Australia’s most common eating disorder is under-recognised: Expert

Evelyn Lewin

13/02/2020 3:35:56 PM

It represents nearly half of all eating disorders, is as common in men as it is in women, and affects around one million people.

Woman eating a burger on a park bench.
BED is characterised by frequently eating excessive amounts of food, often when not hungry.

‘It’s not spoken about enough.’
That is Rachel Simeone, a psychologist who specialises in eating disorders, from InsideOut Insitute.
What she is referring to is binge eating disorder (BED), a condition she said is not commonly spoken about in the general public and remains ‘under-recognised’ by health professionals.
‘When we think about eating disorder, we tend to think of anorexia [nervosa] in a young woman,’ Ms Simeone told newsGP.
‘In fact, that’s the smallest prevalence rate, and BED has the highest prevalence rate of any eating disorder.’
According to Eating Disorders Victoria, BED is a psychological illness characterised by frequently eating excessive amounts of food, often when not hungry.
It is not the same as overeating, as it is recurrent and more serious, with feelings of guilt, disgust and depression often following a bingeing episode.
The disorder also differs from bulimia nervosa, insofar as binges are not followed by purging behaviour.
An estimated 47% of Australians with an eating disorder have BED. In fact, Ms Simeone said current prevalence rates suggest it affects approximately one million Australians.
While patients with severe anorexia nervosa can be identified clinically, patients with BED do not fit into any single particular pattern.
‘You can’t look at someone and know that they have BED,’ she said.
Patients with BED come in ‘all shapes and sizes,’ Ms Simeone said. However, she said obesity is a common comorbidity, as is type 2 diabetes.
It has psychological comorbidities, too.
The binge eating behaviour is usually performed in secret when the patient is alone, meaning often close friends and family do not know the patient is engaging in such behaviours.
‘There’s quite a lot of shame and guilt around this behaviour,’ Ms Simeone said.
She said other comorbidities include anxiety and depression.
Unlike other eating disorders, Ms Simeone said the prevalence rates of BED are equal in men and women.
It is also more likely to occur in people aged in their 20s and 30s, unlike other eating disorders which tend to occur more in teens.
‘But it can occur across the age spectrum,’ she said.
GPs can play a vital role in helping patients with this condition, Ms Simeone said, especially because patients with BED often present to their GP asking for help with weight loss.
‘The best thing that GPs can do is ask questions,’ she said.
‘Even just basic questions about nutrition and eating behaviours, that should give you a clue whether someone’s going on a diet and how extreme those dieting practices are, whether they’re engaging in compensatory behaviours … how they feel about their bodies, and what sort of things they’re doing with their food.’
Those kinds of questions might ‘raise a flag’ that a patient may have an eating disorder, she said.
GPs are then ideally placed to help patients with the condition.
‘It’s important for GPs to know that if [a patient] has BED, sending them off to, say, a dietitian for weight loss will actually exacerbate the BED,’ she said.
Instead, Ms Simeone said effective treatment for BED is to refer a patient to a dietitian who specialises in eating disorders, or a psychologist who specialises in eating disorders – or both.
She said psychological input is often critical for such patients as they engage in these binge eating behaviours for a deeper reason.
‘People aren’t necessarily making a choice to eat in this way,’ she said.
‘It’s serving a purpose for them and can be difficult for them to change for that reason, even though it’s not helping them in the long term.
‘It might be that they’re using [binge eating] to cope with difficult emotions. It could be part of a diet cycle, where they’re under-eating, getting hungry, overeating.’
Whatever the underlying reason for binge eating, Ms Simeone said when such behaviours occur, patients do not have control in that moment.
‘It can be quite difficult. If you set goals around [treating BED] without helping to treat that underlying cause, then they’re going to fail in those goals and feel even worse and probably end up needing to eat more to cope with that,’ she said.
While dietitians and psychologists who specialise in eating disorders remain the mainstay of treatment, Ms Simeone said self-help programs can also prove effective, as can certain amphetamines in intractable cases.
Binge eating disorder was only recognised as a condition in its own right when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) was released in 2013.
Before then, it fell under the category of Eating Disorder Not Otherwise Specified (EDNOS).
The DSM-5 classification and criteria for BED is available in Australian Family Physician (now Australian Journal of General Practice).
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