Treating Metabolic Disorders in Women with BED and BN

A Norwegian study compared CBT with a physical and nutritional approach

Binge-eating, with or without purging, may have impact on metabolic health, according to a report from a Norwegian team led by Dr. Therese Fostervold Mathisen, from Ostfold University College, Fredrikstad, Norway (Eat Weight Disord. 2023. 28:41). This recent study documents such effects, and examines whether treatment can help.

The study: two randomized groups

Dr. Fostervold Mathisen and her team designed a randomized controlled study that evaluated the effects of two 16-week treatment interventions for BN and BED. This program included two approaches: (1) physical exercise and diet therapy (PED-t), or (2) cognitive behavioral therapy (CBT). Fasting blood samples were collected at the beginning of the study, at 6 months, and at 12 months.

The final study group included 151 women diagnosed with BN or BED; the participants were 18 to 40 years of age, and had body mass indexes, or BMIs, of 17.5 to 35 kg/mg2. Mean BMIs differed between the two groups. The women were randomly assigned to outpatient treatment with either group sessions of CBT or PED-t. Those in the PED-t group met weekly, with supervised, progressive resistance exercise, directly followed by dietary therapy and homework for two additional exercise sessions (one of resistance exercise and one featuring an interval running session). Those in the CBT group used Fairburn’s individual CBT therapy, adapted for groups, and met weekly for 20 weeks.

How the type of treatment affected metabolic changes

In the current study, 32.5% and 39.1% of the participants had high levels of triglycerides and LDL-c, respectively. Low HDL-c levels were more common among women with BED (21.2%) compared to those with BN (5.1%). There was a favorable change overall in lipid profiles for both groups when pretreatment levels were compared with post-treatment levels. Changes in lipid and hormone markers, depending on pretreatment diagnoses, were significantly less favorable among women with pretreatment diagnoses of BED than among women with pretreatment diagnoses of BN. The changes did not persist at follow-up.

More women with BED compared with those with BN had low HDL-c readings, which may be detrimental by increasing the risk of cardiovascular disease. The researchers had hypothesized that the PED-t treatment would have a greater effect on lipid levels, but this was not supported by the results. There were also only minor benefits to metabolic profiles from remission after treatment.

When viewed as a group, women with BN or BED had initial measurements that seemed to indicate healthy blood lipids, blood glucose, and thyroid hormone levels, but a significant number of participants had metabolic risk factors for cardiovascular disease.

These results make the case for efforts to understand the importance of lipid and glucose changes in those with BED and BN, and to develop appropriate ways to monitor and manage these effects.

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