Low carbohydrate ketogenic therapy as a metabolic treatment for binge eating and ultraprocessed food addiction.

PURPOSE OF REVIEW: The aim of this study was to highlight the recent advancements and future directions for potential use of a low carbohydrate ketogenic dietary approach to treat binge eating and ultraprocessed food addiction. Herein, we explore proposed mechanisms of why a diet low in refined carbohydrates, processed sugar and higher fat content may be helpful in alleviating symptoms. RECENT FINDINGS: Emerging evidence suggests there may be a metabolic role in development of maladaptive eating. These findings broaden our understanding of eating psychopathology causes. Ultraprocessed, refined or high glycemic index carbohydrates are a possible trigger mediating neurochemical responses similar to addiction. The carbohydrate-insulin model of obesity supports observations of these foods triggering abnormal blood sugar and insulin spikes subsequently leading to changes in metabolic and neurobiological signaling. This results in overeating symptoms and hunger exacerbation, which differs from observed effects of healthy fat consumption and lack of similar insulin spikes. As supported in recent case series, significantly reducing or abstaining from these addictive-like ultraprocessed foods and highly refined carbohydrates could be considered a treatment approach. SUMMARY: The current review highlights recent and pertinent evidence with respect to theoretical and practical application of low carbohydrate ketogenic therapeutic approaches for ultraprocessed food addiction and binge eating symptoms. VIDEO ABSTRACT:.

Patients' views on a new treatment for Bulimia nervosa and binge eating disorder combining physical exercise and dietary therapy (the PED-t). A qualitative study.

A new group based treatment for patients with bulimia nervosa (BN) and binge eating disorder (BED), combining guided Physical Exercise and Dietary therapy (PED-t), has shown the capacity to alleviate BN and BED symptoms. The PED-t is run by therapists with a professional background in sport sciences and nutrition, which in many clinical settings is an uncommon group of professionals. The symptom reduction effects using the PED-t need validation from patients who have been given this kind of treatment, as negative experiences may impinge further clinical implementation. To explore such experiences, semistructural interviews were conducted with 15 participants. The interviews were transcribed and analyzed using a systematic text condensation approach. Overall, patients experienced the format and content of the PED-t as beneficial and as providing tools to manage BN- and BED symptoms. The patients' experiences of therapist credibility was enhanced by their appreciation of the therapists' professional background. Finally, some treatment modifications were suggested. Overall, the PED-t may thus be offered to patients with BN and BED, by a new set of professionals, and in uncommon settings. This possibility calls for future effectiveness studies integrating both parametric and experiential data.

Guided self-help to manage binge eating in a dietetic-led community weight management service.

An estimated 30% of patients accessing community weight management services experience symptoms of binge eating disorder (BED). Guided self-help (GSH) is the recommended first line of treatment for BED. This study is a preliminary investigation into the effectiveness of GSH delivered by dietitians for patients with binge eating within a weight management service and a consideration of the association between wellbeing, therapeutic relationship and outcomes. The study was conducted as a single group, pre- and post-intervention study with 24 patients reporting symptoms of binge eating who completed the self-help manual with guidance from a trained community dietitian. Primary outcomes were eating disorder psychopathology and behaviours (Eating Disorder Evaluation Questionnaire), depression and anxiety. Principle results showed a significant reduction on all subscales of eating disorder psychopathology, anxiety and depression. There was a reduction in loss of control over eating but the 40% reduction in binge episodes was not statistically significant. Mid-treatment sessional ratings were positively associated with outcome. In conclusion, the GSH intervention was appropriate for dietitian delivery to patients with obesity and binge eating behaviour. This research indicates potential for other dietetic-led weight management services to deliver such interventions and support patients with binge eating accessing their service.

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

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Resumen ejecutivo "Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa, bulimia nerviosa, trastorno por atracón y otros" / No disponible

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Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: bulimia nerviosa, trastorno por atracón y otros / No disponible

La bulimia nerviosa y el trastorno por atracón constituyen entidades nosológicas propias. Ambas muestran una gran variabilidad en su presentación y gravedad, lo que implica la individualización del tratamiento y la necesidad de equipos multidisciplinares. Los pacientes con bulimia nerviosa pueden presentar desde desnutrición y estados carenciales a exceso de peso, mientras que en los trastornos por atracón es habitual el sobrepeso u obesidad, que condiciona a su vez otras comorbilidades. Muchos de los síntomas y complicaciones derivan de las conductas compensatorias. Se dispone de diversas herramientas terapéuticas para el tratamiento de estos pacientes. El abordaje nutricional contempla el consejo dietético individualizado que garantice un adecuado estado nutricional y la correcta educación nutricional. Su objetivo es facilitar la adopción voluntaria de comportamientos alimentarios que fomenten la salud y que permitan la modificación a largo plazo de los hábitos alimentarios y el cese de conductas purgantes y atracones. El soporte psicológico es el tratamiento de primera línea y debe abordar el trastorno de la conducta alimentaria y las comorbilidades psiquiátricas que frecuentemente presentan. Los psicofármacos, aunque eficaces y ampliamente utilizados, no son imprescindibles. El manejo se realiza principalmente a nivel ambulatorio, siendo el hospital de día útil en pacientes seleccionados. Se debe reservar la hospitalización para corregir aquellas complicaciones somáticas o psiquiátricas graves o como medida de contención de las situaciones conflictivas no tratables de forma ambulatoria. La mayoría de las recomendaciones de las guías se basan en consensos de expertos, existiendo poca evidencia que evalúe los resultados clínicos y de coste-eficacia

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

Nutritional and neuropsychological profile of the executive functions on binge eating disorder in obese adults / Perfil nutricional y neuropsicológico de las funciones ejecutivas en el transtorno por atracón en adultos obesos

Objective: To examine the relationships between obese patients with and without binge eating disorder (BED) and the neuropsychological profiles of their executive functions. Methods: Data from 36 obese individuals (BMI ≥ 30 kg/m2) were divided into two groups, where one group was found to be positive for signs of BED according to the Binge Eating Scale. Two neuropsychological tests of executive function were carried out: the Go/No-go Task and the Iowa Gambling Task (IGT). Nutritional status was evaluated by measures of body weight, height and abdominal circumference, and from these, body mass indexes (BMI) were calculated. Results: Both groups presented similar nutritional characteristics; there were no differences when it came to the health status of individuals with or without BED. Participants found positive for signs of BED had the lowest IGT scores (p = 0.004), and Go/No-go omission scores (p = 0.015) and commission scores (p = 0.04). Further statistically significant differences were also observed here between the two groups. Statistical differences in the IGT results correlated with BED, and were associated categorically (p = 0.005). Conclusion: Obese individuals frequently present deficits in selective attention, inhibitory control, decision-making and planning that can be directly related to binge eating and which is linked to BED. Nutritional status did not differ between the two groups studied, and did not show any connection with the disorder (AU)

Objetivo: examinar las relaciones entre los pacientes obesos con y sin trastorno por atracón (TA) y los perfiles neuropsicológicos de sus funciones ejecutivas. Métodos: los datos de 36 individuos obesos (IMC ≥ 30 kg/m2) se dividieron en dos grupos, donde se encontró que un grupo era positivo para los signos de BED de acuerdo con la escala de Binge Eating Scale. Se realizaron dos pruebas neuropsicológicas de la función ejecutiva: la Tarea Ir/No-ir y la Tarea de Juego de Iowa (IGT). El estado nutricional fue evaluado por medidas de peso corporal, estatura y circunferencia abdominal, y de estos se calcularon los índices de masa corporal (IMC). Resultados: ambos grupos presentaron características nutricionales similares; No hubo diferencias en cuanto al estado de salud de las personas con o sin BED. Los participantes encontraron positivos para los signos de BED que tuvieron los puntajes IGT más bajos (p = 0,004), y puntuaciones de omisión IR/No-ir (p = 0,015) y comisiones (p = 0,04). Otras diferencias estadísticamente significativas también se observaron aquí entre los dos grupos. Las diferencias estadísticas en los resultados IGT se correlacionaron con BED, y se asociaron categóricamente (p = 0,005). Conclusión: los individuos obesos frecuentemente presentan deficiencias en la atención selectiva, el control inhibitorio, la toma de decisiones y la planificación que pueden estar directamente relacionados con el atracón y que está relacionado con la BED. El estado nutricional no difirió entre los dos grupos estudiados, y no mostró ninguna relación con el trastorno (AU)

"Las penas con pan duelen menos": The role of food and culture in Latinas with disordered eating behaviors.

This study elucidated the experiences of eighteen Latina adults (mean age = 38.5 years) from "Promoviendo una Alimentación Saludable" Project who received nutritional intervention as part of the clinical trial. Half of the participants were first generation immigrants from Mexico (50%), followed by U.S. born with 16.7%. Remaining nationalities represented were Bolivia, Colombia, Guatemala, Honduras, Peru, and Venezuela with 33.3% combined. The average duration of living in the U.S. was 11.1 years. The mean body mass index (BMI) at baseline was 36.59 kg/m(2) (SD = 7.72). Based on the DSM-IV, 28% (n = 5) participants were diagnosed with binge-eating disorder, 33% (n = 6) with bulimia nervosa purging type and 39% (n = 7) with eating disorder not otherwise specified. Participants received up to three nutritional sessions; a bilingual dietitian conducted 97.8% of sessions in Spanish. In total, fifty nutritional sessions were included in the qualitative analysis. A three step qualitative analysis was conducted. First, a bilingual research team documented each topic discussed by patients and all interventions conducted by the dietitian. Second, all topics were classified into specific categories and the frequency was documented. Third, a consensus with the dietitian was performed to validate the categories identified by the research team. Six categories (describing eating patterns, emotional distress, Latino culture values, family conflicts associated with disturbed eating behaviors, lack of knowledge of healthy eating, and treatment progress) emerged from patients across all nutritional sessions. Considering the background of immigration and trauma (60%, n = 15) in this sample; the appropriate steps of nutritional intervention appear to be: 1) elucidating the connection between food and emotional distress, 2) providing psychoeducation of healthy eating patterns using the plate method, and 3) developing a meal plan.

Adherence to the Mediterranean diet is inversely related to binge eating disorder in patients seeking a weight loss program.

BACKGROUND & AIM: The key factors influencing the development of Binge Eating Disorder (BED) are not well known. Adherence to the Mediterranean diet (MD) has been suspected to reduce the risk of several mental illnesses such as depression and anxiety. There are no existing studies that have examined the relationships between BED and MD. METHODS: Cross-sectional study of 1472 participants (71.3% women; mean age: 44.8 ± 12.7) at high risk of BED. A MD score (MED-score) was derived from a validated food frequency questionnaire and BED by Binge Eating Scale questionnaire (BES). Body mass index, waist circumference and total body fat (%) were assessed by anthropometric measurements. RESULTS: 376 (25.5%) cases of self reported BED were identified. 11.1% of participants had a good adherence to MD (MED-score ≥ 9). After adjustments for age, gender, nutritional status, education, and physical activity level, high MED-score was associated with lower odds for BED (odds ratios and 95% confidence intervals of a BED disorder for successive levels of MED-score were 1 (reference), 0.77 (0.44, 1.36), 0.66 (0.37, 1.15), 0.50 (0.26, 0.96), and 0.45 (0.22, 0.55) (P for trend: <0.01). Olive oil and nut consumption were associated with low risk of BED development whereas butter, cream, sweets and commercial bakery/sweets/cakes consumption increased the risk. We did not find a cumulative effect of depression and anxiety on MED-score in binge eaters. CONCLUSIONS: These results demonstrate an inverse association between MD and the development of BED in a clinical setting among subjects at risk of BED. Therefore, we should be cautious about generalizing the results to the whole population, although reverse causality and confounding cannot be excluded as explanation. Further prospective studies are warranted.

The role of orexigenic and anorexigenic factors in an interdisciplinary weight loss therapy for obese adolescents with symptoms of eating disorders.

AIM: The aim of this study was to evaluate the role of orexigenic and anorexigenic factors in an interdisciplinary weight loss therapy for obese adolescents with symptoms of eating disorders. METHODS: Thirty-seven post-pubertal, obese adolescents (14 to 19 years old) with symptoms of eating disorders were submitted to long-term interdisciplinary therapy (1 year). Bulimic and binge eating symptoms were measured using the Bulimic Investigatory Test, Edinburgh, and the Binge Eating Scale respectively. Neuropeptide Y, melanin-concentrating hormone, total ghrelin, alpha-melanocyte stimulating hormone and leptin were measured using radioimmunoassay. RESULTS: After long-term interdisciplinary therapy, the adolescents showed significantly improved body composition, visceral and subcutaneous fat and reduced symptoms of bulimia and binge eating. Intriguingly, orexigenic peptides were up-regulated after short-term therapy and down-regulated at the end of therapy, whereas the anorexigenic pathway was improved with therapy. Furthermore, after long-term therapy, a negative correlation was observed between leptin concentration and melanin-concentrating hormone. DISCUSSION: We suggest that long-term therapy promotes an intrinsic association between weight loss, improvement of eating disorder symptoms and a decrease in orexigenic factors. Together, these results represent a more effective course by which patients can normalise behaviours related to eating disorders as well the actions of hormones involved in energy balance, and thus advance obesity control. CONCLUSION: Long-term interdisciplinary therapy was effective to improve anorexigenic and orexigenic factors that influence energy balance and avoid the development of eating disorders in obese adolescents. However, the associations between eating disorders and neuroendocrine factors need to be confirmed in future studies.

Multivariate therapeutic approach to binge-eating disorder: combined nutritional, psychological and pharmacological treatment.

Treatment for binge-eating disorder (BED) is directed towards either the physical or psychopathological impairments, and often does not cover all the alterations characterizing the disease. In 30 BED patients, we monitored the effects of three types of 6-month treatment, randomly assigned to one of the three treatment groups, each consisting of 10 patients. Group 1 received a 1700-kcal diet (21% proteins, 27% lipids, 52% carbohydrate), cognitive-behavioural therapy (CBT), sertraline (50-150 mg/day) and topiramate (25-150 mg/day); group 2 received the same diet, CBT, sertraline; and group 3 received nutritional counselling and CBT. Binge frequency and weight were assessed every month. The Eating Disorder Inventory-2, the Symptoms Check List-90-Revised (SCL-90-R) and the Personality Diagnostic Questionnaire-4-Revised (PDQ-4-R) were administered before and after treatment. Binge frequency and excessive weight decreased significantly only in group 1 patients, in whom improvement was noted in total Eating Disorder Inventory-2 scores and the subitems 'bulimia', 'drive for thinness', 'maturity fear', 'ascetism', in total SCL-90-R scores and in the subitem 'somatization', in PDQ-4-R subitems 'schizotypic personality' and 'dependent personality'. Group 2 patients improved on the SCL-90-R subitems 'depression' and 'interpersonal relationship' and in the PDQ-4-R 'schizoid personality'. Combination therapy seems to be the only fully effective treatment in BED patients.