The development of hunger and fullness during a laboratory meal in patients with binge eating disorder

OBJECTIVE: This study aimed to test the hypothesis that, compared to similarly obese participants without BED, individuals with BED have a disturbance in the development of fullness and reduction of hunger during the course of a standard meal of large size. METHOD: Thirteen patients with BED and 14 obese control participants consumed 975 g of a milkshake. Participants received no information about how much they had eaten or how much of the meal remained to be consumed. Participants were interrupted after every 75 g consumed to rate hunger and fullness. RESULTS: Final fullness ratings were higher in patients with BED, but there were no differences in mean duration or mean rate of eating, or in changes in subjective ratings of hunger and fullness per gram of food. DISCUSSION: The current study reports the surprising finding of no difference in reports of hunger and fullness between patients with BED and obese controls.     

A comparison of energy intake and food selection during laboratory binge eating episodes in obese women with and without a binge eating disorder diagnosis

OBJECTIVE: The purpose of the study was to compare energy intake and food selection of laboratory binge eating episodes in obese women with and without binge eating disorder (BED). METHOD: Twenty women, 12 meeting BED criteria, and 8 BMI and age matched obese controls, engaged in a laboratory binge eating episode. RESULTS: BED participants consumed significantly more total food in kilocalories than the non-BED obese group and more kilocalories of fat. However, there were no differences between the groups in the proportion of calories from any macronutrient. There was a nonsignificant trend for the BED group to consume more total grams of food. During the binge, the BED group consumed more dairy products. CONCLUSION: Results of the study confirmed that women with BED consumed significantly more total food in kilocalories than the non-BED obese women when they were allowed to have a binge eating episode in a laboratory setting.     

Binge eating and satiety in bulimia nervosa and binge eating disorder: effects of macronutrient intake

OBJECTIVE: The current study tested the hypothesis that supplemental dietary protein would reduce binge eating frequency and test meal intake in women with bulimia nervosa (BN) or binge eating disorder (BED). METHOD: Eighteen women with BN or BED ingested high-carbohydrate or high-protein supplements (280 kcal) three times daily over two 2-week periods. On the morning after each period, participants were given a high-protein or high-carbohydrate supplement (420 kcal) 3 hr before an ad libitum meal. RESULTS: Binge eating episodes occurred less frequently during protein supplementation (1.12 episodes per week) than during carbohydrate supplementation (2.94 episodes per week) or baseline (3.01 episodes per week). Participants reported less hunger and greater fullness, and consumed less food at test meals, after protein than after carbohydrate (673 vs. 856 kcal). DISCUSSION: Adding protein to the diets of women with BN and BED reduced food intake and binge eating over a 2-week period. These findings may have implications for the longer-term treatment of these disorders.     

Food presentation and energy intake in a feeding laboratory study of subjects with binge eating disorder.

OBJECTIVE: The purpose of this study was to examine the influence of the number of foods presented and the amount of food presented on overeating or binge eating behavior in obese subjects with and without binge eating disorder (BED). METHOD: Ten subjects (5 BED, 5 non-BED), male and female, aged 18-65, participated. Their body weight was > or =130% of their ideal body weight (IBW). They were evaluated in a feeding laboratory setting on four occasions when they were presented with (a) either one or two binge foods presented in (b) either two or four times the amount of their self-reported usual intake during a binge/overeating episode. Measurement included energy intake and self-recorded measures of hunger, fullness, anxiety, and depression. RESULTS: The results indicated that the number and amount of food presented influenced significantly the amount of food consumed. Although subjects with BED tended to eat more than the non-BED obese, the differences did not reach statistical significance. DISCUSSION: The results have implications for the interpretation of results obtained in feeding laboratory settings, suggesting that attention needs to be given to both the number and amount of foods presented because both variables have an impact on the amount of food eaten during overeating or binge eating episodes.     

Validity of test meals for determining binge eating

Assessment of binge eating has been criticized because of serious doubts concerning the accuracy of self-report. This experiment tested the validity of a laboratory test meal as an indicator of binge eating. Eight individuals diagnosed with binge-eating disorder (BED), eight obese non-binge-eaters, and eight normal-weight non-binge-eaters ate a test meal under conditions designed to increase the likelihood of inducing a binge episode. Non-binge-eaters, regardless of weight, felt in control of their eating and ate a relatively small amount of the test meal, while participants with BED ate significantly more food and felt significantly more out of control. Eating behavior during test meals can be a useful indicator of BED diagnostic status and may be a useful method for objectively defining binge eating.     

Binge size increases with body mass index in women with binge-eating disorder

OBJECTIVE: To determine whether meal size is related to body mass index (BMI) in obese subjects with binge-eating disorder (BED). RESEARCH METHODS AND PROCEDURES: Five groups of subjects each consumed two laboratory-test meals on nonconsecutive days. Forty-two women, categorized by BMI and BED diagnosis, were instructed to "binge" during one meal and to eat "normally" during another. Eighteen women had BMI values >38 kg/m(2) (more-obese) and 17 had BMI values between 28 to 32 kg/m(2) (less-obese). Twelve of the more-obese and nine of the less-obese individuals met Diagnostic and Statistical Manual (DSM)-IV criteria for BED. Seven normal-weight women also participated as controls. RESULTS: Subjects with BED ate significantly more in both meals than subjects without BED. Binge meals were significantly larger than normal meals only among subjects with BED. The more-obese subjects with BED ate significantly more than the less-obese subjects with BED, but only when they were asked to binge. Intake of the binge meal was significantly, positively correlated with BMI among subjects with BED. Subjects with BED reported significantly higher satiety ratings after the binge than after the normal meal, but subjects without BED reported similar ratings after both meals. Regardless of instructions and diagnosis, obese subjects consumed a significantly higher percentage of energy from fat (38.5%) than did normal-weight subjects (30.8%). DISCUSSION: During binge meals, the energy intake of subjects with BED is greater than that of individuals of similar body weight without BED and is positively correlated with BMI.     

Test meal intake in obese binge eaters in relation to mood and gender

OBJECTIVE: We assessed test meal intake in men and women with and without binge eating disorder (BED) in relation to mood score (Zung scale). METHODS: Eighty-five overweight subjects (24 males and 61 females) participated; 30 subjects with BED and 55 without BED. Following an 8-hr fast, subjects consumed a liquid test meal until extremely full. RESULTS: BED subjects consumed significantly more (p =.009) of the test meal (1,032 g +/- 429) than the non-binge eaters (737 g +/- 399). The men ingested more than the women (p =.002). BED subjects also had higher depression scores (p =.01), without differing by gender. However, depression scores were unrelated to test meal intakes (r = -.01). DISCUSSION: The larger meal intakes of the BED group may be due to the larger stomach capacity previously found in both bulimics and obese subjects. The findings also support the premise that BED, listed in the DSM-IV appendix for further study, is found in a distinct subgroup of overweight individuals.     

Detailed analysis of binges in obese women with binge eating disorder: Comparisons using multiple methods of data collection

OBJECTIVE: This study compares multiple methods of assessing food intake in obese women with binge eating disorder (BED). METHOD: Twelve women meeting BED criteria completed six random 24-hour dietary recalls, engaged in a laboratory binge eating episode, and completed the EDE interview. RESULTS: There was not a significant difference in total or macronutrient intake when binge eating episodes were assessed via the recall and laboratory methods. However, within-individual correlations were low for the size of different binge eating episodes collected by the two methods. Significantly more calories were consumed during objective than during subjective binges, and significant differences in macronutrient composition were observed. Meal patterning data collected by the EDE and the recalls were comparable. CONCLUSION: The findings suggest only moderate agreement between the methods that were examined. Future investigations with larger sample sizes are needed to examine the relationship among these different methods of assessing food intake.     

Circulating levels of neuroactive steroids in patients with binge eating disorder: a comparison with nonobese healthy controls and non-binge eating obese subjects

OBJECTIVES: Increased plasma levels of allopregnenolone (3alpha,5alpha-tetrahydroprogesterone [3alpha,5alpha-THP]), dehydroepiandrosterone (DHEA), and DHEA sulphate (DHEA-S) have been reported in patients with anorexia nervosa or bulimia nervosa. To assess whether those changes are related to malnutrition, we investigated plasma levels of neuroactive steroids in women with binge eating disorder (BED) who compulsively binge as bulimic patients, but do not incur malnutrition. METHODS: Sixty-eight women participated in the study (31 nonobese healthy controls, 9 nonobese patients with BED, 16 obese patients with BED, and 12 obese non-binge eating women). Blood samples were collected in the morning for determination of plasma levels of 3alpha,5alpha-THP, DHEA, DHEA-S, and cortisol. RESULTS: Nonobese BED women had significantly higher plasma levels of DHEA, DHEA-S, and 3alpha,5alpha-THP than nonobese healthy women. Similarly, obese individuals with BED exhibited significantly higher neurosteroid plasma levels than non-binge eating obese subjects. No significant differences in plasma cortisol levels were observed among the groups. DISCUSSION: This study shows increased plasma levels of neuroactive steroids in BED patients. These findings could have been influenced by methodologic limitations (e.g., the absence of diurnal sampling). However, they suggest that if malnutrition is involved in the determination of increased plasma levels of neuroactive steroids in people with anorexia or bulimia nervosa, then different factors may induce similar effects in people with BED. Alternatively, common unknown factors could be responsible for neurosteroid changes in anorexia nervosa, bulimia nervosa, and BED.     

The diagnostic validity of the criteria for binge eating disorder

OBJECTIVE: This paper considers whether the criteria currently used to classify the diagnosis of binge eating disorder (BED) are valid and appropriate. METHOD: We review evidence that reflects on the validity of the current criteria for binge eating episodes and BED, using literature retrieved through major psychology and psychiatry search engines (e.g., PsycInfo, PubMed). RESULTS: Evidence from experimental research points to the relative importance of episode frequency, the amount of food consumed at episodes, the subjective sense of loss of control over eating, and several additional criteria associated with binge episodes in BED. Evidence on the differences in psychopathology between BED and bulimia nervosa and between BED and obesity without binge eating, as related to diagnostic criteria, is reviewed. CONCLUSION: Although evidence concerning the diagnostic criteria of BED is mixed, broadening certain diagnostic criteria for binge eating episodes and BED might more accurately reflect the research literature and increase the number of individuals eligible for inclusion in treatment programs.     

Behavioral assessment of satiety in bulimia nervosa

The abnormalities in eating behavior associated with bulimia nervosa suggest that patients with this illness may have a disturbance in satiety. The present study employed a six-meal protocol to assess satiety in both binge and non-binge eating episodes in women with bulimia nervosa and normal controls by examining whether an increase in the size of a soup preload led to a decrease in the amount of food consumed in a subsequent test meal. In control subjects, the increase in preload size was associated with an increase in fullness and a reduction in consumption of the non-binge test meal. Patients did not report consistent changes in ratings of hunger and fullness in response to the change in preload size, and few patients were able to complete the non-binge meals and refrain from vomiting afterwards. When instructed to binge eat, patients ate considerably more than control subjects, but patients did significantly reduce their intake of the test meal after the large compared to the small preload. These findings demonstrate that, although patients with bulimia nervosa exhibit abnormalities in the development of satiety, some mechanisms responsible for the control of food intake are functional during binge eating episodes.     

A comparison of quality of life in obese individuals with and without binge eating disorder

OBJECTIVE: This study investigates whether binge eating disorder (BED) in obese individuals is associated with a greater degree of impairment in quality of life (QOL) than obesity alone. METHOD: Treatment-seeking obese individuals with and without BED were compared on QOL scores using the Impact of Weight on Quality of Life (IWQOL-Lite) questionnaire. RESULTS: With the exception of the Physical Function subscale, obese individuals with BED scored significantly higher than non-BED participants on each of the subscales and on the total scale of the IWQOL-Lite. For all participants, body mass index (BMI) was related significantly to scores on the Physical Function and Public Distress subscales of the IWQOL-Lite. DISCUSSION: Obese individuals with BED have impaired functioning on psychosocial aspects of QOL in addition to poorer physical functioning associated with obesity. These findings underscore the pervasive impact of BED in obese individuals, as BED is associated with more impairment than obesity alone.     

Cravings and food consumption in binge eating disorder

The purpose of this study was to extend existing work that examines the role of cravings in Binge Eating Disorder (BED). The current study uses a case–control design to establish a relationship between cravings and food exposure, and between cravings and food consumption in individuals diagnosed with BED. Twenty-nine females with BED, 40 obese controls, and 50 normal-weight controls were first presented with a neutral cue and completed a food-craving measure. They were then presented with their favourite snack food and completed the craving measure again, after which they were allowed to consume the food. The BED group had significantly higher scores for pre- and post-craving measures, and consumed more food compared to the controls. There was, however, no significant interaction between group and craving scores. Results also showed a positive correlation between food consumption and cravings scores both before and after food exposure for individuals with BED. The findings suggest that the level of cravings prior to food exposure may be sufficient to predict overeating in BED and that treatment may want to target this as a defining feature that differentiates individuals with BED from those who do not binge eat.     

Effect of a very low calorie diet on the diagnostic category of individuals with binge eating disorder

OBJECTIVE: This study examined the factors associated with the diagnostic outcome of obese individuals with and without binge eating disorder (BED) 1 year after completing a very low calorie diet (VLCD) program. METHOD: Participants included 63 individuals with BED, 36 individuals with subthreshold BED, and 29 individuals with no binge eating symptoms. Diagnoses before and after VLCD were obtained using the Structured Clinical Interview for DSM-IV (SCID) interviews. The severity of psychiatric symptoms were assessed using various rating scales. RESULTS: Fifty-six percent (n = 36) of the participants who met criteria for BED at baseline did not meet diagnostic criteria 1 year later. None of the baseline factors were statistically associated with outcome. DISCUSSION: Although the main hypothesis was not supported, absence of a BED diagnosis at 12-month follow-up after a VLCD diet appears to be associated with less weight gain at 1-year follow-up regardless of baseline diagnosis.     

Test meal intake in obese binge eaters in relation to impulsivity and compulsivity

OBJECTIVE: Studies have linked increased impulsivity and compulsivity with bulimia nervosa (BN). Less is known about this relationship in binge eating disorder (BED). METHOD: Seventy-nine overweight participants (28 male, 65 females) were classified as BED (n = 22), BE (Subthreshold BED, not meeting full criteria for BED) (n = 21), and non-BED (n = 36). Following an 8-hr fast, participants completed psychological scales to assess impulsivity, compulsivity, and depression. They then consumed a liquid test meal until extremely full. RESULTS: Test meal intake (TMI) was significantly greater for both BED and BE than non-BED participants. Impulsivity and depression scores were significantly higher in BED and BE than in non-BED participants. Men had significantly higher compulsivity scores than women. Impulsivity correlated significantly with TMI, accounting for 16% of the variance. CONCLUSION: There was greater impulsivity in BED and BE, compared with non-BED. Moreover, impulsivity was the best predictor of TMI, and may play a larger role in BE than previously realized.     

Plasma ghrelin concentrations are lower in binge-eating disorder

Binge-eating disorder (BED), characterized by binge meals without purging afterward, is found in about 30% of obese individuals seeking treatment. The study objective was to ascertain abnormalities in hormones influencing appetite in BED, especially ghrelin, an appetite-stimulating peptide, which was expected to be elevated. Measurements were made of plasma insulin, leptin, glucagon, cholecystokinin, and ghrelin, as well as glucose following an overnight 12-h fast, prior to and after ingestion (from 0 to 5 min) of a nutritionally complete liquid meal (1254 kJ) at 0830 h, at -15, 0, 5, 15, 30, 60, 90, and 120 min. Appetite ratings including hunger and fullness were also obtained. An acetaminophen tracer was used to assess gastric emptying rate. Three groups of comparably obese women (BMI = 35.9 +/- 5.5; % body fat = 44.9 +/- 4.7) participated: 12 nonbinge eating normals (NB), 14 subthreshold BED, and 11 BED. The BED subjects, compared to NB subjects, had lower baseline ghrelin concentrations prior to the meal, a lower area under the curve (AUC), with lower levels at 5, 15, 30, 90, and 120 min, and a smaller decline in ghrelin postmeal (all P < 0.03). The other blood values did not differ among groups, and neither did gastric emptying rate nor ratings of fullness. The BED subjects were then randomly assigned to treatment with cognitive-behavior therapy and diet (n = 5) or to a wait-list control (n = 4). Baseline ghrelin (P = 0.01) and AUC increased (P = 0.02), across both conditions, in which most subjects (7 of 9) stopped binge eating. The lower fasting and postmeal plasma ghrelin levels in BED are consistent with lower ghrelin levels in obese compared to lean individuals and suggests downregulation by binge eating.     

A comparison of the accuracy of self-reported intake with measured intake of a laboratory overeating episode in overweight and obese women with and without binge eating disorder

Purpose

Research has demonstrated significant underreporting of food intake in obese individuals with and without binge eating disorder (BED). An improved understanding of the accuracy of self-reported food intake is central to diagnosis of eating disorders and monitoring response to treatment. The purpose was to: (1) confirm those with BED consume significantly more kilocalories (kcal) than overweight/obese controls when instructed to overeat in the laboratory and (2) compare dietary recall data with measured intake.

Methods

Fifteen women fulfilling BED criteria and 17 controls participated in an overeating episode and completed a 24-h dietary recall.

Results

BED participants consumed significantly more kilocalories according to both methodologies. The BED group self-reported 90% of the measured intake compared to 98% for the control group. Mean differences between the methods indicated that on average both groups underreported intake; however, the mean difference between methods was significantly greater in the BED group.

Conclusions

Findings confirm that those with BED consume significantly more than controls during a laboratory binge and controls tended to be more accurate in recalling their intake 24 h later.     

The role of daily hassles in binge eating

OBJECTIVE: The present study investigated the relationship between daily hassles and the frequency and caloric intake of eating episodes among normal-weight women who engage in binging (n = 17) and those who do not (n = 17). METHOD: For 2 weeks, participants self-monitored their food intake during the day and completed The Hassles Scale each evening before retiring. RESULTS: Results indicated that women who engage in binge eating rated daily hassles as significantly more stressful than women who do not binge. Also, women who engage in binge eating consumed significantly more calories on those days characterized by higher as opposed to lower levels of stress. DISCUSSION: Theoretical and clinical implications of these findings are discussed.     

Implicit wanting and explicit liking are markers for trait binge eating. A susceptible phenotype for overeating

The present study used a measure of trait binge eating (Binge Eating Scale; BES) to examine its association with behavioural markers of appetite and food reward. Non-obese female participants consumed a preload before freely selecting and consuming from a test meal. Subjective hunger and hedonic measures of explicit liking and implicit wanting for food were obtained. Food selection and intake of the test meal were measured. Findings were compared according to individual differences in trait binge eating. BES scores correlated with BMI, food intake and selection of high fat sweet foods in the test meal. Comparison of BES scores revealed that higher scores were associated with weaker suppression of hunger after the preload, greater explicit liking for food generally, and increased implicit wanting for high fat sweet food. Trait binge eating is functional at low levels and implicit wanting measured simultaneously with explicit liking may be useful markers for reward-driven overconsumption in this susceptible phenotype.     

Slower Eating Speed Lowers Energy Intake in Normal-Weight but not Overweight/Obese Subjects

BackgroundThe effect of eating speed on energy intake by weight status is unclear.ObjectiveTo examine whether the effect of eating speed on energy intake is the same in normal-weight and overweight/obese subjects.DesignThe effect of slow and fast eating speed on meal energy intake was assessed in a randomized crossover design.Participants/settingThirty-five normal-weight (aged 33.3±12.5 years; 14 women and 21 men) subjects and 35 overweight/obese (44.1±13.0 years; 22 women and 13 men) subjects were studied on 2 days during lunch in a metabolic kitchen.InterventionThe subjects consumed the same meal, ad libitum, but at different speeds during the two eating conditions. The weight and energy content of the food consumed was assessed. Perceived hunger and fullness were assessed at specific times using visual analog scales.Statistical analysesEffect of eating speed on ad libitum energy intake, eating rate (energy intake/meal duration), energy density (energy intake per gram of food and water consumed), and satiety were assessed by mixed-model repeated measures analysis.ResultsMeal energy intake was significantly lower in the normal-weight (804.5±438.9 vs 892.6±330.2 kcal; P=0.04) but not the overweight/obese (667.3±304.1 vs 724.8±355.5 kcal; P=0.18) subjects during the slow vs the fast eating condition. Both groups had lower meal energy density (P=0.005 and P=0.001, respectively) and eating rate (P<0.0001 in both groups) during the slow vs the fast eating condition. Both groups reported less hunger (P=0.01 and P=0.03, respectively), and the normal-weight subjects reported more fullness (P=0.02) at 60 minutes after the meal began during the slow compared with the fast eating condition. There was no eating speed by weight status interaction for any of the variables.ConclusionsEating slowly significantly lowered meal energy intake in the normal-weight but not in the overweight/obese group. It lowered eating rate and energy density in both groups. Eating slowly led to lower hunger ratings in both groups and increased fullness ratings in the normal-weight group at 60 minutes from when the meal began.