress, and disordered eating symptoms. The network of personality traits, psychological distress, and disordered eating symptoms was estimated, including its central and bridge nodes.

RESULTS

The central nodes in the network were the facets of openness (like adventure), extraversion (like going to social and recreational parties), and disordered eating symptoms (dissatisfaction with body weight or shape). Moreover, certain facets of neuroticism (always worrying something bad will happen), psychological distress (feeling worthless), and an inverse facet of extraversion (bored by parties with lots of people) were identified as essential bridge nodes in maintaining the structure of the network.

CONCLUSION

Our findings suggest that personality traits (e.g., openness and extraversion) and body dissatisfaction are important in maintaining the network in a community sample of Chinese adults. While future replication is needed, findings from this study suggest that individuals with negative self-thinking, predisposed neuroticism, and extraversion may be at risk of developing disordered eating symptoms.

PUBLIC SIGNIFICANCE

The present study contributes to existing knowledge by employing a network perspective to examine the associations between disordered eating symptoms, big-five personality traits, and psychological distress in a Chinese adult community sample. The identified facets of neuroticism and extraversion and symptoms of psychological distress may be worthy of targeting in the prevention and treatment of disordered eating in the Chinese context.

Sex differences in regional gray matter density in pre-adolescent binge eating disorder: a voxel-based morphometry study

BACKGROUND

Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with broad medical and psychiatric morbidity, and obesity. While BED may be characterized by altered cortical morphometry, no evidence to date examined possible sex-differences in regional gray matter characteristics among those with BED. This is especially important to consider in children, where BED symptoms often emerge coincident with rapid gray matter maturation.

METHODS

Pre-adolescent, 9-10-year old boys (N = 38) and girls (N = 33) with BED were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development Study. We investigated sex differences in gray matter density (GMD) via voxel-based morphometry. Control sex differences were also assessed in age and body mass index and developmentally matched control children (boys N = 36; girls N = 38). Among children with BED, we additionally assessed the association between dorsolateral prefrontal (dlPFC) GMD and parent-reported behavioral approach and inhibition tendencies.

RESULTS

Girls with BED uniquely demonstrate diffuse clusters of greater GMD (p < 0.05, Threshold Free Cluster Enhancement corrected) in the (i) left dlPFC (p = 0.003), (ii) bilateral dmPFC (p = 0.004), (iii) bilateral primary motor and somatosensory cortex (p = 0.0003) and (iv) bilateral precuneus (p = 0.007). Brain-behavioral associations suggest a unique negative correlation between GMD in the left dlPFC and behavioral approach tendencies among girls with BED.

CONCLUSIONS

Early-onset BED may be characterized by regional sex differences in terms of its underlying gray matter morphometry.

Unequivocally large, but not enormous: An examination of the nutritional content of objective and subjective binge-eating episodes using ecological momentary assessment data

OBJECTIVE

This study compared the macronutrient profiles of subjective binge-eating episodes (SBEs), objective binge-eating episodes (OBEs), and typical eating episodes.

METHOD

Twenty-one adults with binge eating completed ecological momentary assessment of all eating episodes for 2 weeks, including detailed monitoring of food types and portions. Binge-eating episodes (N = 237) were coded as OBEs (n = 76) or SBEs (n = 161). Calories and macronutrients were computed using manufacturer information and USDA Food and Nutrient Database for Dietary Studies. Multilevel regression models compared the eating episode types on caloric and macronutrient content.

RESULTS

OBEs contained an average of 121.5 (95.1) g fat, 363.7 (289.1) g carbohydrates, 65.2 (38.2) g protein, 20.9 (16.4) g fiber, and 2856.2 (1869.2) calories. SBEs contained 31.6 (30.5) g fat, 76.5 (54.0) g carbohydrates, 20.5 (21.6) g protein, 5.3 (5.9) g fiber, and 695.1 (505.9) calories. Although OBEs contained significantly more calories and grams of all macronutrients than SBEs (p < .001), the macronutrient proportions of OBEs and SBEs did not differ. The proportions of carbohydrates (p = .005) and protein (p < .001) in SBEs significantly differed from typical eating episodes.

DISCUSSION

Our findings offer preliminary evidence that OBEs and SBEs are more comparable in macronutrient profile than typical eating episodes.

PUBLIC SIGNIFICANCE STATEMENT

The present study compared the calories and grams of macronutrients in objectively large binge-eating episodes, subjectively large binge-eating episodes, and typical meals and snacks. Results suggest that objectively and subjectively large binge-eating episodes demonstrate similar profiles of macronutrients, which are different from the macronutrient profile of meals and snacks. These results may help the eating disorder field better study the impact of subjectively large binge-eating episodes.

Eating Disorders in Youth with Chronic Health Conditions: Clinical Strategies for Early Recognition and Prevention

Youth with chronic health conditions face an elevated risk of eating disorders and disordered eating behaviors. Contributors to this phenomenon may include the unique threats faced by this vulnerable population to their body image, their relationships with food and eating, and their mental health and self-esteem. However, youth with chronic health conditions may also experience more severe medical complications and mortality from eating disorder behaviors because of the additional risks conveyed by their underlying conditions. In this review, clinical strategies are provided to support youth with chronic health conditions through early recognition of eating disorder behaviors and prompt referral to treatment, which is important for a better prognosis. Suggestions are also given to mitigate their risk of developing eating disorders by proactively addressing risk factors and offering thoughtful anticipatory guidance that promotes a positive relationship with food and eating.

Current Discoveries and Future Implications of Eating Disorders

Eating disorders (EDs) are characterized by severe disturbances in eating behaviors and can sometimes be fatal. Eating disorders are also associated with distressing thoughts and emotions. They can be severe conditions affecting physical, psychological, and social functions. Preoccupation with food, body weight, and shape may also play an important role in the regulation of eating disorders. Common eating disorders have three major types: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). In some cases, EDs can have serious consequences for an individual's physical and mental health. These disorders often develop during adolescence or early adulthood and affect both males and females, although they are more commonly diagnosed in young adult females. Treatment for EDs typically involves a combination of therapy, nutrition counseling, and medical care. In this narrative review, the authors summarized what is known of EDs and discussed the future directions that may be worth exploring in this emerging area.

Aberrant functional connectivity between reward and inhibitory control networks in pre-adolescent binge eating disorder

BACKGROUND

Behavioral features of binge eating disorder (BED) suggest abnormalities in reward and inhibitory control. Studies of adult populations suggest functional abnormalities in reward and inhibitory control networks. Despite behavioral markers often developing in children, the neurobiology of pediatric BED remains unstudied.

METHODS

58 pre-adolescent children (aged 9-10-years) with BED (mBMI = 25.05; s.d. = 5.40) and 66 age, BMI and developmentally matched control children (mBMI = 25.78; s.d. = 0.33) were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in resting-state functional MRI functional connectivity (FC) within and between reward and inhibitory control networks. A seed-based approach was employed to assess nodes in the reward [orbitofrontal cortex (OFC), nucleus accumbens, amygdala] and inhibitory control [dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)] networks via hypothesis-driven seed-to-seed analyses, and secondary seed-to-voxel analyses.

RESULTS

Findings revealed reduced FC between the dlPFC and amygdala, and between the ACC and OFC in pre-adolescent children with BED, relative to controls. These findings indicating aberrant connectivity between nodes of inhibitory control and reward networks were corroborated by the whole-brain FC analyses.

CONCLUSIONS

Early-onset BED may be characterized by diffuse abnormalities in the functional synergy between reward and cognitive control networks, without perturbations within reward and inhibitory control networks, respectively. The decreased capacity to regulate a reward-driven pursuit of hedonic foods, which is characteristic of BED, may in part, rest on this dysconnectivity between reward and inhibitory control networks.

Metabolic profile in women with bulimia nervosa or binge-eating disorder before and after treatment: secondary analysis from the randomized PED-t trial

PURPOSE

Chaotic eating and purging behavior pose a risk to the metabolic health of women with bulimia nervosa (BN) and binge-eating disorder (BED). This study reports on one-year changes in blood markers of metabolic health and thyroid hormones in women with BN or BED attending two different treatments.

METHODS

These are secondary analyses from a randomized controlled trial of 16-week group treatment of either physical exercise and dietary therapy (PED-t) or cognitive behavior therapy (CBT). Blood samples collected at pre-treatment, week eight, post-treatment, and at 6- and 12-month follow-ups were analyzed for glucose, lipids (triglycerides (TG), total cholesterol (TC), LDL cholesterol (LDL-c), HDL cholesterol (HDL-c), apolipoprotein A (ApoA) and apolipoprotein B (ApoB) lipoproteins), and thyroid hormones (thyroxine (T4), thyroid stimulating hormone (TSH), and thyroperoxidase antibodies).

RESULT

The average levels of blood glucose, lipids and thyroid hormones were within the recommended range, but clinical levels of TC and LDL-c were detected in 32.5% and 39.1%, respectively. More women with BED compared with BN had low HDL-c, and a larger increase over time in TC and TSH. No significant differences occurred between PED-t and CBT at any measurement. Exploratory moderator analyses indicated a more unfavorable metabolic response at follow-up among treatment non-responders.

CONCLUSION

The proportion of women with impaired lipid profiles and unfavorable lipid changes, suggests active monitoring with necessary management of the metabolic health of women with BN or BED, as recommended by metabolic health guidelines.

LEVEL OF EVIDENCE

Level I: Evidence obtained from a randomized, experimental trial.

TRIAL REGISTRATION NUMBER

This trial was prospectively registered in the Norwegian Regional Committee for Medical and Health Research Ethics on December 16, 2013, with the identifier number 2013/1871, and in Clinical Trials on February 17, 2014, with the identifier number NCT02079935.

The Clinical Phenotype of Binge Eating Disorder among Postmenopausal Women: A Pilot Study

Binge eating disorder (BED), a form of overnutrition, may impact healthy aging for postmenopausal women. In community samples, 12-26% of older women (ages 60+) engage in binge eating. In younger adults, BED is comorbid with physical and psychological morbidities. However, little is known regarding the clinical phenotype, including medical and psychiatric comorbidities, of BED in postmenopausal women. This pilot study sought to identify psychosomatic, cardiometabolic, body composition, and physical function characteristics of postmenopausal, older adult (age ≥60 years) women with BED. Participants (N = 21, ages 60-75) completed a battery of physical assessments and surveys assessing psychosomatic health. Overall, 62% of women reported BE onset during peri- or post-menopause. Rates of comorbid depression, anxiety, sleep problems, and a history of severe menopausal symptoms were high. Cardiometabolic health was poor, and 42.9% met the criteria for metabolic syndrome. Additionally, 71.4% met the BMI criteria for obesity, and 40% of this sample met the criteria for sarcopenic obesity. Almost half of the sample presented with at least one mobility limitation; 85.7% had poor endurance. Evidence suggests that BED is highly comorbid with other chronic health conditions and may complicate treatment of these conditions, warranting further investigation and increased attention from healthcare providers serving postmenopausal women.

Influence of parental anxiety and beliefs about medicines on feeding and exercise in children living with asthma

This study's primary objective was to establish differences in beliefs about medicines, levels of asthma-related anxiety and diet and exercise behaviours between parents of children with well controlled and poorly controlled asthma. Secondary objectives were to explore how asthma control might shape relationships between parental cognitions and parenting practices concerning paediatric asthma. Parents of children with asthma aged 10-16 years (N = 310) completed standardised questionnaires measuring beliefs about medicines, parental asthma-related anxiety, parenting attitudes towards child activity, parental feeding and asthma control. Parents of children with poorly controlled asthma reported significantly greater asthma medication necessity and concern, asthma-related anxiety, control of child activity, pressure to exercise and unhealthy feeding practices. Moderation analyses indicated that the relationship between parental concern about asthma medicine and parental control of child activity was strongest in children with poorly controlled asthma. Also, the relationship between parental asthma-related anxiety and use of food to regulate child emotion was only significant when asthma was poorly controlled. Parental beliefs about asthma medicines and asthma-related anxiety may indirectly influence asthma outcomes through unhealthy parenting practices around exercise and diet. Eliciting and understanding parents' perceptions of asthma medications and anxiety may facilitate personalised interventions to improve asthma control.

Estrés percibido en mujeres con síndrome metabólico: un estudio transversal

Introducción: El estrés percibido ha sido sugerido como un factor de riesgo para el desarrollo del Síndrome Metabólico (SM). Sin embargo, poco se sabe sobre esta asociación entre las mujeres. Objetivo: evaluar el estrés percibido en mujeres con Síndrome Metabólico (SM). Materiales y Métodos: estudio transversal, basado en un ensayo clínico no aleatorizado, con pacientes de un centro de salud pública (RBR-43K52N). La variable resultada fue SM, utilizando los criterios NCEP/ATPIII. Se recogieron datos sociodemográficos, antropométricos, bioquímicos, hemodinámicos y aplicación de PSS. Resultados: La muestra estuvo compuesta por 75 mujeres afectadas por SMet (47,69± 8,15 años; 155,65±0,07 cm; 82,43±17,79 kg; IMC de 33,96±6,42). Se encontraron valores altos de WHR entre mujeres estresadas y no estresadas. La puntuación media de PSS fue de 27,73±9,17. En los grupos, hubo una diferencia significativa para PSS entre mujeres estresadas y no estresadas (35,24±5,22 y 20,42±5,53, respectivamente; p=0,001). También se observó que las mujeres estresadas tenían niveles más altos de triglicéridos y niveles más bajos de HDL-c en comparación con las mujeres no estresadas, aunque sin diferencia estadística. Discusiones: Los hallazgos sugieren que las mujeres categorizadas como estresadas tenían puntajes PSS más altos, niveles más altos de triglicéridos y niveles más bajos de HDL-c en comparación con mujeres no estresadas. Conclusiones: la puntuación de PSS fue significativamente mayor entre las mujeres con parámetros lipídicos de SM alterados, con niveles de HDL más bajos y triglicéridos elevados. Como citar este artículo: Barros, Vinicius Santos; de Araújo, Wilkslam Alves; de Jesus, Marcos Vinicius Santos; Damaceno, Taynnan de Oliveira; Rocha, Roseanne Montargil; Fernandes, Josicélia Dumêt; Rosa, Randson Souza; Santos, Isleide Santana Cardoso.  Estresse percebido em mulheres com síndrome metabólica: um estudo transversal. Revista Cuidarte. 2023;14(1):e2634. http://dx.doi.org/10.15649/cuidarte.2634

Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review

Individuals with eating disorders (ED) experience prolonged malnutrition, binge episodes, and compensatory behaviours that affect every organ system. Psychological and physiological symptoms are worsened with comorbid dysfunctional exercise, seen in up to 80% of those with an ED. Although return to exercise is an important component of treatment and recovery, little is known about the contraindications and risks of exercise engagement specific to those with an ED. This paper provides a comprehensive narrative review of the medical and physiological complications of engaging in exercise during ED treatment and outlines when exercise may be contraindicated or used in modified or cautionary ways. We conducted a literature search on MEDLINE, PubMed, and PsychArticles to identify relevant articles, which yielded six categories of medical and physiological complications of ED that may be exacerbated by exercise: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.

Prevalence, associations and health outcomes of binge eating in adults with type 1 or type 2 diabetes: Results from Diabetes MILES - The Netherlands

AIMS

To examine the prevalence and health risks of binge eating in people with diabetes.

METHODS

Self-report data were analysed from a subsample (n = 582 type 1 diabetes/735 type 2 diabetes) of Diabetes MILES - the Netherlands, an online survey. Prevalence of binge eating was compared across diabetes type and treatment and between participants with and without binges for eating styles, diabetes treatment and outcomes, weight, BMI and psychological comorbidity. Associations between binge eating, HbA_1c , BMI, diabetes distress were assessed using hierarchical linear regression analyses.

RESULTS

23% (n = 308) of participants reported eating binges, with 16% at least monthly, and 6% at least weekly. Prevalence and frequency of binges did not differ across diabetes type or treatment. People reporting binges scored higher on dietary restraint, emotional and external eating and reported higher weight and BMI than those without binges. Only people with type 1 diabetes and eating binges had a higher HbA_1c . Hierarchical regression analyses demonstrated that binge eating was independently associated with higher HbA_1c (β = 0.12, p=0.001), BMI (β = 0.13, p < 0.001) but not with diabetes distress.

CONCLUSIONS

This study found binge eating to be associated with eating styles, BMI and HbA_1c . However, our cross-sectional data do not allow for conclusions on causality. Future studies could further examine the directions of these associations and their clinical implications.

Association of family history of schizophrenia and clinical outcomes in individuals with eating disorders

BACKGROUND

Familial co-aggregation studies of eating disorders (EDs) and schizophrenia reveal shared genetic and environment factors, yet their etiological and clinical relationship remains unclear. We evaluate the influence of schizophrenia family history on clinical outcomes of EDs.

METHODS

We conducted a cohort evaluation of the association between family history of schizophrenia and ED clinical features, psychiatric comorbidities, and somatic and mental health burden in individuals born in Sweden 1977-2003 with anorexia nervosa (AN) or other EDs (OED: bulimia nervosa, binge-eating disorder, and ED not otherwise specified).

RESULTS

Of 12 424 individuals with AN and 20 716 individuals with OED, 599 (4.8%) and 1118 (5.4%), respectively, had a family history of schizophrenia (in up to third-degree relatives). Among individuals with AN, schizophrenia in first-degree relatives was significantly associated with increased comorbid attention-deficit/hyperactivity disorder (ADHD) [HR(95% CI) 2.26 (1.27-3.99)], substance abuse disorder (SUD) [HR (95% CI) 1.93 (1.25-2.98)], and anxiety disorders [HR (95% CI) 1.47 (1.08-2.01)], but higher lowest illness-associated body mass index (BMI) [1.14 kg/m², 95% CI (0.19-2.10)]. Schizophrenia in any relative (up to third-degree) in AN was significantly associated with higher somatic and mental health burden, but lower ED psychopathology scores [-0.29, 95% CI (-0.54 to -0.04)]. Schizophrenia in first-degree relatives in individuals with OED was significantly associated with increased comorbid ADHD, obsessive-compulsive disorder, SUD, anxiety disorders, somatic and mental health burden, and suicide attempts.

CONCLUSIONS

We observed different patterns of ED-related outcomes, psychiatric comorbidity, and illness burden in individuals with EDs with and without family histories of schizophrenia and provide new insights into the diverse manifestations of EDs.

The Relationship between Binge Drinking and Binge Eating in Adolescence and Youth: A Systematic Review and Meta-Analysis

Adolescence and youth are critical periods in which alcohol consumption is usually initiated, especially in the form of binge drinking. In recent years, it is increasingly common to find adolescents and young people who also present binge behaviors towards unhealthy food with the aim of alleviating their anxiety (emotional eating) and/or because of impulsive personality. Despite the social and health relevance of this issue, it remains scarcely studied and more preventive research needs to be developed. Our meta-analysis study aimed to evaluate the relationship and co-occurrence of both binge behaviors during adolescence and young adulthood to clarify the link between binge drinking and eating. Selective literature search on different online databases was performed. We identified discrete but significant results regarding the direct association between binge drinking and binge eating in correlation coefficients and odds ratio. Future research should focus on the common psychological background and motives behind these problematic behaviors owing to their clinical implications for effective prevention and treatment.

A Review of Binge-Eating Disorder in Black Women: Treatment Recommendations and Implications for Healthcare Providers

PURPOSE OF REVIEW

We review relevant factors and barriers to care for binge-eating disorder (BED) in Black women. We examine evidence for the treatment of BED and provide recommendations to improve cultural relevance for assessing and treating BED in Black women.

RECENT FINDINGS

BED is the most common eating disorder among Black women. Moreover, evidence supports alternative factors that contribute to the onset of BED in Black women, including stress, trauma, and food insecurity. Furthermore, though there are evidence-based treatments for BED, disparities persist in access to care and treatment retention. Recommendations for increasing the cultural relevance of assessments and treatments are provided. Gaps in the literature remain on the use of evidence-based treatments for BED among Black women. As such, healthcare providers should include Black women as co-collaborators in their care and seek out training and consultation to aid in providing culturally affirming treatment.

Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD)

Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.

Management of eating disorders for people with higher weight: clinical practice guideline

INTRODUCTION

The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population.

AIM

The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations.

METHODS

The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience.

RECOMMENDATIONS

Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed.

CONCLUSIONS

This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.

Meta-Analysis and Systematic Review of Resting-State High-Frequency Heart Rate Variability in Binge-Eating Disorder

Abstract. Binge-eating disorder (BED) is associated with a greater risk for cardiac problems and co-occurring health conditions. Resting-state measures of high-frequency heart rate variability (HF-HRV), which is a physiological proxy of self-regulatory neural functioning, may aid understanding of health risks. We systematically reviewed and meta-analyzed the literature on HF-HRV in individuals with BED and without BED. Six studies were reviewed in the qualitative synthesis, and five studies assessing HRV in individuals with BED ( n = 153) and without BED ( n = 124) were included in the meta-analysis. A non-significant effect size (Hedges’ g = .08, SE = 0.36, 95% CI [−0.62, 0.78]; z = 0.23, p = .82) was found, suggesting no difference in HF-HRV between groups. Age, BMI, and BMI-matched control status were not significant covariates. Synthesizing the five studies with available data, we found no difference in resting-state HF-HRV between individuals with and without BED. There was high heterogeneity in the sample, suggesting potential moderators. We discuss potential mechanisms, methodological and demographic confounds, and future directions for study.

Binge eating disorder and eating self-efficacy in adults seeking bariatric surgery

This study assessed the relationships between binge eating disorder (BED) and eating self-efficacy in a sample of patients prior to bariatric surgery. The study also examined the extent that BED status accounted for variance in self-efficacy after controlling for demographic factors (age, sex and race), physical variables (comorbidities and body mass index [BMI]) and depressive symptoms. This was a cross-sectional study of pre-surgical data from patients seeking bariatric surgery at a university-based healthcare system (N = 98; mean ± SD age of 46.2 ± 12.5 years; BMI of 45.4 ± 7.2 kg/m² ; 86.7% female; and 60.2% of patients self-identified as White). Patients completed the Weight and Lifestyle Inventory (WALI), Beck Depression Inventory-II (BDI-II) and Weight Efficacy Lifestyle Questionnaire. Of the total sample, 15.3% met criteria for BED, 33.7% had subthreshold BED and 51.0% were free of this disorder. In adjusted analyses, total self-efficacy was significantly lower in patients with subthreshold BED (B ± SE = -15.88 ± 7.23, p = .03) and individuals with BED (B ± SE = -35.07 ± 10.23, p = .001) than in those without BED. Patients with BED, compared to those without, had significantly worse scores (in adjusted analyses) on the self-efficacy subscales of negative emotions (p = .003), availability of food (p < .001), social pressure (p = .004) and positive activities (p = .03). In patients seeking bariatric surgery, total self-efficacy scores were significantly lower in patients with BED and subthreshold BED than those without BED. The results suggest that eating self-efficacy may be an important factor to target in patients with BED who seek bariatric surgery.

The clinical significance of binge eating among older adult women: an investigation into health correlates, psychological wellbeing, and quality of life

BACKGROUND

One type of overnutrition, binge eating (BE; eating an unusually large amount of food with loss of control), is prevalent among older adult women. Yet, little is known about the clinical significance of this eating disorder pathology in older adults, especially in relation to health outcomes used in geriatrics, while controlling for associations with body mass index (BMI).

METHOD

Women (N = 227) aged 60-94 completed two measures of BE and health/wellness questionnaires online. We used multivariable analyses to compare women with Clinical-frequency BE (≥ weekly frequency), Subclinical-frequency BE (< weekly), and No BE on health/wellness outcomes controlling for BMI. We conducted partial correlations controlling for BMI to examine associations between BE severity and health indices.

RESULTS

Controlling for BMI, the Clinical-frequency BE group reported poorer health-related quality of life (physical function, role limitations due to both emotional and physical problems, vitality, emotional wellbeing, social function, and pain) and poorer psychological health (depression, body image) compared to both Subclinical-frequency BE and No BE. The Clinical-frequency BE group also reported poorer sleep, nutritious food consumption, general health, and positive affect compared to No BE. Associations between a separate measure of BE severity and health indices confirmed findings from group comparisons.

CONCLUSION

Weekly BE may offer a promising screening benchmark for identifying one type of overnutrition in older women that is associated with numerous indicators of poorer health, independent of the effects of BMI. More research is needed to understand risks for and consequences of BE unique to older adult women. Binge eating (BE; eating an unusually large amount of food with loss of control), is prevalent among older adult women and is associated with health problems in younger populations. Yet, little is known about how BE is related to other health problems in older adults. We compared health behaviors, physical health, health-related quality of life, and psychological health between older adult women who reported weekly or more frequent BE (i.e., Clinical BE), those with low frequency BE (i.e., Subclinical BE), and those with no BE, while accounting for BMI. Older women in the Clinical BE group reported poorer health-related quality of life, more depression symptoms, and worse body image compared to the Subclinical BE and No BE groups. Compared to the No BE group, the Clinical BE group also reported poorer sleep, less frequent consumption of nutritious foods, worse health, and less frequent positive emotions. Using a separate measure of BE severity, we found similar associations with these health outcomes. Engaging in weekly BE may represent one type of overnutrition behavior in older women that is associated with numerous indicators of poorer health. More research is needed to understand risks for and consequences of BE unique to older adult women.

Regional gray matter abnormalities in pre-adolescent binge eating disorder: A voxel-based morphometry study

BACKGROUND

Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with an array of multisystemic organ morbidity, broad psychiatric morbidity, and obesity. Despite behavioral markers often developing in early childhood, the neurobiological markers of early-onset BED remain understudied, and developmental pathophysiology remains poorly understood.

METHODS

71 preadolescent children (aged 9-10-years) with BED and 74 age, BMI and developmentally matched control children were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in gray matter density (GMD) via voxel-based morphometry (VBM). We additionally performed region of interest analyses, assessing the association between GMD in nodes of the reward (orbitofrontal cortex; OFC) and inhibitory control (dorsolateral prefrontal cortex; dlPFC) networks, and parent-reported behavioral inhibition and approach tendencies.

RESULTS

Diffuse elevations in cortical GMD were noted in those with BED, which spanned prefrontal, parietal, and temporal regions. No areas of reduced GMD were noted in those with BED. No alterations in subcortical GMD were noted. Brain-behavioral associations suggest a distinct and negative relationship between GMD in the OFC and dlPFC, respectively, and self-reported markers of hedonic behavioral approach tendencies.

CONCLUSIONS

Early-onset BED may be characterized by diffuse morphological abnormalities in gray matter density, suggesting alterations in cortical architecture which may reflect decreased synaptic pruning and arborization, or decreased myelinated fibers and therefore inter-regional afferents.

Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews

AIMS/HYPOTHESIS

Estimates of the global prevalence of type 2 diabetes vary between 6% and 9%. The prevalence of type 2 diabetes has been investigated in psychiatric populations but a critical appraisal of the existing evidence is lacking, and an overview is needed. This umbrella review summarises existing systematic reviews of observational studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder.

METHODS

We searched PubMed, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews from inception to 17 January 2021 and screened reference lists of included systematic reviews. On the basis of prespecified criteria, we included systematic reviews investigating the prevalence of type 2 diabetes in adults (aged ≥18 years) with a psychiatric disorder. Titles and abstracts of 5155 identified records and full texts of 431 selected studies were screened by two independent reviewers, based on predefined eligibility criteria and an a priori developed extraction form, following the PRISMA and MOOSE guidelines. Risk of bias was assessed with the ROBIS instrument. Data extracted from primary studies were synthesised using random-effects meta-analyses.

RESULTS

A total of 32 systematic reviews with 245 unique primary studies were identified and met inclusion criteria. Twelve had low risk of bias. They reported type 2 diabetes prevalence estimates ranging from 5% to 22% depending on the specific psychiatric disorder. We meta-analysed data for ten categories of psychiatric disorders and found the following prevalence estimates of type 2 diabetes: in people with a sleep disorder: 40%; binge eating disorder: 21%; substance use disorder: 16%; anxiety disorder: 14%; bipolar disorder: 11%; psychosis: 11%; schizophrenia: 10%; a mixed group of psychiatric disorders: 10%; depression: 9%; and in people with an intellectual disability 8%. All meta-analyses revealed high levels of heterogeneity.

CONCLUSIONS/INTERPRETATION

Type 2 diabetes is a common comorbidity in people with a psychiatric disorder. Future research should investigate whether routine screening for type 2 diabetes and subsequent prevention initiatives for these people are warranted. PROSPERO registration no. CRD42020159870.

Is work-family conflict a pathway between job strain components and binge eating? A cross-sectional analysis from the ELSA-Brasil study

BACKGROUND

Job strain has been reported as a trigger for binge eating, yet the underlying mechanisms have been unclear. The aim of this study was to evaluate whether work-family conflict is a pathway in the association between job strain and binge eating, considering the possible effect-modifying influence of body mass index (BMI).

METHODS

This cross-sectional analysis included 12,084 active civil servants from the multicenter Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Job strain was assessed using the Demand-Control-Support Questionnaire. Work-family conflict was considered as a latent variable comprising three items. Binge eating was defined as eating a large amount of food in less than 2 h at least twice a week in the last six months with a sense of lack of control over what and how much was eaten. Structural equation modelling was used to test the role of work-family conflict in the association between job strain and binge eating, stratifying for BMI.

RESULTS

For individuals of normal weight, positive associations were found between skill discretion and binge eating (standardized coefficient [SC] = 0.209, 95%CI = 0.022-0.396), and between psychological job demands and work-family conflict (SC = 0.571, 95%CI = 0.520-0.622), but no statistically significant indirect effect was found. In overweight individuals, psychological job demands, skill discretion, and work-family conflict were positively associated with binge eating (SC = 0.099, 95%CI = 0.005-0.193; SC = 0.175, 95%CI = 0.062-0.288; and SC = 0.141, 95%CI = 0.077-0.206, respectively). Also, work-family conflict was observed to be a pathway on the associations of psychological job demands and decision authority with binge eating (SC = 0.084, 95%CI = 0.045-0.122; and SC =  - 0.008, 95%CI =  - 0.015- - 0.001, respectively).

CONCLUSIONS

Work-family conflict partly explains effects of high levels of psychological job demands and low levels of decision authority on binge eating among overweight individuals. Moreover, skill discretion is positively associated with binge eating, regardless of BMI category.

Binge eating among older women: prevalence rates and health correlates across three independent samples

BACKGROUND

Emerging research indicates that binge eating (BE; consuming unusually large amounts of food in one siting while feeling a loss of control) is prevalent among older women. Yet, health correlates of BE in older adult populations are poorly understood. The original study aimed to investigate BE prevalence, frequency, and health correlates in a sample of older adult women. Based on results from this first study, we then sought to replicate findings in two additional samples of older adult women from separate studies.

METHOD

Using self-reported frequencies of BE from three separate samples of older women with very different demographics, we compared BE prevalence, frequency, and health correlates among older women. Study 1 (N = 185) includes data collected online (86% White; 59% overweight/obese status). Study 2 (N = 64) was conducted in person at a local food pantry (65% Hispanic; 47% household income < $10,000/year). Study 3 (N = 100) comprises data collected online (72% White; 50% Masters/Doctoral Degree).

RESULTS

Per DSM-5 frequency criterion of BE at least weekly, we found prevalence rates ranging from 19 to 26% across the three samples. Correlates of BE frequency included elevated negative mood, worry, BMI, and less nutritious food consumption.

CONCLUSIONS

Across three very different samples in terms of race/ethnicity, education, food security status, measurements, and sampling methodology, we found fairly consistent rates of self-reported BE at least weekly (19-26%). Results suggest that BE is related to negative health indices among older women and support the need for more research in this population.

Gonadal Hormone Influences on Sex Differences in Binge Eating Across Development

PURPOSE OF REVIEW

Binge eating is a transdiagnostic symptom that disproportionately affects females. Sexually dimorphic gonadal hormones (e.g., estradiol, testosterone) substantially impact eating behavior and may contribute to sex differences in binge eating. We examine recent evidence for the role of gonadal hormones in binge eating risk across development.

RECENT FINDINGS

Both organizational (long-lasting impact on the central nervous system (CNS)) and activational (transient influences on the CNS) hormone effects may contribute to sex differences in binge eating. Gonadal hormones also impact within-sex variability in binge eating, with higher estradiol levels in females and higher testosterone levels in males protective across development. Emerging evidence suggests that the impact of gonadal hormones may be greatest for people with other risk factors, including genetic, temperamental (e.g., high negative affect), and psychosocial (e.g., exposure to weight-based teasing) risk. Gonadal hormones contribute to sex differences and within-sex variability in binge eating across development.

Efficacy and safety of dasotraline in adults with binge-eating disorder: a randomized, placebo-controlled, fixed-dose clinical trial

OBJECTIVE

The aim of this fixed-dose study was to evaluate the efficacy and safety of dasotraline in the treatment of patients with binge-eating disorder (BED).

METHODS

Patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for BED were randomized to 12 weeks of double-blind treatment with fixed doses of dasotraline (4 and 6 mg/d), or placebo. The primary efficacy endpoint was change in number of binge-eating (BE) days per week at week 12. Secondary efficacy endpoints included week 12 change on the BE CGI-Severity Scale (BE-CGI-S) and the Yale-Brown Obsessive-Compulsive Scale Modified for BE (YBOCS-BE).

RESULTS

At week 12, treatment with dasotraline was associated with significant improvement in number of BE days per week on the dose of 6 mg/d (N = 162) vs placebo (N = 162; -3.47 vs -2.92; P = .0045), but not 4 mg/d (N = 161; -3.21). Improvement vs placebo was observed for dasotraline 6 and 4 mg/d, respectively, on the BE-CGI-S (effect size [ES]: 0.37 and 0.27) and on the YBOCS-BE total score (ES: 0.43 and 0.29). The most common adverse events on dasotraline were insomnia, dry mouth, headache, decreased appetite, nausea, and anxiety. Changes in blood pressure and pulse were minimal.

CONCLUSION

Treatment with dasotraline 6 mg/d (but not 4 mg/d) was associated with significantly greater reduction in BE days per week. Both doses of dasotraline were generally safe and well-tolerated and resulted in global improvement on the BE-CGI-S, as well as improvement in BE related obsessional thoughts and compulsive behaviors on the YBOCS-BE. These results confirm the findings of a previous flexible dose study.

Delineating the role of binge eating in cancer research

PURPOSE

Binge eating is defined as consumption of a large amount of food accompanied by a sense of loss of control over eating. While binge eating is associated with poor physical, behavioral, and psychosocial health, it has not been studied in cancer research. Therefore, the overarching goal of this review is to delineate the role of binge eating in cancer research and to spur new research in this area. Specifically, in this review, we outlined (1) binge eating as a possible risk factor that contributes to cancer risk, (2) how binge eating may develop after cancer diagnosis, and (3) how binge eating may be associated with health and relapse during survivorship.

CONCLUSIONS

It is critical to elucidate the role of binge eating in the prevention of cancer and long-term cancer survivorship. This review suggested a number of ways that binge eating may increase risk for cancer as well as several pathways that may lead to the development of binge eating after cancer diagnosis.

LEVEL OF EVIDENCE

Level V: narrative review.

Association between Visceral Adiposity Index, Binge Eating Behavior, and Grey Matter Density in Caudal Anterior Cingulate Cortex in Severe Obesity

Visceral adipose tissue accumulation is an important determinant of metabolic risk and can be estimated by the visceral adiposity index (VAI). Visceral adiposity may impact brain regions involved in eating behavior. We aimed to examine the association between adiposity measurements, binge eating behavior, and grey matter density. In 20 men and 59 women with severe obesity, Grey matter density was measured by voxel-based morphometry for six regions of interest associated with reward, emotion, or self-regulation: insula, orbitofrontal cortex, caudal and rostral anterior cingulate cortex (ACC), ventromedial prefrontal cortex (vmPFC), and dorsolateral prefrontal cortex (DLPFC). Binge eating behavior, depression and impulsivity was assessed by the Binge Eating Scale, Beck Depression Inventory and UPPS Impulsive Behavior Scale, respectively. Men and women were distinctively divided into two subgroups (low-VAI and high-VAI) based on the mean VAI score. Women with high-VAI were characterized by metabolic alterations, higher binge eating score and lower grey matter density in the caudal ACC compared to women with low-VAI. Men with high-VAI were characterized by a higher score for the sensation-seeking subscale of the UPPS–Impulsive Behavior Scale compared to men with low-VAI. Using a moderation–mediation analysis, we found that grey matter density in the caudal ACC mediates the association between VAI and binge eating score. In conclusion, visceral adiposity is associated with higher binge eating severity in women. Decreased grey matter density in the caudal ACC, a region involved in cognition and emotion regulation, may influence this relationship.

Revictimization Is Associated With Higher Cardiometabolic Risk in Sexual Minority Women

OBJECTIVES

Although there is evidence that interpersonal trauma is associated with cardiometabolic risk in women, previous studies have not assessed the potential role of revictimization (victimization in both childhood and adulthood) among sexual minority women.

METHODS

We used data from the Chicago Health and Life Experiences of Women study to examine the associations of revictimization (including physical, sexual, and any revictimization) with self-reported psychosocial factors, health behaviors, and cardiometabolic risk factors (e.g., obesity, hypertension, and diabetes). We tested multiple logistic regression models, adjusted for covariates, to estimate odds ratios of the associations between revictimization and cardiometabolic risk.

RESULTS

The sample included 615 sexual minority women with a mean age of 40.0 years; 38.7% White. Eighty-three (13.5%) and 101 (16.4%) participants reported experiencing sexual revictimization and physical revictimization, respectively. Each form of revictimization was associated with higher odds of reporting lifetime depression and recent binge eating, but lower odds of having high social support. Physical revictimization was associated with higher odds of obesity (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 1.38-4.10) and hypertension (AOR, 3.31; 95% CI, 1.70-6.46). Similarly, participants who reported any revictimization were more likely to have obesity (AOR, 2.36; 95% CI, 1.42-3.92) and hypertension (AOR, 2.60; 95% CI, 1.31-5.26). No form of revictimization was associated with a higher odds of diabetes.

CONCLUSIONS

The higher odds of obesity and hypertension observed among sexual minority women who reported revictimization reinforce the need for early interventions to reduce cardiometabolic risk in this vulnerable population.

Psychiatric disorders as risk factors for type 2 diabetes: An umbrella review of systematic reviews with and without meta-analyses

Having a psychiatric disorder may increase the risk of developing type 2 diabetes[T2D] and this umbrella review aims to determine whether people with a psychiatric disorder have an increased risk of developing T2D and to investigate potential underlying mechanisms. A literature search was performed to identify systematic reviews of longitudinal studies investigating different psychiatric disorders as risk factors for incident T2D in humans (≥18 years). A total of 8612 abstracts were identified, 180 full-text articles were read, and 25 systematic reviews were included. Six categories of psychiatric disorders were identified. Except for eating disorders, all psychiatric disorders were associated with increased risk of incident T2D ranging from RR = 1.18 [95% CI 1.12-1.24] to RR = 1.60 [95% CI 1.37-1.88] for depression; from RR = 1.27 [95% CI 1.19-1.35] to OR = 1.50 [95% CI 1.08-2.10] for use of antidepressant medication; from OR = 1.93 [1.37-2.73] to OR = 1.94 [1.34-2.80] for use of antipsychotic medication; from RR = 1.55 [95% CI 1.21-1.99] to RR = 1.74 [95% CI 1.30-2.34] for insomnia, and finally showed OR = 1.47 [95% CI 1.23-1.75] for anxiety disorders. Plausible underlying mechanisms were discussed, but in most reviews corrections for mechanisms did not explain the association. Notable, only 16% of the systematic reviews had a high methodological quality.

Binge eating and alcohol consumption: an integrative review

OBJECTIVE

To identify the relationship between binge eating and alcohol consumption.

METHODS

This is an integrative literature review of publications from 2015 to 2019, using the Pubmed, Cinhahl, Psynet, Lilacs, Embase and Web of Science virtual databases and the descriptors ("Binge-Eating" OR "Bulimia") AND Alcohol* in English, Spanish and Portuguese.

RESULTS

A total of 964 articles were found. After reading the titles and abstracts and excluding duplicates, 36 articles were included in the final sample (35 in English and one in Portuguese). They were grouped into three thematic categories: "sample profile and characterization", "genetic and environmental factors", and "emotions and behavior".

CONCLUSIONS

The data indicate the existence of a relationship between binge eating and alcohol use, and some factors were associated with this comorbidity. Still, there were few publications on the theme at the national level, indicating the need for developing more research. These findings may support therapeutic actions and strategies for identification of cases, embracing approaches and more effective treatments to meet the individual's biopsychosocial demands.

LEVEL OF EVIDENCE

Level V, narrative review.

Treatment outcomes of psychotherapy for binge-eating disorder in a randomized controlled trial: Examining the roles of childhood abuse and post-traumatic stress disorder

OBJECTIVE

To examine childhood abuse and post-traumatic stress disorder (PTSD) as predictors and moderators of binge-eating disorder (BED) treatment outcomes in a randomized controlled trial comparing Integrative Cognitive-Affective Therapy with cognitive-behavioural therapy administered using guided self-help.

METHOD

In 112 adults with BED, childhood abuse was defined as any moderate/severe abuse as assessed by the Childhood Trauma Questionnaire, lifetime PTSD was assessed via the Structured Clinical Interview for DSM-IV, and outcomes were assessed via the Eating Disorder Examination (EDE). Covariate-adjusted regression models predicting binge-eating frequency and EDE global scores at end of treatment and 6-month follow-up were conducted.

RESULTS

Lifetime PTSD predicted greater binge-eating frequency at end of treatment (B = 1.32, p = 0.009) and childhood abuse predicted greater binge-eating frequency at follow-up (B = 1.00, p = 0.001). Lifetime PTSD moderated the association between childhood abuse and binge-eating frequency at follow-up (B = 2.98, p = 0.009), such that childhood abuse predicted greater binge-eating frequency among participants with a history of PTSD (B = 3.30, p = 0.001) but not among those without a PTSD history (B = 0.31, p = 0.42). No associations with EDE global scores or interactions with treatment group were observed.

CONCLUSIONS

Results suggest that a traumatic event history may hinder treatment success and that PTSD may be more influential than the trauma exposure itself.

Emotion Regulation, Physical Diseases, and Borderline Personality Disorders: Conceptual and Clinical Considerations

This perspective paper aims at discussing theoretical principles that could explain how emotion regulation and physical diseases mutually influence each other in the context of borderline personality disorder (BPD). Furthermore, this paper discusses the clinical implications of the functional relationships between emotion regulation, BPD and medical conditions considering dialectical behavior therapy (DBT) as a well-validated therapeutic intervention, which encompasses these issues. The inflexible use of maladaptive emotion regulation strategies (e.g., suppression, experiential avoidance, and rumination) might directly increase the probability of developing physical diseases through a physiological pathway, or indirectly through a behavioral pathway. Some metabolic and chronic medical conditions could significantly impact emotional functioning through biological alterations involved in emotion regulation. Several empirical studies have shown high co-occurrence rates between BPD and several chronic physical diseases, especially ones linked to emotion-based maladaptive behaviors. DBT addresses physical diseases reported by individuals with BPD reducing problematic behaviors functionally associated to emotion dysregulation and identifying physical health as a goal for Building a Life Worth Living.

Reevaluating Cue Exposure and Response Prevention in a Pilot Study: An Updated Treatment for Binge Eating Disorder

Approximately half of individuals with binge eating disorder (BED) fail to improve when treated with cognitive behavioral therapy; thus, better treatments are needed. Cue exposure and response prevention (CERP) may be one option, but its full potential for reducing binge eating remains unknown because prior applications for binge eating have not utilized the broad range of strategies believed to optimize exposure therapy. The current single-subject AB design investigated the acceptability and effectiveness of a comprehensive CERP treatment among 8 women who met DSM-5 criteria for binge eating disorder. Changes in the number of binges were measured from baseline to the end of treatment, and desire to eat, salivation, and idiographic expectancies of aversive outcomes to food-cue exposure (idiographic CS-US expectancies), including expectancies about ability to tolerate distress when exposed to food cues were measured across the course of treatment. Statistical analysis revealed a significant reduction in the number of binges from baseline to the end of treatment. Across the course of treatment, desire to eat and idiographic CS-US expectancies reduced, and distress tolerance expectancies increased. No participants dropped out and all reported being maximally satisfied with the treatment. Based on these findings, future randomized-control trials with larger samples should examine the efficacy of CERP and mechanisms underlying change with the aim of establishing a more effective treatment for binge eating disorder.

Are the Criterion B binge-eating symptoms interchangeable in understanding binge-eating severity? An item response theory analysis

OBJECTIVE

The Criterion B binge-eating symptoms represent five symptoms associated with binge eating. Any three out of five symptoms can be used to meet Criterion B. However, Criterion B symptoms may not be interchangeable in terms of how binge-eating severity is associated with each symptom. Item response theory (IRT) can test how endorsing each symptom relates to the overall level (i.e., severity) of binge-eating measured by Criterion B. We used IRT to identify (a) how each Criterion B symptom corresponded with binge-eating severity in a transdiagnostic binge-eating sample and (b) how well each symptom differentiated individuals with differing levels of severity.

METHOD

Participants (N = 219) were adults (80.8% female) with a current ED that included objective binge-eating episodes assessed via semi-structured interview. A two-parameter logistic IRT model evaluated how endorsement of each Criterion B symptom corresponded with the level of latent binge-eating severity.

RESULTS

"Eating large amounts when not hungry" and "eating alone" reflected the highest binge-eating severity. "Eating alone" was the best discriminator across different binge-eating severity levels, whereas "uncomfortably full" was the poorest discriminator across binge-eating severity levels.

DISCUSSION

Criterion B symptoms were not interchangeable in terms of what level of binge-eating severity corresponded with symptom endorsement. "Eating large amounts when not hungry" or "eating alone" may signify elevated binge-eating severity, whereas "uncomfortably full" and "feeling disgusted/depressed/guilty" were not necessarily indicative of elevated severity. Results suggested that Criterion B may need to be revised to eliminate symptoms that are redundant with other binge-eating diagnostic criteria.

Predictors of treatment response durability in psychotherapy for binge-eating disorder: Examining the roles of self-discrepancy, self-directed style, and emotion dysregulation

OBJECTIVE

To examine changes in hypothesized maintenance mechanisms during treatment as predictors of treatment response durability in binge-eating disorder (BED) treatment, using data from a randomized clinical trial comparing the efficacy of Integrative Cognitive-Affective Therapy for BED with cognitive-behavioral therapy delivered using guided self-help.

METHOD

Adults with BED (N = 112) received 17 weeks of treatment. Regression models were conducted to examine the extent to which changes in hypothesized maintenance mechanisms from baseline to end of treatment predicted treatment outcomes at 6-month follow-up, adjusting for demographics, study site, and baseline level of treatment outcome.

RESULTS

During-treatment reductions in negative self-directed style and emotion dysregulation predicted reductions in the primary treatment outcome (i.e., binge-eating episode frequency) at follow-up. During-treatment reductions in emotion dysregulation also predicted improvements at follow-up across all three secondary treatment outcomes examined (i.e., global eating disorder [ED] psychopathology, depressive symptoms, and anxiety symptoms), as did during-treatment reductions in actual-ideal self-discrepancy and actual-ought self-discrepancy. Increases in positive self-directed style (e.g., self-affirmation) and reductions in negative self-directed style (e.g., self-blame) during treatment each predicted improvements in anxiety symptoms at follow-up. When predictors were examined simultaneously, the most salient predictors of treatment response durability identified were negative self-directed style for binge-eating episode frequency, actual-ought self-discrepancy and emotion dysregulation for depressive symptoms, and emotion dysregulation for anxiety symptoms. No predictors emerged as most salient for global ED psychopathology.

DISCUSSION

Results indicate that negative self-directed style and emotion dysregulation are particularly important treatment targets in relation to behavioral treatment outcomes in BED.

Beliefs about binge eating: The psychometric properties of the Persian version of the eating beliefs questionnaire

Background

Metacognitive beliefs play an essential role in the maintenance of binge eating behavior. Examining the psychometric properties of tools in societies with different cultures than western societies can help with examining the external validity of those tools. This research aimed at standardization and validation of the Eating Beliefs Questionnaire (EBQ-18) in Iran.

Materials and Methods

Persian version of the EBQ-18 was produced through forward translation, reconciliation, and back translation. A total of 302 non-WEIRD nonclinical students were selected through convenience sampling method and completed a set of questionnaires, including the EBQ-18, Eating Attitude Test-16 (EAT-16), Difficulties in Emotion Regulation Scale-16 (DERS-16), Weight Efficacy Lifestyle Questionnaire-Short Form (SF), self-esteem scale, and self-compassion scale (SCS) short-form. The construct validity of the EBQ-18 was assessed using confirmatory factor analysis and divergent and convergent validity. Internal consistency and test-retest reliability (2 weeks' interval) were used to evaluate the reliability. Data analysis was performed using LISREL (version 8.8) and SSPS (version 22) softwares.

Results

EBQ-18 and subscales were found to be valid and reliable measures, with high test-retest reliability and good internal consistency in the nonclinical sample. Cronbrash's Alpha coefficient, for the whole of scale, negative beliefs scale, Permissive Beliefs scale, and Positive Beliefs scale were gained. 96.,89.,90, and. 94 respectively. Intraclass correlations coefficient, for the whole of scale, negative beliefs scale, Permissive Beliefs scale, and Positive Beliefs scale were gained. 84.,78.,75, and. 87, respectively. In terms of convergent validity, EBQ-18 and subscales showed a significant positive correlation with selfreport measures of EAT-16 and DERS-16 (P < 0.01). EBQ-18 and subscales showed a negative correlation with self-compassion, self-esteem, and eating self-efficacy, thus demonstrated divergent validity with these constructs (P < 0.01). The results showed that three factors of negative beliefs, positive beliefs, and permissive beliefs had the goodness of fit indices (root mean square error of approximation = 0.08, normed fit index = 0.97, nonnormed fit index = 0.98, comparative fit index = 0.98, and standardized root mean square residual = 0.04). The results of this study support the EBQ-18 three-factor model.

Conclusion

These findings indicate that the EBQ-18 is a reliable measure of eating beliefs in the Iranian population. In addition, the study supplements the literature on the cross-cultural validity of this measure.

Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences

The pharmacological treatment of patients with an eating disorder (ED) often includes medications to treat their ED, comorbid mental health problems, malnutrition and the physical health problems resulting from it. The currently approved pharmacological treatment options for EDs are limited to fluoxetine for bulimia nervosa (BN) and - in some countries - lisdexamfetamine for binge eating disorder (BED). Thus, there are no approved pharmacological options for anorexia nervosa (AN), even though study results for olanzapine and dronabinol are promising. Topiramate might be an additional future option for the treatment of BN and BED. Selective serotonin reuptake inhibitors (SSRI), mirtazapine and bupropion could be considered for the treatment of comorbid unipolar depression. However, AN and BN are contraindications for bupropion. For ED patients with a manic episode, we recommend olanzapine in AN and risperidone in BN and BED; whereas for bipolar depression, olanzapine (plus fluoxetine) seems appropriate in AN and lamotrigine in BN and BED. Acute anxiety or suicidality may warrant benzodiazepine treatment with lorazepam. Proton-pump inhibitors, gastroprokinetic drugs, laxatives and hormones can alleviate certain physical health problems caused by EDs. Therapeutic drug monitoring, pharmacogenomic testing, a more restrictive use of "pro re nata" (PRN) medication, an interdisciplinary treatment approach, shared decision making (SDM) and the formulation of common treatment goals by the patients, their family or carers and clinicians could improve treatment success and safety. Novel genetic, immunological, microbiome and brain imaging research as well as new pharmacological developments like the use of psychedelics, stimulants, novel monoaminergic drugs, hormone analogues and drugs which enhance the effects of psychotherapy may extend our therapeutic options in the near future.

Somatic symptoms and binge eating in women's daily lives

OBJECTIVE

The present study aimed to determine whether the momentary severity of women's somatic symptoms was concurrently and prospectively associated with their engagement in binge eating in naturalistic settings.

METHOD

Thirty women (M_age = 34.13, SD = 13.92) who had engaged in binge eating at least once over the month prior to study entry completed a 14-day ecological momentary assessment (EMA) protocol. During each of the 14 days, participants received five semi-random surveys via text message that assessed momentary somatic symptom severity (i.e., headaches, stomachaches/pain, chest/heart pain, faintness/dizziness, shortness of breath, fatigue) and disordered eating behaviors. Generalized estimating equations were used to determine whether momentary somatic symptoms were concurrently and prospectively (i.e., by participants' next assessment) associated with the occurrence of binge eating behavior, while controlling for age and body mass index.

RESULTS

At the within-person level, more severe stomachaches/pain, faintness/dizziness, shortness of breath, and fatigue were concurrently associated with an increased likelihood of engaging in binge eating. Further, at the between-person level, more severe stomachaches/pain, chest/heart pain, shortness of breath, and fatigue in general were associated with binge eating across the EMA protocol. Momentary stomachache/pain severity also prospectively predicted women's engagement in binge eating behavior at the next assessment.

CONCLUSIONS

The present results provide initial evidence that multiple somatic symptoms may serve as momentary correlates or proximal antecedents of binge eating behavior in women's daily lives. Somatic symptoms may consequently prove useful to target in eating disorder treatments, perhaps via interoceptive exposure interventions.

Eating behavior and metabolic syndrome over time

PURPOSE

We evaluated the longitudinal associations between eating behaviors (EB) and risk of metabolic syndrome (MetS).

METHODS

We obtained complete data on EB, assessed using the Dutch Eating Behavior Questionnaire, and MetS components at baseline and follow-up. Participants included 1876 individuals (704 men, 1172 women; mean age, 45.0 ± 12.8 years) from those participating in the Korean Healthy Twin study. A generalized estimating equation model was applied, with sociodemographic factors, health-related factors, follow-up interval, and EB (baseline and changes over time) as independent factors.

RESULTS

MetS at baseline was 21.5%, while incident MetS and persistent MetS were 12.0% and 66.6%, respectively, at the 3.13 ± 1.38 years follow-up period. In men, baseline restrained EB had positive associations with concurrent MetS (odds ratio [95% confidence interval] per 1 point increase in the score, 1.55 [1.33-1.81]) and persistent MetS (1.53 [1.16-2.01]); baseline external EB and change in external EB had positive associations with persistent MetS (1.56 [1.04-2.33], 1.37 [1.01-2.22], respectively). In women, baseline restrained EB had a positive association with concurrent MetS (1.14 [1.01-1.30]); baseline external EB had an inverse association with persistent MetS (0.71[0.52-0.98]); baseline emotional EB had positive associations with concurrent, incident, and persistent MetS (1.23 [1.01-1.50], 2.14 [1.50-3.06], and 1.92 [1.40-2.64], respectively); and change in emotional EB had positive associations with incident and persistent MetS (1.50 [1.05-2.15], 1.62 [1.14-2.29], respectively).

CONCLUSION

Higher restrained and external EB, and an increase in external EB in men; and higher restrained and emotional EB, and an increase in emotional EB in women may be associated with increased risk of concurrent, incident, or persistent MetS.

LEVEL OF EVIDENCE

III, cohort study.

The role of negative urgency in risky alcohol drinking and binge-eating in United Kingdom male and female students

Identifying students at risk of developing binge-eating and alcohol use disorders is a priority in the United Kingdom (UK). Although relationships between negative urgency (impulsive behavior during times of negative emotion), risky drinking, and binge-eating have been established in students from other countries, these links have yet to be replicated in male and female UK students. UK students aged 18-30 (n = 155) completed the: (1) the Urgency, Pre-meditation, Perseverance, Sensation Seeking (UPPS-P) negative urgency subscale; (2) Alcohol Use Disorders Identification Test (AUDIT); and (3) Binge-Eating Scale (BES). For categorical analysis, participants were assigned to one of four groups as a function of AUDIT and BES clinical cut-off scores: (1) no risk (28%); (2) risky drinkers (47%); (3) binge-eaters (6%); and (4) risky drinkers + binge-eaters (19%). For dimensional analysis, across students with non-zero AUDIT and BES scores (n = 141), BES, AUDIT, gender, and their interactions were entered as predictors in the same block of a regression. UPPS-P negative urgency was the dependent variable. Categorical results indicated that binge-eaters with and without risky drinking endorsed significantly higher negative urgency than students with no risk. Dimensional results showed that although higher BES and AUDIT scores were positively linked to higher negative urgency, but only the BES was significantly associated. Furthermore, BES shared substantially more variance with negative urgency than the AUDIT, and the BES-negative urgency relationship was stronger in male students than female students. High risk students may benefit the most from interventions that help regulate negative emotion.

Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.