Elsevier

Women's Health Issues

Volume 26, Issue 4, July–August 2016, Pages 420-428
Women's Health Issues

Women Veterans' Health
Binge Eating among Women Veterans in Primary Care: Comorbidities and Treatment Priorities

https://doi.org/10.1016/j.whi.2016.02.004Get rights and content

Abstract

Background

Little is known about the clinical profile and treatment priorities of women with binge eating disorder (BED), a diagnosis new to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. We identified comorbidities and patients' treatment priorities, because these may inform implementation of clinical services.

Methods

Data were collected from women veteran primary care patients. Analyses compared those who screened positive for BED (BED+), and those without any binge eating symptoms (BED−).

Results

Frequencies of comorbid medical and psychological disorders were high in the BED+ group. The BED+ group's self-identified most common treatment priorities were mood concerns (72.2%), weight loss (66.7%), and body image/food issues (50%). Among those with obesity, a greater proportion of the BED+ group indicated body image/food issues was their top treatment priority (12.9% vs. 2.8%; p < .01), suggesting that these patients may be more apt to seek treatment beyond weight management for their problematic eating patterns.

Conclusions

Women primary care patients with BED demonstrate high medical and psychological complexity; their subjective treatment priorities often match objective needs. These findings may inform the development of targeted BED screening practices for women with obesity in primary care settings, and the eventual adoption of patient-centered BED treatment resources.

Section snippets

Study Design and Setting

Women veterans completed interviewer-administered surveys in primary care clinics as part of a larger cross-sectional study (Kimerling et al., 2015) conducted at the four founding sites of the VA Women's Health Practice-Based Research Network (Frayne et al., 2013). The VA Women's Health Practice-Based Research Network, a partnership of clinicians and researchers across 60 sites nationally, provides infrastructure for evaluating health services-related research questions among a broad base of

Descriptive Analyses

The rates of positive BED screens (7.5%) and obesity (47.0%) were high. Overall, 22.0% had class 1 obesity (BMI = 30.0–34.9 kg/m2), 14.8% had class 2 obesity (BMI = 35.0–39.9 kg/m2), and 10.2% had class 3 obesity (BMI ≥ 40 kg/m2). As Table 1 shows, women in the BED+ group were more likely than the BED− group to be unmarried/unpartnered, to have four or more primary care visits in the past year, and to have lower annual household income. In the obesity subsample, the direction of group

Discussion

We evaluated women veteran primary care patients in the VA with the potential to seek mental health and/or behavioral medicine services, and found that women who screened positive for BED had a more complex clinical profile and distinct treatment priorities. Broadly, to highlight our main findings, women in the BED+ group were more likely than other women to have a low household income, and were less likely to be married or partnered. Depression symptoms and several psychological conditions

Acknowledgments

This study was funded by the VA HSR&D (Project SDR 10–012). Dr. Yano's effort was funded by a VA HSR&D Service Senior Research Career Scientist Award (RCS 05–195). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Diane L. Rosenbaum, PhD, is a postdoctoral fellow at Drexel University in the Department of Psychology. Her research interests include binge eating disorder and maladaptive eating, obesity and weight control, and weight and eating interventions for women.

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    Diane L. Rosenbaum, PhD, is a postdoctoral fellow at Drexel University in the Department of Psychology. Her research interests include binge eating disorder and maladaptive eating, obesity and weight control, and weight and eating interventions for women.

    Rachel Kimerling, PhD, is a clinical psychologist and investigator with the National Center for PTSD and the Center for Innovation to Implementation at VA Palo Alto Health Care System. Her research focuses on women's health services, veterans, trauma, and PTSD.

    Alyssa Pomernacki, MPH, is a coordinator for the VA Women's Health Practice-Based Research Network at the Center for Innovation to Implementation, VA Palo Alto Health Care System. Her research interests include women's health services, veterans, and public health programming.

    Karen M. Goldstein, MD, MSPH, is a researcher at the Durham VAMC Center for Health Services Research in Primary Care, and an Assistant Professor at Duke University. Her research focuses on cardiovascular disease in women, and health outcomes in vulnerable populations.

    Elizabeth M. Yano, PhD, MSPH, is Director, VA HSR&D Center for the Study of Innovation, Implementation and Policy, and Adjunct Professor, Health Policy and Management at the UCLA School of Public Health. Her research focuses on primary care delivery models.

    Anne G. Sadler, PhD, RN, is a researcher, Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, and an associate professor, Psychiatry, The University of Iowa. She studies military violence risk factors and postdeployment care engagement.

    Diane Carney, MA, is the Program Manager of the VA Women's Health Practice-Based Research Network at the Center for Innovation to Implementation, VA Palo Alto Health Care System. Her research interests include women's health research, veterans, and patient-centered care.

    Lori A. Bastian, MD, MPH, is Senior Research Associate, VA Connecticut Healthcare System, and Professor, Division Chief of General Internal Medicine, University of Connecticut Health Center. Her research focuses on improving care for women veterans, women's health behaviors, and smoking cessation.

    Bevanne A. Bean-Mayberry, MD, MHS, is an investigator at VA Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation and Policy and UCLA David Geffen School of Medicine. Her research focuses on improving women's health care services.

    Susan M. Frayne, MD, MPH, is a researcher, VA Palo Alto Health Care System, Center for Innovation to Implementation, and Professor of Medicine, Stanford University. Her research includes health care for women veterans, improving primary care, and health sequelae of trauma.

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