Lecture 15 Binge Eating

Question 1

diagnostic criteria for BE

Answer 1

A. recurrent episodes of binge eating. An episode is characterised as both:

1. eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances
2. a sense of lack of control over eating during this episode, some report dissociative quality

loss of control present when do not have objectively large amount of food -> subjective binge eating

B. binge-eating episode associated with 3+:

• eating faster
• eating until uncomfortably full
• eating large amount when not feeling hungry
• eating alone
• feeling disgusted, depressed, guilty afterward

C. marked distress: typically ashamed of eating problems, attempt to conceal

D. once a week for 3 months

E. not associated with compensatory behaviour

Question 2

specifiers

Answer 2

current severity

mild: 1-3/week
moderate: 4-7 (once a day)
severe: 8-13
extreme: 14+ (twice a day)

Question 3

BE associated with

Answer 3

early onset obesity
severity of obesity
increased rate of psychopathology

Question 4

relationship between BE and obesity

Answer 4

41% overweight/obese in community meet criteria for BE

52% overweight/obese in weight loss programmes meet criteria for BE

88% individuals with BE had obesity at some point in their lives

Question 5

prevalence of BE

Answer 5

increases linearly over time, rates in 2015 6x 1998

1998: 2.7% once weekly, 1.1% twice weekly
2015: 13% once weekly, 3.5% twice weekly

Question 6

3 month prevalence of DSM-5 ED in 2008/9

Answer 6

AN: 0.46%
BN: 0.66%
BE 5.58%
sub-threshold BED 6.92%

Question 7

how abnormal is BE

Answer 7

health-related quality of life impairment attenuated over time, such that BE scored similarly to population norms on measures of HRQoL

weekly BE no longer associated with increased days out of role compared to 2005

in 2015, 50% of once/twice weekly BE report do not experience distress related to the act of BE, but distress related to QoL impairment and higher number of days out of role

Question 8

risk factors of BE

Answer 8

single greatest risk factor: dieting

runs in family, genetic influence: 17% to 39% of variance

trauma (esp. early-life), low self-esteem, body dissatisfaction, negative emotionality, overevaluation of weight and shape, difficulty regulating emotional states, parental substance use

triggers: negative affect, interpersonal stressors, dietary restraint, boredom

Question 9

comorbid conditions

Answer 9

similar to other ED

depression and anxiety most common (54% depression, 37% anxiety)

substance use and personality disorders ( 25%)

few gender differences observed, men had higher lifetime rates of substance use disorder, current rates of OCD

Question 10

assessment tools

Answer 10

SCOFF: 5-item screening tool, simple administration and scoring, not BE-specific

Binge Eating Scale: 16-item self-report, scoring more complicated

BEDS-7: 7-item diagnostic screener, follows DSM-5 criteria

Question 11

psychological treatment of BED

Answer 11

major systematic review 2012, 13 studies of BED treatment, 5 studies with mixed samples including BED

CBT most common, ~70%
DBT
Interpersonal Psychotherapy (IPT)
Brief Strategic Therapy (BST)
Behavioural Weight Loss (BWL)

Question 12

outcome: binge abstinence

Answer 12

end treatment
DBT (64%) > IPT (60%) > CBT (46%) > BWL (38%)

follow-up
IPT (63%) > CBT (59%) > BWL (41%) > BST (20%)

duration:
BST (6m) < CBT (6-24m) < BWL/IPT (12-24m)

Question 13

treatment of BED

Answer 13

overall evidence
CBT > self-help = IPT > DBT = BWL

reduced BE
CBT = IPT = DBT > self-help > BWL

reduced weight
BWL > self-help/CBT/IPT/DBT

Question 14

HAPIFED

Answer 14

a healthy approach to weight management and food in eating disorders

problem: psychological therapies for BE while impacting binge frequency do not lead to weight reduction

solution: integrate best of BWL with CBT
sustain weight loss by reducing disordered eating, enhancing psychological wellbeing and improving appetite regulation

Question 15

treatment feature

Answer 15

Hapifed:

• CBT formulation
• psycho-education of ED and obesity
• dietician
• monitoring with appetite cues
• cognitive therapy
• multidisciplinary
• 30sessions, 6mth
• mood regulation
• weight loss
• behavioural activation

CBT-E

• no dietitian
• no multidisciplinary
• 20/4
• no weight loss
• no behavioural activation

BWL

• no cognitive therapy
• 16/4
• no mood regulation

Question 16

pilot study changes in ED from baseline to end of treatment

Answer 16

Weight: -1.1 kg slow and modest weight loss
eating concern: -2.4
weight concern: -1.5
shape concern: -1.4
global score: -1.1
objective BE: -4.0
subjective BE: -1.0

Question 17

changes in mental health from baseline to end of treatment

Answer 17

depression: -5.0
stress: -4.0
anxiety: -3.0

Question 18

binge eating e-therapy

Answer 18

online CBT intervention: 28-access to food diary, daily SMS reminders

significant decrease in binge frequency, binge days and associated loss of control

37% decrease in binge episode frequency

no significant changes in compensatory behaviours

significant decrease in dietary restraint, eating concern, shape concern, global EDE-Q scores

Question 19

vyvanse

Answer 19

LDX approved for adult moderate to severe BED in US, Canada, Australia

LDX produced statistically significant and clinically meaningful reductions in BE days/week compared with PBO

time to relapse significantly favoured LDX over PBO

percentage of participants with observed relapse:
32.1% for PBO, 3.7% for LDX

BE abstinence, reduced BE frequency, reduced related psychopathology, weight loss, sympathetic nervous system arousal