Binge Eating Disorder

Question 1

Binge eating disorder

Answer 1

Binge eating disorder = similar to bulimia.

• They don’t use dangerous weight-loss methods ― purging / laxatives / extreme dieting etc.
• Most do not seek medical help, unless for obesity ― unlike BN sufferers, those with BED are typically overweight.
• If a BED client presents for weight loss as they are obese, they will need extra support to address the bingeing. You can work with them in tandem with a mental health professional or refer your client to a programme such as Overeaters Anon (OA).
• It is thought that 10 to 15% of mildly obese people enrolled in weight loss programmes have BED.

Question 2

Clinical presentation:

Answer 2

• Discreet episodes of rapid and excessive food consumption not necessarily driven by hunger or metabolic need.
• Individuals will eat until they feel uncomfortably full and may or may not use compensatory behaviours for them, such as self-induced vomiting.
• Binge eating is often accompanied by feelings of loss of control and psychological distress.
• Not surprisingly, overweight and obesity, together with the associated physical and psychological health concerns, are commonly comorbid with binge eating

Question 3

Proposed diagnostic criteria:

Answer 3

Recurrent episodes of binge eating.

• Lacks control over her eating during the binge-eating episode.
• Episodes are associated with three of the following:

– Eats more rapidly than normal.

– Eats until uncomfortably full.

– Eats large amounts of food when not feeling hungry.

– Eats alone, because is embarrassed about the amounts eaten.

– Feels disgusted with self, depressed or guilty for overeating.

• Is very distressed with regard to the binge eating.
• Binge eating occurs at least two days a week for six months or more.

Question 4

What precipitates a binge?

Answer 4

• Food deprivation patterns (dieting / starvation patterns).
• Stress and stress responses.
• Adaptations within the natural reward pathways, specifically the endogenous opioids and dopamine.
• Acute tryptophan depletion and disturbances in serotonin levels.

Question 5

Nutritional aims for BN and BED

Answer 5

• To reduce the number of binges by addressing any blood sugar imbalances and increasing insulin receptor sensitivity.
• To encourage healthy eating patterns and dispel any food myths.
• To increase inhibitory neurotransmitter levels.
• BN, specifically, fosters harm minimisation and prevents the use of purging techniques.
• Eating regular meals (even if a binge has occurred).
• Mindfulness programmes can help to facilitate healthy eating patterns again, as listening to body signs of hunger and giving the body what it needs can help to break the binge-purge-starve cycle.

Question 6

Therapeutics — protein, tryptophan and bulimia:

Answer 6

• Studies have shown protein-rich meal supplements enhance recovery time compared to carbohydrate-rich supplements. It is, therefore, indicated to use good quality protein to aid recovery.
• Acute tryptophan depletion in bulimics increases the urge to binge and lowers mood. Therefore, a diet lacking tryptophan can increase BN and BED risk in vulnerable people

Question 6

Therapeutics — inositol and bulimia:

Answer 6

• Research has revealed the benefits of using inositol in those with BN and BED. It is thought that inositol increases serotonin receptor sensitisation. Dosage: 1g x 3 daily.

Question 7

Therapeutics — help clients to identify binge triggers:

Answer 7

• Keeping a food, symptom and emotional diary can help to identify trigger situations to binge (e.g., seeing mum, confrontation, feeling sad etc.).
• Explaining to clients the link between mood and fluctuating blood sugar levels and tryptophan levels are important to help with understanding the physiological sensations of needing to binge.
• Identifying triggers is extremely important ― as then choice can be given to other options to use at the time of stress.
• When the binge happens, not allowing guilt to be an option.

Question 7

Therapeutics — fostering healthy eating patterns

Answer 7

• Reinforce healthy food choices and dispel any food myths that may have arisen.
• Try to encourage regular eating patterns.
• Be aware of the impact of exercise on the calorie needs of the day.
• Be on the lookout for fad dieting in between binges, as this will make it worse