Binge eating disorder is the eating disorder most common in the United States, but previous studies have presented conflicting views on the duration of the disorder and the likelihood of relapse.
A new five-year study by researchers at McLean Hospital, a member of the Mass General Brigham Health System, showed that 61 percent and 45 percent of individuals still suffered from binge eating disorder 2.5 and 5 years after initial diagnosis, respectively. According to the authors, these results contradict previous prospective studies that documented faster remission times.
The research results were published on Psychological Medicine.
Binge eating disorder is among the most common
“Most importantly, binge eating disorder improves with time, but for many people it lasts for years,” said first author Kristin Javaras, DPhil, Ph.D., assistant psychologist in the Division of Women’s Mental Health at McLean.
“As a clinician, the clients I work with often report many, many years of binge eating disorder, which seemed very discordant with studies that suggested it was a transient disorder. It is very important to understand how long binge eating disorder lasts and how likely people are to relapse so we can provide better care.”
Binge eating disorder, which is estimated to affect between 1% and 3% of U.S. adults, is characterized by episodes during which people feel a loss of control over eating. The average age of onset is 25 years.
While previous retrospective studies, which rely on people’s sometimes faulty memories, have reported that binge eating disorder lasts an average of seven to sixteen years, prospective studies that track individuals with the disorder over time have suggested that many individuals with the disorder enter into remission within a much shorter time frame: from one to two years.
The researchers noted that most previous prospective studies had limitations, including a small sample size (<50 participants), and were not representative because they focused only on adolescent or young adult women, most of whom had a BMI less than 30. while approximately two-thirds of individuals with binge eating disorder have a BMI of 30 or greater.
To better understand the course of binge eating disorder, researchers followed 137 adult community members with the disorder for five years. The participants, who ranged in age from 19 to 74 and had an average BMI of 36, were assessed for binge eating disorder at the start of the study and retested 2.5 and 5 years later.
After five years, most study participants still had episodes of binge eating, although many showed improvements. After 2.5 years, 61% of participants still met full criteria for binge eating disorder at the time the study was conducted, and an additional 23% experienced clinically significant symptoms, although they were below the threshold for binge eating disorder.
After 5 years, 46% of participants met all criteria and an additional 33% experienced clinically significant but subthreshold symptoms. Notably, 35% of individuals who were in remission at 2.5-year follow-up had relapsed to full or subthreshold binge eating disorder at 5-year follow-up.
The criteria for diagnosing binge eating disorder have changed since the study was conducted, and Javaras notes that under the new guidelines, an even greater percentage of study participants would have been diagnosed with the disorder at 2-year follow-ups ,5 and 5 years. .
Javaras added that because the study participants were community members who may or may not have received treatment, rather than patients enrolled in a treatment program, the study results are more representative of the natural course of binge eating disorder.
When comparing this community sample to those involved in treatment studies, treatment appeared to lead to faster remission, suggesting that people with binge eating disorders would benefit from the intervention. According to Javaras, there are large inequalities in the choice of who receives treatment for eating disorders.
Although there was variation among participants in the likelihood of remission and the time it took, the researchers were unable to find any strong clinical or demographic predictors for the duration of the disorder.
“This suggests that no one is much less or more likely to improve than anyone else,” Javaras said.
Since the study’s conclusion, researchers have studied and developed treatment options for binge eating disorder and examined screening methods to better identify individuals who would benefit from treatment.
“We are studying binge eating disorder with neuroimaging to gain a better understanding of the neurobiology involved, which could help improve or develop new treatments,” Javaras said.
“We are also looking at ways to catch people earlier, because many don’t even realize they have binge eating disorder, and there is a great need for greater awareness and screening so that intervention can begin sooner.”
Gay and bisexual teens have double the risk of binge eating disorder
An additional study, published in the Journal of Eating Disorders, finds that lesbian, gay, and bisexual (LGB) adolescents in the United States are more than twice as likely to report binge eating disorder as their heterosexual peers.
“Young people who identify as lesbian, gay or bisexual may face discrimination, bullying and stigmatization because of their sexual orientation. These stressors can lead to low self-esteem and binge eating disorder,” says lead author Jason Nagata, MD, associate professor of pediatrics at the University of California, San Francisco.
“Uncontrolled eating can cause psychological effects such as depression and anxiety, and long-term physical health problems, including diabetes and heart disease.”
Researchers analyzed data from 10,197 adolescents ages 10 to 14 who are part of the Adolescent Brain Cognitive Development Study, the largest long-term study of brain development and children’s health in the United States. The data was collected in the period 2018-2020.
Parents answered questions about their children’s eating behaviors and teenagers were asked about their sexual orientation.
Binge eating disorder is characterized by frequently eating unusually large amounts of food and feeling unable to stop eating. Binge eating disorder is the most common eating disorder in the United States, although it is understudied and often misunderstood. The study also found that teenage boys were 28 percent more likely to binge eat than girls.
“Adolescent boys may have a drive toward muscularity and larger size that may lead to consuming greater quantities of food,” says co-author Kyle T. Ganson, Ph.D., assistant professor in the Factor-Inwentash Faculty of University of Toronto. Social work. “In the context of muscularity-oriented goals, boys are more likely than girls to engage in ‘light eating’ which has been linked to binge eating episodes.”
“Adolescents with eating disorders should seek professional help. Eating disorders are best supported by an interdisciplinary team that includes a mental health, medical and nutritional professional,” says Nagata. “Given the higher risk of eating disorders among LGBTQ+ youth, it is important that healthcare providers promote a welcoming environment for youth of all sexual orientations and genders.”
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