Binge Eating Disorder by Dr. Giorgio A. Tasca, C.Psych. Director of Research, Eating Disorders Program, The Ottawa Hospital
It often comes as a surprise to many people that binge eating disorder (BED) is the most prevalent of the eating disorders. As many as 3.6% of Canadians suffering from BED, whereas about 0.9% suffer from anorexia nervosa, and about 1.5% suffer from bulimia nervosa. BED involves binge eating at least once a week for a period of 3 consecutive months or more, and experiencing distress about the binge eating, but with no compensatory behaviors. So, unlike bulimia nervosa, people who suffer from BED do not purge after a binge. Binge eating is defined as eating an amount of food that most people would consider very large (over-eating) and having a sense of loss of control during the over-eating episode. Over-eating without loss of control is not a binge, nor is feeling out of control while eating a small or normal amount of food.
BED occurs most often in women, but once again many people are surprised to learn that BED occurs quite often in men as well. As many as 30% to 40% of people with BED are men. This is quite different from anorexia nervosa and bulimia nervosa in which men make up to 10% of all sufferers. BED often co-occurs with depression, so that about 49% of people with BED had a lifetime incidence of depression. By contrast, depression occurs in about 8% of the general population. Obesity is very common in those with BED so that more than 60% of those with BED are also obese. In Canada, about 23% of the general population are obese. Obesity is defined as a body mass index (BMI) of 30 or higher. (BMI is a ratio of weight measured in kilograms divided by height in meters squared. BMI less than 18.5 is underweight, 18.5 to 25 is normal weight, 25 to 29 is overweight, and BMI greater than 30 indicates obesity.) As a result, those with BED and obesity often develop medical problems like diabetes and high blood pressure.
Treatments for BED include medications, self help, and group psychological treatments. Medications that are often prescribed for BED include some antidepressants that might help with cravings and low mood. Some anticonvulsant medications have also been helpful for BED. However, medications can have unpleasant side effects for some that make it difficult to take the medications and benefit from them. Self help can also be helpful for some with BED. These interventions are often based on cognitive behavioral models such as is found in Christopher Fairburn’s book: “Overcoming Binge Eating”. This book focuses on eating regular healthy meals, monitoring what one eats and how one feels, and developing problem solving strategies. Group psychological treatments are also effective for some with BED. In such groups people can benefit from learning from others, from feeling a sense of community, and from achieving a better understanding of what leads to a binge. For example, often, relationship stresses and sensitivities can lead to negative feelings (anger, sadness, loneliness). Sometimes, one might binge in order to cope with or numb these feelings. So developing better relationship patterns might help to feel better about oneself, which could lead to fewer binges.
At The Ottawa Hospital we are currently conducting a stepped care treatment trial for BED. Stepped care refers to providing the right level of care for people depending on what they need. For example, some people may only need a low intensity treatment like self help, whereas others may need more intense treatment like group therapy. In our study we will provide everyone with the first step of low intensity self help, which is an evidence based intervention. After completing self help, we will randomly assign people (by flip of a coin) either to receive group therapy or to wait for a period of time. We want to see who benefits from self help alone and who requires the more intensive treatment. We are still recruiting participants with BED for this treatment study. For more information you can go to our web site at: www.med.uottawa.ca/cedr or email at firstname.lastname@example.org.