Learning Objectives
By the end of this section, you will be able to:
- Differentiate between bulimia nervosa and binge eating disorder and discuss the driving factors and comorbidities that accompany binge eating disorder
- Plan nursing care and discuss nursing implications for clients in treatment for binge eating disorder
Repeated episodes of excessive eating in shorter amounts of time than most people would eat in that situation accompanied by significant lack of control of eating is called binge eating disorder (BED) (APA, 2013). It is the most common eating disorder in the United States and affects approximately 1.25 percent of adult persons AFAB, 0.42 percent of adult persons AMAB, and 1.6 percent of all teens (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2021). Individuals who binge tend to eat even when they are full or not hungry and may also feel shame or guilt after eating. They exhibit control issues where they consume large amounts of food and have the inability to stop eating. Binge eating recently became categorized as an eating disorder in the DSM-5 after it was formerly recognized as an eating disorder not otherwise specified (APA, 2013).
Comparison with Bulimia Nervosa and Driving Factors behind BED
Bulimia nervosa and binge eating disorder can present in similar fashions. In both disorders, there is a loss of control that can occur with food during binge eating episodes. There are also repeated episodes of eating large quantities of food in a short period of time.
Bulimia versus Binge Eating Disorder
The major difference between the two is that there are no repeated purging behaviors that occur in binge eating disorder. Some people with binge eating disorder may occasionally try strategies to prevent weight gain but not on a regular basis (NIDDK, 2021). These clients tend to be overweight from excess consumption of calories versus clients with bulimia who may be normal weight.
Psychological, Emotional, and Social Drivers of Behaviors
Psychological drivers can play an important role in the behaviors seen with binge eating disorders. Alterations in impulse control are thought to be central to BED, including dysfunctions related to emotion regulation and reward processing (Giel et al., 2022); stress is a common prompt for binge eating episodes.
Other drivers associated with BED include being teased about weight, issues with weight, and body dissatisfaction (Giel et al., 2022). For example, individuals from families that are highly critical of a child’s weight and/or size are at increased risk for developing BED (NIDDK, 2021). Adverse childhood experiences have also been associated with BED.
Risk for Medical Comorbidities
Clients with BED are at risk for medical comorbidities. The most common medical comorbidities seen with BED are obesity, hypertension, arthritis, high cholesterol, cardiac conditions, diabetes, smoking, sleep issues, and metabolic syndrome (Giel et al., 2022). The increase in these medical comorbidities also increases morbidity and mortality. Being obese increases the risk of health-related problems like type 2 diabetes, heart disease, and some cancers (NIDDK, 2021).
Nursing Care
Nurses may encounter clients with BED due to medical complications or attempts to lose weight. Studies have shown that about 50 percent of individuals with BED seek help for their condition and may have barriers related to stigma and shame (Giel et al., 2022). Another barrier to seeking care can include not being aware that they have an eating disorder, so awareness of BED is important. Nursing care for these clients should include an accurate assessment using validated screening tools like the SCOFF questionnaire. Other useful tools are the Eating Attitudes Test (EAT) and the Questionnaire on Eating and Weight patterns (QEWP-R). EAT is a twenty-six-question test used to screen for disordered eating and QEWP-R is a five-question tool used to screen for BED based on diagnostic criteria.
The physical exam should include vital signs and height and weight measurements. Since clients with binge eating disorder can have high BMIs, nurses may need access to scales with large weight capacities. These clients may also require blood sugar monitoring in addition to labs due to their risk of diabetes.
Treatment Interventions
Nursing interventions will focus on weight loss, treating comorbid conditions, avoiding medical complications, and increasing the client’s self-esteem. It may be easier to manage eating behaviors and portions in a controlled environment like in the hospital setting and the client must be encouraged to transition toward self-care. Education and resources to provide discharge support are essential to ensure that clients can continue to make progress. This support may include arranging follow-up care and referrals in the community, providing appropriate contacts for routine care and for emergencies, reviewing medications, and reviewing healthy lifestyles.
Children and Adolescents
Children and adolescents may not be diagnosed with BED but may exhibit issues with control of eating (Giel et al., 2022). This makes diagnosing pediatric populations a challenge because they may not meet the full criteria due to limitations or restrictions regarding food access. Currently, there are no specific guidelines on managing BED in pediatric populations and studies related to treatment are lacking.
Psychotherapy and Behavioral Modifications
Psychotherapy is first-line treatment for BED and can include modalities like CBT, IPT, and DBT (Giel et al., 2022). CBT helps to restructure maladaptive cognitive processes that lead to overeating, such as low self-esteem. Self-help CBT programs that focus on regular eating behaviors, self-control, and problem-solving have also been effective in managing BED (Iqbal & Rehman, 2022). IPT can explore interpersonal function and issues with self-esteem while DBT can be used to help regulate emotions and improve distress responses (Giel et al., 2022).
Behavioral therapies that focus on diet therapy and physical activity have been proven to be effective in treating BED. Diet therapy is used to promote weight loss and includes calorie restrictions, meal planning, and controlling eating behaviors (Amianto et al., 2015). Physical activity is used with caution in clients with medical complications but can be a useful adjunct to diet therapy in stable clients. Physical activity can help promote weight loss and improve mood and overall health (Amianto et al., 2015).
Pharmacology
Lisdexamfetamine is the only FDA-approved medication for BED on the market in the United States. It has been shown to help decrease binge eating and decrease body weight by up to 6 percent (Giel et al., 2022). Lisdexamfetamine is a controlled medication that should be used with caution due to its potential for abuse.
Other medications that have been used to treat BED include SSRIs, antiepileptics medications, stimulants, and weight loss medications. SSRIs like fluoxetine have been shown to reduce bingeing; it is the most commonly prescribed SSRI due to its efficacy with bulimia (Amianto et al., 2015). Antiepileptics like topiramate decrease hunger and stimulants like atomoxetine also decrease bingeing and promote weight loss (Amianto et al., 2015). Phentermine is another stimulant used for weight loss but must be used with caution because of adverse cardiovascular effects that can occur. Medications used for weight loss like orlistat, in combination with a low-calorie diet, can be effective in helping with weight loss but are not helpful for reducing binge eating (Amianto et al., 2015).
Surgical Interventions
Severe obesity in individuals with BED can be treated with bariatric surgery. Severe obesity is defined as clients with a BMI of >40 or >35 with comorbid conditions (Amianto et al., 2015). Bariatric surgery is controversial for clients with BED because it is usually contraindicated in clients with an eating disorder diagnosis. Clinical data and research have shown that it can be effective in BED treatment when it is done in conjunction with psychological interventions and follow-up care (Amianto et al., 2015).
Collaborative Care
BED is a complex eating disorder that requires collaboration from multiple disciplines during care planning. Nurses will play a key role in assessing these clients and implementing interventions from the care plan, such as medication management and health education. Assistive personnel will be essential in completing tasks delegated from the nurse like taking vital signs, passing food trays, and weighing clients. Clients at high risk for suicide may be monitored one-on-one by assistive personnel with frequent assessments by the nurse. Psychiatry and psychology professionals may help manage the disordered thought processes that occur with binge eating. Cardiology or endocrinology professionals may be part of the team if there are medical complications like diabetes or cardiac issues. Nutritionists may also help manage diet therapy and meal planning. A collaborative effort may result in more positive outcomes for the client.
The Therapeutic Relationship and Binge Eating Disorder
Clients with BED often feel a lot of shame and guilt about their condition making a therapeutic relationship an essential part of their care. In addition to providing compassionate, nonjudgmental care, it is important for nurses to be patient and flexible. Clients with BED may lack motivation or have physical limitations due to obesity that may make it difficult to complete tasks. Be flexible with therapeutic efforts and add treatment strategies one at a time to help with satisfaction and compliance (Amianto et al., 2015).