1. Home
  2. binge-eating disorder

binge-eating disorder

Eating Disorders: A Review

Author/s: 
Evelyn Attia, B Timothy Walsh

Importance: Eating disorders are characterized by disturbances in eating behavior and occur worldwide, with a lifetime prevalence of 2% to 5%. They are more common among females than males and may be associated with medical and psychiatric complications, impaired functioning, and decreased quality of life.

Observations: Common eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/restrictive food intake disorder. These disorders may be associated with changes in weight, electrolyte abnormalities (eg, hyponatremia, hypokalemia), bradycardia, disturbances in reproductive hormones (eg, decreased estradiol levels in females), and decreased bone density. Individuals with anorexia nervosa, bulimia nervosa, and binge-eating disorder have high lifetime rates of depression (76.3% for bulimia nervosa, 65.5% for binge-eating disorder, and 49.5% for anorexia nervosa) and higher rates of suicide attempts than those without eating disorders. Anorexia nervosa is associated with a mortality rate of 5.1 deaths per 1000 person-years (95% CI, 4.0-6.1), nearly 6 times higher than that of individuals of the same age without anorexia nervosa; 25% of deaths among individuals with anorexia nervosa are from suicide. First-line treatments for eating disorders include nutritional support, psychotherapy, and pharmacotherapy. Behaviorally focused therapies, including cognitive behavioral therapy, may be effective, especially for bulimia nervosa and binge-eating disorder. Youth with anorexia nervosa benefit from family-based treatment with parental oversight of eating, resulting in a remission rate at 6 to 12 months of 48.6% vs 34.3% with individual treatment (odds ratio, 2.08; 95% CI, 1.07-4.03; P = .03). Fluoxetine and other antidepressants decrease episodes of binge eating in individuals with bulimia nervosa, even in those without depression (fluoxetine vs placebo, standardized mean difference = -0.24 [small effect size; 95% CI, -0.41 to -0.08]). Antidepressants and the central nervous system stimulant lisdexamfetamine reduce binge frequency in binge-eating disorder compared with placebo (antidepressants vs placebo, standardized mean difference = -0.29 [small effect size; 95% CI, -0.51 to -0.06]; lisdexamfetamine vs placebo, Hedges g = 0.57 [medium effect size; 95% CI, 0.28-0.86]). There are currently no effective medications for treatment of anorexia nervosa. Individuals with serious medical or psychiatric complications of eating disorders such as bradycardia or suicidality should be hospitalized for treatment.

Conclusions and relevance: Globally, eating disorders affect 2% to 5% of individuals during their lifetime and are more common in females than males. In addition to weight changes, eating disorders may cause electrolyte abnormalities, bradycardia, disturbances in reproductive hormones, and decreased bone density, and are associated with increased risk of depression, anxiety, and suicide attempts. First-line treatments of eating disorders include nutritional support, psychotherapy, and pharmacotherapy.

Keywords 
eating disorder

Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis

Author/s: 
Dawes, AJ, Maggard-Gibbons, M, Maher, AR, Booth, MJ, Miake-Lye, I, Shekelle, PG

IMPORTANCE:

Bariatric surgery is associated with sustained weight loss and improved physical health status for severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery; however, the prevalence of these conditions and whether they are associated with postoperative outcomes remains unknown.

OBJECTIVE:

To determine the prevalence of mental health conditions among bariatric surgery candidates and recipients, to evaluate the association between preoperative mental health conditions and health outcomes following bariatric surgery, and to evaluate the association between surgery and the clinical course of mental health conditions.

DATA SOURCES:

We searched PubMed, MEDLINE on OVID, and PsycINFO for studies published between January 1988 and November 2015. Study quality was assessed using an adapted tool for risk of bias; quality of evidence was rated based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.

FINDINGS:

We identified 68 publications meeting inclusion criteria: 59 reporting the prevalence of preoperative mental health conditions (65,363 patients) and 27 reporting associations between preoperative mental health conditions and postoperative outcomes (50,182 patients). Among patients seeking and undergoing bariatric surgery, the most common mental health conditions, based on random-effects estimates of prevalence, were depression (19% [95% CI, 14%-25%]) and binge eating disorder (17% [95% CI, 13%-21%]). There was conflicting evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Neither depression nor binge eating disorder was consistently associated with differences in weight outcomes. Bariatric surgery was, however, consistently associated with postoperative decreases in the prevalence of depression (7 studies; 8%-74% decrease) and the severity of depressive symptoms (6 studies; 40%-70% decrease).

CONCLUSIONS AND RELEVANCE:

Mental health conditions are common among bariatric surgery patients-in particular, depression and binge eating disorder. There is inconsistent evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Moderate-quality evidence supports an association between bariatric surgery and lower rates of depression postoperatively.

Keywords 
mental health bariatric surgery weight loss depression meta-analysis

5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study

Author/s: 
Järvholm, K, Bruze, G, Peltonen, M, Marcus, C, Flodmark, CE, Henfridsson, P, Beamish, AJ, Gronowitz, E, Dahlgren, J, Karlsson, J, Olbers, T

BACKGROUND:

Mental health problems are prevalent among adolescents with severe obesity, but long-term mental health outcomes after adolescent bariatric surgery are not well known. We aimed to assess mental health outcomes over 5 years of follow-up after Roux-en-Y gastric bypass surgery in adolescents who participated in the Adolescent Morbid Obesity Surgery (AMOS) study.

METHODS:

This was a non-randomised matched-control study in adolescents aged 13-18 years who had a BMI of 40 kg/m2 or higher, or 35 kg/m2 or higher in addition to obesity-related comorbidity; who had previously undergone failed comprehensive conservative treatment; and were of pubertal Tanner stage III or higher, with height growth velocity beyond peak. A contemporary control group, matched for BMI, age, and sex, who underwent conventional obesity treatment, was obtained from the Swedish Childhood Obesity Treatment Register. Data on dispensed psychiatric drugs and specialist treatment for mental disorders were retrieved from national registers with complete coverage. In the surgical group only, questionnaires were used to assess self-esteem (Rosenberg Self-Esteem [RSE] score), mood (Mood Adjective Checklist [MACL]), and eating patterns (Binge Eating Scale [BES] and Three-Factor Eating Questionnaire-R21 [TFEQ]). This study is registered with ClinicalTrials.gov (NCT00289705).

FINDINGS:

Between April 10, 2006, and May 20, 2009, 81 adolescents (53 [65%] female) underwent Roux-en-Y gastric bypass surgery, and 80 control participants received conventional treatment. The proportion of participants prescribed psychiatric drugs did not differ between groups in the years before study inclusion (pre-baseline; absolute risk difference 5% [95% CI -7 to 16], p=0·4263) or after intervention (10% [-6 to 24], p=0·2175). Treatment for mental and behavioural disorders did not differ between groups before baseline (2% [-10 to 14], p=0·7135); however, adolescents in the surgical group had more specialised psychiatric treatment in the 5 years after obesity treatment than did the control group (15% [1 to 28], p=0·0410). There were few patients who discontinued psychiatric treatment post-surgery (three [4%] receiving psychiatric drug treatment and six [7%] receiving specialised care for a mental disorder before surgery). In the surgical group, self-esteem (RSE score) was improved after 5 years (mixed model mean 21·6 [95% CI 19·9 to 23·4]) relative to baseline (18·9 [17·4 to 20·4], p=0·0059), but overall mood (MACL score) was not (2·8 [2·7 to 2·9] at 5 years vs 2·7 [2·6 to 2·8] at baseline, p=0·0737). Binge eating was improved at 5 years (9·3 [7·4 to 11·2]) relative to baseline (15·0 [13·5 to 16·5], p<0·0001). Relative changes in BMI were not associated with the presence or absence of binge eating at baseline.

INTERPRETATION:

Mental health problems persist in adolescents 5 years after bariatric surgery despite substantial weight loss. Although bariatric surgery can improve many aspects of health, alleviation of mental health problems should not be expected, and a multidisciplinary bariatric team should offer long-term mental health support after surgery.

FUNDING:

Swedish Research Council, VINNOVA, Västra Götalandsregionen, ALF VG-region, Region Stockholm, Swedish Child Diabetes Foundation, Swedish Heart and Lung Foundation, Tore Nilsson's Foundation, SUS Foundations and Donations, Capio Research Foundation, and Mary von Sydow's Foundation.

Keywords 
mental health children adolescent bariatric surgery obesity
Subscribe to binge-eating disorder