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Binge eating disorder

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Updated 2023 APA, 2022 USPSTF, 2022 SIGN, and 2021 CPG guidelines for the diagnosis and management of binge eating disorder.

Background

Overview

Definition
BED is characterized by regular episodes of consuming large amounts of food and experiencing a loss of control over eating behavior.
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Pathophysiology
The pathophysiology of BED is complex, involving genetic and environmental factors, as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control, and emotion regulation in individuals with BED.
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Epidemiology
The worldwide prevalence of BED for the years 2018-2020 is estimated to be 0.6-1.8% in adult women and 0.3-0.7% in adult men.
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Risk factors
Risk factors for BED are diverse and include psychological factors, societal influences, and certain comorbidities. It is commonly associated with obesity and somatic and mental health comorbidities, including mood and anxiety disorders.
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Disease course
The clinical manifestations of BED are characterized by regular episodes of binge eating during which individuals ingest large amounts of food and experience a loss of control over their eating behavior. Unlike other eating disorders, BED does not involve inappropriate compensatory behaviors or extreme dietary restraint.
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Prognosis and risk of recurrence
The prognosis of BED is often chronic, with individuals experiencing considerable burden and impairments in QoL.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of binge eating disorder are prepared by our editorial team based on guidelines from the American Psychiatric Association (APA 2023), the The Scottish Intercollegiate Guidelines Network (SIGN 2022), the U.S. Preventive Services Task Force (USPSTF 2022), the Canadian Practice Guidelines (CPG 2021,2020), the American College of Endocrinology (ACE/AACE 2016), the American ...
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Screening and diagnosis

Indications for screening: as per APA 2023 guidelines, screen for the presence of an eating disorder as part of an initial psychiatric evaluation.
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Diagnostic investigations

Initial evaluation: as per APA 2023 guidelines, assess the following during the initial evaluation of patients with a possible eating disorder:
height and weight history (maximum and minimum weight, recent weight changes)
presence of, patterns in, and changes in restrictive eating, food avoidance, binge eating, and other eating-related behaviors (rumination, regurgitation, chewing, and spitting)
patterns and changes in food repertoire (breadth of food variety, narrowing or elimination of food groups)
presence of, patterns in, and changes in compensatory and other weight control behaviors, including dietary restriction, compulsive or driven exercise, purging behaviors (laxative use, self-induced vomiting), and use of medication to manipulate weight
percentage of time preoccupied with food, weight, and body shape
prior treatment and response to treatment for an eating disorder
psychosocial impairment secondary to eating or body image concerns or behaviors
family history of eating disorders, other psychiatric illnesses, and other medical conditions (obesity, IBD, diabetes mellitus).
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  • Laboratory tests

  • ECG

  • Screening for comorbidities

Medical management

Multidisciplinary care: as per APA 2023 guidelines, provide a documented, comprehensive, culturally appropriate, and person-centered treatment plan incorporating medical, psychiatric, psychological, and nutritional expertise, commonly via a coordinated multidisciplinary team, in patients with an eating disorder.
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  • Setting of care

  • Pharmacotherapy (general principles)

  • Pharmacotherapy (antidepressants)

  • Pharmacotherapy (stimulants)

  • Pharmacotherapy (anticonvulsants)

  • Pharmacotherapy (obesity medications)

Nonpharmacologic interventions

Lifestyle modifications: as per AACE/ACE 2016 guidelines, offer a structured behavioral/lifestyle program in conjunction with CBT or other psychological interventions in patients with overweight or obesity and BED.
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  • Psychotherapy

  • Technology-based interventions

  • Yoga

Specific circumstances

Pregnant patients: as per SIGN 2022 guidelines, elicit history of current or past history of eating disorders in females during pregnancy and postnatal period, recognizing the potential barriers for disclosure.
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