Field Notes

Binge-Eating Disorder Not as Transient as Previously Thought

Binge-eating disorder is the most prevalent eating disorder in the United States, but previous studies have presented conflicting views of the disorder's duration and the likelihood of relapse. A new five-year study led by investigators from McLean Hospital, a member of the Mass General Brigham health care system, showed that 61% and 45% of individuals still experienced binge-eating disorder 2.5 and five years after their initial diagnoses, respectively. These results contradict previous prospective studies that documented faster remission times, according to the authors.

"The big takeaway is that binge-eating disorder does improve with time, but for many people, it lasts years," says first author Kristin Javaras, DPhil, PhD, an assistant psychologist in the division of women's mental health at McLean. "As a clinician, oftentimes the clients I work with report many, many years of binge-eating disorder, which felt very discordant with studies that suggested that it was a transient disorder. It's very important to understand how long binge-eating disorder lasts and how likely people are to relapse so that we can better provide better care."

The results were published in Psychological Medicine, published by Cambridge University Press.

Binge-eating disorder, which is estimated to impact somewhere between 1% and 3% of US adults, is characterized by episodes during which people feel a loss of control over their 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 seven to 16 years on average, prospective studies tracking individuals with the disorder over time have suggested that many individuals with the disorder enter remission within a much smaller timeframe—from one to two years.

However, the researchers note that most previous prospective studies had limitations, including a small sample size (<50 participants), and they weren’t representative because they focused only on adolescent or young-adult females, most of whom had BMIs less than 30, whereas around two-thirds of individuals with binge-eating disorder have BMIs of 30 or more.

To better understand the timeframe of binge-eating disorder, the researchers followed 137 adult community members with the disorder for five years. Participants, who ranged in age from 19 to 74 and had an average BMI of 36, were assessed for binge-eating disorder at the beginning of the study and reexamined 2.5 and five years later.

After five years, most of the study participants still experienced binge-eating episodes, though many showed improvements. After 2.5 years, 61% of participants still met the full criteria for binge-eating disorder at the time the study was conducted, and a further 23% experienced clinically significant symptoms, although they were below the threshold for binge-eating disorder.

After five years, 46% of participants met the full criteria, and a further 33% experienced clinically significant but subthreshold symptoms. Notably, 35% of the individuals who were in remission at the 2.5-year follow-up had relapsed to either full- or subthreshold binge-eating disorder at the five-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 larger percentage of the study's participants would have been diagnosed with the disorder at the 2.5 and five-year follow-ups.

Javaras adds that because participants in the study were community members who may or may not have been receiving treatment, rather than patients enrolled in a treatment program, the study's results are more representative of binge-eating disorder's natural time course. When comparing this community sample with those in treatment studies, treatment appeared to lead to faster remission, suggesting that people with binge-eating disorders will benefit from intervention. There are major inequities in who receives treatment for eating disorders, according to Javaras.

Though there was variation amongst participants in the likelihood of remission and how long 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 get better than anyone else," Javaras explains.

Since the study ended, the researchers have been investigating and developing treatment options for binge-eating disorder and examining screening methods to better identify individuals who would benefit from treatment.

"We’re studying binge-eating disorder with neuroimaging to get a better understanding of the neurobiology involved, which could help enhance or develop new treatments," Javaras says. "We’re also examining ways to catch people earlier because many don't even realize they have binge-eating disorder, and there’s a major need for increased awareness and screening so that intervention can begin earlier."

— Source: McLean Hospital

 

Asking Adults With Obesity if Their Weight During Childhood Could Help Determine Their Mortality Risk

Being asked whether you consider yourself to have been a normal weight, plumper, or thinner as a child when attending a doctor’s appointment as an adult might appear like a very strange question to ask, but new research presented at this year’s European Congress on Obesity in Venice, Italy, suggests that such questions can help identify increased mortality risk in adults living with obesity. The study is by William Johnson, PhD, an epidemiology expert based at Loughborough University in the United Kingdom, and colleagues.

Obesity in adulthood and childhood is a major public health concern. Risk stratification for related diseases might be possible by asking adults simple questions but evidence is lacking to support such a clinical recommendation because most studies don’t explicitly test for effect modification of the association of adulthood obesity with outcomes by child weight status. The aim of this study was to evaluate whether the associations of adulthood overweight and obesity with mortality and incident disease differ according to self-reported child body weight.

The sample comprised 191,181 men and 242,806 women aged 40 to 69 years at baseline in the UK Biobank prospective cohort study between 2006 to 2010. The outcomes were all-cause mortality and incident CVD, obesity-related cancer, and breast cancer. The authors measured BMI at baseline (categorized as normal weight, overweight, or living with obesity) and self-reported perceived body weight at age 10 years (about average, thinner, or plumper).

Computer models were developed, with adjustment for age, ethnicity, relative age voice break (males) or age at beginning periods (females), and comparative height at age 10 years.

The actual question asked to adults living with obesity was: “When you were 10 years old, compared to average, would you describe yourself as: thinner, about average, or plumper?” They were asked this as part of their recruitment into the UK Biobank project between 2006 to 2010. Around one-half (51%) reported being normal weight, while one-third (33%) reported being thinner, and one in six (16%) reported being plumper. 

Participants were followed up until an event or December 19, 2022, for all-cause mortality; September 1, 2023, for incident CVD; and March 15, 2022, for incident obesity-related cancer and breast cancer. Across the recruited cohort during follow-up, 8% died, 35% developed CVD, and 2% of the whole cohort (men and women) developed obesity-related cancer—including cancers of the colon, uterus, esophagus, gallbladder, stomach, kidney, pancreas, rectum, thyroid, brain lining (meningioma), and also multiple myeloma. And 5% of women developed breast cancer.

In both sexes, living obesity in adulthood (vs normal weight) was associated with a 15% increased risk of all-cause mortality (death from any cause), whereas living with overweight (vs normal weight) showed no statistically significant relationship.

For adult men who reported having a normal weight at 10 years old, living with obesity was associated with a 28% (1.28 times) increased risk of all-cause mortality compared with adult men with normal weight. For men reporting being thinner at age 10, living with obesity as an adult was associated with a 63% (1.63 times) increased risk of all-cause mortality compared with men with normal weight. And for men reporting being “plumper” at age 10, there was a 45% (1.45 times) increased risk of all-cause mortality for those living with obesity as adults compared with those living with normal weight.

Thus, comparing risk between groups, for adult men living with obesity, compared with those reporting normal weight as children, reporting being plumper at age 10 years was associated with a 13% increased risk of all-cause mortality (1.45 compared with 1.28) (borderline statistical significance), and reporting being thinner as a child was associated with a 28% increased risk of all-cause mortality. (1.63 compared with 1.28) (statistically significant).

For adult women who reported having a normal weight at 10 years old, living with obesity was associated with a 38% (1.38 times) increased risk of all-cause mortality compared with adult women living with normal weight. For women reporting being thinner at age 10, living with obesity was associated with a 60% (1.6 times) increased risk of all-cause mortality compared with women of normal weight. For women reporting being plumper at age 10, there was a 32% (1.32 times) increased risk of all-cause mortality for those living with obesity as adults compared with those living with normal weight.

And comparing risk between groups for adult women living with obesity, compared with those reporting normal weight as children, reporting being plumper at age 10 years was not associated with an increased risk of all-cause mortality (1.38 similar to 1.32), whereas reporting being thinner as a child was associated with a 16% increased risk of all-cause mortality (1.60 vs 1.38), which is statistically significant.

For CVD, increased risks were seen for adult men and women living with obesity compared with those living with normal weight, whatever they reported as 10-year-old children, but differences between them were smaller or not statistically significant. For obesity-related cancers, associations were much weaker and mostly not statistically significant.

The authors conclude: “Adulthood overweight and obesity may confer greater risks for all-cause mortality and incident CVD among individuals who perceive themselves to have been a thinner or plumper than average child. Asking adult patients whether they were about average, thinner, or plumper as a child may help with risk stratification for some, but not all, diseases.”

“Of course, regardless of your perceived weight status as a child, it’s no surprise that our data show living with obesity as an adult is associated with an increased risk of death and various diseases.”

— Source: European Association for the Study of Obesity