Binge Eating Disorder: Current Research & Evidence Based Best Practices

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Shanna James
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1 Binge Eating Disorder: Current Research & Evidence Based Best Practices Chevese Turner CEO & Founder Binge Eating Disorder Association (BEDA) My BED Journey Family history of eating disorders/substance abuse/trauma/mood disorders Experienced size bias, body-hatred, teasing around height and weight at early age Early anxiety & depression Feelings of being outsider retreated to food as comfort. Restriction and managed dieting encouraged early Eating disorder took center stage and contributed to delay in adult development 1

2 My BED Journey Preoccupation around weight loss further stunted development (life begins x pounds from now) With each binge or diet, sense of failure increased and willingness to engage in life decreased Learned that acceptance is first step to wellness and recovery Addressing psychological issues, including internalized weight stigma and trauma absolutely necessary Complexities of BED BED is NEVER about willpower! BED ALWAYS makes sense: What is the function or purpose of the disorder? Causes are complex and unique to each person 2

3 5/13/13 What is Known BED affects approximately 15 million people % of women and 2% of men (Hudson, et al 2007) Affects 15% to 50% of samples drawn from weight-control programs (Hudson et al, 2007) Affects approx 2-4% of general population and 8% of obese population (DeAngelis, 2002) 49% of those seeking bariatric surgery (Hudson et al, 2007) What is Known Most common eating disorder (Hudson, 2007) Men almost equally affected Most misdiagnosed ED ( obesity as focus) Preoccupation with body weight and shape Addition to the DSM-5 in means more people seeking tx, increase in research 3

4 Clinical Definition of BED DSM V Criteria Recurrent episodes of binge eating : Eating in a discrete period of time (e.g. 2 hours) an amount of food larger than most people would eat in a similar period under similar circumstances A sense of a lack of control over the eating during the episode Binge eating episodes associated with at least 3 of the following: Eating more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not hungry Secretive eating Feeling disgusted, depressed or guilty after binge DSM V Criteria (cont) Clinical Definition of BED Binge eating occurs, on average, 1 day per week for at least 3 months (proposed DSM V) Disturbance does not occur exclusively during the course of anorexia or bulimia Compulsive Eating (grazing) vs. Emotional Eating (normal) vs. Binge Eating Disorder 4

5 DSM-5 Inclusion: How Did It Happen? Excessive concern for weight and body shape Wilfley, Wilson, and Agras (2003) and Streigel-Moore, Cachelin, Dohm, Pike, Wilfley, and Fairburn (2001) Body image disturbances are more pronounced in obese binge eaters than in obese non-binge eaters Tuchen-Caffier & Schlüssel, 2005, pp Co-morbid mood disturbances common Wilfley, et al (2003) DSM-5 Inclusion: How Did It Happen? Non-BED obesity and BED are different: several studies concluded that psychopathology is significantly more prominent in individuals with BED when compared with obese non-bed subjects. Impairment and distress experienced by those who meet criteria for BED is clinically different from individuals who just present obesity or overweight (Brownley, et al, 2007) Clinical Utility: BED can be differentiated from AN/BN through recovery rates, diagnostic stability, age of onset, gender distribution, Body Mass Index (BMI), dietary restraint, relative age of onset of dieting and binge eating, psychiatric comorbidity, and binge characteristics (Wonderlich et al., 2009, p. 699) 5

6 DSM-6? Restriction is an important part of understanding binge eating disorder 50% 45% 45% 40% 35% 30% 25% 24% 20% 15% 13% 12% 10% 5% 0% 6% Never Almost never Sometimes Fairly often Very often Prevelence of Overweight/ Obesity in those with BED 6

7 Genetic Heritability 50-60% Strong impulse to soothe Risk Factors Learned behavior food is early, available soothing mechanism; restrictive behavior (binge/ restrict patterns aka yo-yo dieting) Biological restriction, diet rules, body equates weight loss with danger and triggers cravings and food obsession, hx of parent or self with depression, ineffective emotional regulation Family of Origin Issues 10 going on 40 ; caretaker role, often oldest child or the responsible one; difficulties separating from family (guilt for autonomy is common) Risk Factors Personality socially anxious, emotionally sensitive, pervasive and powerful inner critic, often people pleasers ; may be covertly rebellious/angry Trauma sexual, physical, emotional, significant loss at early age; exposure to negative comments about weight, shape/size, and eating (weight stigma/ discrimination) 7

8 Those with BED are NOT getting help 87% are not receiving any sort of treatment for BY FAR the most common eating disorder Receiving help from Primary Care Physician 10% Psychiatrist 1% Psychologist, other therapist 2% Other health care professional 3% Taking medication 2% No current help, but has received help in past 9% Has never received help for binge eating 78% Treatment Evaluation for eating disorder and trauma Psychological intervention Behavioral weight loss ineffective over long term (91% regain within 5 years) EVERY client with BED in a larger body will come to you and request help to lose weight pursuit of this will entrench eating disorder pathology and set up restrict/binge and lose/gain cycles Internalized weight stigma work Acceptance, mindfullness techniques 8

9 Treatment Psychotherapy w/ed-trained therapist Education about Weight Stigma Family Therapy Nutrition Counseling Groups Pharmacological Treatment Somatic therapies (trauma) Movement Art and Expressive Therapies Weight Stigma Experiencing weight stigma predicts behaviors related to unhealthy restraint and binge eating: Dieting behaviors Dietary restraint Bulimic behaviors Binge-eating Unhealthy/extreme weight control behaviors Fasting Using diet pills, laxatives and/or diuretics Vomiting/purging Using a food substitute (e.g. powder) Skipping meals Puhl, et al

10 Public perceptions of BED reinforce stigma - Often viewed as problem of willpower, low-self-esteem, depression - not as a legitimate eating disorder - Perception of binge eating increases stigma of obesity - Eating disorders often trivialized - subset of public believes might not be too bad - Target of more blame than other psychological disorders LaPorte, 1997; Mond & Hay, 2008; Wilson et al., 2009; Becker et al., 2010; Crisp, 2005; Mond et al., 2006; 2007; Roehrig & McLean, 2009; Stewart et al., 2006; Wingfield et al., 2011; Wilson et al., 2009 Health Consequences Weight Stigma results in maladaptive eating behaviors: - Binge eating - Unhealthy weight control practices - Coping with stigma by eating more food Haines, et al., 2006; Neumark-Sztainer et al., 2002; Puhl & Brownell, 2006, Puhl et al., 2007; Puhl & Luedicke,

11 Health Consequences Contributes to Higher Weights: - Higher calorie intake - More weight gain - Avoidance of movement - Increase in cardiovascular problems - Poor quality of life Schvey, Puhl, & Brownell, 2011; Carels et al, 2009; Wott & Carels, 2010 Coping with weight stigma Study: asked 2449 women How do they cope with stigma experiences? 79% reported eating; turning to food as coping mechanism * Stigma is a stressor *acute and chronic form of stress - Eating is common coping strategy in response to stress Puhl & Brownell,

12 Internalizing weight stigma Study: 1013 women who belonged to a national non-profit weight loss support organization: Women who internalized experiences of weight stigma and blamed themselves for stigma engaged in more frequent binge eating. This was true even after accounting for self-esteem, depression, and amount of stigma experienced Puhl et al., 2007 Recovery Recovery is about hearing the inner world with curious, compassionate ears; about speaking the truth of the body, the heart and the mind. It is about honoring somatic cues most of the time, slowly taking judgment and obsession out of eating and movement. Recovery is learning to challenge cultural ideals of beauty, recognize the damage of weight stigma and bias on one s body image, and heal from the possible traumas of living in a bigger body in this culture. Recovery from BED requires advocacy, both internal and external. Recovery is not about never overeating again, nor is it s purpose weight loss (although it may occur). The work is to recognize when the eating disorder presents itself, why it does so, and have the resources available to address, and when possible over time, heal, the trigger. And it is about valuing the whole Self, including the ED, as is. 12

13 QUESTIONS? Chevese Turner CEO & Founder BEDA THANK YOU Direct line:

Learning to LOVE your Body, Weight Loss, and Exercise

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