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 bedstudy@toh.on.ca.
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