Racial, Ethnic, and Sex Differences in Eating Disorder Onset Among U.S. Military Service Members.

Bulimia nervosa (BN) and binge eating disorder (BED) are the most prevalent eating disorders (EDs) among military personnel. Although sex differences are noted in ED prevalence in military and civilian samples, mixed findings have emerged when evaluating racial and ethnic differences. The present study examined independent associations and interactions between sex, race, ethnicity, and probable BED and BN onset. The sample included 91,413 and 96,245 service members from the Millennium Cohort Study for BED and BN analyses, respectively. Up to four datapoints (from 2001-2013) were used to conduct longitudinal complementary log-log regression analyses, as participants were followed until the outcome occurred or until study completion. BN was more likely among women than men, and no sex difference emerged for BED onset. BN was more likely among Hispanic/Latinx, Multiracial, Black, and Asian/Pacific Islander (API) while BED was less likely among Black and API versus non-Hispanic/Latinx White (NHW) service members. Interactions revealed greater likelihood of BN in Hispanic/Latinx service members was driven by men. Additional efforts are needed amongst racially and ethnically diverse groups in preventing and detecting EDs in military personnel. Future intersectionality research could elucidate systemic inequities and other contributing factors to ED onset to inform prevention and treatment efforts.

Changes in evening-shifted loss of control eating severity following treatment for binge-eating disorder.

BACKGROUND: Loss of control eating is more likely to occur in the evening and is uniquely associated with distress. No studies have examined the effect of treatment on within-day timing of loss of control eating severity. We examined whether time of day differentially predicted loss of control eating severity at baseline (i.e. pretreatment), end-of-treatment, and 6-month follow-up for individuals with binge-eating disorder (BED), hypothesizing that loss of control eating severity would increase throughout the day pretreatment and that this pattern would be less pronounced following treatment. We explored differential treatment effects of cognitive-behavioral guided self-help (CBTgsh) and Integrative Cognitive-Affective Therapy (ICAT). METHODS: Individuals with BED (N = 112) were randomized to receive CBTgsh or ICAT and completed a 1-week ecological momentary assessment protocol at baseline, end-of-treatment, and 6-month follow-up to assess loss of control eating severity. We used multilevel models to assess within-day slope trajectories of loss of control eating severity across assessment periods and treatment type. RESULTS: Within-day increases in loss of control eating severity were reduced at end-of-treatment and 6-month follow-up relative to baseline. Evening acceleration of loss of control eating severity was greater at 6-month follow-up relative to end-of-treatment. Within-day increases in loss of control severity did not differ between treatments at end-of-treatment; however, evening loss of control severity intensified for individuals who received CBTgsh relative to those who received ICAT at 6-month follow-up. CONCLUSIONS: Findings suggest that treatment reduces evening-shifted loss of control eating severity, and that this effect may be more durable following ICAT relative to CBTgsh.

Near-infrared spectroscopy and electroencephalography neurofeedback for binge-eating disorder: an exploratory randomized trial.

BACKGROUND: Binge-eating disorder (BED) co-occurs with neurobehavioral alterations in the processing of disorder-relevant content such as visual food stimuli. Whether neurofeedback (NF) directly targeting them is suited for treatment remains unclear. This study sought to determine feasibility and estimate effects of individualized, functional near-infrared spectroscopy-based real-time NF (rtfNIRS-NF) and high-beta electroencephalography-based NF (EEG-NF), assuming superiority over waitlist (WL). METHODS: Single-center, assessor-blinded feasibility study with randomization to rtfNIRS-NF, EEG-NF, or WL and assessments at baseline (t0), postassessment (t1), and 6-month follow-up (t2). NF comprised 12 60-min food-specific rtfNIRS-NF or EEG-NF sessions over 8 weeks. Primary outcome was the binge-eating frequency at t1 assessed interview-based. Secondary outcomes included feasibility, eating disorder symptoms, mental and physical health, weight management-related behavior, executive functions, and brain activity at t1 and t2. RESULTS: In 72 patients (intent-to-treat), the results showed feasibility of NF regarding recruitment, attrition, adherence, compliance, acceptance, and assessment completion. Binge eating improved at t1 by -8.0 episodes, without superiority of NF v. WL (-0.8 episodes, 95% CI -2.4 to 4.0), but with improved estimates in NF at t2 relative to t1. NF was better than WL for food craving, anxiety symptoms, and body mass index, but overall effects were mostly small. Brain activity changes were near zero. CONCLUSIONS: The results show feasibility of food-specific rtfNIRS-NF and EEG-NF in BED, and no posttreatment differences v. WL, but possible continued improvement of binge eating. Confirmatory and mechanistic evidence is warranted in a double-blind randomized design with long-term follow-up, considering dose-response relationships and modes of delivery.

The natural course of binge-eating disorder: findings from a prospective, community-based study of adults.

BACKGROUND: Epidemiological data offer conflicting views of the natural course of binge-eating disorder (BED), with large retrospective studies suggesting a protracted course and small prospective studies suggesting a briefer duration. We thus examined changes in BED diagnostic status in a prospective, community-based study that was larger and more representative with respect to sex, age of onset, and body mass index (BMI) than prior multi-year prospective studies. METHODS: Probands and relatives with current DSM-IV BED (n = 156) from a family study of BED ('baseline') were selected for follow-up at 2.5 and 5 years. Probands were required to have BMI > 25 (women) or >27 (men). Diagnostic interviews and questionnaires were administered at all timepoints. RESULTS: Of participants with follow-up data (n = 137), 78.1% were female, and 11.7% and 88.3% reported identifying as Black and White, respectively. At baseline, their mean age was 47.2 years, and mean BMI was 36.1. At 2.5 (and 5) years, 61.3% (45.7%), 23.4% (32.6%), and 15.3% (21.7%) of assessed participants exhibited full, sub-threshold, and no BED, respectively. No participants displayed anorexia or bulimia nervosa at follow-up timepoints. Median time to remission (i.e. no BED) exceeded 60 months, and median time to relapse (i.e. sub-threshold or full BED) after remission was 30 months. Two classes of machine learning methods did not consistently outperform random guessing at predicting time to remission from baseline demographic and clinical variables. CONCLUSIONS: Among community-based adults with higher BMI, BED improves with time, but full remission often takes many years, and relapse is common.

Lisdexamfetamine maintenance treatment for binge-eating disorder following successful treatments: randomized double-blind placebo-controlled trial.

BACKGROUND: Controlled research examining maintenance treatments for responders to acute interventions for binge-eating disorder (BED) is limited. This study tested efficacy of lisdexamfetamine (LDX) maintenance treatment amongst acute responders. METHODS: This prospective randomized double-blind placebo-controlled single-site trial, conducted March 2019 to September 2023, tested LDX as maintenance treatment for responders to acute treatments with LDX-alone or with cognitive-behavioral therapy (CBT + LDX) for BED with obesity. Sixty-one (83.6% women, mean age 44.3, mean BMI 36.1 kg/m2) acute responders were randomized to LDX (N = 32) or placebo (N = 29) for 12 weeks; 95.1% completed posttreatment assessments. Mixed-models and generalized-estimating equations comparing maintenance LDX v. placebo included main/interactive effects of acute (LDX or CBT + LDX) treatments to examine their predictive/moderating effects. RESULTS: Relapse rates (to diagnosis-level binge-eating frequency) following maintenance treatments were 10.0% (N = 3/30) for LDX and 17.9% (N = 5/28) for placebo; intention-to-treat binge-eating remission rates were 59.4% (N = 19/32) and 65.5% (N = 19/29), respectively. Maintenance LDX and placebo did not differ significantly in binge-eating but differed in weight-loss and eating-disorder psychopathology. Maintenance LDX was associated with significant weight-loss (-2.3%) whereas placebo had significant weight-gain (+2.2%); LDX and placebo differed significantly in weight-change throughout treatment and at posttreatment. Eating-disorder psychopathology remained unchanged with LDX but increased significantly with placebo. Acute treatments did not significantly predict/moderate maintenance-treatment outcomes. CONCLUSIONS: Adults with BED/obesity who respond to acute lisdexamfetamine treatment (regardless of additionally receiving CBT) had good maintenance during subsequent 12-weeks. Maintenance lisdexamfetamine, relative to placebo, did not provide further benefit for binge-eating but was associated with significantly better eating-disorder psychopathology outcomes and greater weight-loss.

Person-specific and pooled prediction models for binge eating, alcohol use and binge drinking in bulimia nervosa and alcohol use disorder.

BACKGROUND: Machine learning could predict binge behavior and help develop treatments for bulimia nervosa (BN) and alcohol use disorder (AUD). Therefore, this study evaluates person-specific and pooled prediction models for binge eating (BE), alcohol use, and binge drinking (BD) in daily life, and identifies the most important predictors. METHODS: A total of 120 patients (BN: 50; AUD: 51; BN/AUD: 19) participated in an experience sampling study, where over a period of 12 months they reported on their eating and drinking behaviors as well as on several other emotional, behavioral, and contextual factors in daily life. The study had a burst-measurement design, where assessments occurred eight times a day on Thursdays, Fridays, and Saturdays in seven bursts of three weeks. Afterwards, person-specific and pooled models were fit with elastic net regularized regression and evaluated with cross-validation. From these models, the variables with the 10% highest estimates were identified. RESULTS: The person-specific models had a median AUC of 0.61, 0.80, and 0.85 for BE, alcohol use, and BD respectively, while the pooled models had a median AUC of 0.70, 0.90, and 0.93. The most important predictors across the behaviors were craving and time of day. However, predictors concerning social context and affect differed among BE, alcohol use, and BD. CONCLUSIONS: Pooled models outperformed person-specific models and the models for alcohol use and BD outperformed those for BE. Future studies should explore how the performance of these models can be improved and how they can be used to deliver interventions in daily life.

Executive functioning and treatment outcome among adolescents undergoing cognitive-behavioral therapy for binge-eating disorder.

BACKGROUND: Cognitive-behavioral therapy (CBT) is an evidence-supported treatment for adolescents with binge-eating disorder (BED). Executive dysfunctions, which are associated with binge eating and elevated body weight in youth, may undermine CBT outcomes by making it difficult for youth to engage with or adhere to treatment, including recalling and/or implementing intervention strategies in real-world contexts. METHODS: We assessed 73 adolescents [82.2% female; Mage = 15.0 ± 2.5 year; M baseline standardized body mass index (zBMI) = 1.9 ± 1.0 kg/m2] with BED at baseline, posttreatment, 6-, 12-, and 24-month follow-up. Linear mixed models examined the effects of baseline executive functioning (EF) on loss of control (LOC) eating and weight change following CBT. Linear and logistic regressions probed associations between EF, attendance, and attrition. RESULTS: More impulsive decision-making, as reflected in higher baseline scores on the Iowa Gambling Task, predicted better attendance (ß = .07; p = .019) and more frequent LOC eating following treatment (ß = .12; p = .017). Lower cognitive flexibility, as reflected in lower baseline T-scores on the Comprehensive Trail Making Test complex sequencing index, predicted higher zBMI following treatment (ß = -.03; p = .003). Inhibition, concentration, attention, and parent-reported EF behavior symptoms were not associated with outcome, attendance, or attrition. CONCLUSIONS: More impulsive decision-making and lower cognitive flexibility were associated with suboptimal response to CBT for BED, although findings should be interpreted with caution in light of the sample size and waitlist control design. Future research should examine whether strengthening EF could improve eating and weight outcomes among adolescents with BED who have lower pre-treatment EF.

Reward and Inhibitory Control as Mechanisms and Treatment Targets for Binge Eating Disorder.

PURPOSE OF REVIEW: Recent research has highlighted alterations in reward and inhibitory control among individuals with binge eating disorder, identifying both constructs as potential targets for treatment. Treatments targeting reward and inhibitory control for binge eating disorder are emerging. This review aims to summarize the recent literature evaluating reward and inhibitory control in binge eating disorder compared to weight-matched controls using behavioral paradigms and neuroimaging. This review also aims to summarize recent literature evaluating treatments for binge eating targeting these mechanisms and highlights additional work needed in these areas. RECENT FINDINGS: Reward hypersensitivity and impaired inhibitory control are mechanisms underlying binge eating disorder. Individuals with binge eating disorder experience higher initial reward to food, and later, higher anticipatory reward but lower experienced food reward which maintains binge eating behavior. Treatments targeting reward and inhibitory control for binge eating include behavioral, computerized trainings, pharmacological, and neuromodulation treatments. The majority of trials are small but demonstrate promise in reducing binge eating and targeting theorized mechanisms. Larger, randomized trials are needed. Changes in reward and inhibitory control are present in individuals with binge eating disorder and treatments targeting these mechanisms demonstrate initial promise. Greater research is needed evaluating reward and inhibitory control simultaneously and with weight-matched comparison groups, as well as larger randomized trials that target both processes simultaneously.

What medical providers need to elevate outpatient care for adolescents and young adults with binge-eating disorder: A novel protocol.

PURPOSE: Binge-eating disorder (BED) in adolescents and young adults is underrecognized and understudied and no standardized guidelines exist for medical providers caring for this population. To highlight the lack of extant evidence, we examine the demographic characteristics of youth with BED in an academic eating disorders (EDs) program and primary care clinic and describe the needs of their medical care providers. METHOD: A retrospective chart review was conducted for patients who met criteria for BED from July 2021 to June 2022. We surveyed their medical providers to understand their needs in caring for this population. A multidisciplinary team with expertise in the care of youth with EDs amalgamated current evidence in caring for youth with BED into a protocolized care schema designed for implementation in the outpatient medical setting. RESULTS: Eighteen youth with BED were reviewed, 14 identified as female, 3 as male, and 1 as "Other." Average age was 15.4 (2.7) years old, and mean body mass index was 35.90 (8.25). 33.3% (6) patients identified as White/Caucasian, followed by 22.2% (4) Hispanic/Latinx. Eleven of 18 were privately insured. The most common medical recommendations were for regular meals and snacks and for individual psychotherapy. Medical providers desired more education about identification and management of youth with BED. CONCLUSIONS: To address the lack of medical care guidelines for youth with BED, recommendations in this Forum include: increased education for medical providers, standardized medical monitoring, an emphasis on psychotherapy, and a weight-inclusive orientation. PUBLIC SIGNIFICANCE: Adolescents and young adults with BED are underrecognized and undertreated. Little is known about the characteristics of these patients and the medical care these patients receive within academic EDs program. For the first time, preliminary recommendations for medical care are provided.

Using Continuous Glucose Monitoring to Passively Classify Naturalistic Binge Eating and Vomiting Among Adults With Binge-Spectrum Eating Disorders: A Preliminary Investigation.

OBJECTIVE: Binge eating and self-induced vomiting are common, transdiagnostic eating disorder (ED) symptoms. Efforts to understand these behaviors in research and clinical settings have historically relied on self-report measures, which may be biased and have limited ecological validity. It may be possible to passively detect binge eating and vomiting using data collected by continuous glucose monitors (CGMs; minimally invasive sensors that measure blood glucose levels), as these behaviors yield characteristic glucose responses. METHOD: This study developed machine learning classification algorithms to classify binge eating and vomiting among 22 adults with binge-spectrum EDs using CGM data. Participants wore Dexcom G6 CGMs and reported eating episodes and disordered eating symptoms using ecological momentary assessment for 2 weeks. Group-level random forest models were generated to distinguish binge eating from typical eating episodes and to classify instances of vomiting. RESULTS: The binge eating model had accuracy of 0.88 (95% CI: 0.83, 0.92), sensitivity of 0.56, and specificity of 0.90. The vomiting model demonstrated accuracy of 0.79 (95% CI: 0.62, 0.91), sensitivity of 0.88, and specificity of 0.71. DISCUSSION: Results suggest that CGM may be a promising avenue for passively classifying binge eating and vomiting, with implications for innovative research and clinical applications.