To understand the implications of binge eating or compulsive overeating, it is first imperative to understand the term binge eating. Consumption of large quantities of food above the normal threshold to satisfy psychological needs rather than appetite is referred to as “binge eating.” It is more common in women and revolves around futile attempts at reducing weight. Binge eating is a psychological disorder and is characterized by frequent eating, purging, and a self-image that is unduly influenced by weight. The concept of a healthy diet vanishes as soon as a person involves in binge eating. Rather than having a balanced diet compulsive overeating results in consumption of a specific kind of food and leaving the rest. This ultimately causes the accumulation of a certain kind of nutrient at the cost of ill health. Research has postulated that binge eating is associated with type 2 diabetes, heart ailments, high blood pressure, high cholesterol levels, gall bladder disease, and certain types of cancers are also associated with binge eating (Tina, 2007).
Studies have shown that Binge eating is the most prevalent disorder when it comes to psychiatric illnesses. In a study conducted at McLean hospital where the different eating disorders were compared Binge eating came out to be the most prevalent among the disorders. This was the first time that data was compiled on eating disorders. The study was published in the Journal of Biological psychiatry and was based upon data obtained over two years in the National Comorbidity Survey Replication, which was a survey of more than nine thousand people from across the country and their mental health. The survey found that 0.9 percent of women and.3 percent of men reported having anorexia nervosa at some point in their lives and 1.5 % of women and.5 percent of men reported having bulimia nervosa. Binge eating on the other hand afflicts 3.5% of women and 2 % of men at some point in their lives. The survey found that the average lifetime duration of anorexia was 1.7 years and 8.1 years for binge eating. These findings warrant the inclusion of the binge eating disorder into the diagnostic and statistical manual (Hudson, 2007).
Now the vast number of binge eaters has also been classified based on the class or race they belong to and a recent study has pointed out stark relationships between binge eating and African Americans. As related to anorexia nervosa, Binge eating was found to have greater prevalence when it came to African Americans. The adult population of Afro-Americans was compared with that of children and it was found out that the disorder occurred in both of the extremes. The study was conducted between 2001-2003 and was based on interviews carried out in homes of adolescents and adults. The interviews stressed the stress levels, amount of food eaten and other features attached. It was found out that anorexia was the rarest disorder while Binge eating was the most prevalent disorder among adults and adolescents. Persistence for the disorders was lowest for anorexia and highest for binge eating disorder among adults. In conclusion, the study postulated that the prevalence of eating disorders within the U.S. Black population varies by type of disorder, age cohort, gender, and ethnic group among adults, and by type of disorder among adolescents. Clinicians need preparation and training to recognize and treat eating disorders in ethnically diverse patient populations (Taylor, 2007).
In another study, the patients diagnosed with anorexia nervosa and bulimia nervosa, their parents, and therapists were recruited and the study aimed at examining differences between clinical groups and a control group in terms of attachment styles and perceptions of memories of parental rearing. Within the clinical groups, relations among these variables and therapeutic bonds were explored. In addition, parents’ and their daughters’ attachment styles were compared. The results showed differences between clinical and control groups, the daughters in the control group reported lower levels of attachment anxiety compared to those of the clinical groups; their mothers exhibited higher security than mothers of anorectic patients and lower avoidance than mothers of bulimic patients. For the anorectic group, the therapeutic bond was associated with higher father’s emotional support and lower rejection; in the bulimic group, the therapeutic bond was related to higher maternal emotional support and lower rejection as well as to lower paternal overprotection (Tereno, 2007).
It has also been postulated that depression has a very significant relationship with binge eating. In a study that studied patients suffering from binge eating disorder, an evaluation was made for their relationship with depression. Using the diagnostic and statistical manual for evaluating depression, it was pointed out that the majority of the patients with this disorder also suffered from depression (Emery, 2007).
These are some of the facts related to the prevalence of the issue. The long-term effects on health are a major concern for modern-day physicians. With the large number of ailments being contributed to overeating, the focus has been on weight reduction and consumption of a balanced diet. Cardiovascular problems have been regarded as the topmost among those which lead to a high mortality rate. In the present day scenario, cardiovascular problems have resulted from the sedentary lifestyle or what we call a type of personality. A lot of factors contribute to this among which is lack of exercise, increased fat intake, obesity, etc. To be able to evaluate the risk factor ire is necessary that we should be well conversant with the factors affecting and controlling cardiovascular problems. The major risk factors include the following: Cigarette smoking, Elevated blood pressure, elevated total cholesterol and LDL, low serum HDL cholesterol, Diabetes mellitus, advancing age. The other risk factors include obesity, physical inactivity, family history; psychological factors elevated homocysteine, prothrombic factors, and inflammatory markers. These are all in one or the other way related to binge eating.
Some are modifiable while others are classified as nonmodifiable. Enzyme level elevations have long been used as markers in the case of different pathologies and cardiac disease is no exception. (Cotran, 2006). A lot has been written and explained with regards to the different enzyme levels which are elevated in the case of cardiovascular pathologies. In the case of an MI, biochemical analysis has been regarded as mandatory along with ECG.
Before we indulge in the details of the topic it might be prudent to explain the reason or the cause of the elevated enzymes. What happens is that the cell contains various cellular proteins along with its various organelles. During acute stress, the cell tries to overcome that stress by bringing about changes in its morphology, such as cell swelling, failure of the different endothelial pumps, and hypoxic response to compensate for the stress. In case the stress is an irreversible one the cell begins to “lyse” and results in cellular proteins being leaked out through the cell wall and ultimately the cell wall resolves. This procedure of a cell wall breaking down and the cellular particles leaking out constitute the basis for the elevated enzymes in a certain pathology. By this, we may understand that the elevation of enzymes is in concurrence with a cellular injury and can be utilized as a marker in case of any disease process in which the individual cell structure is being affected (Carney, 2006).
Now keeping this in mind we come to the point that the basic cause of all this is infected inactivity and unhealthy eating. Binge eating is a part of the whole picture. A study that concentrated on the relationship between binge eating and obesity lead to the conclusion that binge eating is one of the outcomes of obesity-related treatment and the patient end up eating more carbohydrates than he previously was. This results in the conversion of carbohydrates into fatty acids through etherification and subsequent accumulation of lipids. This in the long term gives rise to type two diabetes.
Type two diabetes has long been associated with obesity and the treatment revolves around abstaining from excessive eating and indulging in overeating. What causes this rapacious appetite? It is a combination of different stimuli stemming from several sources, from hormonal stimulation to feedback response to noncompliance of tissues. The result is that the appetite center or the satiety center is not pacified and this results in overindulgence in eating. Binge eating is a disorder that emerges due to the combination of many factors. These may be psychological, cultural, environmental, or societal. These factors may also include chemical imbalances in neurotransmitters such as serotonin, pancreatic polypeptides and cytokine activate (Nicholls, 2005).
Multiple organ systems are affected due to binge eating ranging from gastrointestinal to cardiovascular to electrolytic abnormalities. Pulmonary aspiration and renal failure are not far-fetched possibilities either. Binge eating has been thought to be a disease of the white population but the black population has not been spared as pointed out earlier. A few hypotheses which suggest the development of Binge eating disorder are as follows. Serotonergic functioning is supposed to play an important role when it comes to binge eating disorders. Low serotonin levels are consistent with binge eating disorders. The satiety center is not satisfied and this results in indulgence in overeating. Increased levels of pancreatic polypeptides have also been postulated to be a major contributor to this disorder. Pancreatic polypeptide is associated with appetite and its raised levels result in an increase in appetite and thus indulgence into overeating. Premorbid psychiatric disorders are also thought to be linked to binge eating (Carney, 1996).
A strong history of dieting is also associated with the development of binge eating disorders. Cultural factors also play a huge role. Binge eating is observed in inhabitants of developed countries which have an excess food supply and thus it is a personal choice of people to indulge in overeating. Of the major organ systems affected the major ones and the effect that binge eating has on them are as follows. Starting from the CNS the patient experiences seizure activity, this might be due to the decreased levels of neurotransmitters and the imbalance of polypeptide hormones. The seizure may take any form from localized to grand mal or generalized ones.
The electrolytic abnormality may lead to hypokalemia. Now hypokalemia which develops as a result of electrolytic abnormality leads to cardiac arrhythmias. Increased carbohydrate content ultimately leads to the formation of fatty acids and sterols. A brief account of the logogram might show us that the lipogram consists of levels of LDL, HDL, total cholesterol, and triglycerides. Before comprehending the other effects of binge eating and its effect on the cardiovascular system we must make ourselves conversant with the various lipids. Cholesterol is a sterol. The normal level of cholesterol varies from 150-250 mg%. Hypercholesterolemia, hypertension, binge eating, and cigarette smoking have been identified as major independent risk factors for the development of premature cardiovascular diseases.
In plasma, cholesterol and TG form integral components of macromolecular complexes called lipoproteins which are conjugated proteins. The lipid part is the prosthetic group and lipid-free proteins are designated as apoproteins or apo lipoproteins. Lipoproteins serve as a carrier of lipids in plasma. Since lipids account for much of the energy expenditure of the body, the problem is presented with a problem in the transportation of hydrophobic lipids. And this arouses a need to form hydrophilic lipoprotein complexes. Lipids are classified based on density as High density, low density, chylomicrons, and very low-density lipoproteins.
The density is expressed as the Svedberg unit. LDL is designated to take and transport lipids to the peripheries of the body and is responsible for the deposition of the lipids in the peripheral arteries and veins resulting in the formation of atheromatous plaques and deep venous thrombosis, while HDL is involved in the transport of lipids to the center i.e. the liver where metabolism can take place. HDL is also termed as good cholesterol while LDL is referred to as bad cholesterol. Females have a higher HDL as compared to males and this results in decreased risk of females for cardiovascular problems.
The deposition of fatty acids or cholesterol in the peripheries of the body is correlated with the formation of atheromatous plaques. There is a more accepted theory that that inflammation fuels the development and progression of atherosclerosis. Inflammation can also cause certain plaques to rupture Blood clots tend to form over ruptured plaques and then can occlude arteries. Excess LDL in the blood might trigger arterial inflammation and cholesterol-lowering therapies can reduce it. The various levels as prescribed by physicians for the different ranges of the lipids are as follows.
The presence of C-Reactive protein is a marker of inflammation and highly elevated levels even in the presence of low levels of LDL is a risk factor indicator, In a study where people were administered stations when their LDL was normal but c reactive protein was raised it resulted in lowering of the incidence of heart attack or stroke. This proves beyond doubt that the inflammatory cascade is responsible for the increased risk factor of cardiovascular disease. This picture explains why many heart attacks come from out of the blue, the plaques that rupture does not necessarily protrude vary far in the blood channel and so may not cause angina.. So examining both the c reactive protein and cholesterol is a more reliable indicator for the risk assessment of cardiac pathology. Statins are prescribed for patients who are at a risk for a cardiovascular problem.
The various statins are pharmaceutical products that are prescribed to patients who are at risk of developing a cardiac problem. The statins effect by acting on different pathways in the lipid metabolism and then affecting them, thus resulting in lower levels of lipids or controlling the ratio of LDL and HDL Pharmaceutical studies have shown that statins affect the liver function and so the estimation of the levels of the liver enzymes is required for patients on statins and contributes in the estimation of risk factors (Walsh, 1998).
When it comes to the pulmonary system binge eating may result in the pulmonary aspiration of gastric contents leading to pneumonia and pneumomediastinum. Gastrointestinal abnormalities may revolve around esophagitis, delayed gastric emptying pancreatitis, and esophageal rupture. Muscular weakness may be observed due to muscular tenant and this is as a result of the inordinate supply of calcium in an unbalanced diet. Renal function is also impaired because of the increased osmotic load and psychiatric manifestations like substance abuse, depression, and suicidal tendencies are also a hallmark of binge eating disorder (Ellen, 1997).
The treatment of binge eating disorders mainly revolves around counseling and awareness. Medication therapy has also shown to be of considerable use but only a limited number of patients receive lifetime remission on medication alone and relapses occur as soon as the medication is discontinued. The relapse rate is around 30% and patients may experience on and off symptoms for a considerably long time (Walsh, 1998).
The treatment should focus on personal behavioral modifications. Psychological counseling along with comprehensive teaching and education programs may help create the awareness that is needed to be built up regarding binge eating disorders. Teachers should also be included in the program and should be made aware to be on the lookout for children that might be experiencing these symptoms. When we talk about awareness, the crucial point of awareness of the family cannot be overlooked as these are the people that are most close to the patients. Close family contacts should be informed and educated about the disorder.
If these measures fail then gastric procedures like Roux-en-Y gastrojejunostomy have proved to be quite useful when it comes to the treatment of such disorders, but the cost and the repercussions of the procedure need to be kept in mind. Studies have shown that even after surgical procedures the patient might go on to have bouts of binge eating and this might adversely affect the outcome of the procedure. Binge eating has its roots in the mind and it is the mind that needs to be elucidated to be made aware regarding the hazards of binge eating.
Physicians must be made aware that it is a disease like any other ailment and needs to be looked into and cured. The policies in practice at the moment need to concentrate more on the issue of education and implementing strategies to combat the future burden of disease. More research into establishing protocols might as well make the use of medicines against binge eating a reality through a lot of medicines are being used for treating the disorder as well. At the moment health care professionals should concentrate on bridging the gap between the patients.
Taking a cursory look over the findings and treatment options presented in this paper, the point which comes into the limelight is the fact that the family-based approach to binge eating is still in its developmental stages. The development of procedural initiatives and education of the health staff along with the patient and their families is the key to effective binge eating. With more and more research finding its way and newer treatment modalities, binge eating management may find the breakthrough it needs. The future lies in expanding our horizons and looking beyond what we deem possible. Effective overeating management through a family-based approach may not be a far-fetched reality after all.
References
Cotran RS, Kumar V, Collins T. (2006). Robbins Pathologic Basis of Disease. WB Saunders and Co.
Carney CP, Andersen A E. (1996). Eating disorders. Guide to medical evaluation and complications. Psychiatric Clinical journal of North America, 19, 657-59.
Ellenhorn M J. (1997). Ellenhorn’s Medical Toxicology. Williams & Wilkins.
Emery CF , Fondow MD, Schenieder CM, Christofi FL, Hunt C. (2007). Gastric bypass surgery is associated with reduced inflammation and less depression: a preliminary investigation. Journal of obese surgery, 8, 759-763.
James I. Hudson. (2007). Binge eating more common than other disorders. Journal of biological psychiatry, 2.
Nicholls D, Viner R. (2005). Eating disorders and weight problems. Nicholls.
Taylor JY, Caldwell CH, Baser RE, Faison N, Jackson JS. (2007). Prevalence of eating disorders among blacks in the national survey of American life. Journal of eating disorders, 3, 33-39.
Tereno S , Soares I , Martis C , Celani M , Sampaio D. (2007). Attachment styles, memories of parental rearing and therapeutic bond: a study with eating disordered patients, their parents and therapists. The Journal of European eating disorder, 5, 26-37.
Walsh BT, Devlin MJ. (1998) Eating disorders: progress and problems. Williams & Wilkins.