Binge eating behavior in patients with eating disorders

The purpose of this study was to determine whether the objectively observed binge eating behavior of obese subjects meeting the proposed DSM-IV criteria for binge eating disorder would be similar to that observed in patients with bulimia nervosa. Non-obese patients with bulimia nervosa (BN), obese subjects with binge eating disorder (BED), obese and non-obese women without eating disorders were each instructed to binge eat single- and multiple-item meals. In the multiple-item meal, the obese subjects with BED ate significantly more (1515 kcal) than obese subjects without BED (1115 kcal), but they ate less than the normal-weight bulimic patients (2680 kcal). The non-obese controls ate amounts similar to the obese non-binge-eating-disordered group (1093 and 1115.2 kcal, respectively). In the single-item meal, consisting of ice cream, patients with BN ate significantly more than any other group (1307 kcal), while obese subjects with or without binge-eating disorder ate significantly more (762 kcal) than non-obese controls (308 kcal). This study has demonstrated that although both BN and BED are characterized by recurrent episodes of binge eating, quantitatively there appear to be differences between the eating disturbances in the two disorders. Because single- and multiple-item meals differ in external cues, these results also suggest that the obese subjects with BED may be disinhibited by external cues, while obese subjects without BED may be inhibited by external cues.     

Maintenance of binge eating through negative mood: a naturalistic comparison of binge eating disorder and bulimia nervosa

OBJECTIVE: To examine negative mood as a proximal antecedent and reinforcing condition of binge eating in binge eating disorder (BED) and bulimia nervosa (BN). METHOD: Using an ecological momentary assessment design, 20 women with BED, 20 women with BN, and 20 nonclinical control women were recruited from the community, provided with a portable minicomputer, and asked to rate their mood and list their thoughts at randomly-generated beep sounds and before, during, and after episodes of eating. RESULTS: In both eating disorder groups mood before binge eating was more negative than before regular eating and at random assessment. Binge eating was followed by a deterioration of mood. The BED group revealed less antecedent negative mood than the BN group and less concomitant negative cognitions about food/eating and stress. CONCLUSION: Affect regulation difficulties likely lead to binge eating in both disorders, but binge eating may not be effective for regulating overall mood.     

Energy density effects on food intake, appetite ratings, and loss of control in women with binge eating disorder and weight-matched controls

Individuals with binge eating disorder have increased gastric capacity and may require excessive food intake and increased volume in the stomach to produce satiation. The present study examined whether lower energy density (ED) meals lead to lower energy intake more than higher-ED meals in women with binge eating disorder (BED) and weight-matched controls. Women with BED (n=15) and healthy weight-matched controls (n=15) were instructed to consume as much as they wished during two test meals on non-consecutive days. Participants were served two hedonically similar versions of a pasta salad (19% protein, 50% carbohydrate, 31% fat): low-ED (1.0 kcal/g) and high-ED (1.6 kcal/g), and food intake and appetite ratings were assessed. Energy intake was significantly lower in the low-ED condition than in the high-ED condition across all participants. BED participants were more likely to report greater prospective consumption, desire for dessert, loss of control over eating, and less enjoyment after meals. Decreasing the energy density of food consumed may help target disturbances in satiation in women with frequent binge eating.     

Baclofen for binge eating: an open-label trial

OBJECTIVE: Baclofen is a GABA-B agonist that may be useful in the treatment of substance use disorders, and also reduces 'binge-like' eating in rodents. We hypothesized that baclofen might be effective in reducing binge eating episodes in binge eating disorder (BED) and bulimia nervosa (BN). METHOD: Seven women with BED (n = 4) or BN (n = 3) took baclofen (60 mg/day) for 10 weeks. RESULTS: Six out of seven patients completed the full 10-week trial. Five out of seven participants (3 BED; 2 BN) demonstrated 50% or greater reduction of frequency of binge eating from beginning to end of the study. Three out of seven participants (2 BED; 1 BN) were free of binge eating at study end. Four out of seven participants elected to continue baclofen at study end. Baclofen was well tolerated by the participants. CONCLUSION: In this open-label trial, baclofen was associated with decreased binge eating frequency in patients with BED and BN.     

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.     

Hedonics of binge eating in women with bulimia nervosa and binge eating disorder.

OBJECTIVE: Potential differences in the hedonics of binge eating between female subjects with bulimia nervosa (BN) and female subjects with binge eating disorder (BED) were examined. METHOD: Women seeking treatment for BN (N = 29) and BED (N = 49) completed the Eating Hedonics Questionnaire. RESULTS: Subjects in both groups reported similar precipitants and levels of distress associated with binge eating. Of interest, BED subjects were more likely to report that they enjoyed the food, the taste of the food, the smell and the texture of the food while binge eating. In addition, the BED group reported more relaxation and less physical discomfort and anxiety as a consequence of binge eating compared to the BN group. DISCUSSION: There are interesting and potentially important differences between individuals with BN and BED in the cognitions and behaviors associated with binge eating.     

Recorded food intake of obese women with binge eating disorder before and after weight loss

Because binge eating in obese individuals has been postulated to be a reaction to dietary restriction, we examined the recorded food intake of 17 obese women with and 16 obese women without binge eating disorder (BED) during 1-week periods before and 3 months after a very low calorie diet program in order to determine the effects of dietary restriction on binge eating frequency and severity. Before weight loss, rather than reporting severe caloric restriction, women with BED reported greater average energy intake than nonbinge eaters on both a total (2707 vs. 1869 kcal/day, p < .01) and weight-adjusted (25.1 vs. 18.1 kcal/kg, p < .01) basis, with both higher intake on nonbinge days and an increased frequency of binge days. After weight loss, there was no significant difference in energy intake, on either a total or weight-adjusted basis, between subjects with and without BED. Although average daily energy intake fell for both groups after weight loss, only subjects with BED reported significantly decreased energy intake when adjusted for change in body weight. This resulted from decreased intake on nonbinge days and a decreased frequency of binge days. Before weight loss, subjects with BED reported an average energy intake equivalent to 94% of their predicted energy expenditure. Whereas subjects without BED reported intake only 64% of predicted (p = .002). After weight loss, there was no significant difference between subjects with and without BED in the percentage of predicted energy expenditure reported as intake (64% vs. 58%). Restraint was similar in both groups before weight loss, but those with BED reported greater hunger and disinhibition. After weight loss treatment, restraint increased significantly, whereas disinhibition and hunger remained elevated in subjects with BED. Disinhibition, rather than restraint, appears to be a major contributor to the disordered eating of these individuals. Unlike normal-weight women with bulimia nervosa, dietary restriction does not appear to worsen symptoms of bingeeating in obese women with BED. Over the short term, subjects with BED may respond to a standard weight loss treatment program with improvements in binge eating behaviors. © 1994 by John Wiley & Sons, Inc.     

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.     

Stress response and binge eating disorder

In clinical practice, obese patients report stress as a primary trigger for binge eating. However, the biological mechanism underlying this relationship is poorly understood. This paper presents, a theoretical overview of how cortisol secretion, a major component of the stress response, could play a role in binge eating, given that exogenous glucocorticoids can lead to obesity by increasing food intake. I will discuss findings from recent studies demonstrating links between laboratory stress, cortisol, food intake and abdominal fat in humans. Cortisol is elevated following laboratory stressors in women with anorexia nervosa (AN), bulimia nervosa (BN), and obesity, but has not been widely studied in women with binge eating disorder (BED). Additionally, I will review recent findings demonstrating a greater cortisol response to stress in obese women with BED compared to non-BED.     

Comparison of binge eating disorder and bulimia nervosa in a community sample.

OBJECTIVE: This study examined the relationship between binge eating disorder (BED), a newly proposed eating disorder, and bulimia nervosa (BN). METHOD: Three groups recruited from the community were compared: women with BED (n = 150), women with purging BN (n = 48), and women with nonpurging BN (n = 14). RESULTS: The three groups did not differ significantly in education, weight or shape concern, and current or lifetime prevalence of nine major mental disorders. Women with BED, compared with women with purging BN, were older, less likely to have a history of anorexia nervosa, and less likely to have been treated for an eating disorder. Obesity was more commonly associated with BED than with either subtype of BN. DISCUSSION: Our results lend some support to BED as an eating disorder distinct from purging BN. More research is needed to clarify the position of nonpurging BN relative to BED and purging BN.     

Meal-induced changes in tryptophan:LNAA ratio: effects on craving and binge eating

This study investigated the effects of meals varying in macronutrient composition on plasma tryptophan/large neutral amino acid (tryp:LNAA) ratios and subsequent appetite and mood in women defined as "food cravers." Nine women consumed one of each of a high protein, high carbohydrate and mixed meal on three separate days. Blood samples and appetite and mood ratings were taken before and at intervals up to 150 min after meal consumption. The first subsequent ad libitum food intake was recorded in diaries. The tryp:LNAA ratio increased significantly after the carbohydrate meal compared to protein and mixed meals. No significant correlations between change in tryp:LNAA ratio and mood or macronutrient intake at the ad libitum eating episode were observed. There was a negative correlation between tryp:LNAA ratio and desire to binge eat (p=0.03) and a trend towards a negative correlation between tryp:LNAA ratio and craving for carbohydrate-rich foods (p=0.07). Participants whose ad libitum eating episode was categorized as a binge had a trend (p=0.06) toward lower plasma tryp:LNAA ratio than those who did not binge. Regression analysis showed that the effects of change in tryp:LNAA ratio on desire to binge eat was independent of meal type and changes in insulin and glucose concentrations. These findings suggest that reducing plasma tryp:LNAA ratio, via consumption of a protein-rich meal, may mediate the desire to binge eat in susceptible women.     

Energy intake patterns in obese women with binge eating disorder

OBJECTIVE: For binge eating disorder (BED) to be accepted as a distinct diagnostic category in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, it must be demonstrated that the criteria identify a diagnostic entity that is distinct from bulimia nervosa and obesity. This study examined the difference in total energy intake per day, patterns of energy intake throughout the day, and nutrient content of foods consumed in obese individuals who met the criteria for BED (on binge and non-binge days) and those who did not. RESEARCH METHODS AND PROCEDURES: Twenty women, 12 who met Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria for BED and 8 matched obese controls, participated in the study. All participants underwent six random 24-hour dietary recall telephone interviews conducted by experienced interviewers using the Nutrition Data Software System. RESULTS: The BED group ingested significantly more kilocalories on days when they had binge eating episodes than the obese control group on average. The BED group ate significantly more in the evening on binge days than their control group counterparts. There is some indication in the data that those with BED may be restricting caloric intake. Finally, data indicated that the BED group ate significantly more protein, carbohydrate, and fat on binge days than on non-binge days. However, the proportion of kilocalories from each nutrient shifted on BED binge days compared with non-binge days to favor consumption of fat over carbohydrates. DISCUSSION: More research needs to be done to determine if these findings are reproducible. Then, the neurobiological underpinnings of these differences in nutrient intake patterns and nutrient selection can be studied to help to determine the biological basis of the disorder.     

Satiety and test meal intake among women with binge eating disorder

OBJECTIVE: The purpose of the study was to measure test meal consumption and the changes in hunger and fullness during a test meal in obese individuals with and without binge eating disorder (BED) and normal-weight controls. METHOD: Twelve women with BED, 12 obese control participants, and 12 normal-weight control participants participated in two single-item test meal sessions. In one session participants were instructed to "binge," and the other eat a normal meal. Participants made ratings of hunger and fullness on visual analog scales after every 75-g increment of food. RESULTS: In comparison to obese or normal-weight controls, patients with BED consumed significantly more food to reach a similar level of fullness or hunger. CONCLUSION: Individuals with BED consumed significantly more food and showed blunted changes in hunger and fullness during both the binge and nonbinge meals. These findings suggest that individuals with BED may have disturbances in satiety that in some ways resemble those described among individuals with bulimia nervosa.     

Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: implications for DSM-5

Objective:

We assessed the impact of reducing the binge eating frequency and duration thresholds on the diagnostic criteria for bulimia nervosa (BN) and binge eating disorder (BED).

Method:

We estimated the lifetime population prevalence of BN and BED in 13,295 female twins from the Swedish Twin study of Adults: Genes and Environment employing a range of frequency and duration thresholds. External validation (risk to cotwin) was used to investigate empirical evidence for an optimal binge eating frequency threshold.

Results:

The lifetime prevalence estimates of BN and BED increased linearly as the frequency criterion decreased. As the required duration increased, the prevalence of BED decreased slightly. Discontinuity in cotwin risk was observed in BN between at least four times per month and at least five times per month. This model could not be fit for BED.

Discussion:

The proposed changes to the DSM‐5 binge eating frequency and duration criteria would allow for better detection of binge eating pathology without resulting in a markedly higher lifetime prevalence of BN or BED. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)     

Predictors of treatment outcome for binge eating disorder

OBJECTIVE: The purpose of this study was to identify predictors of short-term treatment outcome for individuals with binge eating disorder (BED). METHOD: Fifty women who met DSM-IV criteria for BED were enrolled in a manual-based group cognitive-behavioral therapy that consisted of fourteen 1-hr sessions over an 8-week period. Baseline measures included the frequency of self-reported binge eating from the Eating Behaviors-IV (EB-IV), severity of binge eating and dietary restraint using the Binge Eating Scale (BES) and Three-Factor Eating Questionnaire (TFEQ), depressive symptoms as assessed by the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS), and self-esteem as measured by the Rosenberg Self-Esteem Questionnaire (RSEQ). RESULTS: Logistic regression analyses indicated that the baseline frequency of self-reported episodes of binge eating that were objectively large predicted the likelihood of such episodes at the end of treatment. No variables predicted the likelihood of binge eating episodes that were objectively and subjectively large at the conclusion of treatment. DISCUSSION: This study indicates that the frequency of binge eating episodes at baseline is predictive of outcome status at the end of treatment, suggesting that meaningful prognostic factors in BED are identifiable.     

Effects of binge eating on satiation, satiety, and energy intake of overweight children

BACKGROUND: Children who report episodes of binge eating gain more weight than do children not reporting binge eating. However, how binge eating affects children's food intake at meals is unknown. OBJECTIVE: We compared the energy intake and postmeal satiety of children with and without a history of binge eating during buffet meals. DESIGN: Sixty overweight children aged 6-12 y were categorized into those reporting past binge-eating episodes (n = 10) and those reporting no such episodes (n = 50). Children selected lunch twice from a multiple-item, 9835 kcal, buffet meal: after an overnight fast and after a standardized breakfast. Children ate ad libitum, until they reported they were full. The main outcome measures were energy intake during meals and duration of postmeal satiety, after adjustment for covariates, including age, race, sex, socioeconomic status, and body composition. RESULTS: After the overnight fast, children in the binge-eating group consumed more energy [x (+/-SD): 1748 +/- 581 compared with 1309 +/- 595 kcal; P = 0.04] and exhibited a shorter satiety duration (194 +/- 84 compared with 262 +/- 89 min; P = 0.03) than did children in the non-binge-eating group. After the standardized breakfast, binge-eating children reported a shorter satiety duration (75 +/- 62 compared with 132 +/- 62 min; P = 0.01) and consumed more energy at the postbreakfast meal (1874 +/- 560 compared with 1275 +/- 566 kcal; P = 0.004). CONCLUSION: The ability to consume large quantities of palatable foods, coupled with decreased subsequent satiety, may play a role in the greater weight gain found in binge-eating children.     

Food selection and intake of obese women with binge-eating disorder.

We studied food selection and intake of 19 women [body mass index (in kg/m2) > 30] [corrected], 10 of whom met proposed DSM-IV criteria for binge-eating disorder (BED). All subjects ate two multicourse meals in the laboratory, and were given tape-recorded instructions at each meal either to binge or eat in a normal fashion. Subjects with BED consumed significantly more energy than did subjects without BED at both the binge [12,400 vs 8440 kJ (2963 vs 2017 kcal), P < 0.005] and normal [9810 vs 6870 kJ (2343 vs 1640 kcal), P < 0.02] meals. During the binge meal subjects with BED consumed a greater percentage of energy as fat (38.9% vs 33.5%, P < 0.002) and a lesser percentage as protein (11.4% vs 15.4%, P < 0.01) than did subjects without BED. There were no differences in macronutrient composition of food choices between groups in the normal meal. Obese women who meet criteria for BED show differences in both intake and macronutrient composition of food choices from obese women who do not meet these criteria when asked to eat in a laboratory setting, supporting the validity of this new diagnosis.     

Stress-induced laboratory eating behavior in obese women with binge eating disorder

Aim of the study was to compare the microstructural eating behavior of obese patients with and without binge eating disorder (BED) after stress induction in laboratory. Seventy-one female subjects were investigated (mean BMI 36.9). Thirty-five fulfilled criteria for BED. A 2×2 factorial design with repeated measurement (stress vs. no stress) on the second factor was applied. Stress was induced by the Trier Social Stress Test (TSST) and chocolate pudding served as laboratory food. Variables of eating behavior were measured by a universal eating monitor (UEM). Only in participants with BED stress was associated with an increase in the initial eating rate and a diminished deceleration of eating at the end of the meal. Generally, BED subjects ate with larger size of spoonfuls during the laboratory meal than non BED controls. The eating behavior of obese patients with binge eating disorder seems to be significantly affected by stress. The stress-induced eating behavior of BED patients is characterized by a stronger motivation to eat (indicated by a fast initial eating rate) as well as by a lack of satiety perception (indicated by less deceleration of eating rate).     

Energy and macronutrient intake in bulimia nervosa

Energy deprivation and malnutrition are often thought to be key factors in the maintenance of bulimia nervosa (BN). Our review shows that it is unclear how much energy is actually available to BN patients' metabolism because the contribution of food consumed during binge eating is generally neglected. Also, there is little evidence for another key hypothesis that binge-eating episodes are triggered by carbohydrate craving. This study examined energy consumption and macronutrient composition of meals and binge-eating episodes in food diaries. Forty female BN patients, 40 female panic disorder (PD) patients, and 40 healthy women recorded their food intake while in their natural environment during two consecutive days. We did not find the expected evidence for chronic energy deprivation and malnutrition in BN patients. Also, there was no evidence that carbohydrate craving drives binge eating. The implications for models of BN and for treatments targeting eating behavior are discussed.