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Binge Eating Disorder

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Binge Eating Disorder THE MOST COMMON CONDITION YOU'RE NOT DIAGNOSING: BINGE- EATING DISORDER Learning Objectives •Identify the presenting symptoms and risk factors for binge-eating disorder •Incorporate both psychotherapy and pharmacotherapy into the management of patients with binge-eating disorder Prevalence of Binge-Eating Disorder (BED) Most prevalent eating disorder, with lifetime prevalence of 0.85% More common in females than males (~3:1) Median age of onset is 21.1 years old Udo T, Grilo CM. Biol Psychiatry 2018;84(5):345-54. DSM History for Diagnosing BED 1980 1980s 1987 1994 2000-2004 2013 Binge behavior Concept of “Bulimia” was “Eating EDNOS was BED was was included as purging and replaced by Disorder Not the most recognized as a component of non-purging “Bulimia Otherwise common autonomous the DSM-III bulimia was Nervosa” in Specified” diagnosis for eating disorder diagnostic refined DSM-III-R; (EDNOS) was eating in DSM-5 criteria for criteria now the option for disorders; bulimia; criteria required both diagnosing diagnosis did not require binge eating BED in DSM-IV captured BED engaging in and primarily compensatory compensatory behaviors behaviors DSM=Diagnostic and Statistical Manual of Mental Disorders Citrome L. CNS Spectr 2015;20(Suppl 1):44-51. DSM-5 Binge-Eating Disorder Diagnostic Criteria Recurrent episodes of binge The binge-eating episodes are associated with 3 (or more) of eating. An episode is the following: characterized by both of the 1. Eating much more rapidly than normal following: 2. Eating until feeling uncomfortably full 1. Eating more than most people 3. Eating large amounts of food when not physically hungry A in a discrete period of time B 4. Eating alone because of feeling embarrassed by how much 2. A sense of lack of control one is eating overeating during the episode 5. Feeling disgust with self, depressed, or very guilty afterward Marked distress regarding binge The binge eating occurs, on average, at least once a week for 3 C eating is present D months The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in E bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa Mild: 1–3 weekly binge episodes (39.7%) Severe: 8–13 weekly binge episodes (10%) Moderate: 4–7 weekly binge episodes (47.4%) Extreme: >14 weekly binge episodes (3%) Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association; 2013; Grilo CM et al. Behav Res Ther 2015;71:110-4. Important Non-Diagnostic Features of BED •Overvaluation (i.e., undue importance to the point of defining self-worth) of body shape and weight •Reported by ~50% of BED patients •Associated with severity of eating pathology and psychological distress •Has negative prognostic significance •Obesity is common (36–56%) Kornstein SG. J Clin Psychiatry 2017;78(Suppl 1):3-8; Coffino JA et al. Obesity (Silver Spring) 2019;27(8):1367-71; Udo T, Grilo CM. Biol Psychiatry 2018;84(5):345-54; Hudson JI et al. Biol Psychiatry 2007;61(3):348-58; Kessler RC et al. Biol Psychiatry 2013;73(9):904-14. A Significant Public Health Concern •Frequently comorbid with psychiatric disorders •Increased risk of comorbid medical (i.e., metabolic) conditions •Lower quality of life and social functioning •Higher mortality rates •Elevated risk of suicide Kornstein SG et al. Prim Care Companion CNS Disord 2016;18(3):10.4088/PCC.15r01905; Perez M, Warren CS. Obesity (Silver Spring) 2012;20(4):879-85; Suokas JT et al. Psychiatry Res 2013;210(3):1101-6; Udo T et al. BMC Med 2019;17(1):120. Lifetime Psychiatric Comorbidities of BED 100 90 93.8% 80 69.9 ≥1 lifetime 70 67.7 59.0 comorbidity 60 56.0 50 40 31.6 30 Comorbidity (%) 20 2.3 Any Lifetime Psychiatric Mean total # 10 lifetime 0 comorbidities Mood Anxiety Posttraumatic Substance use Personality or disorders disorders stress disorder disorders conduct disorders Udo T, Grilo CM. Int J Eat Disord 2019;52(1):42-50. Medical Comorbidities of BED BED Somatic Comorbidities (Adjusted Odds Ratioa) Diabetes (1.59)* Hypertension (1.44)* High cholesterol (1.43)* High triglycerides (1.54)* a Adjusting for sociodemographic variables (age, The mean total number of chronic sex, race/ethnicity, educational level) and somatic conditions in BED (2.3 ± psychiatric comorbidities (any mood disorders, any substance use disorder, any personality/ 0.18) is greater than the number conduct disorders, and posttraumatic stress in controls with no specific eating disorder). *p<0.05. disorder (1.4 ± 0.02, p<0.05) Udo T, Grilo CM. Int J Eat Disord 2019;52(1):42-50. BED May Confer Risk of Metabolic Syndrome Over and Above Obesity Alone Individuals with BED also reported significantly higher 5-year incidence of dyslipidemia (hazard ratio [HR]=2.2) and ≥2 metabolic syndrome components (HR=2.4) than control individuals The 5-year incidences of hypertension and type 2 diabetes were not significantly different by group Findings from 134 overweight/obese adults with BED and 134 overweight/obese adults with no history of eating disorders interviewed at 2.5 and 5 years of follow-up. Analyses were adjusted for age, sex, baseline body mass index (BMI), and interval BMI change. Hudson JI et al. Am J Clin Nutr 2010;91(6):1568-73. Patients With BED Have Unfavorable Inflammatory Profile Over and Above Obesity Non-BED Obese BED Obese P-value adjusted for Mean (standard deviation) Mean (standard deviation) body mass index Glycated hemoglobin (%) 5.5 (0.6) 5.8 (0.7) 0.001 Uric acid (mg/dL) 5.3 (1.3) 11.1 (24.7) 0.05 Erythrocyte sedimentation 11.8 (10.6) 23.0 (13.3) <0.001 rate (mm/h) High-sensitive C-reactive 4.2 (4.9) 7.9 (7.3) <0.001 protein (mg/L) White blood cells (x103/µL) 6848.5 (1737.3) 7923.5 (2094.2) <0.001 Fasting insulin (µU/mL) 20.4 (11.4) 40.0 (53.0) 0.01 Homeostasis model 4.9 (3.1) 11.6 (22.7) 0.01 assessment index Visceral adiposity index 131.8 (89.1) 231.8 (164.9) 0.01 Results from a cross-sectional study of 115 white obese (body mass index > 30) patients (BED=30; non- BED=85) seeking weight reduction. Sucurro E et al. Medicine (Baltimore) 2015;94(52):e2098. Calorie and Macronutrient Consumption in BED With Obesity • Obese individuals with BED consume more calories than obese individuals without BED when asked to binge eat and when asked to eat a normal (i.e., non-binge) meal in the laboratory • Obese individuals with and without BED have comparable energy expenditure Macronutrient Intake During Laboratory Overeating Episode 1400 1200 *** 1000 * 800 BED Obese 600 Non-BED Obese 400 # *** p<0.001 200 ESTIMATED KCAL ESTIMATED * p<0.05 0 # Carbohydrates Fat Protein p=0.06 Bartholome LT et al. Eur J Nutr 2013;52(1):193-202; Raymond NC et al. Obesity (Silver Spring) 2012;20(4):765-72; Raymond NC et al. Int J Eat Disord 2007;40(1):67-71; Guss JL et al. Obes Res 2002;10(10):1021-9. BED Dysregulation in the Peripheral and Central Signals Controlling Feeding • BED patients who are lean or obese demonstrate dysfunction in the ghrelin signaling system • Larger gastric capacity in BED may further reduce satiety signals (i.e., leptin, CCK, GLP- 1, and PYY3-36) and contribute to overeating • Leptin, adiponectin, and insulin may also be dysregulated in BED αMSH=alpha-melanocyte stimulating hormone; AgRP: agouti gene-related peptide; CCK: cholecystokinin; GI: gastrointestinal; GLP: glucagon-like peptide; NPY: neuropeptide Y; POMC: pro-opiomelanocortin; PYY: peptide YY. Geliebter A et al. Am J Lifestyle Med 2008;2(4):305-14; Hellström PM et al. Br J Nutr 2004;92(Suppl 1):S47-57; Monteleone P et al. Psychoneuroendocrinology 2005;30(3):243-50; Khalil RB, Hachem C. Eat Weight Disord 2014;19(1):3-10; Ilyas A et al. Mol Cell Endocrinol 2019;497:110307. Identifying BED BED Risk Factors •Family history of BED •Childhood obesity •Familial eating problems •Parent with mood or substance use disorder •Trauma and stressful life events •Family discord, high parental demands or parental perfectionism, and parental separation Hudson IJ et al. Arch Gen Psychiatry 2006;63(3):313-9; Striegel-Moore RH et al. Int J Eat Disord 2005;37(1):11-8; Blomquist KK et al. Compr Psychiatry 2011;52(6):693-700; Pike KM et al. Psychiatry Res 2006;142(1):19-29; Degortes D et al. Eur Eat Disord Rev 2014;22(5):378-82. Recognition of BED •Perform clinical assessment • Ask about eating habits, not just appetite and weight •Use screening tools, especially for… • Patients who are reluctant to discuss eating habits • Overweight/obese patients seeking treatment for weight loss • Patients with mood or anxiety disorders • Patients with substance abuse or impulse-control issues Kornstein SG et al. Prim Care Companion CNS Disord 2016;18(3):10.4088/PCC.15r01905. Diagnostic Questions to Identify BED Do you think you eat more food than the average person your age? Do any other members of your family have eating problems? Have you felt like some of your eating has seemed out of control? Have you had any concerns about your eating behaviors or your relationship with food? Are there times when you eat in secret? Does your weight fluctuate? Do you eat more when you are stressed or anxious? Citrome L. J Clin Psychiatry 2017;78(Suppl 1):9-13; Kornstein SG et al. Prim Care Companion CNS Disord 2016;18(3):10.4088/PCC.15r01905.
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