Binge Eating Disorder (BED) is the most common eating disorder in the US with a lifetime prevalence of 2.8%. Females have a higher prevalence (3.5%) compared to males (2.0%). It can occur at any age but is most common in adolescents and young adults. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recognizes BED as a serious medical condition characterized by recurrent episodes of eating large quantities of food quickly and to the point of discomfort, accompanied by a sense of loss of control.
Diagnostic Criteria and Symptoms
The DSM-5 further defines BED as consuming more than what the average person would under a similar period under and circumstances accompanied by a sense of lack of control (American Psychiatric Association, 2013). Binge eating episodes are associated with three or more of the following: 1) eating rapidly, 2) eating until uncomfortably full, 3) eating large amounts when not physically hungry, 4) eating alone due to embarrassment, and 5) feeling disgusted, depressed, or guilty afterward. The binge period occurs at least once a week for three months.
BED differs from the bulimia nervosa and anorexia nervosa eating disorders. Bulimia involves binge eating followed by compensatory behaviors like vomiting or excessive exercise, while anorexia involves an intense fear of gaining weight and significant food restriction, leading to low body weight.
The binge eating episodes can lead to physical health problems such as obesity (although it can occur at any weight) type 2 diabetes, and hypertension.
Causes
The causes of BED involve genetic, psychological, and environmental factors. Experiencing external shaming in the presence of emotional vulnerability exemplifies how environmental and psychological contributors can combine and compound the difficulty towards a successful recovery (Duarte et al., 2017).
A chief environmental culprit is ultra-processed foods (UPFs). High in added sugars, fats, and salts, UPFs are hyper-palatable and potentially addictive which can prompt overconsumption and binge eating. The rapid digestion and absorption of UPFs can spike blood sugar followed by crashes, triggering hunger and more binges. The availability and marketing of UPFs also contribute. See the June 2nd and 15th Tribune articles on food processing and food addiction respectively
Treatment
Treatment for BED typically involves psychotherapy, pharmacotherapy, and nutritional counseling. Cognitive-behavioral therapy (CBT) is an effective treatment helping patients modify dysfunctional thoughts and behaviors related to eating and body image. Pharmacotherapy options include lisdexamfetamine, FDA-approved for BED, and selective serotonin reuptake inhibitors (SSRIs).
Registered dietitians play a crucial role by providing nutritional counseling, promoting healthy eating habits, addressing nutritional deficiencies, and developing individualized meal plans to reduce the frequency of binge eating episodes (Academy of Nutrition and Dietetics, 2016).
Insurance Reimbursement
Insurance coverage for BED treatment varies. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires most group health plans to provide the same coverage for mental health and substance use disorder treats as medical/surgical. Many insurance carriers recognize BED as a serious condition and cover its treatment.
Conclusion
BED is a serious and distinct eating disorder characterized by recurrent binge eating without compensatory behaviors. It is associated with significant emotional distress and physical health problems. The contribution of ultra-processed foods to BED highlights the need for public health strategies to reduce their consumption and promote healthier eating patterns. In addition to psychotherapy and pharmacotherapy, registered dietitians play an essential role in providing nutrition counseling and insurance reimbursement for treatment is increasingly available, improving access to necessary care.
Patrick Traynor, PHD, MPH, RD, CPT has an insurance based registered dietitian practice with MNT Scientific, LLC. He has offices in South Lake Tahoe, CA, Sacramento, CA, and Minden, NV and also works via telemedicine. Inquiries can be directed to Dr. Traynor at (530)429-7363 or info@MNTScientific.com.
