Beyond Binge Eating: The Impact of Implicit Biases in Healthcare on Youth with Disordered Eating and Obesity.

(1) Background: Obesity and eating disorders (ED) can coexist resulting in worse health outcomes. Youth with ED are more likely to have obesity relative to peers with a healthy weight. Pediatric providers deliver first-line care to children and youth of all sizes and body shapes from infancy to adolescents. As healthcare providers (HCPs), we bring biases into our practice. Learning to recognize and address these biases is needed to provide the best care for youth with obesity. (2) Purpose: This paper aims to summarize the literature regarding the prevalence of ED beyond binge eating in youth with obesity and discuss how the intersection of weight, gender, and racial biases impact the assessment, diagnosis, and treatment of ED. We provide recommendations for practice and considerations for research and policy. (3) Conclusions: The assessment and treatment of ED and disordered eating behaviors (DEBs) in youth with obesity is complex and requires a holistic approach. This approach begins with identifying and understanding how one's implicit biases impact care. Providing care from a patient-centers lens, which considers how the intersection of multiple stigmatized identities increases the risk for DEBs in youth with obesity may improve long-term health outcomes.

Everyday discrimination as a predictor of maladaptive and adaptive eating: Findings from EAT 2018.

Various types of stressors are associated with maladaptive eating, but how the stressor of everyday discrimination (e.g., less respect, poorer service) relates to maladaptive eating and adaptive eating remains unclear. We examined everyday discrimination as a predictor of maladaptive and adaptive eating. Data were collected in a population-based study, Eating and Activity over Time (N = 1410, ages 18-30). Everyday discrimination was categorized as none, low, moderate, or high. Outcomes included maladaptive eating (i.e., overeating and binge eating) and adaptive eating (i.e., intuitive eating and mindful eating). Modified Poisson regressions estimated the prevalence ratios (PRs) for overeating and binge eating associated with everyday discrimination. Linear regressions estimated associations between everyday discrimination and intuitive and mindful eating scores. After adjustment for age, ethnicity/race, gender, and socioeconomic status, moderate and high levels of discriminatory experiences were each associated with a significantly greater prevalence of binge eating (PR = 2.2, [95% CI = 1.3-3.7] and PR = 3.1, [95% CI = 2.0-4.7], respectively) and lower intuitive (ß = -0.4, [95% CI = -0.7, -0.2] and ß = -0.5 [95% CI = -0.8, -0.3], respectively), and mindful eating scores (ß = -0.3, [95% CI = -0.6, -0.1] and ß = -0.5 [95% CI = -0.8, -0.3], respectively) compared to young adults with no discriminatory experience. Public health efforts to prevent maladaptive eating and encourage the adoption of adaptive eating should consider the potential contribution of everyday discrimination and the need to advocate for equity and inclusion.

Clinical study on electroacupuncture for obese patients with binge eating disorder: A retrospective study.

Binge eating disorder (BED) is a common dietary disorder among obese people. Obesity and eating disorders are related to mental health and physical health. At present, there is no definite and effective method for treatment in clinic. The curative effect of electroacupuncture on obesity is definite. Although there is no conclusive evidence to support its long-term benefits, electroacupuncture has been increasingly used in clinic. This retrospective study determined the prognosis and outcome of electro-acupuncture on obese patients with BED.One hundred forty-three patients with BED and obesity were found from 658 people who participated in the scientific experiment of obesity treatment in Nanjing Hospital of Traditional Chinese Medicine and Nanjing Brain Hospital from March 2015 to June 2018, and 84 patients (aged 18-40 years old) with valid data and uninterrupted treatment were found to be eligible for this retrospective study. According to the intervention methods, the patients were divided into electro-acupuncture combined with cognitive group (n = 32), cognitive therapy group (n = 28), and control group (n = 24). In this study, the 5th edition of Diagnosis and Statistics Manual of Mental Diseases, fasting blood glucose, fasting insulin, total cholesterol (TC), triglyceride, high-density lipoprotein, low-density lipoprotein, body fat rate, muscle mass, visceral index grade, nutrient intake (energy, protein, fat, carbohydrate), body weight, and weight changes before and after treatment were observed.Compared with the cognitive therapy group, negative emotion score, TC, triglyceride, high-density lipoprotein, waist circumference, BW, BMI, body fat percentage of the electroacupuncture combined with cognitive group were lower, while positive emotional scores were higher, and there were significant differences in negative emotional scores, TC, waist circumference and BMI (P < .05). The dietary energy and three major nutrients in the electroacupuncture combined with cognitive group were lower than those in the cognitive group and the blank group (P < .05).The current results suggest that electroacupuncture combined with cognitive therapy is more effective than cognitive therapy alone in treating obese patients with BED. Future prospective studies are necessary to further study the mechanism of electroacupuncture on the obese with BED.

[Consensus document about the nutritional evaluation and management of eating disorders: bulimia nervosa, binge eating disorder, and others]. / Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: bulimia nerviosa, trastorno por atracón y otros.

Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness.

Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities.

Binge-eating disorder (BED) and night-eating syndrome (NES) are two forms of disordered eating associated with overweight and obesity. While these disorders also occur in nonobese persons, they seem to be associated with weight gain over time and higher risk of diabetes and other metabolic dysfunction. BED and NES are also associated with higher risk of psychopathology, including mood, anxiety, and sleep problems, than those of similar weight status without disordered eating. Treatments are available, including cognitive behavior therapy (CBT), interpersonal psychotherapy, lisdexamfetamine, and selective serotonin reuptake inhibitors (SSRIs) for BED; and CBT, SSRIs, progressive muscle relaxation, and bright light therapy for NES.

Treatment of binge eating disorder.

The two specialty psychological therapies of CBT and IPT remain the treatments of choice for the full range of BED patients, particularly those with high levels of specific eating disorder psychopathology such as overvaluation of body shape and weight. They produce the greatest degree of remission from binge eating as well as improvement in specific eating disorder psychopathology and associated general psychopathology such as depression. The CBT protocol evaluated in the research summarized above was the original manual from Fairburn and colleagues. Fairburn has subsequently developed a more elaborate and sophisticated form of treatment, namely, enhanced CBT (CBT-E) for eating disorders. Initial research suggests that CBT-E may be more effective than the earlier version with bulimia nervosa and Eating Disorder Not Otherwise Specified patients. CBT-E has yet to be evaluated for the treatment of BED, although it would currently be the recommended form of CBT. Of relevance in this regard is that the so-called broad form of the new protocol includes 3 optional treatment modules that could be used to address more complex psychopathology in BED patients. One of the modules targeted at interpersonal difficulties is IPT, as described earlier in this chapter. Thus, the broader protocol could represent a combination of the two currently most effective therapies for BED. Whether this combined treatment proves more effective than either of the components alone, particularly for a subset of BED patients with more complex psychopathology, remains to be tested. CBT-E also includes a module designed to address what Fairburn terms "mood intolerance" (problems in coping with negative affect) that can trigger binge eating and purging. The content and strategies of this mood intolerance module overlap with the emotional regulation and distress tolerance skills training of Linehan's dialectical behavior therapy (DBT). Two randomized controlled trials have tested the efficacy of an adaptation of DBT for the treatment of BED (DBT-BED) featuring mindfulness, emotion regulation, and distress tolerance training. A small study by Telch and colleagues found that modified DBT-BED was more effective than a wait list control in eliminating binge eating. A second study showed that DBT-BED resulted in a significantly greater remission rate from binge eating at posttreatment than a group comparison treatment designed to control for nonspecific therapeutic factors such as treatment alliance and expectations.50 This difference between the two treatments disappeared over a 12-month follow-up, indicating the absence of DBT-BED-specific influences on long-term outcomes. Both CBT and IPT have been shown to be more effective in eliminating binge eating than BWL in controlled, comparative clinical trials. Nonetheless, BWL has been effective in reducing binge eating and associated eating problems in BED patients in some studies and might be suitable for treatment of BED patients without high levels of specific eating disorder psychopathology. A finding worthy of future research is the apparent predictive value of early treatment response to BWL, indicating when BWL is likely to prove effective or not. No evidence supports the concern that BWL's emphasis on moderate caloric restriction either triggers or exacerbates binge eating in individuals with BED. Initially, CBTgsh was recommended as a feasible first-line treatment that might be sufficient treatment for a limited subset of patients in a stepped care approach. More recent research, however, has shown that CBTgsh seems to be as effective as a specialty therapy, such as IPT, with a majority of BED patients. The subset of patients that did not respond well to CBTgsh in this research were those with a high level of specific eating disorder psychopathology, as noted. A plausible explanation for this moderator effect is that the original Fairburn CBTgsh manual does not include an explicit emphasis on body shape and weight concerns. Subsequent implementation of this treatment has incorporated a module that directly addresses overvaluation of body shape and weight. Future research should determine whether an expanded form of CBTgsh is suitable for the full range of patients with BED. CBTgsh is recommended as a treatment for BED on two other counts. First, its brief and focused nature makes it cost effective. Second, its structured format makes it more readily disseminable than other longer, multicomponent psychological therapies. It can be implemented by a wider range of treatment providers than more technically complex, time-consuming, and clinical expertise-demanding specialty therapies such as CBT-E and IPT. The latter evidence-based therapies are rarely available to patients with BED in routine clinical care settings. Nevertheless, it must be noted that much of the research on CBTgsh to date has been conducted in an eating disorder specialty clinic setting. The degree to which the treatment can be adapted to a range of clinical service settings remains to be determined. In addition, little is known about the specific provider qualifications and level of expertise required to implement CBTgsh successfully. Despite its brief and focal nature, specific provider skills regarding what and what not to address in treatment are required. Currently available pharmacologic treatments cannot be recommended for treatment of BED. Aside from the inconsistent results of existing studies, the striking absence of controlled long-term evaluation of such treatment argues against its use.As summarized, the evidence-based treatments of CBT, IPT, and CBTgsh result in significant improvement and large treatment effects on multiple outcome measures aside from binge eating in overweight and obese patients. These include specific eating disorder psychopathology (eg, overvaluation of body shape and weight), general psychopathology (eg, depression), and psychosocial functioning. Moreover, these changes are typically well-maintained over 1 to 2 years of follow-up. The exception to this profile of improvement remains weight loss and its maintenance over time. These specialty psychological treatments do not produce weight loss, although successfully eliminating binge eating might protect against future weight gain. BWL consistently produces short-term weight loss, the extent of which has varied across different studies. Long-term weight loss has yet to be demonstrated, however. In this regard, the findings with obese patients with BED are not different than those on the treatment of obesity in general, in which there is little robust evidence of enduring weight loss effects of BWL.

Caffeine consumption among eating disorder patients: epidemiology, motivations, and potential of abuse.

OBJECTIVE: Aim of the study was to investigate caffeine use in different types of eating disorders (ED) patients either using a categorical approach [Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - Text Revision (DSM-IV-TR) diagnostic criteria] or a dimensional perspective. METHOD: Fifty-eight ED female patients [anorexia nervosa (AN), restricting and binge-eating/purging type, N=15; bulimia nervosa (BN) purging type/nonpurging type, N=26; binge eating disorder (BED), N=17] referred to an Eating Disorder Unit and 15 non-clinical controls were administered the Eating Disorder Inventory-2 (EDI-2), the Clinical Global Impression (CGI) and the Caffeine Use Test, an interview specifically developed to investigate caffeine intake. Statistical analyses were then repeated clustering patients according to the presence/absence of purging behaviors (purgers, N=22; non-purgers, N=19; BED, N=17). RESULTS: Current and lifetime caffeine use, measured as mg/day, were similar comparing controls and ED patients as a whole. BN patients showed a significantly higher maximum lifetime caffeine intake (817.4+/-528,9 vs 325.0+/-294.6 mg/die, F=3.246, p<0.05); the same for purgers vs controls (p<0.05). Caffeine abuse was significantly more represented among patients vs controls (p<0.01), but similar among different patients' groups. As for diagnoses according to DSM-IV-TR Substance Use modified for caffeine, no significant difference was found among the different groups, for either Dependence, Intoxication or Withdrawal. Most of patients and controls reported pleasure as the main motivation for caffeine use, followed by increased vigilance and attention and appetite suppression in AN and BN patients. Note that a shift in diagnosis in the course of the ED from non-purging to purging type was associated with an increase in caffeine current, lifetime and maximum lifetime intake (F=1.667 p<0.05), except for BED patients. Severity of the ED measured as CGI score or comorbidity did not affect caffeine intake in patients as a whole, but in the purging subgroup current caffeine use was increased in presence of an anxiety disorder (p<0.05), and decreased in presence of a mood disorder (p<0.01). CONCLUSIONS: Data from the present study are in agreement with previous evidence in literature that a high percentage of ED patients ordinarily use caffeine with an average intake similar to that of the general population, however with a kind of binge attitude. Among heavy drinkers, daily caffeine intake and alcohol/cigarettes use are associated supporting the link with the dimension of impulse disregulation. The substantial number of subjects from our sample satisfying research criteria for Dependence, together with increasing reports of caffeine intoxication, suggests the growing relevance of these issues that deserve further investigation.