Medical Complications of Binge Eating Disorder

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Key points

  • Binge eating disorder is a highly prevalent and significant eating disorder with serious impairments to function and quality of life.

  • Binge eating disorder is associated with many diseases associated with obesity and may confer additional medical risks to individuals with comorbidities.

  • Recognition and treatment of binge eating disorder entail understanding and addressing medical comorbidities while addressing issues specific to binge eating disorder.

Binge eating disorder (BED) is the most common

Obesity, metabolic syndrome, diabetes, and bariatric surgery

Obesity is considered one of the most pressing modern public health concerns because of the cost of medical care associated with it and the costs to society through loss of productivity and impairments in the quality of life of persons affected.6 BED is highly associated with obesity and obesity-related diseases. In a group of adults with BED, 71% had a body mass index (BMI) >30 and more than 25% of children and adolescents with obesity and overweight endorsed binge and loss of control eating.7

Gastrointestinal

Gastrointestinal (GI) concerns are common in obesity and more so in patients with BED. Patients with BED report more acid reflux, dysphagia, bloating, abdominal pain, lower GI urgency, diarrhea, and constipation.42 Dysmotility has been well described in anorexia nervosa and has also recently been described in a population with rapid weight gain (>3 kg in 3 months); however, post hoc analysis revealed an increased risk of deliberate purging after binge eating in this sample, which confounds the

Nutritional concerns

Although obesity is associated with overconsumption of calories, persons with obesity and BED are at risk for nutritional deficiencies. Analyses of the nutritional composition of binges show calorie-dense foods higher in carbohydrates and sugar, with high fat content, and lower in protein.47, 48, 49 Higher-fat diets are associated with decreased intake of vitamins A, C, and folate, and consumption of sweetened beverages is associated with decreased intake of milk, impacting levels of calcium

Cancer

There are multiple risk factors for cancer in persons with BED. Obesity is associated with increased morbidity and mortality from many types of cancer, including colorectal cancers, esophageal adenocarcinoma, cancers of the gallbladder, pancreas, liver, kidney, postmenopausal breast, endometrium, thyroid, ovarian and prostate, and non-Hodgkin lymphoma and multiple myeloma. T2D may further increase the risk for multiple types of cancer and mortality. In addition to obesity and T2D, the use of

Reproductive health

Multiple morbidities related to reproductive health are associated with BED. Urinary incontinence is 3 times more likely in bariatric surgery candidates with BED and mental illness and likely impacted by consequences of both obesity and psychiatric impairment.61, 62 Menstrual concerns, such as amenorrhea, oligomenorrhea, and premenstrual dysphoric disorder, are associated with binge eating. Early menarche has not been described with BED; however, earlier menarche is described in female

Neurologic

Idiopathic intracranial hypertension, a common cause of severe headaches in obesity, is associated with BED.86 As previously described, epilepsy and BED can cooccur during pregnancy.80 Concerning dementias, there have been case reports of abnormal binge eating behaviors as a part of frontotemporal dementia but not Parkinson disease. The long-term risk of neurodegenerative disorders and BED has yet to be examined.87, 88, 89

Sleep

There are multiple sleep abnormalities to be aware of in persons with BED. Disrupted sleep is seen more commonly in BED compared with obese controls, as demonstrated by rest-activity circadian rhythm, a measure of sleep activity.90 In patients seeking bariatric surgery, 52% had obstructive sleep apnea, and in those patients, BED was significantly more common.91 Night eating syndrome (NES), under Other Specified Feeding or Eating Disorders in Diagnostic and Statistical Manual of Mental Disorders

Musculoskeletal

Bone disease can be a long-term sequela of eating disorders, particularly in patients with anorexia nervosa.95 BED is also associated with bone pathologic condition. Obesity, higher body fat percentage, and elevated cortisol levels are associated with lower bone mineral density and bone mineral content; however, the long-term outcomes of these findings are, as of yet, unknown.96, 97, 98 Mobility concerns have been independently associated with obesity and BED in bariatric surgery candidates.61

Treatment considerations

Treatment of BED encompasses psychological, behavioral, and medical treatment. Meta-analyses examining the efficacy of behavioral treatments have established effectiveness of cognitive behavioral therapy (CBT) and interpersonal behavioral therapy to reduce frequency of binge eating behaviors, decreasing eating disorder–related cognitions and increasing the likelihood of abstinence of binge eating behaviors.102, 103, 104 In reviews of treatment interventions, therapist-led CBT showed superiority

Summary

In summary, like other eating disorders, BED presents with medical comorbidity in almost every system in the body and can have devastating consequences on quality and length of life. It is the most common eating disorder and yet has been underidentified and mismanaged in medical settings.106 Individuals with obesity-related diseases are vulnerable to internalized stigma and may avoid necessary health care for fear of stigmatized assessments.107, 108 Improved understanding of the presentation

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