BY: Hunna Watson, PhD
DATE: September 26, 2016
Recent research to come out of UNCs Center of Excellence for Eating Disorders (CEED) in partnership with the Center for Eating Disorders Innovation (CEDI) at Karolinska Institutet demonstrates that adults with binge-eating disorder (BED) are at risk for a broad range of medical problems—not always attributable to obesity. A key take-home message from this research is that mental health clinicians who assess and treat patients with BED are encouraged more than ever to screen patients for BED and refer them for thorough medical evaluation and regular physical monitoring.
A study by our teams, written by Thornton and colleagues, presently in press in the International Journal of Eating Disorders, compared adults with BED to a matched sample of similar individuals without BED, using data obtained from nationwide Swedish health registries. Compared to adults without a diagnosis of BED, those with BED were much more likely to have had contact with the health system for a wide range of medical problems: neurological, immune, respiratory, gastrointestinal, dermatological, musculoskeletal, genitourinary, circulatory and endocrine system diseases. The presence of obesity increased the risk for respiratory and gastrointestinal diseases but not for other classes of illness, suggesting that even in the absence of obesity, BED is associated with increased medical risk. The study builds on prior existing research but also establishes novel associations.
Similarly, this same collaborative team reported on the association between BED and much higher utilization of prescription medication across a broad range of medication categories, in a study published in July in The Primary Care Companion for Central Nervous System Disorders (here). We compared medication use among adults with and without BED across categories of the Anatomical Therapeutics Classification System, which classifies drugs broadly according to the anatomical and chemical systems they impact. Compared with those of the same age with no history of BED, individuals diagnosed with BED in the previous 12 months were: 17 times more likely to be prescribed antidiabetic medication, 15 times more likely to be prescribed tumor/immune disorder medication, twice as likely to be prescribed respiratory system medication, 1.8 times as likely to be prescribed infectious disorders medication, and 1.8 times as likely to be prescribed dermatological medication. These odds ratios were all significant, indicating that use of these medications by people with BED occurred at much higher levels than by chance. Several of these associations stayed significant after adjusting for lifetime psychiatric comorbidity and obesity.
Professional guidelines recommend that mental health clinicians carefully assess patients before commencing a course of treatment (American Psychiatric Association Practice Guideline, 2009). Components of psychological evaluation typically include: the patient’s account of the presenting problem, family and social history, information necessary to establish diagnosis, past and comorbid psychiatric history, medical information, and assessment of height/weight. In inpatient settings for eating disorders, physical examination and laboratory tests are also routinely conducted. However, most people with BED access mental health care on an outpatient, not inpatient, basis. Mental health clinicians routinely consider comorbid psychological issues, such as anxiety, depression, deliberate self-harm, and suicidality, but might not reflect as much on the physical comorbidity that can accompany BED. By being mindful that physical comorbidity is highly relevant for this population, mental health clinicians are ideally placed to encourage and support patients to seek primary care attention for physical issues.
A second key take-home message from these studies is that the primary care practitioner is in an excellent position to screen for BED in at-risk patients. In our studies, individuals with BED had significantly greater medical risk even before the eating disorder was detected by a health care provider, suggesting high need for and use of health care services. There is a typical delay of many years between the the onset of the eating disorder to the time it is diagnosed, and this window needs to be reduced. Help-seeking in primary care for co-occurring issues besides the eating disorder, such as anxiety, depression, and weight management, is far more common (Mond et al., 2007: PMID 17497708). Shame and stigma, or a lack of self-recognition of an eating problem, likely contribute to this delay. Several short, validated screening instruments, such as the 7-question Binge-Eating Disorder Screener (Herman et al., 2016: full-text link) and the 5-question SCOFF (Morgan et al., 1999: PMID 10582927) can help physicians to identify BED and eating problems.
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