Obesity-related Eating Disorders in Women

May 30, 2017


By: Anne McTiernan, MD, PhD, SWHR/Susan G. Komen Network for the Study of Exercise and Breast Cancer Member

In the U.S., more than four in ten women are obese, compared to a little more than a third of men [1]. Women are also more likely than men to experience discrimination about their weight [2]. For example, many women of size hear that if they exercised self-control, they would lose pounds easily. For many, it is just not that simple.

Weight-loss programs that involve reducing calorie intake and increasing physical activity produce an average 10 percent loss of starting weight within six months [3]. Weight-loss medications and bariatric surgery produce more dramatic results than calorie intake reduction alone. Ultimately, all weight-loss methods require significant behavior changes to alter eating patterns, and many people regain lost weight without ongoing support. Many women have difficulty making changes to their dietary choices. For them, eating can be uncontrollable and changing eating habits long-term, can seem impossible.

According to mental health experts, binge eating disorder is the combination of recurrent episodes of binge eating; a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterward; and not using unhealthy compensatory measures to counter the binge eating [4]. This disorder is relatively rare, affecting about two in 100 individuals in their lifetimes [5], but is three times more likely to affect women than men [4]. Many more people engage in periodic binge eating without having a full-scale disorder.

The behavior of “eating when full” has significant consequences. Moments after an episode, the individual may experience gastrointestinal distress, nausea, and sometimes even vomiting. Psychological effects include feelings of embarrassment, self-disgust, depression, or guilt. Long-term binge eating also significantly increases the risk for excessive weight gain and obesity [6]. Studies have found that up to one in five women who are obese, struggle with episodes of binge eating [7]. An additional risk factor for obesity is emotional eating, which typically involves consumption of sweet, fatty, energy-dense foods in response to depression, anxiety, or anger. This type of emotional eating is a strong predictor of weight gain.

While both women and men can eat emotionally, women typically respond to negative emotions, while men eat in response to more positive emotions. Many researchers who study obesity believe that addiction to highly processed, hyper-palatable foods, could contribute to overeating and obesity. A compilation of research studies, including one with almost 200,000 people showed that one in four overweight or obese individuals have characteristics of food addiction and that women are twice as likely as men to have food addictions [8]. Furthermore, more than half of the people diagnosed with an eating disorder report symptoms consistent with food addiction.

Treating obesity in individuals with these eating issues can be complicated. Through diet and exercise, people with binge eating patterns can benefit from the same behavioral treatments as those who do not engage in binge eating. However, those who continue to binge eat lose less weight, and without long-term counseling, the disorder is likely to cause weight gain. Clinical trials are underway to test methods for treating people who engage in emotional eating [9]. Given the current epidemic of obesity, it is critical to develop and test new ways to prevent and treat obesity in people with challenges in controlling the type and amount of food that they eat.

Anne McTiernan, MD, PhD, conducts research on the effects of diet, exercise, and weight loss on cancer and health. Currently, she is faculty at the Fred Hutchinson Cancer Research Center and professor at the University of Washington Schools of Public Health and Medicine in Seattle, Washington. She is the author of Starved: A Nutrition Doctor’s Journey from Empty to Full (Central Recovery Press, November 2016).

References:

  1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL.Tr ends in Obesity Among Adults in the United States, 2005 to 2014. 2016 Jun 7;315(21):2284
  2. Spahlholz J, Baer N, König HH, Riedel-Heller SG, Luck-Sikorski C. Obesity and discrimination – a systematic review and meta-analysis of observational studies.Obes Rev. 2016 Jan;17(1):43-55.
  3. Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011 Dec;34(4):841-59.
  4. Berkman ND, Brownley KA, Peat CM, Lohr KN, Cullen KE, Morgan LC, Bann CM, Wallace IF, Bulik CM. Management and Outcomes of Binge-Eating Disorder. Comparative Effectiveness Review No. 160. (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2012-00008-I.) AHRQ Publication No. 15(16)-EHC030-EF. Rockville, MD: Agency for Healthcare Research and Quality; December 2015. effectivehealthcare.ahrq.gov/reports/final.cfm.
  5. Cossrow N, Pawaskar M, Witt EA, Ming EE, Victor TW, Herman BK, Wadden TA, Erder MH. Esti­­­mating the Prevalence of Binge Eating Disorder in a Community Sample From the United States: Comparing DSM-IV-TR and DSM-5 Criteria. J Clin Psychiatry. 2016 Aug;77(8):e968-74. doi: 10.4088/JCP.15m10059.
  6. Pacanowski CR, Senso MM, Oriogun K, Crain AL, Sherwood NE. Binge eating behavior and weight loss maintenance over a 2-year period. See comment in PubMed Commons below J Obes. 2014;2014:249315. doi: 10.1155/2014/249315. Epub 2014 May 8.
  7. Alessandro Leone, Giorgio Bedogni, Veronica Ponissi, Alberto Battezzati, Valentina Beggio, Paolo Magni, Massimiliano Ruscica and Simona Bertoli. Contribution of binge eating behaviour to cardiometabolic risk factors in subjects starting a weight loss or maintenance programme. British Journal of Nutrition (2016), 116, 1984–1992.
  8. Pursey KM, Stanwell P, Gearhardt AN, Collins CE, and Burrows TL. The prevalence of food addiction as assessed by the Yale Food Addiction Scale: a systematic review. Nutrients 2014, 6, 4552-4590
  9. Lillis J, Niemeier HM, Ross KM, Thomas JG, Leahey T, Unick J, Kendra KE, Wing Weight loss intervention for individuals with high internal disinhibition: design of the Acceptance Based Behavioral Intervention (ABBI) randomized controlled trial. BMC Psychol 2015; 3(1): 17.

By: Anne McTiernan, MD, PhD, SWHR/Susan G. Komen Network for the Study of Exercise and Breast Cancer Member

In the U.S., more than four in ten women are obese, compared to a little more than a third of men [1]. Women are also more likely than men to experience discrimination about their weight [2]. For example, many women of size hear that if they exercised self-control, they would lose pounds easily. For many, it is just not that simple.

Weight-loss programs that involve reducing calorie intake and increasing physical activity produce an average 10 percent loss of starting weight within six months [3]. Weight-loss medications and bariatric surgery produce more dramatic results than calorie intake reduction alone. Ultimately, all weight-loss methods require significant behavior changes to alter eating patterns, and many people regain lost weight without ongoing support. Many women have difficulty making changes to their dietary choices. For them, eating can be uncontrollable and changing eating habits long-term, can seem impossible.

According to mental health experts, binge eating disorder is the combination of recurrent episodes of binge eating; a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterward; and not using unhealthy compensatory measures to counter the binge eating [4]. This disorder is relatively rare, affecting about two in 100 individuals in their lifetimes [5], but is three times more likely to affect women than men [4]. Many more people engage in periodic binge eating without having a full-scale disorder.

The behavior of “eating when full” has significant consequences. Moments after an episode, the individual may experience gastrointestinal distress, nausea, and sometimes even vomiting. Psychological effects include feelings of embarrassment, self-disgust, depression, or guilt. Long-term binge eating also significantly increases the risk for excessive weight gain and obesity [6]. Studies have found that up to one in five women who are obese, struggle with episodes of binge eating [7]. An additional risk factor for obesity is emotional eating, which typically involves consumption of sweet, fatty, energy-dense foods in response to depression, anxiety, or anger. This type of emotional eating is a strong predictor of weight gain.

While both women and men can eat emotionally, women typically respond to negative emotions, while men eat in response to more positive emotions. Many researchers who study obesity believe that addiction to highly processed, hyper-palatable foods, could contribute to overeating and obesity. A compilation of research studies, including one with almost 200,000 people showed that one in four overweight or obese individuals have characteristics of food addiction and that women are twice as likely as men to have food addictions [8]. Furthermore, more than half of the people diagnosed with an eating disorder report symptoms consistent with food addiction.

Treating obesity in individuals with these eating issues can be complicated. Through diet and exercise, people with binge eating patterns can benefit from the same behavioral treatments as those who do not engage in binge eating. However, those who continue to binge eat lose less weight, and without long-term counseling, the disorder is likely to cause weight gain. Clinical trials are underway to test methods for treating people who engage in emotional eating [9]. Given the current epidemic of obesity, it is critical to develop and test new ways to prevent and treat obesity in people with challenges in controlling the type and amount of food that they eat.

Anne McTiernan, MD, PhD, conducts research on the effects of diet, exercise, and weight loss on cancer and health. Currently, she is faculty at the Fred Hutchinson Cancer Research Center and professor at the University of Washington Schools of Public Health and Medicine in Seattle, Washington. She is the author of Starved: A Nutrition Doctor’s Journey from Empty to Full (Central Recovery Press, November 2016).

References:

  1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL.Tr ends in Obesity Among Adults in the United States, 2005 to 2014. 2016 Jun 7;315(21):2284
  2. Spahlholz J, Baer N, König HH, Riedel-Heller SG, Luck-Sikorski C. Obesity and discrimination – a systematic review and meta-analysis of observational studies.Obes Rev. 2016 Jan;17(1):43-55.
  3. Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011 Dec;34(4):841-59.
  4. Berkman ND, Brownley KA, Peat CM, Lohr KN, Cullen KE, Morgan LC, Bann CM, Wallace IF, Bulik CM. Management and Outcomes of Binge-Eating Disorder. Comparative Effectiveness Review No. 160. (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2012-00008-I.) AHRQ Publication No. 15(16)-EHC030-EF. Rockville, MD: Agency for Healthcare Research and Quality; December 2015. effectivehealthcare.ahrq.gov/reports/final.cfm.
  5. Cossrow N, Pawaskar M, Witt EA, Ming EE, Victor TW, Herman BK, Wadden TA, Erder MH. Esti­­­mating the Prevalence of Binge Eating Disorder in a Community Sample From the United States: Comparing DSM-IV-TR and DSM-5 Criteria. J Clin Psychiatry. 2016 Aug;77(8):e968-74. doi: 10.4088/JCP.15m10059.
  6. Pacanowski CR, Senso MM, Oriogun K, Crain AL, Sherwood NE. Binge eating behavior and weight loss maintenance over a 2-year period. See comment in PubMed Commons below J Obes. 2014;2014:249315. doi: 10.1155/2014/249315. Epub 2014 May 8.
  7. Alessandro Leone, Giorgio Bedogni, Veronica Ponissi, Alberto Battezzati, Valentina Beggio, Paolo Magni, Massimiliano Ruscica and Simona Bertoli. Contribution of binge eating behaviour to cardiometabolic risk factors in subjects starting a weight loss or maintenance programme. British Journal of Nutrition (2016), 116, 1984–1992.
  8. Pursey KM, Stanwell P, Gearhardt AN, Collins CE, and Burrows TL. The prevalence of food addiction as assessed by the Yale Food Addiction Scale: a systematic review. Nutrients 2014, 6, 4552-4590
  9. Lillis J, Niemeier HM, Ross KM, Thomas JG, Leahey T, Unick J, Kendra KE, Wing Weight loss intervention for individuals with high internal disinhibition: design of the Acceptance Based Behavioral Intervention (ABBI) randomized controlled trial. BMC Psychol 2015; 3(1): 17.