Binge Eating Disorder and Metabolic Syndrome

Obese patients with BED
may be at increased risk.

Reprinted from Eating Disorders Review
May/June 2012 Volume 23, Number 3
©2012 Gürze Books

Metabolic syndrome is a cluster of conditions — increased blood pressure, elevated blood glucose levels, increased insulin resistance, excess body fat around the waist, or abnormal cholesterol levels — all of which increase the risk of heart disease, stroke, and diabetes mellitus. Metabolic syndrome is common in obese patients with binge eating disorder (BED) seen in primary care settings.

According to clinicians at Yale University School of Medicine, New Haven, CT, little is known about the relationship of specific eating behaviors or patterns characteristic of BED to metabolic syndrome. Improving the understanding of the frequency and correlates of metabolic syndrome in obese patients with BED is important because this subgroup may be at increased risk for developing the syndrome. And, certain eating behaviors associated with metabolic abnormalities are similar to some of the characteristics of BED. For example, eating large amounts of food in a defined period of time is associated with increased fasting serum glucose levels, exaggerated insulin secretion, elevated lipid levels, and lowered glucose tolerance. Eating rapidly is associated with higher waist-hip circumference ratio, elevated serum lipid levels, and fatty liver in obese persons. As the authors, Dr. Rachel D. Barnes and her colleagues, note, irregular meal patterns are also associated with metabolic syndrome in the general population (Prim Care Companion CNS Disord 2011; 13: PCC, 10m01050).

The authors conducted a study of a consecutive series of 81 obese patients (21 men and 60 women with body mass indexes, or BMIs, of at least 30 kg/m2) who also met DSM-IV-TR research criteria for BED. Nineteen met the criteria for subthreshold BED (at least 1 binge episode weekly) and 62 met the full criteria. All 81 were included in this study to be consistent with the anticipated DSM-5 BED criteria since considerable research has shown that subthreshold BED individuals generally do not differ significantly from those with full BED. Mean BMI was 88.3 kg/m2, and the mean age was 43.2 years.

The patients underwent tests for physical and metabolic functioning; a weight and eating history was obtained, and a structured clinical interview was done to determine current and historical obesity variables. The participants answered such questions as, “At what age to you remember first going on a diet?” Patients were asked about frequency of dieting, and binge eating episodes. They also completed the Questionnaire for Eating and Weight Patterns-Revised, a self-report measure used to assess age at onset of overweight, weight cycling (the number of times the participant had gained and lost 20 lb), and frequency of dieting after the age of 18.The participants also completed the Beck Depression Inventory, and the Three-Factor Eating Questionnaire-Restraint subscale.

Men met the criteria more often

Thirty-five (43%) of the 81 patients met Adult Treatment Panel III criteria for metabolic syndrome. These criteria, which are 6 components of the metabolic sydrome that related to cardiovascular disease are: abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, insulin resistance glucose intolerance, proinflammatory state, and prothrombotic state.

 Men had significantly higher rates of metabolic syndrome than did women (66% vs. 35%, respectively). After controlling for gender, it was reported that patients with metabolic syndrome started dieting at a significantly older age and spent less of their adult lives dieting than did those without metabolic syndrome. The groups did not differ significantly on age at onset of obesity of binge eating, weight cycling, or highest or lowest adult BMIs.

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