WASHINGTON, DC — Binge eating isn’t a contraindication for referral to intensive lifestyle interventions, including weight loss diets, but patients who engage in the behavior may require additional treatment, new research suggests.
New findings from the Action for Health in Diabetes (Look AHEAD) study were presented here on October 31 at Obesity Week 2017 by Ariana M. Chao, PhD, RN, a family nurse practitioner who provides medical management for participants enrolled in research studies at the Center for Weight and Eating Disorders at the University of Pennsylvania School of Medicine, Philadelphia.
The results were also simultaneously published in Obesity.
The novel data counter the concern that imposing restrictions on eating may trigger or exacerbate binge-eating behavior, but at the same time people who self-reported binge eating tended to lose less weight.
“Individuals [who binge eat] should not be excluded from lifestyle modification programs. However, binge eating should be assessed regularly during weight loss. Patients who report continued binge eating during behavioral weight loss may need to be referred for additional treatment, such as cognitive-behavioral therapy,” Dr Chao told Medscape Medical News.
Asked to comment, Eric Ravussin, PhD, Boyd Professor at Louisiana State University, Baton Rouge, and coeditor of Obesity, told Medscape Medical News, “The question is, ‘Is it safe in people with symptoms of binge eating or who practice it to put them on calorie restriction?’ The answer is yes.”
However, he also said that given that binge eating was fairly common — about 1 in 10 of the overweight/obese Look AHEAD study participants with type 2 diabetes exhibited it. “Before putting people on a weight loss diet you have to asses that.”
Indeed, Dr Chao noted, “Despite how common binge eating is among patients with obesity, it is frequently overlooked. Previous studies have indicated that rates of diagnosis and referral to treatment are low.”
Intensive Lifestyle Intervention Doesn’t Appear to Trigger Binge Eating
The Look AHEAD study, a randomized controlled trial that compared intensive lifestyle intervention with diabetes support and education in people with type 2 diabetes and body mass index of 25 kg/m2 or greater (or 27 kg/m2 or greater among those receiving insulin), included 4901 participants.
The intensive lifestyle intervention included individual and group sessions focused on improving diet and physical activity, with the goal of a mean weight loss of at least 7% of initial body weight.
Binge eating was assessed annually with a self-report questionnaire that asked whether participants had consumed a large amount of food in a short period while feeling a loss of control over eating at least once in the past 6 months. They were also asked about the frequency of the binges.
At baseline, 11.2% (n = 546) reported having one or more binge-eating episodes in the past 6 months, while 1.1% met diagnostic criteria for binge eating disorder (recurrent episodes of binge eating that occur at least once per week for at least 3 months, accompanied by marked distress and not associated with compensatory behaviors, such as purging).
Weight and questionnaire data were available for 89% of the participants at 4 years.
Of those without any binge eating at baseline, 10.2% of the intensive lifestyle intervention group and 8.3% of the diabetes support and education group had begun the behavior during the study period. The difference didn’t quite achieve statistical significance, with a hazard ratio of 1.22 and P value of .06.
In both groups, those who began binge eating during the study had made more previous weight loss attempts, while older age and better physical and mental health-related quality-of-life scores were associated with a lower likelihood of binging.
For the 546 patients who reported binge eating at baseline, the average number of binging days declined over the 4 years (P < .001 in both groups).
By year 4, nearly half of patients in both study groups who were binging at baseline had completely stopped (46% of the intensive lifestyle and 47% of diabetes support and education groups). No significant factors predicting remission were identified.
Weight Loss Greater for Those Without Binge Eating
At year 4, in the intensive lifestyle group, those who reported no binge eating at any time lost a mean of 4.6% of initial weight, while those who had begun binging during the study and those who had had the behavior the entire time lost less weight (3.1% and 1.9% of initial weight; P = .02 and P = .01, respectively).
Weight loss for those with completely remitted binge eating was 4.7%, similar to the rate in the group that never engaged in the behavior.
Dr Ravussin noted that the self-reporting of the binge-eating behavior was a limitation of the study and that the assessment was done via a short questionnaire, “not a formal binge-eating scale.”
Indeed, although not used in the study, many tools and questionnaires have been developed to screen for binge eating and disordered eating behaviors.
Addressing Binge Eating in Clinical Practice
Such tools include the Questionnaire on Eating and Weight Patterns-5, the Eating Disorder Screen for Primary Care, and the SCOFF questionnaire.
“These brief assessments can be administered efficiently in primary care settings,” Dr Chao said.
And for those identified with binging, she said, “Evidence-based treatments for binge eating include psychological treatments, such as cognitive-behavioral therapy and interpersonal therapy. Pharmacological therapies are also available for patients who meet criteria for binge eating disorder.”
Dr Chao reports grant support from Shire Pharmaceuticals. Dr Ravussin has disclosed no relevant financial relationships.
Obesity Week 2017. Presented October 31, 2017.
Obesity. Published online October 30, 2017. Full text
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