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Binge Eating Disorder (BED). Allison Boese. Objectives. Be able to describe the etiology of binge eating disorder Be able to describe the ADA recommendations for treatment Be able to describe the desired outcomes of Medical Nutrition Therapy

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Binge eating disorder bed l.jpg

Binge Eating Disorder(BED)

Allison Boese


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Objectives

  • Be able to describe the etiology of binge eating disorder

  • Be able to describe the ADA recommendations for treatment

  • Be able to describe the desired outcomes of Medical Nutrition Therapy

  • Be able to explain ethical and clinical challenges involved in treatment


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What is binge eating disorder?

  • Large quantities of food in a short period of time, two or more times per week.

  • Eat until uncomfortably full

  • Eating large amounts when not hungry

  • Eating alone

  • Feeling disgusted with one’s self

  • Similar to bulimia nervosa

    Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073-2080.


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Health Risks

  • Psychiatric disorders

  • Obesity

    • Arteriosclerosis

    • Type 2 Diabetes

    • Hypertension

    • Hyperlipidemia

      A E Dingemans, M J Bruna and E F van Furth. International Journal of Obesity. March 2002, Volume 26, Number 3, Pages 299-307


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Typical Candidates for Binge Eating Disorder

  • 3% of the general population

  • 30% of obese persons

  • Almost equal amongst the sexes

  • Occurs across ethnically diverse populations

  • Adulthood

    Grilo, Carlos M. Encyclopedia Article. The McGraw-Hill Companies (2007)


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Binge Eating Disorder & Type II Diabetes

  • Herpertz & colleagues reported that in 322 patients with type II diabetes, the incidence of eating disorders was 6.5-9%

  • The most common was binge eating disorder

    Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073-2080.


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Gastric Bypass Patients

  • In the same study done by Herpertz & colleagues, they found that a large amount of individuals seeking gastric bypass surgery met the criteria for having binge eating disorder

    Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073-2080.


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Contributing Factors to Binge Eating Disorder

  • Repeated experiences with negative comments about shape, weight and eating

  • Negative self evaluation

  • Perfectionism

  • Childhood Obesity

  • Low self-esteem

    Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073-2080.


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Contributing Factors Continued…

  • High levels of body consciousness

  • Low perceived levels of social support

  • High use of “escape avoidance coping”

    • Hiding from emotions

    • Filling a void

    • Subconsciously maintaining an overweight appearance

    • Self punishment2

      1 Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073-2080.

      2 The Something Fishy Website on Eating Disorders (1998-2007)


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BED Patients and Family Support

  • Hodges EL, Cochrane CE, Brewerton TD (1998) “found that BED subjects rated their family environment as less supportive and cohesive, and less engendering of direct and open expression of feelings than healthy controls.”

  • The BED group scored lower than other eating disorder groups on family support.

    A E Dingemans, M J Bruna and E F van Furth. International Journal of Obesity. March 2002, Volume 26, Number 3, Pages 299-307


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Mental Disorders Associated with Binge Eating Disorder

  • Depression

  • Anxiety disorder

  • Substance abuse


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Treatment Options for Binge Eating Disorder

  • Psychotherapy

    • Cognitive behavioral therapy

  • Behavioral weight loss treatment

  • Psychopharmacology

    Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders. (2006) Journal of the American Dietetics Association, 106, 2073-2080.


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Cognitive Behavioral Therapy (CBT)

  • CBT is the most widely investigated treatment for both BN and BED

  • Treatment of choice for both disorders

  • Gold standard to which other treatments are compared.

    A E Dingemans, M J Bruna and E F van Furth. International Journal of Obesity. March 2002, Volume 26, Number 3, Pages 299-307


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Cognitive Behavioral Therapy

  • Primary focus on reducing binge eating

  • Secondary focus on weight loss

  • Concerned mainly with the patients' present and future rather than with past.


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Three Stages of CBT

  • 1) Identify the rational underlying the CBT approach

  • 2) Replace binge eating habits with healthy pattern of eating

  • 3)Ensure that progress is maintained in the future

    A E Dingemans, M J Bruna and E F van Furth. International Journal of Obesity. March 2002, Volume 26, Number 3, Pages 299-307


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Behavioral Weight Loss Treatment

- Primary focus on weight loss

-Promotes weight loss through increased exercise, improved nutrition & decreased calorie intake

- Short term but not long


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Psychopharmacology

  • Antidepressants

  • Centrally acting appetite suppressants

  • Anticonvulsants

  • Serotonin reuptake inhibitors

  • Short term effect, do not seem to sustain past taking medication


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Nutrition Care Process

  • Nutrition Assessment

  • Nutrition Diagnosis

  • Nutrition Intervention

  • Nutrition Monitoring & Evaluation

    M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole(2007)


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Nutrition Assessment

  • Observe for nonverbal/verbal cues

  • Assess the patient’s nutritional status

  • Collect data related to eating habits that may contribute to binge eating disorder

  • Determine whether or not the patient is in need of nutritional care

    M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole(2007)


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Nutrition Diagnosis

  • Determine possible underlying causes

  • Predict

  • State the problem

  • Suspend judgment

  • Prioritize the importance of different problems

    M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole(2007)


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Nutrition Intervention

  • Set & prioritize reasonable goals

  • Define nutrition prescription

  • Initiate behavioral interventions

  • Match intervention strategies with client needs, diagnoses & values

  • Specify the time & frequency of care

  • Periodically monitor the family’s response to treatment

    M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole(2007)


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Nutrition Monitoring & Evaluation

  • Select appropriate ways to gauge results

  • Define where the patient is not in terms of expected outcomes

  • Determine factors that help or hinder progress

  • Decide between discharge or continuation of nutrition care

    M. Nelms, K. Sucher, Long, Sara. Nutrition Therapy and Pathophysiology. Thomson Brooks/ Cole(2007)


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Ethical Issues

  • Dietitian vs. Counselor

  • No judgment/ preconceived notions


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