Few population-based data on the prevalence of eating disorders exist, and such data are especially needed because of changes to diagnoses in the DSM-5. This study aimed to provide lifetime and ...12-month prevalence estimates of DSM-5–defined anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions.
A national sample of 36,306 U.S. adults completed structured diagnostic interviews (Alcohol Use Disorder and Associated Disabilities Interview Schedule-5).
Prevalence estimates of lifetime AN, BN, and BED were 0.80% (SE 0.07%), 0.28% (SE 0.03%), and 0.85% (SE 0.05%), respectively. Twelve-month estimates for AN, BN, and BED were 0.05% (SE 0.02%), 0.14% (SE 0.02%), and 0.44% (SE 0.04%). The odds of lifetime and 12-month diagnoses of all three eating disorders were significantly greater for women than for men after adjusting for age, race and/or ethnicity, education, and income. Adjusted odds ratios (AORs) of lifetime AN diagnosis were significantly lower for non-Hispanic black and Hispanic respondents than for white respondents. AORs of lifetime and 12-month BN diagnoses did not differ significantly by race and/or ethnicity. The AOR of lifetime, but not 12-month, BED diagnosis was significantly lower for non-Hispanic black respondents relative to that of non-Hispanic white respondents; AORs of BED for Hispanic and non-Hispanic white respondents did not differ significantly. AN, BN, and BED were characterized by significant differences in age of onset, persistence and duration of episodes, and rates of current obesity and psychosocial impairment.
These findings for DSM-5–defined eating disorders, based on the largest national sample of U.S. adults studied to date, indicate some important similarities to and differences from earlier, smaller nationally representative studies.
Objective
To examine psychiatric and somatic correlates of DSM‐5 eating disorders (EDs)—anorexia nervosa (AN), bulimia nervosa (BN), and binge‐eating disorder (BED)—in a nationally representative ...sample of adults in the United States.
Method
A national sample of 36,309 adult participants in the national epidemiologic survey on alcohol and related conditions III (NESARC‐III) completed structured diagnostic interviews (AUDADIS‐5) to determine psychiatric disorders, including EDs, and reported 12‐month diagnosis of chronic somatic conditions. Prevalence of lifetime psychiatric disorders and somatic conditions were calculated across the AN, BN, and BED groups and a fourth group without specific ED; multiple logistic regression models compared the likelihood of psychiatric/somatic conditions with each specific ED relative to the no‐specific ED group.
Results
All three EDs were associated significantly with lifetime mood disorders, anxiety disorders, alcohol and drug use disorders, and personality disorders. In all three EDs, major depressive disorder was the most prevalent, followed by alcohol use disorder. AN was associated significantly with fibromyalgia, cancer, anemia, and osteoporosis, and BED with diabetes, hypertension, high cholesterol, and triglycerides. BN was not associated significantly with any somatic conditions.
Conclusions
This study examined lifetime psychiatric and somatic correlates of DSM‐5 AN, BN, and BED in a large representative sample of U.S. adults. Our findings on significant associations with other psychiatric disorders and with current chronic somatic conditions indicate the serious burdens of EDs. Our findings suggest important differences across specific EDs and indicate some similarities and differences to previous smaller studies based on earlier diagnostic criteria.
Several psychological and behavioral treatment options exist for patients who have been diagnosed with binge-eating disorder (BED). Cognitive-behavioral therapy and interpersonal psychotherapy are ...the most strongly supported interventions for BED, but they do not produce weight loss; behavioral weight loss therapy, a more widely available "generalist" intervention, achieves good outcomes for BED plus produces modest weight loss over the short-term. Relatively little is known about reliable predictors or moderators of treatment outcomes, but research has generally supported 2 significant predictors: (1) the presence of overvaluation of body shape and weight and (2) the occurrence of rapid response to treatment. Clinicians should train to provide patients with evidence-supported psychological and behavioral treatments and follow these intervention protocols faithfully to increase the chances of good outcomes.
To investigate, in a nationally representative sample of US adults, the prevalence of help-seeking in individuals with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) ...eating disorders (EDs) and to examine sex and ethnic/racial differences.
The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N=36,309) included respondents who met the criteria for specific lifetime DSM-5 EDs and answered questions regarding help-seeking for their ED symptoms (anorexia nervosa AN: n=275; bulimia nervosa BN: n=91; and binge-eating disorder BED: n=256).
The prevalence (standard error) estimates of ever seeking any help for AN, BN, and BED were 34.5% (2.80%), 62.6% (5.36%), and 49.0% (3.74%), respectively. Adjusting for sociodemographic characteristics, men and ethnic/racial minorities (non-Hispanic blacks and Hispanics) were statistically significantly less likely to ever seek help for BED than were women or non-Hispanic whites, respectively. Hispanics also were significantly less likely to seek help for AN relative to non-Hispanic whites.
This was the first study in a nationally representative sample of US adults to examine rates of help-seeking, including by sex and ethnic/racial differences, across DSM-5-defined EDs. These findings emphasize the need to develop strategies to encourage help-seeking among individuals with EDs, particularly among men and ethnic/racial minorities.
Rates of suicide are increasing in the US. Although psychiatric disorders are associated with suicide risk, there is a dearth of epidemiological research on the relationship between suicide attempts ...(SAs) and eating disorders (EDs). The study therefore aimed to examine prevalence and correlates of SAs in DSM-5 EDs-anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)-in a nationally representative sample of US adults. In addition, prevalence and correlates of SAs were examined in the two subtypes of AN-restricting (AN-R) and binge/purge (AN-BP) types.
The study included 36,171 respondents in the Third National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III) who completed structured diagnostic interviews (AUDADIS-5) and answered questions regarding SA histories and psychosocial impairment associated with EDs. We evaluated lifetime prevalence of SA, psychosocial impairment, clinical profiles, and psychiatric comorbidity in adults with EDs with and without SA histories, and temporal relationships between age onset of SA and EDs.
Prevalence estimates of suicide attempts were 24.9% (for AN), 15.7% (for AN-R), 44.1% (for AN-BP), 31.4% (for BN), and 22.9% (for BED). Relative to respondents without specific EDs, adjusted odds ratios (AORs) of SAs were significantly greater in all EDs: AN = 5.40 (95% confidence intervals CIs = 3.80-7.67), AN-R = 3.16 (95% CIs = 1.82-5.42), AN-BP = 12.09 (95% CIs = 6.29-23.24), BN = 6.33 (95% CIs = 3.39-11.81), and BED = 4.83 (95% CIs = 3.54-6.60). Among those with SA history, mean age at first SA and number of SAs were not significantly different across the specific EDs. SA was associated with significantly earlier ED onset in BN and BED, longer duration of AN but shorter duration of BN, greater psychosocial impairment in AN and BN, and with significantly increased risk for psychiatric disorder comorbidity across EDs. Onset of BED was significantly more likely to precede SA (71.2%) but onsets of AN (50.4%) and BN (47.6%) were not.
US adults with lifetime DSM-5 EDs have significantly elevated risk of SA history. Even after adjusting for sociodemographic factors, those with lifetime EDs had a roughly 5-to-6-fold risk of SAs relative to those without specific EDs; the AN binge/purge type had an especially elevated risk of SAs. SA history was associated with distinctively different clinical profiles including greater risk for psychosocial impairment and psychiatric comorbidity. These findings highlight the importance of improving screening for EDs and for suicide histories.
Specific psychological treatments have demonstrated efficacy and represent the first-line approaches recommended for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Unfortunately, many ...patients, particularly those with anorexia nervosa, do not derive sufficient benefit from existing treatments, and better or alternative treatments for eating disorders are needed. Less progress has been made in developing pharmacologic options for eating disorders. No medications approved for anorexia nervosa exist, and only one each exists for bulimia nervosa and for binge-eating disorder; available data indicate that most patients fail to benefit from available medications. Longer and combined treatments have generally not enhanced outcomes. This review presents emerging findings from more complex and clinically relevant adaptive treatment designs, as they offer some clinical guidance and may serve as models for future enhanced treatment research. Expected final online publication date for the
, Volume 20 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Undue influence of body shape or weight on self-evaluation--referred to as overvaluation--is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating ...disorder (BED). This article addresses the relevance of a feature reflecting disturbance in body image for the diagnosis of BED.
The distinction between overvaluation of shape/weight and body dissatisfaction is discussed, and empirical research regarding the concurrent and predictive significance of overvaluation of shape/weight for BED is reviewed.
The literature suggests that overvaluation does not simply reflect concern or distress commensurate with excess weight, is reliably associated with greater severity of eating-related psychopathology and psychological distress, and has reliably shown negative prognostic significance.
Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED.
Modest weight losses may be associated with improvements in cardiovascular disease risk factors (CVDRF) in patients with obesity. The effects of weight losses on CVDRF in persons with binge-eating ...disorder (BED) are unknown. This study prospectively examined changes in CVDRF among patients receiving behaviorally-based weight-loss treatment (BBWLT) who attained modest weight losses (≥5 to <10% and ≥10%).
Of 191 participants, CVDRF variables were re-assessed in 168 participants at posttreatment and in 151 at 12-month follow-up. Participants who attained ≥5 to <10% weight loss were compared to those who did not on CVDRFs (total cholesterol, HDL, LDL, triglycerides, HbA1C, mean plasma glucose, heart rate, and systolic/diastolic blood pressure); similar comparisons were completed for those who attained ≥10% weight loss.
At posttreatment, ≥5 to <10% weight loss (N = 42; 25.0%) was associated with significant improvements in HbA1c and mean plasma glucose, whereas ≥10% weight loss (N = 40, 23.8%) was associated with significant improvements in total cholesterol, triglycerides, HbA1c, mean plasma glucose, and heart rate. At 12-month follow-up, ≥5 to <10% weight loss (N = 17; 11.1%) was related to significant improvements on HDL, triglycerides, HbA1c, and mean plasma glucose, whereas ≥10% weight loss (N = 40, 26.0%) was associated with significant improvements on all the CVDRF variables (except blood pressure).
Modest weight loss is associated with significant improvements in CVDRFs in patients with BED and obesity following treatment and at 12-month follow-up. Future work should examine whether improvements in CVDRF are attributable to weight loss per se and/or to other related lifestyle changes.
Individuals with binge-eating disorder and obesity who attain modest weight loss following treatment exhibit improvements in various measures of cardiovascular disease risk compared to those who do not. While weight loss has been challenging for individuals with binge-eating disorder, clinicians should inform patients of the potential health benefits of modest weight loss. Future research should investigate whether weight loss itself and/or related behavioral lifestyle changes drive improved cardiovascular disease risk factors.
Objective
To examine whether baseline chronic stress, morning cortisol, and other appetite‐related hormones (leptin, ghrelin, and insulin) predict future weight gain and food cravings in a ...naturalistic, longitudinal, 6‐month follow‐up study.
Methods
A prospective community cohort of 339 adults (age 29.1 ± 9.0 years; BMI = 26.7 ± 5.4 kg/m2; 56.9% female; 70.2% white) completed assessments at baseline and 6‐month follow‐up. Fasting blood draws were used to assess cortisol and other appetite‐related hormone levels at baseline. At baseline and follow‐up, body weight was measured, and the Cumulative Adversity Interview and Food Craving Inventory were administered. Data were analyzed using linear mixed models adjusting for demographic and clinical covariates.
Results
Over the 6‐month period, 49.9% of the sample gained weight. Food cravings and chronic stress decreased over 6 months (Ps < 0.05). However, after adjusting for covariates, individuals with higher baseline total ghrelin had significantly higher food cravings at 6 months (P = 0.04). Furthermore, higher cortisol, insulin, and chronic stress were each predictive of greater future weight gain (Ps < 0.05).
Conclusions
These results suggest that ghrelin plays a role in increased food cravings and reward‐driven eating behaviors. Studies are needed that examine the utility of stress reduction methods for normalizing disrupted cortisol responses and preventing future weight gain.
Although binge-eating disorder may manifest in childhood, a significantly larger proportion of youth report episodes involving a loss of control while eating, the hallmark feature of binge eating ...that predicts excess weight gain and obesity. Adults with binge-eating disorder often report that symptoms emerged during childhood or adolescence, suggesting that a developmental perspective of binge eating may be warranted. Thus, loss of control eating may be a marker of prodromal binge-eating disorder among certain susceptible youth. The present article offers a broad developmental framework of binge-eating disorder and proposes areas of future research to determine which youths with loss of control eating are at risk for persistent and exacerbated behavior that may develop into binge-eating disorder and adult obesity. To this end, this article provides an overview of loss of control eating in childhood and adolescence, including its characterization, etiology, and clinical significance, with a particular focus on associations with metabolic risk, weight gain, and obesity. A conceptual model is proposed to further elucidate the mechanisms that may play a role in determining which youths with loss of control are at greatest risk for binge-eating disorder and obesity. Ways in which treatments for adult binge-eating disorder may inform approaches to reduce loss of control eating and prevent excess weight gain in youth are discussed.
Public Significance Statement
Loss of control eating, which is prevalent among youth, is prospectively associated with excess weight gain and may be a precursor to binge-eating disorder. A conceptual model suggests mechanisms for study to identify youths at greatest risk for adult binge-eating disorder and obesity. The utility of adult binge-eating disorder treatments for preventing exacerbated disordered eating and excess weight gain in youth is discussed.
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