By Dr. Malavika Varma, with Dr. Aravind Ganesh
For many years, Alicia Raimundo suspected that there was something wrong with her eating habits. She remembers over-eating a lot, even as a child, as a coping mechanism for her struggles with anxiety and depression. She eventually realized that her binges were out of control, and that her urges were worse than those experienced by others. She would eat a lot of food for every major change in her mood, whether as a celebration when she was very happy, or as a consolation when she was very sad.
When Alicia started getting involved in mental health initiatives in 2010, seeking to reduce the stigma surrounding mental illness and encouraging others to seek help, she realized that her binging problems were also holding her mental health back. While she found it relatively easy to share her experiences with depression and anxiety, she found it extremely challenging to disclose the “big secret” of her eating problems. Therapy for her anxiety and mood didn’t seem to reduce her binges. An insightful doctor finally confronted her about her eating habits in 2012 and recognized her symptoms as being in keeping with binge-eating disorder.
Binge Eating Disorder
Binge eating disorder is defined as recurring episodes (one or more times a week, on average, for at least 3 months) of consuming a large amount of food in a short time, accompanied by feelings of distress, guilt, and a loss of control. We caught up with Dr. Rick Ward, a family physician for over 25 years, who has an interest in mental health and currently practices at the Crowfoot Village Family Practice.
He was surprised to find out how much more common binge-eating disorder was in his practice, compared to the more commonly known eating disorders like anorexia and bulimia. Ward estimates that about 3% of adults in his practice suffer from this, and a substantial number are men. However, when thinking about eating disorders, it’s also very important to realize that there is a wide range of normal eating habits.
“We all go through times in life when we overeat in response to stress, anxiety, or other life events. However, people with binge-eating disorder have a pattern of repetitive binge eating, often by themselves, often in response to changes in their mood, and this is typically associated with a lot of guilt and shame, leaving them unhappy,” Ward said.
Unlike those with anorexia or bulimia, people with this disorder don’t use any compensatory behaviour such as self-induced vomiting or over-exercising. They are normally overweight or obese.
“The greater the BMI, the greater the incidence of binge-eating disorder,” Ward said. Conditions like Attention-Deficit Hyperactivity Disorder (ADHD), depression, and anxiety are commonly associated with binge-eating disorder.
Unfortunately, patients with binge-eating disorder tend to view this as a bad habit or “dirty little secret” and don’t realize that it’s treatable. Ward finds it helpful to explain the physiological underpinnings of the disease to patients so they realize it isn’t the result of some mental weakness on their part. The disease is fundamentally a disordered response to stress.
The theory behind the disorder is that high-calorie foods (which people prefer during binges) eaten over a short amount of time stimulate the brain’s reward centre in these patients more than in others. But as with many disorders of the brain/mind, there remains a lot to be understood about the exact mechanisms.
Treatment options now exist
Dr.Ward and his team are fortunate enough to be able to tackle this issue the right way – namely, in a multi-disciplinary manner. There are two psychologists in the clinic that are able to help with Cognitive-Behavioural Therapy (CBT)-type interventions, and a dietician to help patients change their eating habits.
Recently, Vyvanse (Lisdexamfetamine dimesylate or LDX), manufactured by Shire Inc., became the first approved medication for binge-eating disorder; the drug has already been in use for ADHD. The approval for binge-eating disorder was based on a total of five studies which demonstrated the drug helped alleviate symptoms . As always, before we accept this claim, we need to ask three “healthily skeptical” questions:
- Where is the evidence? – The evidence supporting the use of LDX in binge-eating disorder comes from three randomized, placebo-controlled trials in adults with the disorder: an 11-week proof-of-concept (Phase II) study, and two 12-week double-blind (Phase III) studies. In other words, the clinical development of this drug followed a sensible and well-designed trajectory of testing. The main outcome measured in the study was the number of binge-eating days per week, and this was significantly decreased in the group treated with LDX compared to the placebo group. One word of caution here is that the participants in these studies were mainly women, white, overweight/obese, without any other conditions, so these results may not apply to everyone.
- What are the risks versus benefits? – In these trials, the most common side effects (affecting less than 10% of patients) were dry mouth, headache, and insomnia. There were also minimal increases in pulse and blood pressure. Therefore, when Dr. Ward prescribes this drug, he monitors vital signs like weight, pulse, and blood pressure. Ward says it’s difficult to completely quench the symptoms, but success in a disorder like this could mean that a patient who initially binges 5-6 times a week, is now only binging once a week or once every two weeks. Some patients may find the trade-off to be reasonable. Others may choose to try non-medication options like psychological coping strategies or dietary advice before going on this medication.
- Are there any conflicts of interests? – An important conflict of interest of these five studies was that they were all sponsored by Shire, Inc. Other ongoing studies are seeking to examine the long-term efficacy and safety of this drug for binge-eating disorder.
As for Alicia, she has successfully been tackling her binge eating disorder through non-pharmacological approaches (i.e. without medications). She has been participating in peer support groups and group counselling in Toronto – although like many Canadians with eating disorders, she had to be on a waitlist for 2 years – and is continuing to tackle the stigma surrounding mental illness in our community. She hopes that by sharing her story, she can encourage more patients with eating disorders, like binge-eating disorder, to confront the reality of their symptoms without being wracked by shame or guilt, and get the help they need through early diagnosis and treatment.