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Binge-Eating Disorder

How is it similar to Bulimia Nervosa?

How is it different?

  • 3-5% of the population
  • Similar features to BN
    • Recurrent episodes of binge eating
    • Marked distress regarding binge eating
    • Occurs 1X/wk for 3 mo
    • Same severity scale as bulimia nervosa
  • Distinguishing features
    • Not associated w/ recurrent use of inappropriate compensatory disorder
    • Not exclusively during BN or AN 


Avoidant/Restrictive Food Intake Disorder 

How is it similar to Anorexia Nervosa?

How is it different? 


  • Similar features to AN
    • Persistant failure to meet appropriate nutritional/energy needs
    • Not better explained by lack of food or cultural practice
    • Not attributable to a concurrent medical condition or other mental disorder, or beyond what one would expect for another condition/disorder
  • Distinguishing features
    • Not associated w/ a disturbance in the way one’s body weight/shape is experienced
    • Not part of AN or BN 


Other Specified Eating Disorders 

  • Atypical anorexia nervosa (i.e. normal weight)
  • Bulimia nervosa of low frequency or limited duration
  • Binge-eating disorder of low frequency or limited duration
  • Purging disorder
  • Night eating syndrome 


Unspecified Eating Disorders

Other feeding & eating symptoms that cause clinically significant distress or impairment in social, occupational or other important areas of functioning, or having insufficient information to make a more specific diagnosis 


Fill in the blanks


Definition of Obesity (IBW & BMI)

  • Weighting >20% IBW or BMI 30+
  • Overweight (BMI) = 25-29.9
  • Not an eating disorder 


Epidemiology of Obesity 



  • US Adults
    • Upwards of 2/3 of US adults are considered overweight/obese
    • >1/3 of US adults are obese
  • Children
    • Rates in children who are overweight/obese were increasing for many years, but are leveling off
    • Decreasing for very young children (<5)
    • 25% preschool & 35% school-aged children are overweight/obese 


Etiology of Obesity

  • Environmental
  • Genetic
  • Biological
  • Psychological/Social

Balance energy IN > energy OUT

  • Environmental
    • Increased availability of high calorie foods
    • Decreased requirement for physical activity
    • 78% of Americans don’t meet activity level requirements
    • 25% completely sedentary
  • Genetic – identical twins have the greatest risk
  • Biological – set point/satiety, development, medical issues, medications
  • Psychological/Social – culture, family habits, psychiatric comorbidity (binge-eating disorder), low SES


Obesity Risks

  • Cardiovascular
  • Psych
  • Repro
  • Lungs
  • Memory
  • Musculoskeletal 
  • Other

  • Cardiovascular: Type II DM, HTN, CAD, stroke, CV death
  • Cancer
  • Depression, quality of life
  • Reproduction & sexual function
  • Lung function: respiratory disease, asthma, obstructive sleep apnea
  • Memory/Cognitive function: Alzheimer’s disease
  • Musculoskeletal: osteoarthritis, hip replacement, chronic back/limb pain
  • Other: gallstones, gout, kidney, fatty liver, mortality 


How is obesity treated?

  • Commercial dieting & weight loss programs: regain weight in 5 yrs
  • Bariatric surgery
    • Including banding, gastrectomy, gastric bypass
    • BMI >40 or >35 w/ life-threatening condition
    • Initially effective, but questionable regarding long-term weight loss
  • Pharmacologic agents: variable efficacy & safety
  • Sensible diet & exercise 


What type of pharmacotherapy is used to treat obesity?

  • Prescribed pharmacological agents
  • Other: antidepressants, anti-seizure, metformin (not FDA approved)
  • OTC: ephedra, chromium, diuretics, herbal laxatives, hoodia (not considered safe or effective) 


What are the 4 prescribed drugs used to treat obesity?

  • Orlistat (Xenical & Alli)
    • Pancreatic lipase inhibitor limits breakdown of dietary fats
    • 5-10 lb weight loss in first 6 mo, maintained at 24 mo
  • Phentermine (Ionamin)
    • Sympathomimetic amine that decreases appetite
  • Sibutramine hydrochloride (Meridia)
    • Blocks monoamine reuptake that decreases appetite
    • Off the market: heart attack & stroke risk
  • Lorcaserin hydrochloride (Belviq) & Qsymia
    • BMI >30 or >27 w/ weight-related condition 


What is the gold standard for weight loss in obesity?

  • Sensible diet & exercise
  • Calorie intake < calories burned = most effective way to maintain long-term weight loss 


What are some reasonable methods of weight loss in adults & children?

  • Adults
    • 5-10% loss of initial body weight over 6 mo or 1-2 lb weight loss per week
    • Cutting back calorie intake by 500-1000 calories/day
    • Women: 1000-1200 calories/day
    • Men or women who exercise routine: 1200-1600
    • After 10% body weight lost & kept off for 6 mo, consider future weight loss if still overweight
  • Children & Teens
    • Initial goal: maintain weight or slow weight gain by healthy eating & physical activity
    • Obesity: maintenance for 3 mo, then slow weight loss
      • Slower weight loss than w/ adults: from 1 lb/mo
      • ½ weight loss from diet, ½ from exercise 


What are some reasonable dietary changes?

  • Diet
    • Limit portion size, cut out second helpings
    • Limit high calorie foods, high sugar, sugar additives, fast food, high fat
  • Behavioral modification (MOST SUCCESSFUL): recognize external cues, keep food diary, develop new eating patterns (eat slowly, chew food well, stay seated, etc.), use rewards/reinforcements
  • Group therapy 


What is some reasonable physical activity when trying to lose weight?

  • Needs/options vary
  • Example: 150 min of moderate-intensity aerobic activity weekly & muscle-strengthening activities 2+ days/wk; or shorter duration, w/ more vigorous activity 
  • If w/ heart problem, chronic disease or having chest pain or dizziness, seek medical advice