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BED7787 - SECTION 1: QUESTIONS AND ANSWERS ABOUT BINGE EATING DISORDER

What is BED?

Binge Eating is sometimes called compulsive overeating and some researchers believe it is the most common eating disorder, affecting millions of American women and men today. (60) However, studies have shown that BED, in spite of being called compulsive overeating at times, is different and can be differentiated from occasional overeating. (113)

Many people may binge eat from time to time, but it becomes an eating disorder when it is recurrent and out of control. People with BED are often overweight or even obese.

BED/ED Factoid

Girls who diet frequently are 12 times as likely to binge as girls who don't diet.

Source: National Eating Disorders Association (Citing Neumark-Sztainer, D. I’m, Like, SO Fat! 2005, New York: The Guilford Press)

With the publication of the DSM-5, BED is now officially considered a separate diagnostic category separate from Bulimia Nervosa. The DSM-5 code for this disorder is 307.51 prior to October 2015 when ICD-10 supersedes the ICD-9 coding, at which point the code will be F50.8.
 
A brief word about the journey to recognition of this disorder. For more than 40 years the behavior of binge eating has been recognized by the medical field. Since 1994 the behavior of binge eating has been tentatively recognized as a separate psychiatric diagnosis, culminating in its presence as a diagnosis in the DSM-5, as previously noted. (22) Nevertheless, there are still those who dismiss binge eating as a sheer lack of self-control, and not a legitimate eating disorder. What makes this a psychological disorder, rather than just a medical phenomenon, is that the disorder is more about the thought process than the observable behaviors. There are psychological needs in play. We will examine these issues shortly.

In order for a diagnosis of BED to be reached, the DSM-5 requires that the following items be present:
A – Recurrent Episodes of binge eating, which consists of “eating in a discrete period of time an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.

B – The binge-eating episodes are associated with three or more of the following:
1. Eating much more rapidly than normal;
2. Eating until feeling uncomfortably full;
3. Eating large amounts of food when not feeling physically hungry;
4 Eating alone because of feeling embarrassed by how much one is eating; 5. Feeling disgusted with oneself, depressed, or very guilty afterward.

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least once a week for 3 months.

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

There are two important specifiers when making this diagnosis: 1) Level of remission, which may consist of partial or full remission; and 2) Level of severity, which can be Mild (1-3 binge eating episodes per week), Moderate (4-7 episodes per week), Severe (8-13 episodes per week), and Extreme (14 or more episodes per week)

Like bulimic patients and anorexic patients, binge eaters suffer from an acute preoccupation with their body shape and their food consumption.
This preoccupation looms heavy in their self esteem. The body weight or shape of patients with AN, BN or BED exerts undue influence over their self-evaluation, and can lead to a partial or complete denial of the seriousness of their current body weight. (20)

As in bulimia, binges may be triggered by intense negative emotions. These emotions can trigger a need for self-nurturance through the use of food.

Some research also suggests that there may be a chemical aspect of so-called "food addiction." Blood sugar rises abruptly when there is a sudden, extreme intake of carbohydrates, then crashes just as abruptly very shortly thereafter.

This is not unlike a "high" achieved by recreational drugs. Food is used as self-medication to soothe or distract from negative feelings. This is why many people with BED also suffer from anxiety, depression, or other mood disorders.

Complications of binge eating and/or being significantly overweight may include high blood pressure, diabetes, heart disease, high cholesterol, and gallbladder disease. There may also be significant psychological effects such as depression or anxiety...which are, ironically enough, emotions which can trigger more binges. Thus the disorder can create a vicious cycle.

Recovery from binge-eating disorder may involve weight loss, most often under doctor's supervision and often with help of a nutritionist or registered dietician. This is especially important in BED. patients with Type II diabetes. Alternatives to the binge eating behaviors must be learned, as well as the foundations of good nutritional knowledge.

Some theorists also believe that there may be a sizeable sub-group of patients with BED who are survivors of sexual abuse. Some clinicians theorize that the weight gain associated with BED may serve an important psychological purpose for this sub-group. It is theorized that these patients may actually be doing this in an attempt to make themselves overweight, and therefore (in this society anyway), sexually unattractive.

Binge Eating Disorder, like other eating disorders in the "N.O.S." category, can be a gateway to or from other eating disorders.

How Does BED Differ from Anorexia and Bulimia Nervosa?

The relationship between BED and the other major eating disorders is complicated and still somewhat controversial. Currently, however, there is research being done to decide whether or not BED will ultimately be classified as a separate disorder from BN. For now, the field is divided between those who believe the two problems to be different diagnoses and those who believe BED is an extension of Bulimia Nervosa, non-purging type.

There is research supporting clinicians who insist that BED should not be classified as a separate diagnostic entity. However there is also available evidence that supports the conclusion that BED may be a different and distinct syndrome. (127) (108)

The difficulty lies in the amount of overlap between symptoms of the other eating disorders. However, there are enough important differences that a reasonable case can be made for studying BED separately.

For purposes of clarification, let's examine some of these similarities and differences, beginning with a presentation of the criteria for AN and BN as noted in the Diagnostic and Statistic Manual (DSM). We can compare these criteria with those for BED that have already been presented.

As we examine some of the differences between BED and the other major eating disorders, it is important to note that BED studies are still somewhat limited in their scope and methodology. Their sampling seems limited; their assessment methods seem to be concerned only with basic demographic characteristics. This means that what we know has not yet reached a point of full consensus.

TABLE 1.   DSM-IV Criteria for Anorexia Nervosa

Criterion
Description
A
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B
Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Specify type
 
Restricting type
During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
Purging type
During the last three months, the person has regularly engaged in recurrent episodes of a binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).



TABLE 2. DSM-IV Criteria for Bulimia Nervosa

Criterion
Description
A
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

 

(1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

 

(2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
C
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
D
Self-evaluation is unduly influenced by body shape and weight.
E
The disturbance does not occur exclusively during episodes of anorexia nervosa.


Clearly, there is a greater amount of overlap between BED and BN – as opposed to BED and AN. By definition, anorectic patients do not engage in binge eating episodes, while bulimic patients do. For this reason, clinicians who do not view BED as a separate diagnosis are inclined to view BED as a component of BN or a sub-set of BN, as we have already noted.

There are still others believe that BED and BN non-purging are two phases of the same disease. (25)

As a point of clarification when attempting to make an accurate diagnosis, BED patients tend to engage in fasting versus dieting behaviors pursuant to a binge, whereas bulimics use more immediate weight control efforts, such as self-induced vomiting, exercise or laxatives in order to purge the extra calories from the binge more quickly. (22)

When such purging behaviors occur in patients with BN, it is easier to demark the end of a binge. Unlike bulimic patients who purge, take laxatives, thyroid hormones, exercise or diet after a binge, patients who suffer from BED do not compensate for the caloric intake of their bingeing. (131) Instead, they typically alternate between attempting to lose weight through dieting and episodes of bingeing.

Therefore, the diagnosis of BED should not be made if the individual engages in the same compensatory behaviors in which BN patients engage after a binge (purging, excessive exercising, etc.)  (25) However, patients with BN will use fasting or dieting to counterbalance their binges, instead of more intrusive means of weight control. This greater overlap between the two diagnoses was responsible for the difficulty distinguishing BN from BED. (108) Let us look at the points where these two disorders vary.

To begin with, patients who come into treatment for bulimia are, for the most part, of normal weight, or on the thinner spectrum of normal weight. This means that patients with BN will have an easier time hiding their disease, whereas BED patients may a harder time keeping their disease as a secret, especially if the BED has gone on for some time and the patient is heavier that what social norms allow.

Next, studies also suggest that the population suffering from BED is more diverse than the population suffering from BN. This is to say that BED appears to be seen across a more diverse population of people than is BN. Further studies are still needed to provide clearer and more certain information on this topic, however. (6)

What does seem to be clear, though, is that the male to female ratio for BED is much more equal than for BN or AN. The ratio for BED seems to be 2:3. (104) Even given current increases in the prevalence of AN and BN among males, the male to female ratio for BN is closer to 1:7.

The next point in which variance is seen has to do with the amount of time patients engage in bingeing and fasting behaviors. Individuals with BED report longer periods of binge eating, followed by longer periods of fasting.

In fact, one group of researchers determined and reported that almost 25% of binge eating episodes in obese binge eaters lasted for a whole day. (77) This length of time is not in concordance with the DSM IV criteria of having a binge last ‘a discrete period of time.’

Another study reported in its conclusions that pre-morbid perfectionism was present in those patients who would go on to develop Bulimia Nervosa (34), distinguishing it from BED. Whether this perfectionism is the driving force that pushes patients with BN to engage in purging behaviors is not clear.

It has also been reported that patients with BED often come from families that put an unnatural emphasis on the importance of food, where children are required to "clean their plates". (29)

At least one study (33) concluded in its findings that BN and BED patients have different courses and outcomes of their illnesses. The study concluded that the prognosis of BN was poor. However, the great majority of those with BED recovered.

Also, only 1 in 10 women with BED reported a history of BN as well, which would suggest that BED is not an offshoot of BN. (108) This same study also noted that patients with BED had high rates of obesity together with co-morbid psychiatric history - in contrast to women who suffer from BN - who did not present with this combination of problems to a similar degree. (108)

At least one group of researchers, based upon a review of the literature, concluded that "Compared to subjects with BN (DSM-III-R) subjects with BED seem less anxious about their eating patterns and bodyweight, feel less guilty about being overweight, are less preoccupied with their eating behavior, have a better overall opinion of themselves, are able to perceive internal states more accurately, are more socially adjusted, and are more comfortable in maintaining interpersonal relationships." (29)

To present a fair and impartial analysis of this issue, it is also important to report the research on the other side. Making the case against the disorder as a separate nosological entity, some researchers reported that the phenomenon of binge eating is unstable over time. What does this mean?

They report that, over time, the phenomenon of binge eating subsides without therapeutic intervention. (33) These researchers believe that binge eating may be a phase of BN non-purging type.

To complicate matters further, some found out that there was no difference among those patients who binged once or twice weekly. This group of researchers questioned the utility of the frequency of bingeing in the diagnosis. They argued that such frequency was chosen to match the BN criteria only. (128)


BED/ED Factoid

It is estimated that one million men in the US have an eating disorder.

Source: South Carolina Department of Mental Health


How Does BED Differ from Obesity?

In addition to questions about whether BED can be viewed as a diagnostic entity separate from other eating disorders, there are also questions about whether BED can be seen as being clearly distinct from simple obesity. Some researchers believe that obese binge eaters cannot be distinguished from obese non-binge eaters. (114)

Others have noted that there is a significant difference between those individuals who are obese and do suffer from BED and those who are obese but do not suffer from BED. (138)

This is an important difference for clinicians to bear in mind since, more often than not, obese people have to deal with humiliating stereotypes, including the idea that they are "out of control" with their eating. Stereotypes of this sort can hinder the development of a working alliance between the clinician and the patient seeking help.

Recent research seems to suggest that up to 70 percent of the variation in any person's weight may be attributed to genetic factors, as opposed to psychological factors. This suggests that for many people who are obese, genetics may play a greater part than any form of psychological problem or any variation in the social environment in which they live. (116) (117)

This is to say that some people who are obese become so because their genetic orientation makes them become so, not because they have psychological problems or because they suffer from BED. They simply have metabolisms that allow them to gain weight more easily, and have a harder time losing weight than does the average person.

In fact, a seminal study by researchers at Rockefeller University suggests that people with a genetic orientation towards being obese may develop a syndrome called semi-starvation neurosis once they start a program of dieting. (45) The subjects studied experienced a sense of starvation – and concurrent psychological pressure to increase their caloric intake – when they were on a diet that allowed them to maintain their weight within more "healthy" and "normal" parameters.

The conclusions from the study – and others like it – present a complication to the study of BED. There may be people who are genetically predisposed to more obese conditions, and who may therefore not fit the socially determined "standard" of what a person's weight should be.

When these people diet in order to force themselves into compliance with the social ideal, they place themselves in a state of semi-starvation. This predisposes them to over-eating when they are unable to maintain sufficient willpower to stay on their diet. Does this constitute BED, or is it a normal reaction of a body whose normal metabolic equilibrium has been disrupted by the imposition of an unrealistic standard?

There are important diagnostic considerations in this question, and a warning to clinicians to remain humble and open-minded as they perform their evaluations. Again, BED is concerned with psychological process more than behaviors, and part of the diagnostic accuracy is going to depend upon gathering enough evidence to determine whether a patient's obesity is derived from BED or genetic factors. The distinguishing feature with BED is acute preoccupation with body shape.

There are many obese people who are very comfortable with their body size and shape – even though we live in a culture that celebrates thinness and fitness. They may eat more calories than will allow them to keep their healthiest body weight, and they may engage in attempts to lose weight, but they will not engage in the constant self-scrutiny and self-critical thought processes that are typical of the patient with BED.

However, in a culture that is itself overly pre-occupied with issues of weight and appearance, it may be more difficult than ever for a person who is genetically predisposed to obesity to avoid acute preoccupation with body weight. The culture around them may make it almost impossible to feel good about their body weight and size. In such ways do the psychological and cultural intersect, making complications in diagnosis the rule, rather than the exception.

Current research appears to show that not all obese people do suffer from BED, and not all people with BED are obese. There is an occurrence of binge eating among the obese and non-obese populations. (137)

There do appear to be differences that can be noted in distinguishing obese patient with BED from obese patients without BED. Some research indicates that individuals with BED have become obese at an earlier age than obese people who do not suffer from BED. Some researchers have found that the onset of obesity for binge eaters was 11.7 years old while for non-bingers the onset age of obesity was 15.9 years old. (141) Others found the ages to be 14.8 and 18.6 respectively. (80) Apparently these early onset obesity binge eaters begin worrying about their weight earlier in life. (121)

Many researchers seem to think that there need to be further follow up studies examining the course of obesity in treated and untreated binge eaters for BED to be useful subtype of an obesity diagnosis. (22)

BED and Prognosis/Treatment Selection

Much of the debate around the utility of BED as a diagnostic category centers on the fact that the diagnosis does not allow yet for predicting prognosis or treatment selection. There is still not enough evidence on outcome either.

However, it is not fair, others say, to expect for a new diagnosis to be able to predict prognosis or be able to be very accurate in selection of treatments or outcome. The final determination on this question must await further research and further analysis before a clear consensus can emerge.

Types of BED

Although at first sight BED appears to be a homogeneous disorder, researchers and clinicians have found out that it is not. The heterogeneity will be found in three areas. The first element of heterogeneity lies in the fact that both females and males suffer from the disorder. The second element is found in the ethnic differences of the population that suffer from BED, and the third element is found in the different symptomatology seen in patients suffering BED. (75)

Researchers have divided BED into two distinct types to further understand the disorder. Some BED patients begin binge eating after having dieted, while others begin bingeing without dieting first. In the light of this difference, researchers have divided BED into BED BF (bingeing first) and BED DF (dieting first). (75) Unlike BN, it appears that BED is much less related to the phenomenon of deprivation and dieting than BN. (22)


BED/ED Factoid

80-90% of women dislike the size and shape of their bodies.

Source: National Eating Disorders Information Centre of Canada (Citing Hutchison, M Transforming Body Image, 1985, The Crossing Press)


What are the incidence and prevalence of BED?

Information about incidence and prevalence, while not the most interesting aspect of this topic to study, is important in terms of understanding the prevailing trends in BED, which in turn assists the clinician in knowing what population groups are at greater risk for BED, and how BED may vary between different groups. It is also information that helps the clinician to have a clear overview of the extent of the disorder in the public at large. For these reasons, we will spend a little time providing a solid overview of the trends and statistics.

Estimates of the incidence or prevalence of BED vary - depending on the sampling and assessment methods. Binge eating disorder is estimated by some to afflict between 1 and 5 percent of the American population. (58) Community surveys have estimated the current prevalence of binge eating to be between 2-5 percent in the USA. (104) Furthermore, it appears that 30% of those that participate in weight loss programs and 70% of those that attend Overeaters Anonymous may suffer from BED. (25)

Unfortunately - because most studies on BED have been done in obese women participating in weight loss programs - it appears that we do not have a great deal of information on normal weight subjects who meet criteria for BED. It is the common belief among researchers - as well as among clinicians - that the longer BED remains untreated, the more likely the individual is to become obese.

However, in one community study apparently only half of the BED subjects were obese, and only 5% of subjects who were obese suffered from BED. From this study, researchers argued that BED behavior was less prevalent in obese subjects who were not in treatment. (115)

It is important to note that BED seems to be more common in women than in men, with a 65% female, 35% male ratio. This is much higher than what is reported in BN where only 10% of those that are reported are men. (25)
This may provide support for the notion that BED is separate from BN.


BED/ED Factoid

Results from a nationwide survey of more than 2,900 men and women conducted by Harvard University Medical School suggest that more people suffer from binge eating disorder than previously believed. Researchers found out that, 3.5 percent of women and 2 percent of the men surveyed reported having binge-eating disorder at some point.

The private pain of binge eating By Camilla A. Herrera / Stamford Advocate, Tuesday, May 01, 2007



What Other Problems are Typically Co-morbid with BED?

For healthcare professionals who do not specialize in the treatment of BED, it is likely that interactions with eating disordered patients will occur in the initial assessment phase, or when an eating disorder is uncovered during the course of treating some other presenting condition. In either event, the most appropriate role of the clinician will consist of performing a thorough evaluation to determine the full range of problems and symptoms, and to understand what additional or specialized services may be required to successfully treat the patient.

For this reason, it is important for each healthcare professional to be aware of the potential for co-morbid conditions and disorders. While each individual patient will have a unique presentation of problems, it is nevertheless helpful for the clinician to have some basic knowledge about the more likely co-morbid symptoms and conditions.

Researchers in the field of eating disorders seem to agree with the fact that BN and AN patients display the most psychopathology, followed by those patients who have BED, with obese people who do not have BED displaying the least symptomatology.

Psychiatric symptoms frequently co-morbid with BED include depressive symptoms, such as depressed mood, as well as with a history of affective disorders. (25) It must be understood that many depressive features may present with BED, and normalized mood can help in the treatment of BED.
Because of this factor, symptoms of mood disturbances need to be assessed when we suspect BED. Likewise, with a patient who is significantly overweight and suffering from signs of depression, it is always wise to assess for BED.

BED patients seem to suffer from the same automatic thoughts from which depressive patients suffer. (68) Clinicians have also noted social withdrawal, irritability, insomnia and decreased sexual interest. Anxiety symptoms are also frequently paired with embarrassment in social situations.

It also seems that these patients have had more contact with the mental health field than those who do not suffer from BED. (25) Some reports have spoken to a raised rate of lifetime and psychiatric history in the families of these patients, although there is no study concluding on risk factors. (12)

Fears of eating in public may also be evident. Care should be taken to distinguish fear of food / shame of eating too much – as one can see with an eating disorder – and a legitimate social phobia; especially with obese individuals who can be ashamed of their appearance.

It is not known if the co-morbidities between BED and these other conditions are the result of common genetic or environmental factors. The research to date has not been conclusive, and much more study needs to be done before conclusions can be reached.

Furthermore - and to complicate matter even further - some researchers suggest that studies are biased, since they recruit samples from clinics in order to study BED. Ethnicity, severity of binge eating, and social maladjustment were found to increase treatment seeking among participants with BED, rather than levels of psychiatric distress or co-morbidity. These findings suggest that previous studies using recruited clinic samples have not been able to produce unbiased estimates of psychiatric co-morbidity in BED. (125) In other words, what drove people to seek treatment in clinics may not have been co-morbidity or psychiatric distress.

BED and Ethnic Groups

There are three important items to note when it comes to BED and ethnicity. First, no national representative study has been published in the US comparing DSM diagnosis across racial ethnic groups. (41) Second, most epidemiological studies of eating disorders have included only white participants. This weakens the validity of a variety of epidemiological studies that have found no differences in the prevalence of binge eating disorder across different ethnic groups. (102) (104)


Third, it is also important to note that minority populations are less likely than white populations to use mental health services and, consequently, are underrepresented in studies that rely on patient samples. (125) This means there will be many questions unanswered by the research concerning ethnicity and BED. What we can say with some certainty is that recurrent binge eating is a problem for both African-American and white women. (112) Less certainly, some studies have identified that there may be differences across ethnic groups in terms of symptom prevalence and the distress those symptoms bring on.

At least one study concluded that recurrent binge eating was more common among black women than among white women. Eating concerns and depressive affect emerged in this study as significant independent predictor of body image for both groups. (55)

Another interesting study looked at race and clinical functioning in patients with and without BED. (90) In this study eating and psychiatric symptoms were assessed through interviews and self-report.

The study found out that black and white women with BED differed significantly on many eating disorder features. They way they eat, how often and what they eat is different for both white and black women. The frequency of binge eating, as well as the capacity for restraint when food is a stimulus, history of other eating disorders, treatment-seeking, and concerns with eating, weight, and shape differ in both groups.

In all groups, across races, recurrent binge eating was associated with elevated body weight and increased psychiatric symptoms. The study concluded that for both black and white women, binge eating disorder is associated with important impairments in functioning. This study made the case for considering further the construct of race in future research. (90)

A different study concluded that there is not much difference in African-American and Hispanic women when it comes to self reporting on their body image, eating disorders and their depressive affect. Apparently, the higher the weight, the higher the level of both concerns with body image and eating disorders features in both groups.

Another study showed that binge eating seemed to be greater in Hispanic women than in black and white women. In all three groups, those who binged more: 1) had a higher BMI (Body Mass Index); 2) were more depressed; and 3) had a slimmer body ideal. (38)

Apparently, at least one other study indicated that AN and BN occur less frequently in African-American than in Caucasian women. BED was also found to be only marginally less prevalent among African-American women. (109)

In another study, after the researchers controlled for individual economic disadvantage, they found out that there is no difference between black and white people who binge eat. (95) These researchers also discovered an income gradient for females, but not for males. This is to say that the incidence of binge eating was affected by the level of income of the female subjects, but not the male subjects. Lower income levels seemed to lead to an increase in likelihood that BED would be exhibited.

This same study also added an additional complicating factor: age. The researches noted that the frequency of binge eating is highest in adults who are younger than 40 years old. According to this study, the typical male’s bingeing declines first by age 40, and then some more at age 65. In women, apparently, it does not decline until age 65. (95)

The realization that a minority can be at equal risk with the white majority to suffer from an eating problem should prompt the healthcare professional to inquire about eating in patients of all ethnicities. (139) Some researchers pointed that when studying BED research has focused only on the variables of race and gender. (111) (123)

BED/ED Factoid

In 1994, Essence magazine reported that over 50% of African American women responding to a survey were at risk for an eating disorder

Source: South Carolina Department of Mental Health (Citing Essence Magazine, 1994)



Additional Studies on BED and ethnicity

Little is known about BED and ethnic minorities. One study, however, looked at BED in women in Fiji. (6) Interestingly, this study found out that the Fiji women displayed BED even if their traditions and social context were very different from our Western traditions concerning body and weight.

The study looked for several markers of acculturation to Western culture that might explain the development of BED in this sample. By and large, the binge eating was not associated with any of these markers. However, the study suggests that there were present some nontraditional Fijian attitudes toward weight and body shape, and that these attitudes played a contributory role in the Fijian’s women BED.

This suggests that there may be a very complex relationship between BED and cultural elements in any culture. Although it has been said that eating disorders are culturally bound syndromes of the West, it appears that the influences that bring disturbances in traditional eating patterns are far reaching and affect non-Western countries.

Israel is an interesting country because it is a melting pot of cultures with many societies and religions living in one region. Apparently a large number of Jewish –Israeli adolescents in non-clinical settings have been found to have weight and eating concerns. (70)

Like the Jewish population in that area, the Arab population is undergoing changes that are taking them from traditional to a more modern culture. (70) However, thinness among Arabs is regarded as socially unacceptable, as plumpness is seen as a symbol of womanhood and fertility. (4) It is therefore not surprising that low rates of eating disorders have been reported among Arabs. (1) (82) (83) (84)

It is interesting to note that the study found out that the girls who were at higher risk were the younger group, 12-13 years of age. What surprised the researchers was that the Moslem Arab group that had more disordered eating pathology than the Christian Arab group. This is surprising because the Arab Christian group was more in contact with modern Western values. (70)

Even though the study does not address BED per se, there are some interesting observations that came out of the study. The study noted pathology in eating behavior within a population that, in the past, was believed not to have eating pathology. This is important in light of what we know about physicians being less likely to ask members of a minority group pertinent questions about eating disorders. (8)

From a clinician's perspective, perhaps the most important concept to derive from this section is that BED may be present in any patient that arrives at your office – regardless of misperceptions or stereotypes related to race or ethnicity. What we still do not know about the cultural influences that create BED is greater than what we do know. It is best to address this with a very open mind.

Food Consumption among Binge Eaters

Two studies were done by researchers around the issue of food selection and food intake in two groups of people: obese individuals diagnosed with BED and obese individuals without the diagnosis of BED. Both studies showed that obese binge eaters consumed many more calories per meal, even when asked to eat normally. These patients also consumed more calories from fat when bingeing than their counterparts, obese non-binge eaters. Apparently, according to these researchers, these patients consumed half of the calories of those with BN during a binge (on average 3000). (46) (140)

Although it is mostly believed that BED patients are obese, a community survey found out that only half of its BED subjects were obese. (BMI>25.5kg/2. ) (115) One other difference found among BED subjects and those matched for weight, but that do not suffer from BED is that those who do not binge eat consistently eat less calories. In other words, the binge eaters eat more calories not only while bingeing but also when they are eating in a normal manner. In other words, binge eaters have quantifiable disturbed behaviors that can be seen in laboratories. (56)

BED/ED Factoid

Eating disorders are now one of the most common psychological problems facing the young women of Japan

Source: South Carolina Department of Mental Health

 

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