November 9, 2016

Do You Have Patients With Undiagnosed Binge-Eating Disorder?

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Hunna J. Watson, PhD; Andreas Jangmo, MSc; and Cynthia M. Bulik, PhD

University of North Carolina, Chapel Hill (Drs Watson & Bulik); Curtin University and University of Western Australia, Perth (Dr Watson); and Karolinska Institutet, Stockholm, Sweden (Mr Jangmo & Dr Bulik)


Binge-eating disorder (BED) involves recurrent episodes of consuming a large amount of food in a short period of time, with an accompanying sense of loss of control over eating, at least once a week for at least 3 months. BED is more prevalent than anorexia nervosa and bulimia nervosa, striking about 3% of women and 2% of men in their lifetimes.

People with BED are at much higher risk than healthy individuals of having mood and anxiety disorders, metabolic syndrome , and a range of other health conditions. Effective treatments for BED are available. Psychotherapy, specifically cognitive-behavioral therapy, is more effective than pharmacotherapy, although pharmacotherapy is recommended as a second-line treatment. The widest support is for selective serotonin reuptake inhibitors (SSRIs) and one medication approved by the US Food and Drug Administration (lisdexamfetamine). A major concern in health care delivery is that many treatable cases of BED are only being diagnosed many years after illness onset or are not being diagnosed at all.

In our recent study, Swedish national registers were used to detect all treatment-seeking individuals with a lifetime diagnosis of BED and to compare prescription medication utilization to matched healthy controls within 12 months before and after BED diagnosis. Before diagnosis, patients were significantly more likely to have been prescribed medications targeting the nervous system, tumors and immune disorders, cardiovascular system, digestion and metabolism, infectious diseases, skin, and respiratory system. After diagnosis, patients had higher odds of receiving prescriptions across most medication categories. Even when obesity and lifetime psychiatric comorbidity were adjusted for, several associations remained statistically significant.

These findings may help practitioners identify BED sooner. The findings augment previous research suggesting that BED is accompanied by a high disease burden and add to growing evidence that medical comorbidity is more wide-ranging than previously known. Research shows that delays in diagnosis occur for many reasons. Individuals with BED more typically present to the clinic to discuss concerns about anxiety, depression, weight, or other somatic problems rather than BED; they may have poor self-recognition of problematic eating or feel too ashamed or embarrassed to discuss eating and weight-related issues. Further, primary care physicians are missing opportunities to screen for BED. Screening for BED is simple: a brief, 7-item patient-report screening questionnaire (the BEDS-7) can facilitate referral to a mental health professional for accurate diagnosis and treatment. The potential result of improved screening is that more effective management of BED could improve long-term health outcomes and reduce the need for pharmacologic management of related symptoms. Another implication of this work is to encourage mental health professionals to routinely prompt medical review and monitoring of these patients.

In conclusion, heightened awareness of and screening for BED are necessary to ensure that the clinical needs of individuals with BED are met in a timely fashion.

Financial disclosure: Shire provided funding for the study but had no role in data analysis. Shire did not have any input or influence into the blog post, and the opinions expressed are those of the authors. Dr Watson is a stock shareholder of VHT and IBB ETFs, unrelated to the submitted work. Dr Bulik is a consultant for Shire and Ironshore, has received grant/research support from Shire, and has received royalties from Pearson. Mr Jangmo has no relevant personal financial relationships to report.​

Category: Eating Disorders , Medical Conditions , Mental Illness
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