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

Clinical Course

Evidence regarding the course and stability of BED is conflicting and unclear. Several prospective studies have suggested that BED is not a stable disorder, exhibiting high rates of remission over time [26,99,112]. However, the samples have been criticized for being small, completely female, younger than typical individuals with BED, and post-ED treatment. In contrast, a prospective study that included older women and a combination of treated and untreated women suggested remission rates at 1 year that were much lower (7%) [78]. Additionally, a retrospective study [113] reported an average BED duration of 14.4 years. In a review of the studies cited above, Wonderlich et al [6] concluded that “[a]lthough there is variability in the data, it does appear that BED differs from other eating disorders in terms of a greater tendency toward recovery and fluctuation, although this may be embedded in a chronic pattern of remission and relapse.” Viewing BED as a disorder with a chronic pattern of remission and relapse could explain why individuals with BED retrospectively report a longer duration of illness, as they may be more likely to conceptualize their illness as one continuous course punctuated by different periods of severity rather than several distinct bouts of BED. Finally, although diagnostic crossover is a frequent phenomenon among other eating disorders, the crossover rate for BED appears relatively low as compared to anorexia and bulimia [6,26,28,66].

Follow-up

Laboratory examination shows TSH levels within normal limits and cholesterol levels of 48 mg/dL(HDL), 162 mg/dL (LDL), and 270 mg/dL (total). Triglyceride levels are 300 mg/dL and the patient’s fasting glucose level is 115 mg/dL. At the patient’s follow-up appointment, the physician states that a number of laboratory results indicated negative weight-related health consequences, including high cholesterol, high triglycerides, hypertension, and probable pre-diabetes. The patient initially disregards the significance of these results, stating she only gained weight due to her break-up and quitting smoking, and she is motivated to diet to lose weight in the near future. The physician asks for more information about the patient’s eating behavior, in particular asking if she ever feels as if she loses control over her eating. The patient reluctantly admits to this, and the physician provides a referral to a behavioral health specialist. The patient expresses ambivalence and a desire to try to manage her weight on her own. The physician uses motivational interviewing techniques to enhance motivation to follow up on this referral. In addition, the patient is encouraged to make small changes to her diet and slowly increase her exercise by taking walks. Another follow-up appointment is scheduled in 3 months.

• Which treatments are most effective for BED?

Despite the negative sequalae of BED, studies suggest that it often goes untreated [114]. Women with BED, as compared to women with anorexia and bulimia, are less likely to seek treatment for BED and less likely to receive treatment for their eating disorder when they do seek it out [114–116]. Barriers to treatment may include shame and internalized weight stigma, lack of knowledge about where to seek treatment, a belief that willpower should be sufficient to overcome the problem, lack of understanding that BED is a psychiatric disorder, finances/insurance barriers, and lack of BED detection by non-specialist treatment providers [115]. These barriers are particularly concerning, as women with BED report greater health care utilization and comprise a large segment of patients in weight control programs. Therefore, it appears individuals with BED seek help for the negative consequences of the disorder, but they are less likely to seek and receive help for the likely root cause of their concerns. This is a particularly damaging pattern, as the presence of BED may negatively impact the outcome of obesity treatment [117]. There are, however, a number of promising treatments for BED, as described below: