Elsevier

Comprehensive Psychiatry

Volume 53, Issue 7, October 2012, Pages 1021-1027
Comprehensive Psychiatry

Metabolic syndrome in obese men and women with binge eating disorder: developmental trajectories of eating and weight-related behaviors

https://doi.org/10.1016/j.comppsych.2012.02.006Get rights and content

Abstract

Metabolic syndrome (MetSyn), characterized by vascular symptoms, is strongly correlated with obesity, weight-related medical diseases, and mortality and has increased commensurately with secular increases in obesity in the United States. Little is known about the distribution of MetSyn in obese patients with binge eating disorder (BED) or its associations with different developmental trajectories of dieting, binge eating, and obesity problems. Furthermore, inconsistencies in the limited data necessitate elucidation. This study examined the frequency and correlates of MetSyn in a consecutive series of 148 treatment-seeking obese men and women with BED assessed with structured clinical interviews. Almost half of the participants met the criteria for MetSyn. Participants with MetSyn did not differ from those without MetSyn on demographic variables or disordered eating psychopathology. However, our findings suggest that MetSyn is associated with a distinct developmental trajectory, specifically a later age at BED onset and shorter BED duration. Although the findings from this study shed some light on MetSyn and its associations with developmental trajectories of eating and weight-related behaviors, notable inconsistencies characterize the limited literature. Prospective studies are needed to examine causal connections in the development of the MetSyn in relation to disordered eating in addition to excess weight.

Introduction

Obesity has reached epidemic proportions, with more than one third of US adults considered obese (body mass index [BMI] ≥30 kg/m2) [1]. The level of obesity is directly related to metabolic syndrome (MetSyn), a group of vascular risk factors that increase the risk of cardiovascular disease, including hypertension, elevated fasting blood glucose, central adiposity, hypertriglyceridemia, and low serum high-density lipoprotein (HDL) cholesterol level [2], [3]. Metabolic syndrome is a significant risk factor for cardiovascular disease, type II diabetes, all-cause mortality [4], and a growing economic health care burden in the United States [5]. Metabolic syndrome may also be related to health-related quality of life [6], although this is equivocal [5].

The prevalence of MetSyn has increased with the rising rates of obesity. Estimates indicate that 24% of US population has MetSyn [7]. The rates of MetSyn among obese individuals are much higher, with 50% of women and nearly 60% of men meeting the criteria [8]. There also appears to be significant ethnic differences in the prevalence of MetSyn, with Hispanic American women having the highest rates (35.6%) and Caucasian women having the lowest rates (22.8%) [7].

Obesity is a multifaceted problem with complex causes [9]. An important subgroup of obese persons are those who have binge eating disorder (BED) [10]. Binge eating disorder is characterized by recurrent episodes of binge eating (consuming unusually large amounts of food while experiencing a subjective loss of control) without inappropriate compensatory behaviors. Binge eating disorder is associated with severity of obesity, heightened risk for psychiatric symptoms, and elevated levels of self-reported medical symptoms [10]. Obese individuals with BED differ significantly from their non-BED counterparts in their non–binge eating patterns and behaviors [11].

Despite the relationship between obesity and BED, little is known about the association of specific eating behaviors and patterns characteristic of BED to MetSyn. Existing literature suggests that certain eating behaviors associated with metabolic abnormalities are similar to some of the features characteristic of BED. For example, eating large amounts of food in a discreet period is associated with exaggerated insulin secretion, increased fasting glucose levels, decreased glucose tolerance, and elevated serum lipids [12], [13]. Eating rapidly is associated with elevated serum lipids, higher waist-hip circumference ratio, and fatty liver in obese individuals [14]. In addition, irregular meal patterns are associated with MetSyn in the general population [15].

To our knowledge, only 4 published studies have examined MetSyn in obese persons with BED. The first study [16] compared obese men and women with BED seeking weight loss treatment and reported that 32% of participants met the criteria for MetSyn. However, this study observed that rates of MetSyn were much lower than those typically reported in obese populations (50%-60%) and did not examine the correlates of MetSyn [8]. Another study followed overweight and obese individuals with and without BED during a 5-year period and assessed self-reports about components of MetSyn [17]. Individuals with BED, compared with those without BED, were significantly more likely to self-report new diagnoses of MetSyn components (eg, dyslipidemia and hypertension) at follow-up. Hudson and colleagues [17] concluded that BED may confer an added risk for metabolic irregularities independent of weight.

In an examination of obese patients seeking treatment of BED at a university-based research clinic, 60% met the criteria for MetSyn [18]. Metabolic syndrome was significantly associated with ethnicity, BMI, fewer episodes of weight cycling, and meal skipping [18]. Most recently, the fourth study reported that 43% of patients recruited from primary care centers for BED and weight loss treatment met the criteria for MetSyn [19]. Patients without MetSyn started dieting at a significantly younger age, spent more of their adult lives dieting, and reported more current dietary restriction compared with patients with MetSyn. It is unclear if the differences between Roehrig et al [18] and Barnes et al [19] were due to small sample sizes, particularly of men, or because participants were recruited from different sources (ie, specialty clinic vs primary care centers).

Because of the limited and inconsistent research on metabolic abnormalities in obese persons with BED, more research is needed to understand MetSyn in BED. The current study explores the timing of binge eating, diet, and overweight onset to elucidate potential developmental correlates of BED with MetSyn. Research has found distinct developmental trajectories of BED that suggest potentially important clinical implications for an earlier age at binge onset [20], [21], [22]. Individuals who reported an earlier age at binge onset also reported a binge-first (vs diet-first) developmental trajectory [20], [21], [22], a younger age when first met the full BED criteria [21], [22], and younger overweight onset [21], [22]. The current study sought to replicate and extend previous research with a larger sample of both women and men with BED by investigating the frequency of MetSyn and its potential association with eating and weight-related pathology and BED developmental trajectories.

Section snippets

Participants

Participants were 148 consecutively evaluated, treatment-seeking obese individuals who met the full Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) research diagnostic criteria for BED. Participants were recruited via newspaper advertisements seeking obese men and women who eat “out of control” and “want to lose weight” for treatment studies at a medical school-based specialty clinic. Inclusion criteria were a BMI of 30 to 55 kg/m2 and a DSM-IV research diagnosis

Demographic and metabolic variables

Forty-four percent (n = 65) met the criteria for MetSyn; 56.1% (n = 83) did not meet the criteria for MetSyn. Table 1 depicts the comparison of participants with vs without MetSyn on demographic variables as well as MetSyn components. Participants with MetSyn did not differ from those without MetSyn on sex, ethnicity, education, age, or BMI. Participants with MetSyn had, on average, significantly wider waist circumferences, lower levels of HDL, higher levels of triglycerides, higher systolic

Discussion

To our knowledge, this study is the first to examine the associations between MetSyn and the developmental trajectories of disordered eating and weight-related behaviors in a sample of obese treatment-seeking individuals with BED. Understanding the development of MetSyn and associated medical comorbidities in this high-risk subgroup is critically important, given the possible physical consequences and increased health care use of patients with BED [10], [33]. Primary findings indicate that 44%

Acknowledgments

This research was supported by grants from the National Institutes of Health (R01 DK49587, K24 DK070052, and K23 DK071646).

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    1

    Current affiliation: Department of Psychology, Furman University, 3300 Poinsett Highway, Greenville, SC.

    2

    Current affiliation: Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN.

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