Hunger pains

The publication of the results online today in Epidemiology and Psychiatric Sciences is timed to coincide with the beginning of Weight Stigma Awareness Week (September 23-27).

Although both binge-eating disorder and bulimia involve recurrent episodes of excessive food consumption with experienced loss of control, it had been generally assumed that bulimia carried a greater functional burden of illness owing to its more complex symptom profile. A defining symptom of bulimia, lacking in binge-eating disorder, is inappropriate compensatory behavior such as purging or laxative use to offset the weight gain associated with bingeing.

However, compared to matched populations of people with no history of eating disorders, a lifetime history of binge-eating disorder or bulimia each predicted between two- and nearly four-fold increases in current days unable to work or carry out usual activities.

Despite the significant challenges that people with these disorders face, both are generally undetected by medical professionals and therefore left untreated.

"Binge-eating disorder has been largely ignored by health care providers, but it has a tremendous cost to the physical and psychological well-being of people with the disorder," said Ronald Kessler, McNeil Family Professor of Health Care Policy at Harvard Medical School and senior author of the paper. "When all of the cases of the disorder are taken together, the elevated levels of depression, suicide and lost days at work represent substantial costs to society."

The study found that binge-eating disorder and bulimia nervosa both typically arose during adolescence and were associated with a range of later-onset mental disorders (including depression and anxiety disorders) and physical disorders (such as musculoskeletal disorders and diabetes). Early-onset binge-eating disorder was associated with subsequent low rates of employment among men, low rates of marriage among women and high rates of work disability among both men and women.

The researchers concluded that the adverse effects of binge-eating disorder and bulimia on subsequent functioning were largely the result of these later-onset comorbidities. This finding, the researchers said, raises the possibility that expanded efforts at early detection and treatment of eating disorders during the vulnerable school years might help prevent the onset of subsequent mental and physical disorders and impairments associated with these disorders.

In independent commentaries published in the same journal, international experts on eating disorders Janet Treasure and Cynthia Bulik wrote that the evidence in the report argues strongly for proceeding with clinical effectiveness trials to evaluate the long-term effects on adult health and well-being of early detection and treatment of binge-eating disorder and bulimia among students.

The study was based on community surveys in 12 countries. Researchers interviewed a total of 22,635 adult respondents.

Binge-eating disorder was roughly twice as common as bulimia across the countries studied, which included the U.S., several countries in Latin America (Brazil, Colombia, Mexico), a number in Europe (Belgium, Italy, Netherlands, Northern Ireland, Portugal, Romania, Spain) and New Zealand.