1. 8/19/2015 1 Binge Eating Disorder (BED) Allison Boese

2. 8/19/2015 2 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

3. 8/19/2015 3 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.

4. 8/19/2015 4 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

5. 8/19/2015 5 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 McGraw-Hill Companies (2007)

6. 8/19/2015 6 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.

7. 8/19/2015 7 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.

8. 8/19/2015 8 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.

9. 8/19/2015 9 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 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)

10. 8/19/2015 10 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. 8/19/2015 11 Mental Disorders Associated with Binge Eating Disorder Depression Anxiety disorder Substance abuse

12. 8/19/2015 12 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, 2073- 2080.

13. 8/19/2015 13 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

14. 8/19/2015 14 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.

15. 8/19/2015 15 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

16. 8/19/2015 16 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

17. 8/19/2015 17 Psychopharmacology Antidepressants Centrally acting appetite suppressants Anticonvulsants Serotonin reuptake inhibitors Short term effect, do not seem to sustain past taking medication

18. 8/19/2015 18 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)

19. 8/19/2015 19 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)

20. 8/19/2015 20 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)

21. 8/19/2015 21 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)

22. 8/19/2015 22 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)

23. 8/19/2015 23 Ethical Issues Dietitian vs. Counselor No judgment/ preconceived notions