Binge eating

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Joseph Nasr, M.D.[2]

Overview

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable overeating. It is sometimes as a symptom of binge eating disorder. During such binges, a person rapidly consumes an excessive amount of food. Most people who have eating binges try to hide this behaviour from others, and often feel ashamed or depressed about their overeating. Eating binges can be followed by so-called compensatory behaviour, acts by which the person tries to compensate for the effects of overeating. Examples of such acts are purging (induced vomiting or laxative abuse), fasting, and heavy exercising.

Although people who do not have any mental disorder may occasionally experience episodes of overeating, frequent binge eating is often a symptom of an eating disorder. Binge eating is a central feature of bulimia nervosa and binge eating disorder. It is also practiced by some people with an eating disorder not otherwise specified or anorexia nervosa.

BINGE-EATING DISORDER

Step 1. Confirm binge eating with loss of control

Ask with clear definitions:
1.Do you have episodes where you eat much more than most people would in a short time?
2.During those episodes, do you feel unable to stop or control what or how much you eat?

3.How often does this occur per week and for how many months?

Step 2. Document associated features

Check for at least three:
1.Eating rapidly
2.Eating until uncomfortably full
3.Eating when not physically hungry
4.Eating alone due to embarrassment

5.Feeling disgusted, depressed, or guilty afterward

Step 3. Confirm distress and exclude bulimia

1.Marked distress about binge eating is present

2.No recurrent compensatory behaviors such as vomiting, laxatives, fasting, or excessive exercise

Step 4. Frequency and severity specifier

1.Occurs at least once weekly for three months
2.Severity based on binge episodes per week:
Mild 1 to 3
Moderate 4 to 7
Severe 8 to 13

Extreme 14 or more

Step 5. Screen for medical and psychiatric risk

1.Suicidality, severe depression, severe anxiety, substance use
2.Weight gain, metabolic symptoms, sleep apnea symptoms

3.Functional impairment at work, school, or relationships

Step 6. Physical examination

1.Vitals and BMI
2.Assess for hypertension and cardiometabolic risk

3.General exam for complications of obesity when present

Step 7. Investigations focused on comorbidity and risk

1.Glucose or HbA1c
2.Lipid profile

3.Liver function tests as clinically indicated

Step 8. Differential

1.If compensatory behaviors are present, consider bulimia nervosa
2.If restriction and significantly low body weight are present, consider anorexia nervosa

3.Consider mood and anxiety disorders as comorbid drivers of symptom burden

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Binge eating

Overview

See also

BINGE-EATING DISORDER