Binge eating is defined as the recurrent rapid consumption of high calorie meals accompanied by a feeling that eating is out of control.

Bulimia nervosa is an eating disorder characterized by binge eating paired with a purging behavior such as self-induced vomiting.

Binge eating without purging is receiving increased clinical and research attention.

Binge eating is a relative common component in elevated body mass index and obesity. Successful behavior and drug treatment for obesity often includes a significant reduction in the frequency of binge eating.

Binge eating is frequently accompanied by symptoms of gastrointestinal disorders such as gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS). However, these GI symptoms and disorders are also increased in obesity. 

These relationships have made it difficult to determine the specific effects of binge eating on GI symptoms as it is possible these effects may occur through an obesity mechanism.

Christine Peat along with colleagues from the University of North Carolina and Sweden recently published a study teasing out relationships between binge eating, BMI and GI symptoms.

This study used data from the Swedish Twin Study of Adults: Genes and Environment (STAGE). For the current study, over 23,000 twin pairs were interviewed for presence of lifetime history of binge eating, weight history and presence of gastrointestinal symptoms.

The key findings from this study included the following:

• Gastrointestinal reflux symptoms were present in 15.7% of men and 28.9% of women
• Irritable bowel syndrome (broad definition) was present in 3.7% of men and 8.1% of women
• Binge eating was linked to to higher rates of GERD and IBS
• However, when BMI was controlled binge eating was independently related to IBS but not related to GERD

The authors propose three potential mechanisms for this link between binge eating and IBS.

1. Stress may be a common factor as it is known that stress can precipitate bingeing episodes and increase IBS symptoms
2. IBS may cause dietary restriction including periods of fasting. Fasting is known to increase later risk for binge eating as the body attempts to compensate via a strong hunger mechanism
3. Binge eating of large quantities of high fat foods may directly produce IBS symptoms as the GI system responds to a feeding load

The take home message for clinicians treating IBS is that it is important to assess for the presence of binge eating. Successful reduction in the frequency of binge eating may contribute to a successful reduction in IBS symptoms. 

Readers with more interest in this study can access the free full-text manuscript by clicking on the PMID link in the citation below.

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Peat CM, Huang L, Thornton LM, Von Holle AF, Trace SE, Lichtenstein P, Pedersen NL, Overby DW, & Bulik CM (2013). Binge eating, body mass index, and gastrointestinal symptoms. Journal of psychosomatic research, 75 (5), 456-61 PMID: 24182635

I am focusing on recent research in eating disorders this month on Brain Posts.

Here are some of the research abstracts I will be reviewing for upcoming posts.

Clicking on the title will take you to the PubMed abstract and also to a link for the free full-text manuscript.

Higher parental education as a risk factor for eating disorders
This study of the Swedish population examined the effect education and social class on risk for eating disorders. Individuals diagnosed with an eating disorder were more likely to have higher educational levels in their parents. This is an interesting finding as educational typically reduces rates for many psychiatric disorders. 

Increased rates of autoimmune diseases in patients with eating disorders
A study of a large cohort from Finland found higher rates of a variety of autoimmune disorders in a sample of patients treated for eating disorders. Type I diabetes and Crohn's disease were two of the disorders that were more likely to be seen in eating disorder patients compared to controls.

Epidemiology of eating disorders
This literature examined 149 studies on the epidemiology of eating disorders. The review found evidence for genetic and environmental factors as risk factors for eating disorders. Additionally, the review found support for esthetic or weight-oriented sport participation also as risk factors for eating disorders.

Evidence for effective treatment options of eating disorders in young people
This review examined evidence for effective prevention and treatment of eating disorders in adolescents and young adults. The authors note the paucity of large well-designed clinical trials for the treatment of most eating disorders and make recommendations about directions for future research. 

Inferior frontal cortex network abnormalities in anorexia nervosa
This study examined resting functional connectivity in 12 subjects with anorexia nervosa compared to controls. The study found impairment in connectivity in the inferior frontal cortex in those with anorexia nervosa.

Binge eating and risk for gastrointestinal disorders
The Swedish Twin Study of Adults: Genes and Environment (STAGE) cohort was used to look for associations between binge eating and gastrointestinal disorders. Binge eating was found to be increased in irritable bowel syndrome and may be important in effectively managing this disorder. 

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