Binge Eating Disorder (BED) is the most common eating disorder but also the hardest one to recognize in clinical practice. Often underestimated, BED affects a significant portion of the population yet remains underdiagnosed and misunderstood.
Defining Binge Eating Disorder
BED involves recurrent episodes of binge eating, accompanied by feelings of loss of control and distress. These episodes are characterized by specific behaviors like eating rapidly, consuming large amounts of food when not hungry, and experiencing negative emotions afterward. These behaviors occur at least weekly for at least three months. Notably, the hallmark of BED is the loss of control, not the quantity of food consumed.
Identifying Binge Eating Disorder
In clinical practice, identifying BED can be challenging, especially when there's no significant change in weight. We should think about BED if patients exhibit concerns about weight/shape despite no observable weight changes, engage in extreme weight management practices, or display signs of overeating or emotional eating.
We should also keep in mind that patients with significant weight changes might be struggling with binge-eating behavior. Unlike anorexia nervosa, BED typically lacks acute and life-threatening complications. However, it's associated with substantial medical morbidity and impaired quality of life, emphasizing the importance of early detection and intervention. Early detection and intervention can significantly improve outcomes and quality of life for individuals with BED.
Screening Tools and Next Steps
Screening tools like the SCOFF questionnaire or BED-specific assessments such as BED-7 can aid in identifying BED. Moreover, exploring changes in weight and behaviors related to binge eating should prompt further evaluation and intervention. This is a topic that can induce deep feelings of shame and guilt; it’s vital that we approach our patients with empathy and curiosity, not judgment.
Therapist-led cognitive-behavioral therapy (CBT) and medications, including lisdexamfetamine (FDA-approved) and second-generation antidepressants (used off-label), are recommended for BED management. These interventions aim to reduce binge eating frequency, improve psychological outcomes, and enhance overall well-being. BED management, including medication prescription, can be handled by primary care clinicians or specialists. Referral to a psychiatrist or eating disorder specialist may be beneficial, especially for initial evaluation and medication oversight. Note that weight loss is NOT the goal of intervention or a form of treatment in and of itself—rather, eliminating harmful behavior is the ultimate sign of cure.
