Binge Eating Disorder BED Allison Boese 1142020 1

Binge Eating Disorder (BED) Allison Boese 11/4/2020 1

Objectives • Be able to describe the etiology of binge eating disorder • Be able to describe the ADA recommendations for treatment • Be able to describe the desired outcomes of Medical Nutrition Therapy • Be able to explain ethical and clinical challenges involved in treatment 11/4/2020 2

What is binge eating disorder? • Large quantities of food in a short period of time, two or more times per week. • Eat until uncomfortably full • Eating large amounts when not hungry • Eating alone • Feeling disgusted with one’s self • Similar to bulimia nervosa Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073 -2080. 11/4/2020 3

Health Risks • Psychiatric disorders • Obesity – Arteriosclerosis – Type 2 Diabetes – Hypertension – Hyperlipidemia A E Dingemans, M J Bruna and E F van Furth. International Journal of Obesity. March 2002, Volume 26, Number 3, Pages 299 -307 11/4/2020 4

Typical Candidates for Binge Eating Disorder • • 3% of the general population 30% of obese persons Almost equal amongst the sexes Occurs across ethnically diverse populations • Adulthood Grilo, Carlos M. Encyclopedia Article. The Mc. Graw-Hill Companies (2007) 11/4/2020 5

Binge Eating Disorder & Type II Diabetes • Herpertz & colleagues reported that in 322 patients with type II diabetes, the incidence of eating disorders was 6. 5 -9% • The most common was binge eating disorder Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073 -2080. 11/4/2020 6

Gastric Bypass Patients • In the same study done by Herpertz & colleagues, they found that a large amount of individuals seeking gastric bypass surgery met the criteria for having binge eating disorder Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073 -2080. 11/4/2020 7

Contributing Factors to Binge Eating Disorder • Repeated experiences with negative comments about shape, weight and eating • Negative self evaluation • Perfectionism • Childhood Obesity • Low self-esteem Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073 -2080. 11/4/2020 8

Contributing Factors Continued… • High levels of body consciousness • Low perceived levels of social support • High use of “escape avoidance coping” – Hiding from emotions – Filling a void – Subconsciously maintaining an overweight appearance – Self punishment 2 11/4/2020 1 Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073 -2080. 2 The Something Fishy Website on Eating Disorders (1998 -2007) 9

BED Patients and Family Support • Hodges EL, Cochrane CE, Brewerton TD (1998) “found that BED subjects rated their family environment as less supportive and cohesive, and less engendering of direct and open expression of feelings than healthy controls. ” • The BED group scored lower than other eating disorder groups on family support. A E Dingemans, M J Bruna and E F van Furth. International Journal of Obesity. March 2002, Volume 26, Number 3, Pages 299 -307 11/4/2020 10

Mental Disorders Associated with Binge Eating Disorder • Depression • Anxiety disorder • Substance abuse 11/4/2020 11

Treatment Options for Binge Eating Disorder • Psychotherapy – Cognitive behavioral therapy • Behavioral weight loss treatment • Psychopharmacology Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 20732080. 11/4/2020 12

Cognitive Behavioral Therapy (CBT) • CBT is the most widely investigated treatment for both BN and BED • Treatment of choice for both disorders • Gold standard to which other treatments are compared. A E Dingemans, M J Bruna and E F van Furth. International Journal of Obesity. March 2002, Volume 26, Number 3, Pages 299 -307 11/4/2020 13

Cognitive Behavioral Therapy • Primary focus on reducing binge eating • Secondary focus on weight loss • Concerned mainly with the patients' present and future rather than with past. 11/4/2020 14

Three Stages of CBT • 1) Identify the rational underlying the CBT approach • 2) Replace binge eating habits with healthy pattern of eating • 3)Ensure that progress is maintained in the future A E Dingemans, M J Bruna and E F van Furth. International Journal of Obesity. March 2002, Volume 26, Number 3, Pages 299 -307 11/4/2020 15

Behavioral Weight Loss Treatment - Primary focus on weight loss -Promotes weight loss through increased exercise, improved nutrition & decreased calorie intake - Short term but not long 11/4/2020 16

Psychopharmacology • Antidepressants • Centrally acting appetite suppressants • Anticonvulsants • Serotonin reuptake inhibitors • Short term effect, do not seem to sustain past taking medication 11/4/2020 17

Nutrition Care Process • • Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring & Evaluation M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole (2007) 11/4/2020 18

Nutrition Assessment • Observe for nonverbal/verbal cues • Assess the patient’s nutritional status • Collect data related to eating habits that may contribute to binge eating disorder • Determine whether or not the patient is in need of nutritional care M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole (2007) 11/4/2020 19

Nutrition Diagnosis • • • Determine possible underlying causes Predict State the problem Suspend judgment Prioritize the importance of different problems M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole (2007) 11/4/2020 20

Nutrition Intervention • • Set & prioritize reasonable goals Define nutrition prescription Initiate behavioral interventions Match intervention strategies with client needs, diagnoses & values • Specify the time & frequency of care • Periodically monitor the family’s response to treatment M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole (2007) 11/4/2020 21

Nutrition Monitoring & Evaluation • Select appropriate ways to gauge results • Define where the patient is not in terms of expected outcomes • Determine factors that help or hinder progress • Decide between discharge or continuation of nutrition care M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole (2007) 11/4/2020 22

Ethical Issues • Dietitian vs. Counselor • No judgment/ preconceived notions 11/4/2020 23