Binge eating disorder and obesity

Binge eating disorder (BED) was included in the DSM IV as a proposed diagnostic category for further study and as an example for an eating disorder not otherwise specified (EDNOS). BED is characterized by recurrent episodes of binge eating in the absence of regular compensatory behavior such as vomiting or laxative abuse. Related features include eating until uncomfortably full, eating when not physically hungry, eating alone and feelings of depression or guilt. BED is associated with increased psychopathology including depression and personality disorders. Although BED is not limited to obese individuals, it is most common in this group and those who seek help do so for treatment of overweight rather than for binge eating. In community samples, the prevalence of BED has been found to be 2-5%, in individuals who seek weight control treatment the prevalence is 30%. BED is more equal in gender ratio than bulimia nervosa. Eating disorder treatments such as cognitive behavior therapy (CBT) or interpersonal psychotherapy (IPT) improve binge eating with abstinence rates of about 50%. Antidepressants are also effective in reducing binge eating, though less so than psychotherapy. Standard weight loss treatments including bariatric surgery do not seem to exacerbate binge eating problems. Thus, both eating disorder and obesity treatments seem to be beneficial in BED. However, it is recommended today that treatment should first be directed at the disordered eating and associated psychopathology.     

Changes in problematic and disordered eating after gastric bypass,adjustable gastric banding and vertical sleeve gastrectomy: a systematic review of pre‐post studies

Despite differences in their mechanisms and outcomes, little is known about whether postsurgical changes in eating behaviours also differ by bariatric procedure. Following a systematic search, 23 studies on changes in binge eating disorder (BED) and related behaviours, bulimia nervosa and related behaviours, night eating syndrome, grazing and emotional eating after Roux‐en‐Y gastric bypass (RYGB), adjustable gastric banding (AGB) and vertical sleeve gastrectomy (VSG) were reviewed. Significant methodological problems and a dearth of literature regarding many behaviours and VSG were seen. Regarding BED and related behaviours, although later re‐increases were noted, short to medium‐term reductions after RYGB were common, and reported changes after AGB were inconsistent. Short to medium‐term reductions in emotional eating, and from a few studies, short to long‐term reductions in bulimic symptoms, were reported after RYGB. Reoccurrences and new occurrences of problem and disordered eating, especially BED and binge episodes, were apparent after RYGB and AGB. Further conclusions and comparisons could not be made because of limited or low‐quality evidence. Long‐term comparison studies of changes to problematic and disordered eating in RYGB, AGB and VSG patients are needed. It is currently unclear whether any bariatric procedure leads to long‐term improvement of any problematic or disordered eating behaviours.     

Preoperative and post‐operative psychosocial interventions for bariatric surgery patients: A systematic review

Psychosocial interventions are increasingly being utilized to help patients prepare for, and adjust to changes following, bariatric surgery in order to optimize psychosocial adjustment and weight loss. The current systematic review examined the impact of preoperative and post‐operative psychosocial interventions with a behavioural and/or cognitive focus on weight, dietary behaviours, eating pathology, lifestyle behaviours, and psychological functioning. A PsycINFO and Medline search of publications was conducted in March 2019. Two authors assessed retrieved titles and abstracts to determine topic relevance and rated the quality of included studies using a validated checklist. Forty‐four articles (representing 36 studies) met the study inclusion criteria. The current evidence is strongest for the impact of psychosocial interventions, particularly cognitive behavioural therapy, on eating behaviours (eg, binge eating and emotional eating) and psychological functioning (eg, quality of life, depression, and anxiety). The evidence for the impact of psychosocial interventions on weight loss, dietary behaviours (eg, dietary intake), and lifestyle behaviours (eg, physical activity) is relatively weak and mixed. Psychosocial interventions can improve eating pathology and psychosocial functioning among bariatric patients, and the optimal time to initiate treatment appears to be early in the post‐operative period before significant problematic eating behaviours and weight regain occur.     

The association between emotions and eating behaviour in an obese population with binge eating disorder

There is utility in understanding the antecedents of binge eating (BE), with a view to explaining poorer weight loss treatment responses in this subgroup. A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines with the aim of exploring associations between emotions and eating behaviour in a population affected by obesity and binge eating disorder (BED). A comprehensive literature search of four electronic databases (2004–2014) yielded 15 studies for inclusion. Included studies performed poorly on data quality analysis with respect to controlling for confounding variables, and sample size. Included papers largely focused on negative emotions as antecedents of BE; depression was consistently associated with a BED‐obese classification and BE. Negative mood, sadness, tension and instability of emotions were found to be antecedents of BE in an adult BED‐obese sample. However, findings were mixed regarding the role of stress, anger and positive emotions within the BED‐obese population. Recommendations are presented for the identification of BED, and ecologically valid experimental designs that further understanding of the complex and varied emotions that associate with BE. The implications of these and other limitations for both researchers and practitioners are discussed. The paper concludes with recommendations for future research alongside suggestions for practitioners. © 2015 World Obesity     

Food addiction and bariatric surgery: a systematic review of the literature

Emerging research suggests that rates of food addiction are high among individuals seeking bariatric surgery, but little is known about associated features and the prognostic significance of pre‐operative food addiction. Thus, this article provides a systematic review and synthesis of the literature on food addiction and bariatric surgery. Articles were identified through PubMed and SCOPUS databases, resulting in a total of 19 studies which assessed food addiction among pre‐bariatric and/or post‐bariatric surgery patients using the Yale Food Addiction Scale. Most studies were cross‐sectional, and only two studies prospectively measured food addiction both pre‐operatively and post‐operatively. The presence of pre‐surgical food addiction was not associated with pre‐surgical weight or post‐surgical weight outcomes, yet pre‐surgical food addiction was related to broad levels of psychopathology. The relationship between food addiction and substance misuse among individuals undergoing bariatric surgery is mixed. In addition, very few studies have attempted to validate the construct of food addiction among bariatric surgery patients. Results should be interpreted with caution due to the methodological limitations and small sample sizes reported in most studies. Future rigorous research with larger and more diverse samples should prospectively examine the clinical utility and validity of the food addiction construct following bariatric surgery.     

Binge eating disorder: a review

Binge eating disorder (BED) is a new proposed eating disorder in the DSM-IV. BED is not a formal diagnosis within the DSM-IV, but in day-to-day clinical practice the diagnosis seems to be generally accepted. People with the BED-syndrome have binge eating episodes as do subjects with bulimia nervosa, but unlike the latter they do not engage in compensatory behaviours. Although the diagnosis BED was created with the obese in mind, obesity is not a criterion. This paper gives an overview of its epidemiology, characteristics, aetiology, criteria, course and treatment. BED seems to be highly prevalent among subjects seeking weight loss treatment (1.3-30.1%). Studies with compared BED, BN and obesity indicated that individuals with BED exhibit levels of psychopathology that fall somewhere between the high levels reported by individuals with BN and the low levels reported by obese individuals. Characteristics of BED seemed to bear a closer resemblance to those of BN than of those of obesity.A review of RCT's showed that presently cognitive behavioural treatment is the treatment of choice but interpersonal psychotherapy, self-help and SSRI's seem effective. The first aim of treatment should be the cessation of binge eating. Treatment of weight loss may be offered to those who are able to abstain from binge eating.     

Delay Discounting of Reward and Impulsivity in Eating Disorders: From Anorexia Nervosa to Binge Eating Disorder

Evidence points to eating disorder patients displaying altered rates of delay discounting (one's degree of preference for immediate rewards over larger delayed rewards). Anorexia nervosa (AN) patients are believed to have an increased capacity to delay reward, which reflects their ability to override the drive to eat. Contrarily, binge eating disorder (BED) patients are associated with a reduced predisposition to delay gratification. Here, we investigated monetary delay discounting and impulsivity in 80 adult women with EDs (56 AN and 24 BED), diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, and 80 healthy controls. AN‐restrictive (AN‐R) subtype patients showed less steep discounting rates than BED and AN‐bingeing/purging subtype patients. Compared with healthy controls and AN‐R patients, BED and AN‐bingeing/purging patients presented higher delay discounting and positive and negative urgency levels. Our findings suggest that restriction in AN‐R patients is associated with disproportionate self‐control, whereas bingeing behaviours could be more driven by emotional states and impulsivity traits. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Body Image Disturbance in Binge Eating Disorder: A Review

Binge eating disorder (BED) is characterized by frequent binge eating without compensatory behaviour and is thus often associated with obesity. Whereas for the eating disorders anorexia nervosa and bulimia nervosa, one of the main diagnostic features is a negative body image, the research criteria for BED do not include body image disturbance. Although several studies have been conducted on the occurrence of body image disturbance in BED, no review has yet summarized and integrated these findings. Therefore, the present paper reviews studies on the cognitive–affective, perceptual and behavioural components of body image. Many of the reviewed studies reveal that individuals with BED display a higher degree of weight and shape concerns than obese persons without BED. Concerning the perceptual component, no evidence exists to date that persons with and without BED differ in terms of the perception of their own body size. While many studies have examined the cognitive–affective body image component, research on the behavioural manifestations of body image disturbance is generally lacking. However, there is first evidence that persons with BED display an enhanced degree of body checking and avoidance. The results of this review indicate that body image disturbance seems to be a symptom of BED but which still requires further exploration. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Stressful Life Events and Binge Eating Disorder

Although there is evidence about the role played by stressful life events (SE) in the pathogenesis of eating disorders, few studies to date have explored this problem in binge eating disorder (BED). The aim of the present study was to examine SE preceding the onset of BED. A retrospective interview‐based design was used to compare 107 patients with BED and 107 patients with bulimia nervosa (BN), matched for duration of illness. Compared with patients with BN, those with BED reported a greater number of traumatic events in the 6 months preceding onset, revealing more often three types of events: bereavement, separation from a family member and accidents. The presence of SE before onset showed a dose–response relationship with the severity of psychopathology at the time of referral for treatment. Study of SE in patients with BED may be important for better understanding of the pathogenetic pathway to this disorder and to provide adequate treatment. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Correlates of Binge Eating Disorder in French Women

In the present study, patients seeking help for weight control with and without “Binge eating disorder” were compared to community non patients in terms of functional impairment and psychological problems. Subjects with BED self reported psychological difficulties, history of depression, treatment for emotional problems and alcohol abuse significantly more frequently than subjects without BED or subjects from the community. © 1997 John Wiley & Sons, Ltd and Eating Disorders Association.     

Physical activity and weight loss following bariatric surgery

Physical activity is a cornerstone in the medical management of obesity and could be important for weight loss following bariatric surgery. This review aims to describe the evolution of physical activity following massive weight loss induced by bariatric surgery, and to identify the relationship between physical activity and amount of weight loss. A literature search identified 20 publications (19 studies) reporting physical activity data in relation to bariatric surgery. All studies were observational. Self‐assessment of physical activity was used in all the studies. Objective measures (pedometry) were used in two studies. The time frame for physical activity assessment varied: before surgery in two publications, after surgery in nine, and longitudinal pre‐ to post‐operative evolution in nine. The latter nine publications found an increase in physical activity after bariatric surgery. In 10/13 studies where it was described, there was a positive relationship between physical activity level and amount of weight loss. In conclusion, observational evidence of self‐reported physical activity suggests that physical activity increases after bariatric surgery and that physical activity is associated with surgically induced weight loss. However, these findings warrant further evaluation using objective measures of physical activity and testing in controlled trials.     

Food‐related impulsivity in obesity and Binge Eating Disorder – a systematic review

Impulsivity towards food has been recognized as a potential factor leading to increased food intake in obesity. Patients suffering from binge eating disorder (BED) form a specific subgroup of obese people that might be characterized by increased impulsivity. These assumptions, although, have yet to be verified. Therefore, this review evaluates evidence for food‐related impulsivity in obese people with and without BED and examines possible differences between both populations. More precisely, evidence for the two components of impulsivity is analyzed separately: evidence for reward sensitivity, specifically, the urge for appetitive stimuli and evidence for rash‐spontaneous behaviour such as acting disinhibited with no regard for the consequences. Our search resulted in 51 articles demonstrating generally increased food‐related impulsivity. We found particular emphasis on increased reward sensitivity in obese people, which appeared to be more pronounced in people with BED. There was little and conflicting evidence, however, concerning increased rash‐spontaneous behaviour in obese people without BED, but consistent evidence of an increase in obese people with BED. All in all, the evidence supports the view that BED represents a specific phenotype of obesity with increased food‐related impulsivity. Taking these specific deficits into account can enhance the effectiveness of weight reduction programmes and psychotherapy.     

Classifying Adults with Binge Eating Disorder Based on Severity Levels

The clinical utility of the severity criterion for binge eating disorder (BED), introduced in the DSM‐5 as a means of addressing heterogeneity and variability in the severity of this disorder, was evaluated in 189 treatment‐seeking adults with (DSM‐5) BED. Participants classified with mild, moderate, severe and extreme severity of BED, based on their weekly frequency of binge eating episodes, differed significantly from each other in body mass index (BMI), eating disorder features, putative factors involved in the maintenance process of the disorder, comorbid mood, anxiety and personality disorders, psychological distress, social maladjustment and illness‐specific functional impairment (medium‐to‐large effect sizes). They were also statistically distinguishable in metabolic syndrome prevalence, even after adjusting for BMI (large effect size), suggesting the possibility of non‐BMI‐mediated mechanisms. The implications of the findings, providing support for the utility of the binge frequency as a severity criterion for BED, and directions for future research are outlined. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association     

Effects of Rumination and Acceptance on Body Dissatisfaction in Binge Eating Disorder

Overvaluation of shape and weight and the corresponding body dissatisfaction are a maintenance factor for the psychopathology of binge eating disorder (BED). Evidence suggests potential benefits of various emotion regulation (ER) strategies in the modification of body dissatisfaction. Therefore, in the present study body dissatisfaction was experimentally induced in women with BED (n = 30) using model pictures. Then, participants were instructed to either ruminate on present emotions and thoughts or accept whatever thoughts and feelings come up. Body dissatisfaction and mood were assessed prior to, immediately after and 4 minutes after the induction. Main results reveal that ER strategies had no differential impact on body dissatisfaction. However, in the rumination condition mood significantly worsened over time. Overall, the results suggest that ER strategies have a limited impact on the experience of body dissatisfaction in BED. However, having an impact on mood, they may be important with regard to the maintenance of pathological eating behaviour in BED. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Post‐operative behavioural management in bariatric surgery: a systematic review and meta‐analysis of randomized controlled trials

Recent research has provided evidence that bariatric surgery maximizes long‐term weight loss in patients with severe obesity. However, a substantial number of patients experience poor weight loss outcome and weight regain over time. Post‐operative behavioural management may facilitate long‐term weight control in bariatric surgery population. The objective of this systematic review and meta‐analysis was to determine the effects of post‐operative behavioural management on weight loss following bariatric surgery. Eligible articles were systematically searched in electronic databases. Among the 414 citations, five randomized controlled trials, two prospective and eight retrospective cohort trials analysing behavioural lifestyle interventions and support groups fulfilled the inclusion criteria. The main finding is that behavioural management had a positive effect on weight loss following surgery. In 13 studies, patients receiving behavioural management had greater weight loss than patients receiving usual care or no treatment. A meta‐analysis of five randomized controlled trials suggests greater weight loss in patients with behavioural lifestyle interventions compared with control groups. Post‐operative behavioural management has the potential to facilitate optimal weight loss following bariatric surgery, but conclusions were limited by the small and heterogeneous samples of studies. A more rigorous empirical evaluation on its clinical significance is warranted to improve effectiveness of bariatric surgery.     

Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings

This study examined racial differences in eating‐disorder psychopathology, eating/weight‐related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating‐disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Prevalence of Binge Eating Disorder in a Sample of College Students in the North of Portugal

Binge eating disorder (BED) has important associated comorbidities and has been recently considered as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. This study investigates the prevalence of BED in a sample of college students using a two‐stage design. Between October 2008 and July 2009, 805 students attending a public college campus completed the Questionnaire on Eating and Weight Patterns – Revised to screen for possible cases. Eighty‐five students meeting key criteria for BED were invited for a second stage interview using the Eating Disorder Examination. At stage 1, 9.6% of the subjects reported binge eating episodes. At stage 2, a prevalence rate of 0.5% for BED was found, and 1% if the criterion for large amount of food was excluded. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Skeletal effects of bariatric surgery: examining bone loss,potential mechanisms and clinical relevance

Bariatric surgery is the most effective therapeutic approach to morbid obesity, resulting in substantial weight loss and improved cardiometabolic profiles; however, a growing body of evidence suggests that bariatric procedures increase both skeletal fragility and the risk of related future fracture secondary to excessive bone loss. Prospective evidence shows that areal bone mineral density (BMD) assessed by dual energy X‐ray absorptiometry (DXA) declines by as much as 14% in the proximal femoral regions, including the femoral neck and total hip, 12 months postoperatively. Lumbar spine areal BMD outcomes show greater 12‐month postoperative variability across surgical procedures (?8 to +6%) and contrast with no change in volumetric BMD outcomes measured by quantitative computed tomography. Diminished mechanical loading, micronutrient deficiency and malabsorption, along with neurohormonal alterations, offer plausible underlying mechanisms to explain these observed post‐bariatric bone changes, but most remain largely unsubstantiated in this population. Importantly, DXA‐based skeletal imaging may have limited utility in accurately detecting bone change in people undergoing bariatric surgery; partly because excessive tissue overlying bone increases the variability of areal BMD outcomes. Moreover, a paucity of fracture and osteoporosis incidence data raises questions about whether marked post‐bariatric surgery bone loss is clinically relevant or a functional adaptation to skeletal unloading. Future studies that use technology which is able to accurately capture the site‐specific volumetric BMD and bone architectural changes that underpin bone strength in people undergoing bariatric surgery, that consider mechanical load, and that better quantify long‐term fracture and osteoporosis incidence are necessary to understand the actual skeletal effects of bariatric surgery.     

Content of Children's Loss of Control Eating Episodes Assessed by Self‐Report and Laboratory Test Meal

Pediatric loss of control (LOC) eating heightens risk for excessive weight gain and further disordered eating. Assessment of LOC typically involves self‐report interview or laboratory test meal, although no study has concurrently examined data from both methods. We gathered eating episode data via interview (Child Eating Disorder Examination; ChEDE) and a laboratory test meal, among 22 overweight girls (aged 7–12 years) reporting LOC eating. Children consumed more energy during ChEDE episodes, although ChEDE and test meal episodes did not differ in macronutrient content. Episodes' correlation for amount consumed (grams) did not reach significance, p = .076. In exploratory analyses among the seven children reporting LOC during the test meal, episodes were significantly correlated for grams consumed. Findings provide preliminary data to suggest that semi‐structured interviews accurately capture children's LOC episode quantity. Episodes did not qualitatively differ, although children reported consuming more energy during self‐reported episodes. Replication is warranted in larger studies. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.