Hunger pains

Binge-eating disorder, designated only months ago by the American Psychiatric Association as a diagnosis in its Diagnostic and Statistical Manual of Mental Disorders, is associated with substantial lifelong impairments comparable to those of bulimia nervosa, according to a World Health Organization study based on community epidemiological surveys conducted in 12 nations worldwide.

The publication of the results online today in Epidemiology and Psychiatric Sciences is timed to coincide with the beginning of Weight Stigma Awareness Week (September 23-27).

Although both binge-eating disorder and bulimia involve recurrent episodes of excessive food consumption with experienced loss of control, it had been generally assumed that bulimia carried a greater functional burden of illness owing to its more complex symptom profile. A defining symptom of bulimia, lacking in binge-eating disorder, is inappropriate compensatory behavior such as purging or laxative use to offset the weight gain associated with bingeing.

However, compared to matched populations of people with no history of eating disorders, a lifetime history of binge-eating disorder or bulimia each predicted between two- and nearly four-fold increases in current days unable to work or carry out usual activities.

Despite the significant challenges that people with these disorders face, both are generally undetected by medical professionals and therefore left untreated.

"Binge-eating disorder has been largely ignored by health care providers, but it has a tremendous cost to the physical and psychological well-being of people with the disorder," said Ronald Kessler, McNeil Family Professor of Health Care Policy at Harvard Medical School and senior author of the paper. "When all of the cases of the disorder are taken together, the elevated levels of depression, suicide and lost days at work represent substantial costs to society."

The study found that binge-eating disorder and bulimia nervosa both typically arose during adolescence and were associated with a range of later-onset mental disorders (including depression and anxiety disorders) and physical disorders (such as musculoskeletal disorders and diabetes). Early-onset binge-eating disorder was associated with subsequent low rates of employment among men, low rates of marriage among women and high rates of work disability among both men and women.

The researchers concluded that the adverse effects of binge-eating disorder and bulimia on subsequent functioning were largely the result of these later-onset comorbidities. This finding, the researchers said, raises the possibility that expanded efforts at early detection and treatment of eating disorders during the vulnerable school years might help prevent the onset of subsequent mental and physical disorders and impairments associated with these disorders.

In independent commentaries published in the same journal, international experts on eating disorders Janet Treasure and Cynthia Bulik wrote that the evidence in the report argues strongly for proceeding with clinical effectiveness trials to evaluate the long-term effects on adult health and well-being of early detection and treatment of binge-eating disorder and bulimia among students.

The study was based on community surveys in 12 countries. Researchers interviewed a total of 22,635 adult respondents.

Binge-eating disorder was roughly twice as common as bulimia across the countries studied, which included the U.S., several countries in Latin America (Brazil, Colombia, Mexico), a number in Europe (Belgium, Italy, Netherlands, Northern Ireland, Portugal, Romania, Spain) and New Zealand.

The analysis for this paper was carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. These activities were supported by the U.S. National Institute of Mental Health (R01MH070884) and the Mental Health Burden Study (Contract number HHSN271200700030C) and by a number of government agencies in the other participating countries, as well as by foundations and industry sponsors. This study received supplemental support from Shire Pharmaceuticals. Complete funding information is presented in the published paper.

ADDITIONAL CONTACT INFORMATION/ INDEPENDENT INTERNATIONAL EXPERTS
Janet Treasure
King's College London, Institute of Psychiatry
Psychological Medicine, Section of Eating Disorders, UK
Email: janet.treasure@kcl.ac.uk

Cynthia M. Bulik
Distinguished Professor of Eating Disorders
Department of Psychiatry
University of North Carolina at Chapel Hill, USA
Email: cbulik@med.unc.edu

Harvard Medical School has more than 7,500 full-time faculty working in 11 academic departments located at the School's Boston campus or in one of 47 hospital-based clinical departments at 16 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care, Hebrew Senior Life, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital and VA Boston Healthcare System.