Cortisol,Hunger, and Desire to Binge Eat Following a Cold Stress Test in Obese Women with Binge Eating Disorder Gluck ME, Geliebter A, Hung J, and Yahav E. Psychosom Med. 2004 Nov-Dec;66(6):876-81. Nick Bello ED Journal Club 05-Dec-2008

Introduction Binge eating disorder (BED) Frequent and regular intake large amount of food twice a week for 6 months Sense of “loss of control” over eating No inappropriate compensatory behaviors BED is 2% of the nonpatient general community ~ 30% obese people seeking medical treatment

Introduction (continue) Stress and binge eating Stress and negative affect precursors to binge eating Cortisol is the major hormonal component to stress response. Exogenous glucocorticoids induce obesity by increasing food intake. Elevated cortisol levels associated with energy intake in health individuals.

HPA Axis and dexamethasone test (DST)

Cold Pressor Test (CPT) Life, December 1955

Hypothesis Obese women with BED compared with non-BED Increase CORT after CPT More hungry and desire to binge eat after CPT Less CORT suppression after DST

Methods (Participants) Obese women (n=38) were recruited by local advertisements Exclusion Criteria Significant health problem other than obesity Unstable weight (± 5%) for the past 3 months Dieting or smoking current or in the past 3 months Most prescribed medication or substance abuse within the past 6 months Pregnant or lactating, not oral contraceptives

Methods (Participants) Inclusion Criteria PE (medical history, ECG and blood tests) Questionnaire on Eating and Weight Patterns BED if they met the full criteria of DSM IV Non-BED if they denied episodes of overeating BED (n=11) non-BED (n=11)

Procedures Body Composition (first day) Psychological Scales Waist and hip circumferences (WHR) % Body Fat by underwater weighing Psychological Scales Zung Depression Rating Scales CPT ( second day) 12 hour fast and then a fixed meal First blood draw @ 8-9 am Immersed non-dominant hand in 2 min of 0° C ice water Rated Pain, Stress, Hunger and Desire to Binge Eat Blood draws at –10 , 0, 5,15, 30, 45 and 60 min Blood pressure and heart rate

Procedures (More) DST (third day) 1 mg oral dexamethasone @ 11 pm Blood drawn @ ~8am for CORT

Results

Results

Results

Results Insulin DST VAS Ratings No differences No difference between BED and non-BED BED compared with morning CORT relative greater reduction VAS Ratings BED had greater AUC hunger, desire to binge eat, pain, stress

Results

Results Sympathetic Activity Correlations No Differences AUC for CORT was correlated w/ AUC pain AUC for Stress was correlated w/ AUC “desire to binge eat” and Pain AUC Pain was correlated Hunger and “desire to binge eat”

Results