Topiramate use in obese patients with binge eating disorder: an open study.

OBJECTIVE: To assess topiramate's efficacy and tolerability in a group of obese binge eaters with no neuropsychiatric comorbidity. METHOD: We consecutively selected 8 obese patients with binge eating disorder (BED) and no medical or psychiatric comorbidity from individuals seeking treatment for obesity. Treatment with topiramate at 150 mg daily was administered over a 16-week period. To assess outcome, we employed the days with binge episodes per week (DBE), the Binge Eating Scale (BES), the Beck Depression Inventory (BDI), and body weight evaluation. RESULTS: Of the 6 patients who completed the trial, all showed reduced binge eating. Four patients presented a total remission, and 2 had a marked reduction in binge eating frequency. The mean DBE decreased significantly from 4.3 to 1.1 (P = 0.03), as did the BES scores, which fell from 31.8 to 15.3 (P = 0.04). Moreover, there was a statistically significant weight loss (mean 4.1 kg, P = 0.04). The most frequent side effects were paresthesias, fatigue, and somnolence. CONCLUSION: Topiramate may be an effective and well-tolerated agent in the treatment of BED in obese patients.     

Validation de la version française de la Binge Eating Scale : étude de sa structure factorielle,de sa consistance interne et de sa validité de construit en population clinique et non clinique

ObjectiveThe Binge Eating Scale is a widely used scale to assess binge eating disorder in obese patients. Until now, this scale has not been validated on a French population, and no psychometrically sound tool assesses binge eating disorder in the French. This study aimed to test the psychometric properties of a French version of the Binge Eating Scale by establishing its factor structure, internal consistency, and construct validity in both a non-clinical population and a clinical population (obese patients who are candidates for bariatric surgery).MethodsA total of 553 non-clinical subjects and 63 morbidly obese patients who were candidates for bariatric surgery were assessed with the BES and the Bulimic Investigatory Test, Edinburgh or BITE (which assesses both binge eating behaviours and use of inappropriate compensatory behaviours). We tested the factor structure of the instrument, its internal consistency, its construct validity with measures of binge eating, and its construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In 47 out of the 63 obese patients, we assessed binge eating disorder (SCID).ResultsIn the non-clinical population, the BES had a one-factor structure (which accounted for 61% of the variance), excellent internal consistency (α = 0.93), and high construct validity with measures of binge eating. In this population, construct validity with measures of inappropriate compensatory behaviours was confirmed in overweight and obese subjects (P = 0.42), but not in underweight and optimal weight subjects (P < 0.001). In obese patients candidates for bariatric surgery, we demonstrated that the BES had a one-factor structure (which accounted for 46% of the variance), had high internal consistency (α = 0.88) and high construct validity with measures of binge eating and good construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In the subpopulation of 47 obese patients, sensitivity, specificity, positive predictive value and negative predictive value were respectively 75%, 88.4%, 37.5% and 97.4% (BES threshold = 18).DiscussionIn this study, we validated a psychometrically sound French version of the Binge Eating Scale, both in a non-clinical and a clinical sample. The psychometric properties of the French version of the BES are comparable to its original version with a one-factor structure. The BES is a useful tool to assess binge eating disorder in obese patients (e.g., bariatric surgery candidates), but might not differentiate between binge eating disorder and bulimia nervosa in underweight and optimal weight subjects.     

Characteristics of morbidly obese patients before gastric bypass surgery

The prevalence of binge eating disorder (BED) was assessed in a sample of 110 morbidly obese presurgery patients by means of self-report (Questionnaire on Eating and Weight Patterns [QEWP]). Subsequently, patients with (n = 19, 17.3%) and without BED (n = 91, 82.7%) were compared on several eating-related and general psychopathological instruments, as well as an obesity-specific health-related quality-of-life measure. Patients with BED exhibited higher scores than non-BED patients on most of the subscales of two questionnaires measuring eating behavior and attitudes towards eating, shape, and weight (Three Factor Eating Questionnaire [TFEQ], Eating Disorders Examination-questionnaire version [EDE-Q4]) with the exception of the respective restraint subscales. The two groups also differed significantly on the disease-specific quality-of-life measure (Impact of Quality of Life Questionnaire-Lite [IWQOL-Lite]). No differences were found for measures of severity of depressive symptoms (Inventory of Depressive Symptoms [IDS]) and impairment of self-esteem (Rosenberg Self-Esteem Questionnaire [RSE]). Our findings replicate the results of other studies comparing patients with and without BED in samples with different degrees of obesity and extend the results to an obesity-specific quality-of-life measure. Further research needs to investigate the short- and long-term impact of presurgery BED on surgery outcome, as well as the impact of surgery on binge eating and eating-related psychopathology.     

Binge eating disorder: prevalence and psychopathological features in a clinical sample of obese people in Italy

Binge eating disorder (BED) is a recently conceptualized eating disturbance, and its clinical features and prevalence are still a matter of debate. This study uses interview methodology to estimate the prevalence of BED in Italy in a sample of 66 obese people presenting for treatment, and examines potential related features typical of patients with anorexia and bulimia nervosa. The lifetime and the 6-month prevalences of BED were 18.1 and 12.1%, respectively. Breaking the group down on the basis of the current as well as lifetime presence of BED, we found that the weight and shape primary to self-esteem, and the interpersonal distress related to body image, were associated with lifetime BED (P<0.05). All-or-none thinking about food and dieting was typical of BED patients as a whole, either current (P<0.01) or remitted (P<0.05). We discuss two important findings from our study: (a) the key role of self-esteem depending upon weight and shape in discriminating the eating-disordered obese from non-eating-disordered individuals; and (b) the need to explore the whole lifespan when screening for BED, so pointing to the state-trait issue.     

Mood,eating attitudes,and anger in obese women with and without Binge Eating Disorder

Objective: The aim of this study was to evaluate the anger levels and their management in obese patients. Methods: A total of 103 obese women [51 with Binge Eating Disorder (BED) and 52 without BED] were included in the study and compared to 93 healthy controls. They were assessed with the State–Trait Anger Expression Inventory (STAXI), Beck Depression Inventory (BDI), and Eating Disorder Inventory-2 (EDI-2). Results: The BDI score is higher in obese subjects than in controls and obese binge eaters have higher levels of depression than obese patients without BED. Differences among the three groups can be found in almost all subscales of the EDI-2, even after controlling for the variable depression (BDI). For STAXI, the only difference among the three groups, which remains significant after controlling for depression, is the tendency to express anger outside (AX-OUT), which is higher in obese binge eaters. The correlation study highlights the importance of impulsivity in the group of obese binge eaters, whereas in obese patients without BED, the tendency toward anger suppression (AX-IN) is seen. Discussion: Obese patients with BED might be considered a subgroup deserving greater psychiatric interest, both for the greater severity of the eating disorder and for the comorbidity with subthreshold depressive symptoms and with borderline personality traits. In obese patients without BED, eating behavior seems more correlated to the psychological functioning typical of psychosomatic disorders. Implications for treatment are discussed.     

Bupropion Versus Sertraline in the Treatment of Depressive Patients with Binge Eating Disorder: Retrospective Cohort Study

This study sought to compare Bupropion versus Sertraline in the treatment of depressed patients with Binge Eating Disorder (BED) prescribed off-label. Medical records of outpatients with diagnosis of BED and Depression (DSM-IV-TR criteria) were selected: 15 patients were treated with bupropion 150 mg/per day, and 15 with sertraline 200 mg/per day. During the screening and control visits (2°-6°-14°-24° week), the selected patients were first weighed and then evaluated using the following questionnaires: Binge Eating Disorder-Clinical Interview (BEDCI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory X (STAI-X) and Arizona Sexual Experience Scale (ASEX). Both drugs reduced anxious-depressive symptoms and binge frequency: Bupropion showed a better effectiveness in reducing weight and improving sexual performances; weight loss related to it was proportional to the body mass index. Bupropion may be associated with more weight loss in BED, depressed patients than sertraline.     

New data on psychological traits and sleep profiles of patients affected by nocturnal eating

ObjectiveNocturnal eating behavior is shared by patients affected by a parasomnia, sleep-related eating disorder (SRED), and several eating disorders such as night eating syndrome (NES) and binge-eating disorder (BED); however, the differential clinical features of these patients have been poorly studied, with persisting difficulties in defining the borders between these pathologies. The aim of this study was to evaluate polysomnographic and personality characteristics of nocturnal eaters to further differentiate the syndromes.MethodsDuring a period of six months, consecutive patients complaining of nocturnal eating were asked to participate to the study. Twenty-four patients who were found to eat during the polysomnographic recording (PSG) study, and gender-matched control subjects were included. All subjects underwent a full-night video-PSG study and a psychometric assessment including the Eating Disorder Inventory (EDI-2), the self-rating Bulimic Investigatory Test–Edinburgh (BITE), the Temperament and Character Inventory (TCI), and the Barratt Impulsivity Scale (BIS).ResultsNocturnal eaters showed a mild reduction in sleep efficiency and duration due to a moderate sleep fragmentation, whereas the percentage of each sleep stage was not significantly affected. Nocturnal eaters scored higher at many subscales of the EDI-2, at the BITE symptoms subscale, and at the BIS attentional impulsivity subscale.ConclusionThe psychological characteristics found in our patients with NES seem to be typical for patients affected by eating disorders, and support the hypothesis that the nocturnal behavior of these individuals is due to an eating disorder; however, specific traits also allow differentiation of NES from BED.     

Comparison of patients with bulimia nervosa, obese patients with binge eating disorder, and nonobese patients with binge eating disorder

This study compared patients with bulimia nervosa (BN), obese patients with binge eating disorder (BED), and nonobese patients with BED. One hundred sixty-two adult women consecutively evaluated for outpatient clinical trials who met DSM-IV criteria for BN, purging type (N = 46) or for BED (N = 79 obese and N = 37 nonobese) were compared using the Eating Disorder Inventory (EDI). The three groups differed significantly on two (drive for thinness and body dissatisfaction) of the three eating-related scales and on all five of the general personality scales of the EDI. When age and depression level were controlled, findings for the eating-related scales did not change, whereas four of the five general personality scales were no longer significant. Post hoc analyses revealed that the BN group and the nonobese BED group had significantly higher drive for thinness than the obese BED group. The nonobese and the obese BED groups did not differ from each other in any area (other than drive for thinness), including body dissatisfaction. The nonobese and the obese BED groups had significantly lower maturity features than the BN group. Our findings suggest that when the effects of age and depression levels are controlled, treatment-seeking women with BN and BED are generally similar. Certain differences that do exist between women with BN and BED are associated with obesity status (drive for thinness), whereas others are associated with diagnosis (body dissatisfaction, maturity fears).     

Impact of binge eating disorder in the psychopathological profile of obese women

Objective

Our objective was to evaluate the psychopathological profile of obese women with binge eating disorder (BED) using the Symptom Checklist-90 (SCL-90).

Methods

Two hundred twelve obese women who seek for weight loss treatment were sequentially selected to participate in the study. Binge eating disorder was diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Binge eating disorder severity was assessed using Binge Eating Scale. Depressive symptoms were assessed using Beck Depression Inventory. The psychopathological profile was assessed using the SCL-90.

Results

Binge eating disorder was diagnosed in 54 patients (26.6%). Obese patients with BED presented significant higher scores in all domains of SCL-90 (P < .05 for all) in comparison with obese patients without BED. A significant relationship was found among Binge Eating Scale, Beck Depression Inventory, and all domains of the SCL-90 (P < .05 for all). After linear regression, obsessivity-compulsivity (P = .03), interpersonal sensitivity (P = .0064), paranoid ideas (P = .03), and psychoticism (P = .01) were independently related to the severity of BED.

Conclusion

Obese women with BED presented a more severe psychopathological profile than obese controls. Among all, obsessivity-compulsivity, interpersonal sensitivity, paranoid ideas, and psychoticism seem to be strongly linked to BED severity.     

Psychological and physical correlates of disordered eating in male and female Turkish college students

The aim of this study was to examine the relationship between disordered eating and three psychological variables (obsessive and depressive symptoms, self-esteem) and body mass index (BMI) in a sample of male and female college students in Turkey. Maudsley Obsessive-Compulsive Inventory (MOCI), Beck Depression Inventory (BDI), Rosenberg Self Esteem Scale (RSES), Eating Attitude Test (EAT), and Bulimic Investigatory Test, Edinburgh (BITE) scales were administered to 408 college students (279 women; 129 men). By multiple regression analysis, the scales of MOCI, BDI, RSES and BMI were used as potential predictors of EAT and BITE scores for each gender. Obsessionality and BMI were the strongest predictors of bulimic and anorexic symptoms in women. In men, while the strongest predictors of bulimic symptoms were the depressive and obsessive symptoms, the best predictor of anorexic symptoms was obsession scores. There were significant differences and some similarities between male and female Turkish college students.     

Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity

OBJECTIVE: To determine the levels of interoceptive awareness (IA), which measures the ability of an individual to discriminate between sensations and feelings, and between the sensations of hunger and satiety, in eating disorder patients and to identify the clinical, psychopathological and personal variables correlated with IA. SAMPLING AND METHODS: Sixty-one restrictor anorectics, 61 binge-purging anorectics, 104 purging bulimics, 49 obese subjects with binge eating disorder (BED) and 47 obese subjects without BED were compared. They were assessed with the Eating Disorder Inventory-2, the Temperament and Character Inventory, and the Beck Depression Inventory, and their clinical and sociodemographic features were recorded. RESULTS: In all patients, the levels of IA were higher than the 'normal' ones; in bulimia nervosa, they were higher than in anorexia nervosa and obesity. Similar personal features and eating attitudes are shared by patients with bulimia nervosa and BED. In the total sample, the following variables independently correlate with IA: the Beck Depression Inventory, self- directedness and persistence. CONCLUSIONS: The importance of an altered IA in eating disorders is supported. Both depression and a perfectionist and poorly self-directive personality can lead to greater difficulties in discriminating hunger and satiety.     

A randomized, double-blind, placebo-controlled study of sibutramine in the treatment of binge-eating disorder

BACKGROUND: Although antidepressants are the pharmacological agents most often studied in the treatment of binge-eating disorder (BED), preliminary evidence from an open trial suggests that the antiobesity agent sibutramine hydrochloride may be effective. The objective of this study was to evaluate the efficacy and tolerability of sibutramine in obese patients with BED. METHODS: After a 2-week run-in period, 60 obese outpatients (body mass index [calculated as weight in kilograms divided by the square of height in meters] 30-45), who met DSM-IV criteria for BED were randomly assigned to receive sibutramine hydrochloride (n = 30), 15 mg/d, or placebo (n = 30) in a 12-week double-blind study at 2 centers. The primary outcome measure was binge frequency, expressed as the number of days with binge-eating episodes during the past week. Secondary outcome measures included Binge Eating Scale, Beck Depression Inventory scores, weight, and treatment responder status (remission and response). For each efficacy outcome, an intent-to-treat analysis was performed using random regression methods. RESULTS: There was a significant reduction in the number of days with binge episodes in the sibutramine group compared with the placebo group (t203 = 2.14; P =.03); this was associated with an important and significant weight loss (-7.4 kg) compared with a small weight gain in the placebo group (1.4 kg) (t147 = 4.88; P<.001). Sibutramine was also associated with a significantly greater rate of reduction in Binge Eating Scale (t202 = 3.64; P<.001) and Beck Depression Inventory (t201 = 3.72; P<.001) scores. Dry mouth (P =.01) and constipation (P<.001) were more common adverse reactions with sibutramine than placebo. CONCLUSIONS: Sibutramine is effective and well tolerated in the treatment of obese patients with BED. Its effects address 3 main domains of the BED syndrome, ie, binge eating, weight, and related depressive symptoms.     

Binge eating disorder: a need for additional diagnostic criteria

This study compares the core and associated features of binge eating disorder (BED) and bulimia nervosa (BN). One hundred twenty-nine adult females who were obese with BED (n = 51) or non-obese with BED (n = 32) or who had BN (n = 46) were compared using the Eating Disorder Examination-Questionnaire (EDE-Q). The BED groups were older and had a higher body mass index (BMI). The 3 groups were similar in binge frequency, but BN subjects (by definition) purged regularly. The groups differed by dietary restraint, even after controlling for BMI and age, such that the BN group had significantly higher dietary restraint than both BED groups. Cognitively, the 3 groups were similar in the intensity of dysfunctional attitudes regarding eating, weight, and shape. The BMI and age were not associated with these dysfunctional attitudes. Our findings suggest the importance of and the need to consider cognitive--as well as behavioral--diagnostic criteria for BED.     

Eating disorders and insulin-dependent diabetes mellitus (IDDM): relationships with glycaemic control and somatic complications

This study was designed to assess (by means of a diagnostic interview based on DSM-III-R criteria) the prevalence of eating disorders in 69 insulin-dependent diabetic (IDDM) out-patients, and the relationship with somatic risks. We found no cases of anorexia nervosa or bulimia nervosa, current or lifetime, in male patients with IDDM. No female patients with IDDM had anorexia, and 4.8% had current and lifetime bulimia. Eating disorders not otherwise specified (bulimic type) were significantly more frequent in women than in men (lifetime incidence 43% vs. 21%; current incidence 33% vs. 5%), and generally occurred after the onset of IDDM. Self-reports of bulimic behaviours according to the Bulimic Investigatory Test of Edinburgh (BITE) were associated with high levels of glycosylated haemoglobin. There was no association between eating disorders (current or lifetime), with somatic complications being more likely to be explained by a long duration of illness and impaired glycaemic control.     

Temperament and character in obese women with and without binge eating disorder

Obesity is a serious disorder and its treatment involves dietitians, psychologists, and psychiatrists, often with a poor outcome. The role of psychiatric issues in obesity is equivocal, and so is the fact whether emotional and behavioral disturbances are causes or consequences of an individual's overweight condition. We performed a study that included 120 obese women (59 with binge eating disorder [BED] and 61 with non-BED) according to specific selection criteria, and compared to 80 healthy controls. Body mass index (BMI) was calculated for all patients and they were assessed with the Temperament and Character Inventory (TCI). Despite the fact that obese patients with BED and without BED display a similar personality profile, those with BED show lower scores in Self-Directedness (SD). Both groups of obese patients differ from nonobese controls in Novelty Seeking (NS), Harm Avoidance (HA), Cooperativeness (C), and SD. SD seems to be the strongest predictor for the development of BED. The idea that two distinct groups of obese patients exist is supported. Moreover, as regards personality, a lower SD and a higher risk of Personality Disorders were found in obese BED patients. Different severities of overweight do not seem to relate to a specific personality susceptibility.     

Body dissatisfaction and socio-cultural factors in women with and without BED: Their relation with eating psychopathology

The goal of the present study was to assess the role of body dissatisfaction and socio-cultural factors on eating psychopathology in women with Binge Eating Disorder (BED) and women without BED. Seventy obese women consecutively evaluated participated: 35 with BED and 35 without BED who attended for the first time in a weight loss program. All participants completed a battery of questionnaires, including: Body Shape Questionnaire, Questionnaire of Influences on the Aesthetic Body Shape Model, Questionnaire on Eating and Weight Patterns, Three Factor Eating Questionnaire, and they were interviewed with the Interview for the Diagnosis of Eating Disorder-IV. The Body Mass Index, Waist-to-Hip Ratio and Body Fat were calculated. The results showed that 21% of obese women who participated in a weight reduction program met BED criteria. The scores of body dissatisfaction, influences of socio-cultural factors and eating psychopathology were higher in women with BED compared with women without BED. In the same way, significantly stronger correlations were found among influences of socio-cultural factors, specifically, influence of advertisement, social relations and eating psychopathology in women with BED than women without BED. It is concluded that the high body dissatisfaction as well as stronger associations among influence of socio-cultural factors and eating psychopathology could play an important role in women with BED.     

Binge eating, weight gain and psychosocial adjustment in patients with bipolar disorder

Binge Eating (BE) is a common eating pattern in patients with Bipolar Disorder (BD). BE may confer an increased risk for obesity, morbidity, mortality and poorer quality of life. We assessed the presence of BE and its impact on body weight, body image and self-esteem in 50 patients with BD and 50 age- and gender-matched controls. The presence and severity of BE was assessed with the Binge Eating Scale (BES). The Body Image and Self-Esteem Evaluation Scale (B-WISE) was used to assess the psychosocial impact of weight gain. Body Mass Index (BMI) was calculated. Nine (18%) patients had a score > 27, indicating a likely diagnosis of BE. None of the control subjects had a BES score > 17. No association between BES score and the medications was found. Patients had a significantly higher BES score, significantly higher BMI, waist circumference and fasting blood glucose. Although the B-Wise score was higher in the controls, the difference was not statistically significant. This study suggests that BE is prevalent in patients with BD. The presence of BE eating is a predictor of higher BMI, indicating that the disruption of eating behavior may be a pathway to weight gain.     

Correlates and impact of DSM-5 binge eating disorder,bulimia nervosa and recurrent binge eating: a representative population survey in a middle-income country

Purpose

Binge eating disorder (BED), bulimia nervosa (BN) and recurrent binge eating (RBE) are binge eating spectrum conditions causing a significant impact in individual’s health and functioning. Information regarding those conditions came mostly from high-income countries. The objective of this study was to assess the prevalence of DSM-5 BED, BN and RBE and correlates in a representative sample from a metropolitan area of a middle-income country.

Methods

The data were obtained from a cross-sectional population-based household survey in two stages in Rio de Janeiro, Brazil. Noninstitutionalized residents aged 18–60 years were assessed by lay interviewers using the Questionnaire of Eating and Weight Patterns-5 (QEWP-5). Positive cases and a paired sample screen-negative cases were reassessed by phone with the Eating Disorders Section of SCID-I-P (adapted for DSM-5). The data were collected from September 2019 to February 2020.

Results

Overall, 2297 individuals were interviewed. Prevalence of BED was 1.4%, BN 0.7%, RBE 6.2%. Psychiatric comorbidities, such as depression, anxiety and ADHD were significantly more prevalent in people with BED, BN and RBE than in people without these eating problems. Several medical conditions, when controlling for body mass index, were significantly more prevalent in people with BED, BN and RBE. People with BED and BN had marked impairments in work/school, social and family life, reduced mental and physical HRQoL and under half had sought treatment.

Conclusion

As in high income countries, in Rio de Janeiro, Brazil, BED, BN and RBE are prevalent conditions and are associated with elevated BMI, functional impairment, psychiatric and medical comorbidity and poorer HRQoL.

     

A randomized, double-blind trial comparing sertraline and fluoxetine 6-month treatment in obese patients with Binge Eating Disorder

Previous studies support the use of selective serotonin reuptake inhibitors (SSRIs), in overweight patients with Binge Eating Disorder (BED), but results are far from conclusive. Sertraline has been studied less extensively, and there have been a few studies concerning SSRIs that report follow-up data at more than 12 weeks of follow-up. The present study assesses the effectiveness of sertraline and fluoxetine over a period of 24 weeks in obese patients with BED (DSM-IV-TR). Forty-two obese outpatients were randomized and assigned to one of two different drug treatments: 22 were treated with sertraline (dose range: 100-200 mg/day) and 20 with fluoxetine (dose range: 40-80 mg/day). Subjects were assessed at baseline and at 8, 12, and 24 weeks of treatment for binge frequency, weight loss, and severity of psychopathology. No significant differences were found between the two treatments. After 8 weeks of treatment a significant improvement in the Binge Eating Scale score and a significant weight loss emerged. These results were maintained by responders (weigh loss of at least 5% of baseline weight) over 24 weeks. The results suggest that a 6-month treatment with SSRI may be an effective option to treat patients with BED.