Case-Based Review

Binge-Eating Disorder: Prevalence, Predictors, and Management in the Primary Care Setting

Journal of Clinical Outcomes Management. 2015 November;22(11)
Author(s):
Karen K. Saules, PhD
Jillian Carey, MS
Meagan M. Carr, MS
Rachel M. Sienko, MS

 

References

From the Department of Psychology, Eastern Michigan University, Ypsilanti, MI.

Abstract

  • Objective: To describe the epidemiology, clinical features, clinical course, medical complications, and treatment of binge-eating disorder (BED).
  • Methods: Review of the literature.
  • Results: BED, the most common eating disorder, is a distinct pattern of binge eating accompanied by a sense of loss of control over eating without inappropriate compensatory behaviors. Because people with BED more commonly seek treatment for the psychological and medical factors that are associated with the disorder, patients’ first point of contact with the medical profession is likely to be the primary care physician (PCP). The PCP’s role includes making efforts to screen for BED symptoms, employing motivational interviewing strategies to enhance likelihood of following through with treatment, providing psychoeducational information about eating and weight control, monitoring eating, weight, and related medical problems at follow-up visits, and making referrals to behavioral health specialists who can deliver empirically supported treatments for BED.
  • Conclusion: Proper screening and referral in the primary care setting can optimize the likelihood that patients obtain empirically supported treatment.
Binge-eating disorder (BED), first described by Stunkard in the 1950s, is a distinct pattern of binge eating, accompanied by a sense of loss of control over eating without inappropriate compensatory behaviors [1]. It was not until the publication of DSM-IV-TR [2] that BED received systematic study as a separate diagnostic category, when it was included in the appendix Criteria Sets and Axes Provided for Further Study. Until recently, individuals reporting binge eating without recurrent compensatory behavior were diagnosed with an eating disorder not otherwise specified. More recently, the American Psychiatric Association approved BED for inclusion in DSM-5 as its own category of eating disorder [3]. The diagnostic criteria for BED are delineated in Table 1 . In contrast to BED, bulimia nervosa is a longstanding diagnostic category that refers to recurrent episodes of binge eating, accompanied by a sense of loss of control over eating and recurrent inappropriate compensatory behaviors to prevent weight gain (eg, self-induced vomiting, misuse of laxatives or diuretics, fasting)

BED is the most common eating disorder, but it is one for which many do not seek treatment directly. Rather, those struggling with BED more commonly seek treatment for the psychological and medical factors that are strongly associated with the disorder. As will be reviewed below, these factors include poor social adjustment, functional impairment, psychological distress and psychiatric comorbidity, and myriad medical sequelae due to obesity and weight cycling. As such, the BED patient’s point of first contact with the medical profession is most likely to be with the primary care physician, who has several roles in the treatment of BED. There is a limited evidence base for pharmacological treatment of BED, with some medications yielding short-term reductions in binge eating, but none with strong support for long-term efficacy [4]. However, with the recent FDA approval of lisdexamfetamine dimesylate for the treatment of moderate to severe BED, this picture may change. Nonetheless, pharmacologic interventions for comorbid medical conditions will fall solidly in the bailiwick of the primary care physician. In addition, the primary care physician’s role includes making efforts to screen for BED symptoms; employing motivational interviewing strategies to enhance likelihood of following through with treatment; providing psychoeducational information about eating and weight control; monitoring eating, weight, and related medical problems at follow-up visits; and making referrals to behavioral health specialists who can deliver empirically supported treatments for BED. Finally, because BED is typically associated with weight gain over time [5], the primary care physician is encouraged to reinforce the clinical significance of weight maintenance as opposed to necessarily promoting a goal of weight loss. The rationale for this primary care approach is reviewed below, in consideration of the scientific literature and a case study highlighting common clinical features.

Pages

Next Article:

Psychological Distress and Cardiovascular Disease