Binge eating disorder persists longer than previously thought, study finds

Binge eating disorder is the most common eating disorder in the United States, but previous studies have shown conflicting views on the duration of the disorder and the likelihood of relapse. A new five-year study led by researchers from McLean Hospital, a member of the Mass General Brigham Health Care System, found that 61 percent and 45 percent of people still had binge eating disorder 2.5 and 5 years after their initial diagnosis. , respectively. These results contrast with previous prospective studies that documented faster remission times, according to the authors.

The important thing is that binge eating disorder gets better over time, but for many people it lasts for years. As a clinician, often the clients I work with report many, many years of binge eating disorder, which felt very contrary to the studies that suggested it was a transient disorder. It’s really important to understand how long binge eating disorder lasts and how likely people are to relapse so we can provide better care.”

Kristin Javaras, DPhil, PhD, first author, assistant psychologist in the Department of Women’s Mental Health at McLean

The results were published May 28 in Psychological Medicine, [JR1] published by Cambridge University Press.

Binge eating disorder, which is estimated to affect somewhere between 1 percent and 3 percent of US adults, is characterized by episodes in which people feel a loss of control over their eating. The average age of onset is 25 years.

While previous retrospective studies, which rely on people’s sometimes faulty memories, have reported that binge eating disorder lasts an average of seven to sixteen years, prospective studies that follow people with the disorder over time have suggested that many people with the disorder they go into remission within a much shorter time frame – from one to two years.

However, the researchers noted that most previous prospective studies had limitations, including a small sample size (<50 participants) and were not representative because they focused only on adolescent or young adult women, most of whom had a BMI of less than 30. while about two-thirds of people with binge eating disorder have a BMI of 30 or more.

To better understand the time course of binge eating disorder, researchers followed 137 adult community members with the disorder for five years. The participants, who ranged in age from 19 to 74 and had an average BMI of 36, were assessed for binge eating disorder at the start of the study and reassessed 2.5 and 5 years later.

After five years, most of the study participants were still experiencing binge eating episodes, although many showed improvements. After 2.5 years, 61 percent of participants still met full criteria for binge eating disorder at the time the study was conducted, and an additional 23 percent had clinically significant symptoms, although they were below the threshold for binge eating disorder . After 5 years, 46 percent of participants met full criteria, and an additional 33 percent had clinically significant but subthreshold symptoms. Notably, 35 percent of subjects in remission at the 2.5-year follow-up had relapsed into either full-blown or suboptimal binge eating disorder at the 5-year follow-up. The criteria for diagnosing binge eating disorder have changed since the study was conducted, and Javaras notes that under the new guidelines, an even greater percentage of study participants would have been diagnosed with the disorder at the 2.5- and 5-year follow-up .

Javaras added that because the study participants were members of the community who may or may not be receiving treatment, rather than patients enrolled in a treatment program, the study results are more representative of the natural time course of binge eating disorder. When comparing this community sample to those in treatment studies, treatment appeared to lead to faster remission, suggesting that individuals with binge eating disorders would benefit from the intervention. There are wide disparities in who receives treatment for eating disorders, according to Javaras.

Although there was variation among participants in the likelihood of remission and the time it took, the researchers were unable to find strong clinical or demographic predictors of the duration of the disorder.

“This suggests that no one is much less or more likely to become better than anyone else,” Javaras said.

Since the end of the study, researchers have been investigating and developing treatment options for binge eating disorder and are considering screening methods to better identify people who would benefit from treatment.

“We are studying binge eating disorder with neuroimaging to better understand the neurobiology involved, which could help enhance or develop new treatments,” Javaras said. “We’re also looking at ways to catch people earlier, because many don’t even realize they have binge eating disorder and there’s a big need for increased awareness and screening so that intervention can start sooner.”