Last week, April 19th and 20th, I had the honor (along with my UNC colleagues Dr. Cynthia Bulik and Dr. Christine Peat) of attending the NIMH-funded workshop focusing on “Binge Eating Disorder: The Next Generation of Research.” The impetus for the workshop was the pending inclusion of binge eating disorder (BED) as an official diagnosis in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The workshop was hosted by the Uniformed Services University of the Health Sciences in Bethesda, MD, and attracted research and clinical leaders in the field, NIH representatives, and laypersons working with advocacy groups in the fields of eating disorders, obesity, and addictions. The goal of the workshop was to envision the next generation of BED research by capitalizing on the collective wisdom of members of this diverse group, who currently work largely independently.
Attendees were treated to a full day of presentations and discussion on key topics including BED risk factors across the lifespan (Drs. Bulik and Tanofsky-Kraff), assessment of BED and BED comorbidities and consequences (Drs. Tim Walsh and Stephen Wonderlich), the contribution of addictive processes to the development and maintenance of BED (Drs. Nora Volkow and Warren Bickel), obesity and other medical consequences of binge eating in adults and children (Drs. David Ludwig and Alison Field) and in animal models (Dr. Mary Boggiano), and interventions for persons with BED (Drs. Denise Wilfley, James Hudson, and James Mitchell). Special guest speakers from the Department of Defense (Dr. Anne Dobmeyer) and the Binge Eating Disorder Association (Chevese Turner) brought the day to a close by presenting information on the relevance of BED to the health and readiness of military personnel and on the personal and societal costs of BED. Following each presentation, audience members joined in discussions that were facilitated by representatives from the National Institute on Drug Abuse, the National Institute of Mental Health, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Several key take-home messages emerged from the workshop.
1) There is a clear need for improved assessment methods that are brief and therefore can be readily used in primary care settings and easily incorporated into on-going epidemiologic studies.
2) Assessment methods and research models need to incorporate a lifespan perspective to improve understanding of the developmental factors that influence the trajectory of BED and its medical and psychological consequences.
3) Some but not all of the biological disturbances observed in substance use disorders can be observed in BED, and much more research is needed to map out common and unique pathways that may then be examined as targets for treatment in BED.
4) Future BED research will be well-served by adopting the Research Domain Criteria (RDoC) matrix, which defines basic dimensions of functioning (such as ‘attention’ or ‘impulsivity’) across multiple units of analysis, from genes to brain circuits to behaviors, cutting across disorders as traditionally defined. For example, improved understanding of the role of “loss of control” in BED may be achieved more efficiently by studying different patient groups who exhibit a spectrum of impulse control problems (i.e., BED, attention deficit disorder, substance abuse, obsessive compulsive disorder) rather than focusing solely on persons with BED as defined in the DSM.
5) Surgical interventions for obesity, some of which result in the removal or disengaging of key functional sections of the gastrointestinal tract, provide a unique opportunity to understand the role of nutrient sensing and gut-derived peptides in the development and maintenance of BED.
6) Military personnel may be at greater risk for developing BED due to job-related weight and fitness requirements, deployment and relocation stress, and combat-related PTSD and brain injuries that impact impulse control. Basic research is needed to document the prevalence of BED, factors associated with new incident cases, and barriers to treatment seeking in military personnel. Obtaining funding for these research projects is challenging but feasible for non-military investigators.
7) Expanding our toolbox of evidence-based treatments, improving access to such treatments, and confronting obesity-related stigma and other barriers to clinical care are essential to reducing BED and its consequences in our society.
We can all look forward to a summary publication based on the workshop proceedings. For spearheading this effort, all of us who are invested in research, treatment, and advocacy for BED tip our hats to Drs. Marian Tanofsky-Kraff and James Hudson, who did the lion’s share of organizing this groundbreaking workshop.
By: Dr. Kim Brownley