Binge eating disorder revisited: what's new, what's different, what's next

A systematic review and meta-analysis of loss-of-control eating in relation to cardiometabolic health components and inflammatory markers

INTRODUCTION

Loss-of-control (LOC) eating, or the subjective experience of being unable to stop eating, is a hallmark feature of binge-eating episodes, which are also characterized by consuming an unusually large amount of food. However, regardless of the size of eating episode, LOC-eating may be a risk factor for adverse health outcomes. This systematic review and meta-analysis comprehensively examine the relationship of LOC-eating with cardiometabolic health components and inflammatory markers.

METHODS

Search procedures were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines in six electronic databases. Studies of adult or youth samples published in English from the year 2000 onward were included. Given heterogeneity in age groups and adjustment for body mass index across studies, these factors were included as meta-regression moderators.

RESULTS

Fifty-eight studies were identified through the literature search. Among individuals with (versus without) LOC-eating, relative risk ratios provided evidence of a greater relative risk for metabolic syndrome, hypertension, and dyslipidemia; standardized mean differences also provided evidence of higher waist circumference and impaired levels of fasting plasma glucose, high-density lipoprotein (HDL)-cholesterol, and triglycerides, but not blood pressure. Age group did not impact cardiometabolic health components. Body mass index differences moderated the effect on waist circumference. A narrative review of inflammatory markers revealed mixed findings linking inflammatory markers to LOC-eating.

DISCUSSION

Overall, evidence for the relationship between LOC-eating and impaired cardiometabolic health underscores LOC-eating as an important early intervention target for prevention of serious adverse health outcomes.

Validation and Psychometric Properties of the Chinese Version of the Binge Eating Scale in Young Adults

Background

Although structured clinical interviews are considered the gold standard for assessing binge eating disorder (BED), the self-administered Binge Eating Scale (BES) has been widely used as a screening tool for BED in clinical research. However, the psychometric properties of the BES among Chinese young adults remain unclear. This study aimed to examine the validity of a Chinese version of the BES with a large sample.

Methods

A total of 2182 young adult college students were tested using the Simplified Chinese version of BES (SCBES), the 7-Item Binge-Eating Disorder Screener (BEDS-7), the Zung Self-Rating Depression Scale (SDS), the Generalized Anxiety Disorder Scale (GAD-7), and the Dual-Modes of Self-Control Scale (DMSC). The frequency of objective binge-eating episodes was used as a measure of severity. Validity and reliability of the SCBES were assessed through multiple analyses, along with the item analysis.

Results

The data revealed that the SCBES demonstrated reasonable reliability and validity. The Cronbach's α value was 0.813, with a one-month test-retest reliability of 0.835. The exploratory factor analysis (EFA) extracted three first-order factors, which explained a total of 53.82% of the variance. The confirmatory factor analysis (CFA) confirmed the three-factor model (ie, Binge-eating behaviors, Lack of control, Negative affects related to overeating), with a good model fit. The SCBES also demonstrated excellent concurrent and criterion validity, significantly correlating with the BEDS-7 and frequency of objective binge-eating episodes (r=0.760-0.782, p<0.001). Gender, body mass index, depression, anxiety, impulsivity, and self-control were significantly associated with the total score of SCBES.

Conclusion

The SCBES demonstrated sound psychometric properties and exhibited good cross-cultural adaptability in Chinese young adults, with a novel three-factor model fitting the data best. This scale could serve as a useful screening tool for identifying the severity of binge eating behaviors among Chinese youths.

Onset patterns and clinical features of binge-eating disorder in a Japanese clinical sample

OBJECTIVE

This study aimed to investigate the clinical presentation of binge-eating disorder (BED) in a Japanese sample and to examine the relationship between subtypes of BED differing in onset patterns and those differing in prior history of another eating disorder (ED).

METHODS

The study participants were 137 adults who met the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for BED. We subtyped participants based on prior history of another ED: 55 (40.1%) participants with a history of another ED (BED ED+) and 82 participants without such a history (BED ED-).

RESULTS

Unlike in some Western studies, approximately three quarters of participants had a body mass index of <25 kg/m2 . None of the participants reported a history of another ED with purging or excessive exercise. All BED ED+ participants transitioned to BED from anorexia nervosa restricting type (AN-R) or from atypical AN-R. BED ED+ participants reported more severe psychopathology than BED ED-participants. Only 20% had a treatment history for BED. Dieting preceded their first binge eating in 55 participants (DIET-first BED), and binge eating preceded their first dieting in 82 participants (BINGE-first BED). Regarding the relationship between the two different subtypes, all DIET-first BED participants were in the BED ED+ group, whereas all BINGE-first BED participants were in the BED ED-group.

DISCUSSION

Present findings revealed the clinical presentation of BED in a Japan-based study and suggested that subtypes of BED differing in the prior history of another ED yielded an accurate prediction of onset patterns (dieting first vs. binge eating first).

PUBLIC SIGNIFICANCE

This study highlights the need for clinicians to consider subtype differences in onset patterns and clinical features of BED to treat and prevent this disorder. This study revealed that, although individuals with BED in Japan have severe symptoms and a long duration of illness, only 20% have received BED treatment. The results indicate a need to disseminate knowledge about BED to the Japanese public and healthcare providers.

Binge-eating disorder

ABSTRACT

Binge-eating disorder (BED) has the highest prevalence of any eating disorder in the US today. However, the condition is frequently not recognized as an eating disorder by healthcare providers or patients. Patients with this diagnosis often have significant psychiatric and medical comorbidities that might respond to evidence-based treatments. NPs in primary care with awareness of the diagnostic criteria for BED and knowledge of its assessment and treatment options can coordinate care for patients experiencing this health challenge.

Online multidisciplinary treatment of binge eating disorder in people with high weight: a case series study

BACKGROUND

Binge eating disorder (BED) is the most frequent eating behavior among the general population (Guerdjikova in Med Clin 103:669-680, 2019). Many studies on interventions and BED treatments have been carried out in the United States and Europe, few have been reported in Latin American populations. People with this disorder not only have physical consequences of it but also social and psychological ones, therefore a multidisciplinary treatment approach is a good option to treat this condition.

OBJECTIVE

To evaluate the feasibility of a multidisciplinary online intervention (i.e., psychological, nutritional, and physical activity) in patients with BED.

METHOD

The design was a case series study of two clinical treatment groups, with pre-test and post-test psychometric measures along with two follow-ups (at 2 and 6 months). Fifteen people diagnosed with BED (2 men and 13 women), with a mean age of 34.93 years (SD=11.91) and a mean initial BMI of 42, participated in this study. The treatment was carried out over the span of 28 sessions, each one being two hours per week consisting of 1 hour of group therapy and 1 hour of individual therapy. There were four evaluations: pre, post and two follow-ups.

RESULTS

Five patients did not complete the treatment (30%). The comparisons were made through the non-parametric Friedman test, finding a statistically significant decrease in binge eating symptoms (x2=15.57; p=.001), anxiety symptoms (x2=15.96; p=.001) and depression (x2=15.03; p=.002). There was an improvement in clarity (x2=11.60; p=.010) and emotional regulation (x2=7.75; p=.050), only in women. The patients reduced their body weight, and improved their eating and exercise habits by introducing fruits and vegetables and including 20-30 minutes of physical activity into their daily routine. Regarding the Objective Clinical Change Index, in terms of the objective clinical change, a positive change was observed in all the variables addressed.

CONCLUSIONS

The data presented allowed us to conclude that the online multidisciplinary intervention was effective in the treatment of BED. Trial registration Retrospectively registered.

The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions

Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.

Development, validation and clinical use of the Eating Behaviors Assessment for Obesity (EBA-O)

INTRODUCTION

Obesity is a major health problem with an increasing risk of mortality, associated with comorbidities and high rates of dropout. Research demonstrated that pathological eating behaviors could help to phenotype obese patients thus tailoring clinical interventions. Therefore, our aim was to develop (study 1), validate (study 2), and test in a clinical setting (study 3) the Eating Behaviors Assessment for Obesity (EBA-O).

METHOD

Study 1 included the exploratory factor analysis (EFA) and McDonald's ω in a general population sample (N = 471). Study 2 foresaw the confirmatory factor analysis (CFA) and convergent validity in 169 participants with obesity. Study 3 tested the capability of the EBA-O to characterize eating behaviors in a clinical sample of 74 patients with obesity.

RESULTS

Study 1. EFA identified five factors (i.e., food addiction, night eating, binge eating, sweet eating, and prandial hyperphagia), explaining 68.3% of the variance. The final EBA-O consisted of 18 items. McDonald's ω ranged between 0.80 (hyperphagia) and 0.92 (binge eating), indicating very good reliability.

STUDY 2

A second-order five-factor model, through CFA, showed adequate fit: relative chi-square (χ²/df) = 1.95, CFI = 0.93, TLI = 0.92, RMSEA = 0.075, and SRMR = 0.06, thus suggesting the appropriateness of the EBA-O model. Significant correlations with psychopathological questionnaires demonstrated the convergent validity. Study 3. Significant associations between EBA-O factors and emotional-related eating behaviors emerged.

CONCLUSION

The EBA-O demonstrated to be a reliable and easy-to-use clinical tool to identify pathological eating behaviors in obesity, particularly useful for non-experts in eating disorders.

LEVEL OF EVIDENCE

Level V, descriptive research.

Neurobiological Mechanisms Modulating Emotionality, Cognition and Reward-Related Behaviour in High-Fat Diet-Fed Rodents

Affective and substance-use disorders are associated with overweight and obesity-related complications, which are often due to the overconsumption of palatable food. Both high-fat diets (HFDs) and psychostimulant drugs modulate the neuro-circuitry regulating emotional processing and metabolic functions. However, it is not known how they interact at the behavioural level, and whether they lead to overlapping changes in neurobiological endpoints. In this literature review, we describe the impact of HFDs on emotionality, cognition, and reward-related behaviour in rodents. We also outline the effects of HFD on brain metabolism and plasticity involving mitochondria. Moreover, the possible overlap of the neurobiological mechanisms produced by HFDs and psychostimulants is discussed. Our in-depth analysis of published results revealed that HFDs have a clear impact on behaviour and underlying brain processes, which are largely dependent on the developmental period. However, apart from the studies investigating maternal exposure to HFDs, most of the published results involve only male rodents. Future research should also examine the biological impact of HFDs in female rodents. Further knowledge about the molecular mechanisms linking stress and obesity is a crucial requirement of translational research and using rodent models can significantly advance the important search for risk-related biomarkers and the development of clinical intervention strategies.

Binge eating disorder

Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018-2020 is estimated to be 0.6-1.8% in adult women and 0.3-0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics.

Decreased putamen activation in balancing goal-directed and habitual behavior in binge eating disorder

Acute stress is associated with a shift from goal-directed to habitual behavior. This stress-induced preference for habitual behavior has been suggested as a potential mechanism by which binge eating disorder (BED) patients succumb to eating large amounts of high-caloric foods in an uncontrolled manner (i.e., binge episodes). While in healthy subjects the balance between goal-directed and habitual behavior is subserved by the anterior cingulate cortex (ACC), insular cortex, orbitofrontal cortex (OFC), anterior caudate nucleus, and posterior putamen, the brain mechanism that underlies this (possibly amplified) stress-induced behavioral shift in BED patients is currently unknown. In the current study, 76 participants (38 BED, 38 healthy controls (HCs)) learned six stimulus-response-outcome associations in a well-established instrumental learning task. Subsequently, three outcomes were selectively devalued, after which participants underwent either a stress induction procedure (Maastricht Acute Stress Test; MAST) or a no-stress control procedure. Next, the balance between goal-directed and habitual behavior was assessed during functional magnetic resonance imaging. Findings show that the balance between goal-directed and habitual behavior was associated with activity in the ACC, insula, and OFC in no-stress HCs. Although stress and BED did not modulate the balance between goal-directed and habitual behavior, BED participants displayed a smaller difference in putamen activation between trials probing goal-directed and habitual behavior compared with HCs when using a ROI approach. We conclude that putamen activity differences between BED and HC could reflect changes in monitoring of response accuracy or reward value, albeit perhaps not sufficiently to induce a measurable shift from goal-directed to habitual behavior. Future research could clarify potential boundary conditions of stress-induced shifts in instrumental behavior in BED patients.

The prevalence of mental health outcomes among eating disorder patients during the COVID-19 pandemic: A meta-analysis

Background & aims

Patients with eating disorders (ED) are known to suffer from various psychological morbidities thus they are expected to be negatively impacted due to the COVID-19 pandemic. Our meta-analysis aims to evaluate the effect of the COVID-19 pandemic on the pooled prevalence of psychological comorbidities in ED patients.

Methods

Pubmed, Scopus, GoogleScholar, and medRxiv were searched using the keywords COVID19 and Eating Disorders and their related MeSH terms. The articles were included if they contained patients with diagnosed EDs and having evaluated their mental health disturbances during the COVID-19 pandemic. The quality of the included studies was assessed using the “assessing risk of bias in prevalence studies” tool. The heterogeneity was assessed using Cochrane Q and I2 heterogeneity statistics.

Results

A total of 13 articles have been included in this meta-analysis with a sample size of 3056. The pooled prevalence of ED patients who experienced worsening of ED symptoms was 57% (95%CI: 36%–76%), anxiety was 64% (95%CI: 39%–78%), and depression was 55% (95%CI: 12%–87%) during the pandemic.

Conclusions

This meta-analysis provides evidence supporting an increase in the pooled prevalence of mental health disorders among patients suffering from EDs during the COVID-19 pandemic.

Efficacy of a Group Psychoeducation Treatment in Binge Eating Disorder: An Open-Label Study

AIMS

To evaluate the effectiveness of a multidisciplinary group psychoeducation treatment (GPT) in patients with Binge Eating Disorder (BED).

METHODS

We designed an open-label efficacy study that included a population of 45 patients diagnosed with BED. A measure of eating attitudes and associated psychological constructs was obtained through the use of the self-report instruments Eating Disorder Inventory (EDI-3), Binge Eating Scale (BES) and Body Uneasiness Test (BUT). The Symptom Checklist-90 (SCL-90) was also administered to assess general psychopathology. All participants participated in 12 weekly group psychoeducational treatment meetings, 8 of which were conducted by mental health professionals, and a second module of 4 meetings, oriented on health and nutrition education topics, conducted by a dietician.

RESULTS

At the end of treatment, patients showed significant improvements in body mass index (BMI) and binge eating. Paired t-tests showed significant differences at p-value < 0.05 in all eating disorder risk scales and for most of the general psychological scales related to eating disorders. In addition, patients experienced an improvement in their perception of overall body image, a decrease in concerns about physical appearance and less body image avoidance. Finally, results showed that psychoeducation treatment was associated with significant improvements in interpersonal sensitivity.

CONCLUSIONS

The results of this study may indicate that significant short-term improvements can be achieved through a psychoeducation group for BED patients. Although limited by the lack of a control condition, this study adds to a growing body of evidence with promising results, setting the stage for further case-control studies of BED treatment.

Lisdexamfetamine and binge-eating disorder: A systematic review and meta-analysis of the preclinical and clinical data with a focus on mechanism of drug action in treating the disorder

Binge-Eating Disorder (BED) is the most common eating disorder in the United States. Lisdexamfetamine (LDX) was approved in 2015 by the FDA for treatment of BED and is the only drug approved for treating the disorder. There has been no systematic evaluation of the published clinical and preclinical evidence for efficacy of LDX in treating BED and the mechanisms responsible for the therapeutic action of the drug. To address this gap, we conducted a systematic review and meta-analysis using PRISMA guidelines. Fourteen clinical and seven preclinical articles were included. There is consistent evidence from clinical studies that LDX is an effective treatment for BED and that the drug reduces the BED symptoms and body weight of patients with the disorder. There is also consistent evidence from preclinical studies that LDX reduces food intake but no consistent evidence for a preferential reduction of palatable food consumption by the drug in rodents. The evidence on mechanism of action is more limited and suggests LDX may reduce binge eating by a combination of effects on appetite/satiety, reward, and cognitive processes, including attention and impulsivity/inhibition, that are mediated by catecholamine and serotonin mechanisms in the brain. There is an urgent need for adequately powered, placebo-controlled, behavioural and neuroimaging studies with LDX (recruiting patients and/or individuals with subclinical BED symptoms) to further investigate the mechanism of action of the drug in treating BED. An improved understanding of the behavioural and neurochemical mechanisms of action of LDX could lead to the development of improved drug therapies to treat BED.

General impulsivity in binge-eating disorder

BACKGROUND

The nature and significance of impulse-control difficulties in binge-eating disorder (BED) are uncertain. Most emerging research has focused on food-specific rather than general impulsivity. The current study examines the clinical presentation of patients with BED categorized with and without clinical levels of general impulsivity.

METHOD

A total of 343 consecutive treatment-seeking patients with BED were categorized as having BED with general impulsivity (GI+; N = 73) or BED without general impulsivity (GI-: N = 270) based on structured diagnostic and clinical interviews. The groups were compared on demographic, developmental, and psychological features, and on rates of psychiatric and personality comorbidity.

RESULTS

Individuals with BED and general impulsivity (GI+) reported greater severity of eating-disorder psychopathology, greater depressive symptoms, and greater rates of comorbidity than those without general impulsivity (GI-).

CONCLUSIONS

A subtype of individuals with BED and general impulsivity may signal a more severe presentation of BED characterized by heightened and broader psychopathology. Future work should investigate whether these impulse-control difficulties relate to treatment outcomes.

Interactive influences of food, contexts and neurocognitive systems on addictive eating

Compulsive eating is a common symptom of different conditions, including obesity, binge eating disorder and bulimia. One hypothesis is that contemporary food products promote compulsive eating via addiction-like mechanisms. However, what is the addictive substance in food, and what is the phenotypic overlap between obesity / eating disorders and addictions are questions that remain unresolved. In this review, we applied a multilevel framework of addiction, which encompasses the 'drug' (certain foods), the person's mindset, and the context, to improve understanding of compulsive eating. Specifically, we reviewed evidence on the addictive properties of specific foods, the neurocognitive systems that control dietary choices, and their interaction with physical, emotional and social contexts. We focused on different target groups to illustrate distinct aspects of the proposed framework: the impact of food and contextual factors were examined across a continuum, with most studies conducted on healthy participants and subclinical populations, whereas the review of neurocognitive aspects focused on clinical groups in which the alterations linked to addictive and compulsive eating are particularly visible. The reviewed evidence suggest that macronutrient composition and level of processing are associated with the addictive properties of food; there are overlapping neuroadaptations in reward and decision-making circuits across compulsive eating conditions; and there are physical and social contexts that fuel compulsive eating by exploiting reward mechanisms and their interaction with emotions. We conclude that a biopsychosocial model that integrates food, neurobiology and context can provide a better understanding of compulsive eating manifestations in a transdiagnostic framework.

Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review

BACKGROUND

An extensive amount of research has underlined the potential role of impulsivity in the development and maintenance of binge eating behaviour. Food-related impulsivity has particularly received attention given its close relationship with overeating and binge eating episodes. Besides the available evidence, our understanding regarding the effectiveness of treatment modalities for binge eating targeting impulsivity and related constructs (e.g., food craving, inhibitory control, and reward sensitivity) is limited. Thus, this systematic review aimed to investigate whether binge eating behaviour is changeable by interventions that are impulsivity-focused and food-related and whether one of these interventions is superior to the others.

METHOD

A search on PubMed and PsycINFO was performed for relevant articles published up to September 2020. Studies delivering food-related impulsivity treatment to individuals suffering from binge eating episodes and including a control condition without this treatment were investigated. Following the search, 15 studies meeting the eligibility criteria were analysed.

RESULTS

Analyses revealed that available impulsivity-focused approaches can be categorised as psychotherapy, pharmacotherapy, computer-assisted cognitive training, and direct neuromodulation interventions. Regarding their effectiveness, it appeared that all of these approaches might be promising to change food-related impulsivity in individuals with binge eating episodes, particularly to decrease binge eating symptoms. However, a superior intervention approach in this early state of evidence could not be determined, although food-related cue exposure, transcranial direct current stimulation, and the combination of several interventions seem fruitful.

CONCLUSION

Efforts to treat binge eating behaviour with interventions focusing on food-related impulsivity appear to be promising, particularly concerning binge eating frequency, and also for food craving and inhibitory control. Given limited research and varying methods, it was not possible to conclude whether one impulsivity-focused intervention can be considered superior to others.

Impact of High Fat Diet and Ethanol Consumption on Neurocircuitry Regulating Emotional Processing and Metabolic Function

The prevalence of psychiatry disorders such as anxiety and depression has steadily increased in recent years in the United States. This increased risk for anxiety and depression is associated with excess weight gain, which is often due to over-consumption of western diets that are typically high in fat, as well as with binge eating disorders, which often overlap with overweight and obesity outcomes. This finding suggests that diet, particularly diets high in fat, may have important consequences on the neurocircuitry regulating emotional processing as well as metabolic functions. Depression and anxiety disorders are also often comorbid with alcohol and substance use disorders. It is well-characterized that many of the neurocircuits that become dysregulated by overconsumption of high fat foods are also involved in drug and alcohol use disorders, suggesting overlapping central dysfunction may be involved. Emerging preclinical data suggest that high fat diets may be an important contributor to increased susceptibility of binge drug and ethanol intake in animal models, suggesting diet could be an important aspect in the etiology of substance use disorders. Neuroinflammation in pivotal brain regions modulating metabolic function, food intake, and binge-like behaviors, such as the hypothalamus, mesolimbic dopamine circuits, and amygdala, may be a critical link between diet, ethanol, metabolic dysfunction, and neuropsychiatric conditions. This brief review will provide an overview of behavioral and physiological changes elicited by both diets high in fat and ethanol consumption, as well as some of their potential effects on neurocircuitry regulating emotional processing and metabolic function.

Unexpectedly High Prevalence of Breakfast Skipping in Low Body-Weight Middle-Aged Men: Results of the Kanagawa Investigation of Total Checkup Data from the National Data Base-7 (KITCHEN-7)

Breakfast skipping (BS) has been considered to be associated with obesity, particularly among younger generations. However, few studies have addressed this issue in a middle-aged population considering sex and the conditions prior to breakfast. Therefore, we investigated clinical parameters, self-reported BS, late-night dinner (LND) eating, and late-night snacking (LNS) in ten body mass index (BMI) categories in a cross-sectional study of 892,578 non-diabetic people aged 40-74 years old who underwent a checkup. BS and LND were more prevalent in men (20.7% and 40.5%, respectively) than women (10.9% and 17.4%), whereas LNS was more prevalent in women (15.0%) than men (12.2%; all p < 0.0001). The overall prevalence of BS increased linearly with increasing BMI. However, when subjects were divided into men and women, the prevalence of BS showed a U-shaped relationship with BMI in men (n = 479,203). When male subjects were restricted to those in their 40s or those reporting LND, the prevalence of BS further increased, maintaining a U-shaped form. Logistic regression analysis also showed a U-shaped relationship in the adjusted odds ratios of BMI categories for BS in men and a J-shaped curve in women. In conclusion, our study revealed an unexpectedly high prevalence of BS in middle-aged low-body-weight men.

Binge Eating Disorder: A Psychiatrist's Commentary on Clinical Considerations

PURPOSE

Of the 3 major eating disorders, anorexia nervosa, bulimia nervosa, and binge eating disorder (BED), BED is the most common and exists in the practices of most primary care and psychiatric clinicians. However, BED often goes unrecognized and thus untreated.

METHODS

Reviewed in this commentary are the basic elements in the diagnosis of BED, demographic and clinical characteristics, screening options, the importance of comorbidities, pathophysiology, and available treatments.

FINDINGS

Psychological treatments, including cognitive-behavioral therapy, interpersonal therapy, and behavioral weight loss, have been recommended as first-line options and are supported by several different meta-analytic reviews. Lisdexamfetamine is currently the only medication approved by the US Food and Drug Administration for the treatment of BED. Effect sizes for lisdexamfetamine versus placebo for response, remission, and avoidance of relapse in BED are robust, but its use may be limited by tolerability. This is also the case for topiramate, an anticonvulsant that has been used "off-label" to treat BED.

IMPLICATIONS

Additional medication choices approved by the US Food and Drug Administration for the treatment of BED are needed. Moving forward, opportunities to leverage modern technology to broaden access to treatment are highly desirable.