Predictors for treatment outcome of binge eating with obesity: a naturalistic study

This study examines predictors of short-term treatment outcome for obese individuals with binge eating disorder (BED). A battery of assessment questionnaires was given to 212 patients on admission of a CBT day-treatment program for BED. Treatment outcome assessed by changes in eating disorder symptomatology was measured in 182 completers. Linear regression analyses indicated that a combination of variables at baseline predicted 26% of the variance in treatment outcome. High social embedding and higher scores on openness (NEO-PI-R) were significantly related to more improvement after treatment. Higher scores on depressive symptoms (BDI), agoraphobia (SCL-90) and extraversion (NEO-PI-R) were significantly related to less improvement. The analyses show that the level of social embedding and psychopathological comorbidity (state and trait) are predictors for treatment outcome. This study confirms the notion that social context and comorbidity need to be taken into account as described in treatment guidelines of NICE and APA for BED.     

Negative urgency and expectancies increase vulnerability to binge eating in bulimia nervosa

ABSTRACT

Negative urgency (NU), the tendency to act impulsively when distressed, is associated with binge eating. Women who believe that eating alleviates negative affect are also more likely to binge eat. Thus, it is hypothesized that the individuals with high levels of NU, and who endorse these eating expectancies, will binge eat the following acute distress. This study tested these hypotheses using ecological momentary assessment. Sixteen women with the symptoms of BN completed clinical assessments, and were asked to report on distress and binges multiple times daily for two weeks. NU moderated the temporal relationship of negative affect to binges, such that women with lower scores on NU experienced a sharper increase in affect prior to binges. Individual differences in eating expectancies also moderated the relationship of affect to binge eating. Results suggest that women with high levels of NU and expectancy endorsement are triggered to binge by smaller shifts in negative affect than women who do not endorse these traits.     

Evaluation of extinction as a functional treatment for binge eating

Binge eating is a serious behavior problem exhibited by individuals diagnosed with binge eating disorder and bulimia nervosa. Binge eating is thought to be maintained by automatic negative reinforcement in the form of relief from negative emotional responding. Current treatments produce only moderate abstinence, perhaps because they do not attempt to alter the functional consequences of the behavior. Although extinction has been thought impossible with behaviors maintained by automatic negative reinforcement, this study evaluated the application of extinction with binge eating. Four women who reported engaging in binge eating at least twice per week participated. Participants listened to an audio tape recording of the covert verbal behavior associated with their negative emotional responding during the binge to prevent alleviation of the negative emotional responding, thus eliminating the reinforcer in an attempt to reduce the behavior. The procedure effectively reduced frequency of the binges when correctly implemented. Implications and suggestions for future research are discussed.     

Topiramate for binge eating disorder

Topiramate is a new anti convulsant agent that acts on the voltage-activated sodium channels and on the glutamate and GABA receptors; it is furthermore able to reduce hunger and therefore contributes to loss of weight. The authors report the case of a patient suffering from binge eating disorder, who was unresponsive to several therapeutic plans but was successfully treated with topiramate.     

Systematic review of the effects of acute stress in binge eating disorder

Binge eating disorder (BED) is characterized by recurrent episodes of eating an excessive amount of food over a discrete time period, while feeling a loss of control over one's eating. Although stress is one of the most commonly reported triggers of binge eating in individuals with BED, there has been little work examining the stress response specifically in individuals with the disorder. In this review, we examine what is known about how individuals with BED respond to acute stressors. A systematic literature search identified 14 relevant articles that report on the effects of experimentally induced stress on objective measures. Dependent measures that have been examined include changes in the levels of hormones such as cortisol and ghrelin, cardiovascular function, ad libitum food intake and eating rate. In this review, we describe the published findings and discuss their implications in the context of the wider literature. Overall, we found partial evidence that BED is associated with a heightened response to stress. Given the inconsistencies between studies, we suggest that reported differences between individuals with and without BED might be driven by factors that are correlated with, but not specific to, BED. We suggest that two priorities for this research area are to identify factors that modulate the stress response in individuals with BED, and to address the underrepresentation of males in this literature.     

Placebo-controlled trial of sertraline in the treatment of binge eating disorder

OBJECTIVE: The authors' goal was to assess the efficacy of sertraline in the treatment of binge eating disorder. METHOD: Thirty-four outpatients with DSM-IV binge eating disorder were randomly assigned to receive either sertraline (N=18) or placebo (N=16) in a 6-week, double-blind, flexible-dose (50-200 mg) study. Except for response level, outcome measures were analyzed by random regression methods, with treatment-by-time interaction as the effect measure. RESULTS: Compared with placebo, sertraline was associated with a significantly greater rate of reduction in the frequency of binges, clinical global severity, and body mass index as well as a significantly greater rate of increase in clinical global improvement. Patients receiving sertraline who completed the study demonstrated a higher level of response, although the effect was not significant. CONCLUSIONS: In a 6-week trial, sertraline was effective and well tolerated in the treatment of binge eating disorder.     

Guided self-help for binge eating/purging anorexia nervosa before inpatient treatment

Abstract

The goal of this study was to develop a cognitive–behavioral self-help manual for anorexia nervosa. Patients diagnosed with anorexia nervosa (N=102), binge eating/purging type (AN-B/P), were consecutively assigned to one of two conditions: 6-week manualized guided self-help or a wait-list control. All patients thereafter received inpatient treatment in a hospital for behavioral medicine. The primary outcome variable was the number of days in inpatient treatment. Secondary outcome variables were measures of psychopathology. Results showed that duration of inpatient treatment was significantly shorter (by 5.2 days) among participants receiving guided self-help. Body image, slimness ideal, general psychopathology, and some bulimic symptoms improved significantly during self-help. The authors conclude that, to increase effects of therapist-guided self-help in AN-B/P, additional variants of a self-help manual should be tried in different therapeutic settings.     

Negative weight-based attitudes in treatment-seeking obese monolingual Hispanic patients with and without binge eating disorder

Objective

The aims of this study were to compare weight-based attitudes in obese Latino adults with and without binge eating disorder (BED) and to examine whether these attitudes are related to indices of eating disorder psychopathology and psychological functioning.

Method

Participants were a consecutive series of 79 monolingual Spanish-speaking-only obese Latinos (65 female, 14 male) participating in a randomized placebo-controlled trial performed at a Hispanic community mental health center. Participants were categorized as meeting the criteria for BED (n = 40) or obese non–binge-eating controls (n = 39) based on diagnostic and semistructured interviews administered by fully bilingual research clinicians trained specifically for this study.

Results

Analyses revealed that negative attitudes toward obesity did not differ significantly between the BED and non–binge-eating groups nor were they correlated with the intensity of eating disorder psychopathology (eg, levels of weight and shape concerns). Overall, the levels of negative attitudes toward obesity in this Latino/Latina group are similar to those reported previously for samples of English-speaking primarily white obese persons.

Discussion

These findings suggest that it may be obesity per se—rather than eating disorder psychopathology or body image—that heightens vulnerability to negative weight-based attitudes.     

Impact of the neural correlates of stress and cue reactivity on stress related binge eating in the natural environment

Women with symptoms of bulimia nervosa (BN) exhibit decreased response to visual food cues in several limbic and frontal regions compared to controls. Stress causes decreased blood oxygenation level dependent (BOLD) response in these regions in non-clinical samples; there is a lack of data on this topic in BN. This study examined the impact of individual differences in neural reactivity to palatable food cues following acute stress on stress-binge trajectories in everyday life. 16 women with BN symptoms viewed palatable food cues prior to and immediately following an acute stress induction in the scanner. Participants then responded to a series of prompts assessing daily ratings of stress and binge episodes for a period of two weeks. Decreased BOLD signal was observed in response to food cues pre to post stress in the anterior cingulate cortex (ACC), amygdala, and ventromedial prefrontal cortex (vmPFC). Ecological momentary assessment data collection demonstrated that stress increased prior to binge episodes in the natural environment, and decreased following. Changes in activation in the ACC, precuneus, and dorsolateral prefrontal cortex (dlPFC) significantly moderated the relationship of stress to binge eating in daily life, such that women who exhibited decreased response reported significantly increasing stress prior to binges, while women who did not exhibit decreases reported no significant change in stress prior to binges. Individual differences in neural response to food cues under stress appear to underlie distinct antecedants to binge eating.     

Sugar, opioids and binge eating

There is evidence that endogenous opiates are involved in the control of feeding in experimental animals. Several types of experimental obesity are associated with increased opiate production and/or increased numbers and sensitivity of opiate receptors. Research with experimental animals suggests that nutrients, particularly sugar, have an effect on feeding behavior that is mediated by opiates. For instance, the obesity-producing effect of a palatable diet in rodents is blocked by opiate antagonists. Stress induced feeding in rodents leads to preferential sucrose ingestion and is blocked by opiate antagonists and beta-endorphin. The effect of nutrients on the endogenous opiate system of humans is less clear. Clinical experience suggest that carbohydrates (sugar in particular) play a role in binge eating and obesity. Many binge eaters preferentially eat sweets during a binge. Many obese individuals consume more than half of their total daily calories as carbohydrates. Sweet snacking is a frequent behavior at times of stress. Recent evidence suggests that sugar can lead to increased beta-endorphin production in obese subjects.     

Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation

This paper reviews the conceptual foundation of mindfulness-based eating awareness training (MB-EAT). It provides an overview of key therapeutic components as well as a brief review of current research. MB-EAT is a group intervention that was developed for treatment of binge eating disorder (BED) and related issues. BED is marked by emotional, behavioral and physiological disregulation in relation to food intake and self-identity. MB-EAT involves training in mindfulness meditation and guided mindfulness practices that are designed to address the core issues of BED: controlling responses to varying emotional states; making conscious food choices; developing an awareness of hunger and satiety cues; and cultivating self-acceptance. Evidence to date supports the value of MB-EAT in decreasing binge episodes, improving one's sense of self-control with regard to eating, and diminishing depressive symptoms.     

Change in binge eating and binge eating disorder associated with migration from Mexico to the U.S

Exposure to Western popular culture is hypothesized to increase risk for eating disorders. This study tests this hypothesis with respect to the proposed diagnosis of binge eating disorder (BED) in an epidemiological sample of people of Mexican origin in Mexico and the U.S. Data come from the Mexico National Comorbidity Survey, National Comorbidity Survey Replication, and National Latino and Asian American Survey (N = 2268). Diagnoses were assessed with the WMH-CIDI. Six groups were compared: Mexicans with no migrant family members, Mexicans with at least one migrant family member, Mexican return-migrants, Mexican-born migrants in the U.S., and two successive generations of Mexican-Americans in the U.S. The lifetime prevalence of BED was 1.6% in Mexico and 2.2% among Mexican-Americans. Compared with Mexicans in families with migrants, risk for BED was higher in US-born Mexican-Americans with two U.S.-born parents (aHR = 2.58, 95% CI 1.12-5.93). This effect was attenuated by 24% (aHR = 1.97, 95% CI 0.84-4.62) with adjustment for prior-onset depressive or anxiety disorder. Adjustment for prior-onset conduct disorder increased the magnitude of association (aHR = 2.75, 95% CI 1.22-6.20). A similar pattern was observed for binge eating. Among respondents reporting binge eating, onset in the U.S. (vs. Mexico) was not associated with prevalence of further eating disorder symptoms. Migration from Mexico to the U.S. is associated with an increased risk for BED that may be partially attributable to non-specific influences on internalizing disorders. Among respondents reporting binge eating in either country, similar levels of further symptoms were endorsed, suggesting some cross-cultural generalizability of criteria.     

An evaluation of affect and binge eating

The affect regulation model of binge eating suggests that binge eating occurs because it provides momentary relief from negative affect. The purpose of this study was to evaluate change in affect during binge eating to evaluate the merits of this model. Participants were young adult women from a midwestern university. Binge eaters recorded their level of pleasantness using the affect grid at 2-minute intervals before, during, and after binge eating episodes and regular meals. Controls recorded in a similar manner during meals. The results showed a different pattern of affect for binge eaters during binge eating episodes and normal meals and for binge eaters and controls at normal meals. The results support the affect regulation model of binge eating and suggest that binge eating is negatively reinforced because it produces momentary relief from negative affect.     

Screening for binge eating disorder in obese outpatients

The prevalence of binge eating disorder (BED) in clinical samples of obese patients is controversial, and sensitive diagnostic protocols for use in routine clinical practice need to be further defined. Three hundred forty-four obese (body mass index [BMI] > or =30 kg/m2) patients were studied with the Structured Clinical Interview for DSM-III-R to investigate the lifetime prevalence of mental disorders. The current prevalence of BED was assessed using DSM-IV criteria. Eating attitudes and behavior were investigated with the Bulimic Investigation Test, Edinburgh (BITE) and the Binge Eating Scale (BES). The Beck Depression Inventory (BDI) and Spielberg's State-Trait Anxiety Inventory (STAI) were also applied. The prevalence of BED was 7.5%. Patients with BED had a higher BMI compared with obese patients without BED. Differences in the lifetime prevalence of mental disorders in patients with and without BED were not statistically significant. Using the BES as a screening instrument for BED with a threshold of 17, the sensitivity was 84.8%, specificity 74.6%, positive predictive value 26.2%, and negative predictive value 97.9%. Using the BITE with a threshold of at least 10, the sensitivity was 91%, specificity 51.4%, positive predictive value 71.8%, and negative predictive value 98.2%. The BITE can be a valid alternative to the BES as a screening method for BED in obese patients.     

Modification of binge eating in obesity

In a single case study an obese woman was successfully treated for binge eating by using exposure and response prevention. The patient was permitted to eat small amounts of food and was then prevented from eating more. Weight loss occurred during treatment and continued at 2 and 8 month follow-ups.     

Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study.

BACKGROUND: In a single-center, placebo-controlled study, topiramate reduced binge eating and weight in patients with binge eating disorder (BED) and obesity. The current investigation evaluated the safety and efficacy of topiramate in a multicenter, placebo-controlled trial. METHODS: Eligible patients between 18 and 65 years with >or= 3 binge eating days/week and a body mass index (BMI) between 30 and 50 kg/m2 were randomized. RESULTS: A total of 407 patients enrolled; 13 failed to meet inclusion criteria, resulting in 195 topiramate and 199 placebo patients. Topiramate reduced binge eating days/week (-3.5 +/- 1.9 vs. -2.5 +/- 2.1), binge episodes/week (-5.0 +/- 4.3 vs. -3.4 +/- 3.8), weight (-4.5 +/- 5.1 kg vs. .2 +/- 3.2 kg), and BMI (-1.6 +/- 1.8 kg/m2 vs. .1 +/- 1.2 kg/m2) compared with placebo (p < .001). Topiramate induced binge eating remission in 58% of patients (placebo, 29%; p < .001). Discontinuation rates were 30% in each group; adverse events (AEs) were the most common reason for topiramate discontinuation (16%; placebo, 8%). Paresthesia, upper respiratory tract infection, somnolence, and nausea were the most common AEs with topiramate. CONCLUSIONS: This multicenter study in patients with BED associated with obesity demonstrated that topiramate was well tolerated and efficacious in improving the features of BED and in reducing obesity.