5/13/13

1

Binge Eating Disorder: Current Research & Evidence Based

Best Practices

Chevese Turner CEO & Founder

Binge Eating Disorder Association (BEDA)

My BED Journey

•  Family history of eating disorders/substance abuse/trauma/mood disorders

•  Experienced size bias, body-hatred, teasing around height and weight at early age

•  Early anxiety & depression •  Feelings of being outsider…retreated to food as comfort. •  Restriction and “managed dieting” encouraged early •  Eating disorder took center stage and contributed to delay in

adult development

5/13/13

2

My BED Journey

•  Preoccupation around weight loss further stunted development (life begins “x” pounds from now)

•  With each binge or diet, sense of failure increased and willingness to engage in life decreased

•  Learned that acceptance is first step to wellness and recovery •  Addressing psychological issues, including internalized weight

stigma and trauma absolutely necessary

Complexities of BED

•  BED is NEVER about willpower! •  BED ALWAYS makes sense: What is the function or purpose of

the disorder? •  Causes are complex and unique to each person

5/13/13

3

What is Known •  BED affects approximately 15

million people -- 3.5% of women and 2% of men (Hudson, et al 2007)

•  Affects 15% to 50% of samples drawn from weight-control programs (Hudson et al, 2007)

•  Affects approx 2-4% of general population and 8% of obese population (DeAngelis, 2002)

•  49% of those seeking bariatric surgery (Hudson et al, 2007)

What is Known •  Most common eating

disorder (Hudson, 2007) •  Men almost equally affected •  Most misdiagnosed ED

(“obesity” as focus) •  Preoccupation with body

weight and shape •  Addition to the DSM-5 in

means more people seeking tx, increase in research

5/13/13

4

Clinical Definition of BED DSM V Criteria

Recurrent episodes of “binge eating”: Eating in a discrete period of time (e.g. 2 hours) an amount of food larger than most people would eat in a similar period under similar circumstances – A sense of a lack of control over the eating during the episode – Binge eating episodes associated with at least 3 of the following: – Eating more rapidly than normal – Eating until feeling uncomfortably full – Eating large amounts of food when not hungry – Secretive eating – Feeling disgusted, depressed or guilty after binge

Clinical Definition of BED DSM V Criteria (cont)

–  Binge eating occurs, on average, 1 day per week for at least 3 months (proposed DSM V)

–  Disturbance does not occur exclusively during the course of anorexia or bulimia

–  Compulsive Eating (grazing) vs. Emotional Eating (normal) vs. Binge Eating Disorder

5/13/13

5

DSM-5 Inclusion: How Did It Happen? •  Excessive concern for weight and body shape Wilfley,

Wilson, and Agras (2003) and Streigel-Moore, Cachelin, Dohm, Pike, Wilfley, and Fairburn (2001)

•  Body image disturbances are more pronounced in obese binge eaters than in obese non-binge eaters Tuchen-Caffier & Schlüssel, 2005, pp. 142-143

•  Co-morbid mood disturbances common Wilfley, et al (2003)

DSM-5 Inclusion: How Did It Happen? •  Non-BED obesity and BED are different: several studies

concluded that psychopathology is significantly more prominent in individuals with BED when compared with obese non-BED subjects. Impairment and distress experienced by those who meet criteria for BED is clinically different from individuals who just present obesity or overweight (Brownley, et al, 2007)

•  Clinical Utility: BED can be differentiated from AN/BN through recovery rates, diagnostic stability, age of onset, gender distribution, Body Mass Index (BMI), dietary restraint, relative age of onset of dieting and binge eating, psychiatric comorbidity, and binge characteristics (Wonderlich et al., 2009, p. 699)

5/13/13

6

DSM-6? Restriction is an important part of understanding binge eating disorder

6%

45%

24%

12%13%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Never Almost never Sometimes Fairly often Very often

Prevelence of Overweight/Obesity in those with BED

5/13/13

7

Risk Factors •  Genetic

–  Heritability 50-60% –  Strong impulse to soothe

•  Learned behavior –  food is early, available soothing mechanism; restrictive behavior (binge/

restrict patterns aka yo-yo dieting) •  Biological

–  restriction, diet rules, body equates weight loss with danger and triggers cravings and food obsession, hx of parent or self with depression, ineffective emotional regulation

•  Family of Origin Issues –  “10 going on 40”; caretaker role, often oldest child or the “responsible” one;

difficulties separating from family (guilt for autonomy is common)

Risk Factors •  Personality

–  socially anxious, emotionally “sensitive”, pervasive and powerful inner critic, often “people pleasers”; may be covertly rebellious/angry

•  Trauma –  sexual, physical, emotional, significant loss at early age; exposure to

negative comments about weight, shape/size, and eating (weight stigma/discrimination)

5/13/13

8

Those with BED are NOT getting help

87% are not receiving any sort of treatment for BY FAR the most

common eating disorder Receiving help from

 Primary Care Physician 10%  Psychiatrist 1%  Psychologist, other therapist 2%  Other health care professional 3%  Taking medication 2%  No current help, but has received help in past 9%  Has never received help for binge eating 78%

Treatment

•  Evaluation for eating disorder and trauma •  Psychological intervention

–  Behavioral weight loss ineffective over long term (91% regain within 5 years)

–  EVERY client with BED in a larger body will come to you and request help to lose weight – pursuit of this will entrench eating disorder pathology and set up restrict/binge and lose/gain cycles

•  Internalized weight stigma work –  Acceptance, mindfullness techniques

5/13/13

9

Treatment

•  Psychotherapy w/ED-trained therapist •  Education about Weight Stigma •  Family Therapy •  Nutrition Counseling •  Groups •  Pharmacological Treatment •  Somatic therapies (trauma) •  Movement •  Art and Expressive Therapies

Weight Stigma Experiencing weight stigma predicts behaviors related to unhealthy restraint and binge eating:

–  Dieting behaviors –  Dietary restraint –  Bulimic behaviors –  Binge-eating –  Unhealthy/extreme weight control behaviors

–  Fasting –  Using diet pills, laxatives and/or diuretics –  Vomiting/purging –  Using a food substitute (e.g. powder) –  Skipping meals

–  Puhl,etal2007

5/13/13

10

Public perceptions of BED reinforce stigma -  Often viewed as problem of willpower, low-self-esteem, depression -

not as a legitimate eating disorder

-  Perception of binge eating increases stigma of obesity

-  Eating disorders often trivialized - subset of public believes “might not be too bad”

-  Target of more blame than other psychological disorders

LaPorte,1997;Mond&Hay,2008;Wilsonetal.,2009;Beckeretal.,2010;Crisp,2005;Mondetal.,2006;2007;Roehrig&McLean,2009;Stewartetal.,2006;Wingfieldetal.,2011;Wilsonetal.,2009

Health Consequences

Haines, et al., 2006; Neumark-Sztainer et al., 2002; Puhl & Brownell, 2006, Puhl et al., 2007; Puhl & Luedicke, 2011

Weight Stigma results in maladaptive eating behaviors:

- Binge eating

- Unhealthy weight control practices

- Coping with stigma by eating more food

5/13/13

11

Health Consequences

Contributes to Higher Weights:

Schvey, Puhl, & Brownell, 2011; Carels et al, 2009; Wott & Carels, 2010

- Higher calorie intake

-  More weight gain

-  Avoidance of movement

-  Increase in cardiovascular problems

-  Poor quality of life

Coping with weight stigma… Study: asked 2449 women

How do they cope with stigma experiences?

79% reported eating; turning to food as coping mechanism

* Stigma is a stressor *acute and chronic form of stress

-  Eating is common coping strategy in response to stress

Puhl & Brownell, 2006

5/13/13

12

Internalizing weight stigma… Study: 1013 women who belonged to a national non-profit weight loss support organization: • Women who internalized experiences of weight stigma and blamed themselves for stigma – engaged in more frequent binge eating.

• This was true even after accounting for self-esteem, depression, and amount of stigma experienced

Puhl et al., 2007

Recovery Recovery is about hearing the inner world with curious, compassionate ears; about speaking the truth of the body, the heart and the mind. It is about honoring somatic cues most of the time, slowly taking judgment and obsession out of eating and movement. Recovery is learning to challenge cultural ideals of beauty, recognize the damage of weight stigma and bias on one’s body image, and heal from the possible traumas of living in a bigger body in this culture. Recovery from BED requires advocacy, both internal and external. Recovery is not about never overeating again, nor is it’s purpose weight loss (although it may occur). The work is to recognize when the eating disorder presents itself, why it does so, and have the resources available to address, and when possible over time, heal, the trigger. And it is about valuing the whole Self, including the ED, as is.”

5/13/13

13

QUESTIONS?

THANK YOU

Chevese Turner CEO & Founder BEDA chevese.turner@bedaonline.com www.bedaonline.com Direct line: 410.570.9577