Evidence-Based Reviews

Beating obesity: Help patients control binge eating disorder and night eating syndrome

Current Psychiatry. 2006 June;5(6):17-28

These two eating disorders often can be treated successfully without referral to specialized centers.

References

1. Taraldsen KW, Eriksen L, Gotestam KG. Prevalence of eating disorders among Norwegian women and men in a psychiatric outpatient unit. Int J Eat Disord 1996;20:185-90.

2. Lundgren JD, Allison KC, Crow S, et al. Prevalence of the night-eating syndrome in a psychiatric population. Am J Psychiatry 2006;163:156-8.

3. Streigel-Moore RH, Franko DL. Epidemiology of binge eating disorder. Int J Eating Disord 2003;34:S19-S29.

4. Striegel-Moore RH, Wilfley DE, Pike KM, et al. Recurrent binge eating in black American women. Arch Fam Med 2000;9:83-7.

5. Marshall HM, Allison KC, O’Reardon JP, et al. Night eating syndrome among nonobese persons. Int J Eat Disord 2004;35:217-22.

6. Spitzer RL, Yanovski S, Wadden T, et al. Binge eating disorder: its further validation in a multisite study. Int J Eat Disord 1993;13:137-53.

7. Fairburn CG, Cooper Z, Doll HA, et al. The natural course of bulimia nervosa and binge eating disorder in young women. Arch Gen Psychiatry 2000;37:659-65.

8. Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003;289:187-93.

9. Rieger E, Wilfley DE, Stein RI, et al. A comparison of quality of life in obese individuals with and without binge eating disorder. Int J Eat Disord 2005;37:234-40.

10. Yanovski SZ, Nelson JE, Dubbert BK, Spitzer RL. Association of binge eating disorder and psychiatric co-morbidity in obese subjects. Am J Psychiatry 1993;150:1472-9.

11. Gluck ME, Geliebter A, Satov T. Night eating syndrome is associated with depression, low self-esteem, reduced daytime hunger, and less weight loss in obese outpatients. Obes Res 2001;9:264-7.

12. Stunkard AJ, Allison KC. Two forms of disordered eating in obesity: Binge eating and night eating. Int J Obes Relat Metab Disord 2003;7:1-12.

13. O’Reardon JP, Peshek A, Allison K. Night eating syndrome: Diagnosis, epidemiology, and management. CNS Drugs 2005;19:997-1008.

14. Agras WS, Teich CF, Arnow B, et al. One-year follow-up of cognitive-behavioral therapy for obese individuals with binge-eating disorder. J Consult Clin Psychol 1997;65:343-7.

15. Cloak NL, Powers PS. Are undiagnosed eating disorders keeping your patients sick? Current Psychiatry 2005;4(12):65-75.

16. Kushner RF, Roth JL. Medical evaluation of the obese individual. Psychiatr Clin North Am 2005;28:89-103.

17. Wonderlich SA, de Zwaan M, Mitchell JE, et al. Psychological and dietary treatments of binge eating disorder: conceptual implications. Int J Eat Disord 2003;34:S58-S73.

18. Grilo CM, Masheb RM. A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge-eating disorder. Behav Res Ther 2005;43:1509-25.

19. Wilfley DE, Welch RR, Stein RI, et al. A randomized comparison of group cognitive-behavioral therapy and group interpersonal therapy for the treatment of overweight individuals with binge eating disorder. Arch Gen Psychiatry 2002;59:713-21.

20. Telch CF, Agras WS, Linehan MM. Dialectical behavior therapy for binge eating disorder. J Consult Clin Psychol 2001;69:1061-5.

21. Pendleton VR, Goodrick CK, Poston WS, et al. Exercise augments the effects of cognitive-behavioral therapy in the treatment of binge eating. Int J Eat Disord 2002;31:172-84.

22. Agras WS. Pharmacotherapy of bulimia nervosa and binge eating disorder: longer-term outcomes. Psychopharmacol Bull 1997;33:433-6.

23. Clinical guidelines on the identification evaluation and treatment of obesity in adults Executive summary, 1998. Bethesda, MD: National Heart, Lung, and Blood Institute. Available at: http://www.nhlbi.nih.gov/guidelines/obesity. Accessed April 18, 2006.

24. Tsai AG, Wadden TA, Womble LG, Byrne KJ. Commercial and self-help programs for weight control. Psychiatr Clin North Am 2005;28:171-92.

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26. Pawlow LA, O’Neil PM, Malcolm RJ. Night eating syndrome: Effects of brief relaxation training on stress, mood, hunger, and eating patterns. Int J Obes Relat Metab Disord 2003;27:970-8.

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Say “eating disorders,” and young, thin, Caucasian women with anorexia or bulimia nervosa come to mind. Psychiatry outpatients, however, are more likely to have binge eating disorder (BED) or night eating syndrome (NES) and to be middle-aged, obese, male, or African-American.

Like anorexia and bulimia, BED and NES cause distress, impairment, and medical morbidity. But BED and NES are different because you can manage many patients without referring them to eating disorder treatment centers. You can improve patients’ function and quality of life by:

correcting eating disorder behaviors and thoughts
identifying and managing psychiatric comorbidity
identifying and treating associated medical problems (usually obesity complications such as diabetes mellitus, hypertension, and dyslipidemia)
helping them achieve and maintain a healthy (but realistic) body weight.

Characteristics of BED and NES

BED and NES are coded as eating disorder, not otherwise specified in DSM-IV-TR, and their diagnostic criteria are provisional. Research criteria for BED are listed in Appendix B of DSM-IV (Box 1); diagnostic criteria for NES are being developed (Box 2).

Box1

Provisional DSM-IV-TR criteria for binge eating disorder

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (eg, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
2. A sense of lack of control over eating during the episode (eg, a feeling that one cannot stop eating or control what or how much one is eating)
The binge-eating episodes are associated with three (or more) of the following:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because of being embarrassed by how much one is eating
5. Feeling disgusted with oneself, depressed, or very guilty after overeating
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least 2 days a week for 6 months.
Binge eating is not associated with the regular use of inappropriate compensatory behaviors (eg, purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.

Source: American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.

Box2

Provisional criteria for night eating syndrome

Morning anorexia, even if the patient eats breakfast
Evening hyperphagia, in which ≥50% of daily energy intake is consumed after the evening meal
Awakening at least once a night and eating snacks
Duration of at least 3 months
Patient does not meet criteria for bulimia nervosa or binge eating disorder

Source: Birketvedt GS, Florholmen J, Sundsfjord J, et al. Behavioral and neuroendocrine characteristics of the night-eating syndrome. JAMA 1999;282:657-63.

Prevalence. How common are these eating disorders? Two small studies examined BED and NES prevalence in outpatient psychiatric populations. A European study found 4% of 234 psychiatry clinic patients met criteria for BED,¹ whereas 12% in 399 patients in two U.S. clinics met criteria for NES (with possibly higher rates in patients who took atypical antipsychotics).²

Demographics. Men experience BED and NES nearly as often as women, and distribution among women is similar across age groups.³ Binge eating may be more common among African-Americans than Caucasians.⁴

Obesity. One-half or more of persons with BED or NES are obese, with body mass index (BMI) ≥30.^5,6 Obesity prevalence increases over time—from 22% at baseline to 39% 5 years later in one study of BED.⁷

Psychiatric comorbidity. Overweight or obesity increase the risk for early mortality and impaired quality of life.⁸ Persons with obesity plus BED have poorer physical and psychosocial function and lower quality of life than do obese persons without BED.⁹

Structured clinical interviews of 128 obese subjects found higher rates of psychiatric disorders in those with BED. Obesity with comorbid binge eating increased lifetime relative risk:

>6-fold for major depression
>8-fold for panic disorder
>13-fold for borderline personality disorder, compared with obesity alone.¹⁰

Similarly, overweight patients with NES have more depression, lower self-esteem, and more difficulty losing weight than those without NES.¹¹ They meet criteria significantly more often for major depressive disorder, anxiety disorders, and substance use disorders.¹² Most NES patients view their nocturnal eating as shameful,¹³ and distress and guilt are among the diagnostic criteria for BED.

Fortunately, successful treatment of BED or NES almost always improves comorbid medical and psychiatric conditions as well. Ongoing treatment is critical for sustaining weight loss.¹⁴

Diagnosis and evaluation

Start by asking overweight patients if they binge eat or do most of their eating at night. Follow up with questions to assess whether they meet provisional diagnostic criteria for BED or NES and to rule out other disorders in the differential diagnosis (Box 3). These include bulimia and sleep-related eating disorder, which is generally regarded as a parasomnia.