Binge-Eating Disorder: Prevalence, Predictors, and Management in the Primary Care Setting

Further Evaluation

To assess behavioral factors related to obesity and recent weight gain, the physician asks the patient if she ever eats what would be considered an unusually large amount of food for the circumstance. The patient acknowledges that she does so regularly, particularly in response to negative moods. The patient also describes that these episodes contribute to ongoing low mood, such that she feels highly depressed and hopeless following binge episodes. The physician then asks about the patient’s exercise habits and weight management techniques. While the patient denies engaging in compensatory behaviors (eg, vomiting, laxative use) to counteract excessive eating, she does report a history of dieting in which she dramatically restricts her food intake and subsequently loses weight. The patient states that these periods are inevitably followed by a resumption of overeating, and she typically gains back more weight than she originally lost. The patient estimates that she has lost and regained more than 20 lb at least 5 times during her lifetime. In addition, the patient reports difficulty maintaining a regular exercise regimen, especially since the onset of osteoarthritis-related joint pain in the past year. After the evaluation, the physician orders an electrocardiogram (ECG) and blood work. The ECG shows that the P-wave, QRS, and T-wave axes are shifted leftward, but within normal limits. A follow-up appointment is scheduled in 2 weeks.

• What are the medical complications of BED?

BED is associated with numerous negative health sequelae including obesity, sleeping problems, musculoskeletal pain, joint pain, headaches, gastrointestinal problems, menstrual problems, shortness of breath, chest pain, diabetes, low health-related quality of life, and functional health impairments [87–90], with many of these risks persisting even after controlling for BMI [91]. A 5-year follow-up of 134 individuals with BED and 134 individuals with no history of eating disorders, who were frequency-matched for age, sex, and baseline body mass index (BMI), provides further support that BED confers risk of components of metabolic syndrome beyond the risks associated with BMI alone [92]. Specifically, BED cases had higher longitudinal risk of developing dyslipidemia, hypertension, type 2 diabetes, any metabolic syndrome component, and two or more metabolic syndrome components. Alarmingly, these findings even emerge in studies of pediatric samples, wherein BED predicts development of metabolic syndrome, elevated triglycerides, and increases in visceral adiposity [93].

• What are risk factors for BED?

A number of risk factors for BED have been identified, although many are risk factors for a number of psychiatric disorders and not specific to BED. These general risk factors include depression/negative affectivity [94,95], parental mood and substance use disorder, maternal problematic parenting, and separation from parents [95]. A host of risk factors have been identified for disordered eating, in general, including body dissatisfaction [94], early onset of dieting [94], and perfectionism [96]. A number of other variables are risk factors for both BED and bulimia (but not anorexia), including a history of childhood bully and teasing, negative self-evaluation, parental depression, and negative family communication about shape and weight [81,96]. In a study comparing BED cases to psychiatric controls, childhood obesity, familial eating problems, family discord, and high parental demands differentiated the BED cases [95]. In summary, it has been suggested that BED risk is conferred by factors that increase risk of psychiatric disorder in general and those that confer risk for obesity [81]. Of note, the risk factors studied do not appear to differ between black and white women [95].