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Mark S. Gold, MD RiverMend Health Ponte Vedra Beach, FL University of Florida Gainesville, FL

Binge Eating Disorders

Mark S Gold, MD

● Dr. Gold has no disclosures to report.

Disclosures

Discuss the diagnosis of Binge Eating Disorder

Learning Objective 1

Consider the current evidence-based treatments for the management of binge eating disorder

Learning Objective 2

Relationship to Eating Disorders

Gearhardt et al. 2012, Gearhardt et al. 2013, Gearhardt et al. 2014; Meule et al. 2014; Granero et al. 2014.

BED

FOOD ADDICTION

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Kessler RC, et al. Biol Psychiatry. 2013;73(9):904-914. PMID: 23290497; Swanson SA, et al. Arch Gen Psychiatry. 2011;68(7):714-723. PMID: 21383252; Hudson JI, et al. Biol Psychiatry. 2007;61(3):348-358. PMID: 16815322; Taylor JY, et al. Int J Eat Disord. 2007 Nov;40 Suppl:S10-14. PMID: 17879287.

American Psychiatric Association. Diagnostic and Statistical Manual Version 5. American Psychiatric Press 2013.

BED is the Most Common Eating Disorder in the United States •  BED is the most common eating disorder in the United

States. It’s twice as common as anorexia nervosa and bulimia nervosa combined. In fact, we think it occurs in perhaps 2.8% of American adults. We also think it occurs in 1.6% of American adolescents.

•  In community samples, 60%of people with BED are women and 40-percent are men.

•  So it’s very important to realize that not only is this the most common eating disorder, but it affects a wide variety of people, men as well as women, all ages.

National Eating Disorders Association. Website: https://www.nationaleatingdisorders.org/binge-eating-disorder.

American Psychiatric Association. Diagnostic and Statistical Manual Version 5. American Psychiatric Press. 2013.

Hudson JI, et al. Biol Psychiatry. 2007;61(3):348-358. PMID: 16815322; Preti A, et al. J Psychiatr Res. 2009;43(14):1125-1132. PMID: 19427647; Kessler RC, et al. Biol Psychiatry. 2013;73(9):904-914. PMID: 23290497; Swanson SA, et al. Arch Gen Psychiatry. 2011;68(7):714-723. PMID: 21383252.

Hudson JI, et al. Biol Psychiatry. 2007;61(3):348-358. PMID: 16815322; Crow S, et al. Int J Eat Disord. 2001;30(2):222-226. PMID: 11449458; Barnes RD, et al. Prim Care Companion CNS Disord. 2011;13(2). pii: PCC.10m01050. PMID: 21977358; Reichborn-Kjennerud T, et al. Obes Res. 2004;12(9):1445-1454. PMID: 15483209; Javaras KN, et al. J Clin Psychiatry. 2008;69(2):266-273. PMID: 18348600.

Hudson JI, et al. Biol Psychiatry. 2007;61(3):348-358. PMID: 16815322; Kessler RC, et al. Biol Psychiatry. 2013;73(9):904-914. PMID: 23290497; Swanson SA, et al. Arch Gen Psychiatry. 2011;68(7):714-723. PMID: 21383252.

Hudson JI, et al. Biol Psychiatry. 2007;61(3):348-358. PMID: 16815322

Lock J, et al. Int J Eat Disord. 2013;46(6):567-575. PMID: 23625628

Lock J, et al. Int J Eat Disord. 2013;46(6):567-575. PMID: 23625628; Wilson GT, et al. Am Psychol. 2007;62(3):199-216. PMID: 17469898; Grilo CM, et al. J Consult Clin Psychol. 2012 Apr;80(2):186-195. PMID: 22201327.

Agras WS, et al. Arch Gen Psychiatry. 2000;57(5):459-466. PMID: 10807486; Fairburn CG, et al. Arch Gen Psychiatry. 1991;48(5):463-469. PMID: 2021299; Fairburn CG, et al. Arch Gen Psychiatry. 1995;52(4):304-312; PMID: 7702447; Fairburn, CG, et al. Lancet. 2003;361(9355):407-416. PMID: 12573387; Carter JC, et al. Am J Psychiatry. 2003;160(5):973-978. PMID: 12727703; Wilfley DE, et al. Arch Gen Psychiatry. 2002;59(8):713-721. PMID: 12150647; Wilsonn GT, et al. Arch Gen Psychiatry. 2010;67(1):94-101. PMID: 20048227.

Which Foods?

● Preliminary examination of which foods are associated with addictive-like eating behavior

● First study to examine which food attributes (e.g., fat content) may be implicated in food addiction

● Also first to explore whether individual differences, like body mass index (BMI) and gender, may strengthen this association

Forced-Choice Task

● Filled out YFAS ● 35 nutritionally

diverse foods (processed, fat, GL, calories, protein, etc.)

Rank Food Frequency 1 Chocolate 27.60

2 Ice Cream 27.02

3 French Fries 26.94

4 Pizza 26.73

5 Cookie 26.72

6 Chips 25.38

7 Cake 24.84

8 Popcorn (Buttered) 23.39

9 Cheeseburger 21.26

10 Muffin 20.81

Which Foods?

Schulte, Avena, & Gearhardt, 2015

Which Foods?

Schulte, Avena, & Gearhardt, 2015

Rank Food Frequency 26 Apple 10.21

27 Corn (No Butter or Salt) 9.92

28 Salmon 9.44

29 Banana 9.34

30 Carrots (Plain) 9.08

31 Brown Rice (Plain, No Sauce)

8.79

32 Water 6.91

33 Cucumber (No Dip) 6.83

34 Broccoli 6.48

35 Beans 6.47

Mitchell KS, et al. Psychol Med. 2010;40(11):1899-906. PMID: 20132584; Javaras KN, et al. J Clin Psychiatry. 2008;69(2):266-273. PMID: 18348600.

The “Munchies,” or That Uncontrollable Urge to Eat

●  After using marijuana, appear to be driven by neurons in the brain that are normally involved in suppressing appetite, according to a new study by Horvath & Yale School of Medicine researchers in the Feb. 18 issue of the journal Nature.

Koch M, et al. Nature. 2015;519(7541):45-50. PMID: 25707796

Brownley KA, et al. Drugs. 2015;75(1):9-32. PMID: 25428709

Wang GJ, et al. Obesity (Silver Spring). 2011 Aug;19(8):1601-1608. PMID: 21350434.

McElroy, S, et al. Ther Clin Risk Manag. 2012;8:219-241. PMID: 22654518

McElroy, S, et al. Ther Clin Risk Manag. 2012;8:219-241. PMID: 22654518

McElroy, S, et al. Am J Psychiatry. 2003;160(2):255-261. PMID: 12562571

McElroy, S, et al. Am J Psychiatry. 2003;160(2):255-261. PMID: 12562571

Claudino AM, et al. J Clin Psychiatry. 2007;68(9):1324-1332. PMID: 17915969

Brooks SJ, et al. BMC Psychiatry. 2012;12:76. PMID: 22770364

McElroy SL, et al. American Psychiatric Association Annual Meeting. San Francisco 2013. Abstract NR4-25.

McElroy SL, et al. American Psychiatric Association Annual Meeting. San Francisco 2013. Abstract NR4-25

All LDX Subjects Started at 30 mg/day and Were Titrated to an Optimal Dose of 50 or 70 mg/day

Lisdexamfetamine (LDX) in BED

McElroy SL, et al. American Psychiatric Association Annual Meeting. San Francisco 2013. Abstract NR4-25.

LDX Reduces Binge Days/Week

McElroy SL, et al. American Psychiatric Association Annual Meeting. San Francisco 2013. Abstract NR4-25.

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LDX ( n - 174) PBO (n = 176)

LDX baseline: 4.66 mean binge days/wk

PBO baseline: 4.82 mean binge days/wk

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PBO-subtracted differences (LDX – PBO) in LS mean change from baseline was -1.66 ( p < .001)

Baseline Week 12 LDX (n = 174) 4.66 0.77 PBO (n = 176) 4.82 2.57

Lisdexamfetamine

•  Patients who received 50 mg/d of lisdexamfetamine (LDX) and 70 mg/d had a significantly greater mean reduction in binging regarding binge days or actual binge episodes from baseline to week 11

•  These reductions were statistically significant, again both for 50 and 70 mg/d. However, there was not a significant reduction in binge eating behavior on the dosage of 30 milligrams of LDX

•  Suggests that LDX is efficacious for BED at a dose of 50 or 70 mg/d

Citrome L. Int J Clin Pract. 2015;69(4):410-421. PMID: 25752762.

Food  Addic(on  and  Obesity  Work  Relates  to  BED    

●  Growing research in obesity, suggests that there is reduced dopamine, D2 receptor availability in the striatum particularly in people with morbid or severe obesity even after controlling for obesity.

●  Study by Dr. Wang and colleagues took people who had BED with obesity and people who had obesity but no BED.

●  Food stimulus and paired it with methylphenidate and showed that the people with BED had greater caudate dopamine release compared to their non-BED counterparts.

●  Moreover, they found that as the degree of binge eating increased—as the severity of binge eating scale scores increased, the amount of dopamine increase increased.

●  Dopamine increase was correlated with binge eating scale scores, not correlated with weight.

BED- Comorbidities

•  BED is associated with a number of the medical complications of obesity, including type 2 diabetes and components of the metabolic syndrome including dyslipidemia and hypertension.

•  Preliminary evidence suggests that BED may be associated with metabolic abnormalities even when effects of obesity have been accounted for.

•  BED is associated with a broad range of psychiatric disorders including mood, anxiety, substance use, and impulse control disorders

•  Important to treat comorbidities

Psychological Treatments

•  The two best psychological treatments for BED are CBT and interpersonal therapy. CBT-cognitive behavioral therapy works faster than interpersonal therapy, but after approx 6 months the 2 treatments appear to be equally efficacious

•  Psychological treatments are more effective for binge eating than for weight loss. •  The results of behavioral weight loss are mixed. •  Some who do lose weight note the weight loss can be

transient

Studies Assessing BED & Food Addiction among Clinical Samples ●  In a sample of 79 women with BED, 92.4% met the DSM-IV criteria

for substance dependence when questions substituted “substance” with “binge eating” (Cassin and von Ranson, 2007)

●  A recent study found that participants with BED had addictive personality scores similar to what has been reported for individuals with substance dependence disorder (Lent & Swencionis, 2012)

●  In 2009, the Yale Food Addiction Scale (YFAS) was created to study food addiction by applying the DSM-IV criteria for substance dependence to eating behaviors

Cognitive Functions in BED

●  Obese BED individuals exhibit broad cognitive dysfunction compared with obese non-BED individuals on tasks assessing problem solving, plan formulation and implementation, task scheduling, performance monitoring, cognitive flexibility, and working memory

●  Obese individuals with BED also showed reduced preference for delayed rewards and probabilistic rewards compared with obese non-BED individuals and normal-weight individuals, suggesting that impaired decision-making may relate in part to impatience and risk aversion

●  Individuals with BED have been shown to exhibit altered attentional and memory biases regarding food-related cues, and to a lesser extent, body-image–related cues

●  Overweight individuals with BED showed more cognitive interference during performance of a working-memory task than those without BED, regardless of whether the interfering cues were food-related

Clinical Connections

● Binge eating disorder is the most common eating disorder in the US

● There can be serious medical and psychological consequences

● Psychological treatments can be effective

● Pharmacological treatment has been shown to be effective.

Questions & Answers