The nature of the association between binge-eating severity and metabolic syndrome.


within-group heterogeneity and variability in severity of the disorder and assist clinicians in tracking patients’ progress. Four BED severity groups based on the frequency of BE episodes were defined in the DSM-5 [1] as follows: mild (1–3 episodes/week), moderate (4–7 episodes/week), severe (8–13 episodes/week), and extreme (>14 episodes/ week). Recent research detected significant differences in MetSyn prevalence featured by 8.5, 36.5, 64.7 and 93.9% of adults who were classified with DSM-5 mild, moderate, severe, and extreme severity of BED [8]. The fact that these significant between-group differences in MetSyn prevalence persisted even after adjusting for BMI without any attenuation of (large) effect size [8] implies the possibility of non-BMI-mediated mechanisms. Although past research has also suggested links between BE behaviour and metabolic dysfunction and that BED confers a risk of MetSyn even after adjustment for BMI, the nature of this BMI-independent effect remains enigmatic [10, 11]. It may represent a direct effect of BE, possibly due to the large amount of food (often in the range of 2000–5000 kcal) ingested in typical eating binges [10] with metabolic irregularities characterizing the MetSyn being potentially more pronounced in people who binge eat on a frequent basis [8]. Rapid consumption of large amounts of food can also increase oxidative and inflammatory stress [12], and inflammatory changes are assumed to be an important pathway for the development of metabolic abnormalities [11]. Alternatively, since BED seems to be partially caused by genetic factors independent of obesity [13], the likelihood that these or other underlying non-genetic factors increase the risk for MetSyn through separate pathways not mediated by excess BMI and/or frequent BE behaviour cannot be ruled out [10, 11]. For example, besides empirical evidence that the mild, moderate, severe, and extreme severity groups of BED were statistically distinguishable in mood Successful treatment of binge-eating disorder (BED), defined by recurrent binge eating (BE) in the absence of extreme weight compensatory behaviours [1], is critical because of its association with pronounced psychosocial impairment, severe psychiatric-disorder comorbidity and significant morbidity, including medical complications related to excess body mass index (BMI) [2–7]. The authoritative review by Olguin and colleagues recently published in this journal [3] has given an important update on the medical comorbidity of BED. Although the metabolic syndrome (MetSyn) is a constellation of interrelated abnormalities of metabolic origin associated with excess BMI (i.e., obesity), Olguin et al. [3] highlighted that BED may increase the risk of MetSyn over and above the risk attributable to obesity alone. This notion, important for both aetiological and practical implications (see also below), can possibly be complemented by just published evidence [8] on the severity of BED (as defined by the DSM-5 [1]) and its impact on MetSyn, beyond that of excess BMI (i.e., obesity). BED, like bulimia nervosa, is characterized by substantial within-diagnosis heterogeneity such that different individuals with the same disorder may exhibit variations in terms of symptom severity, underscoring the need for valid indicators of disease severity [2, 9]. The DSM-5 [1] introduced a new severity specifier for BED, whose validity and utility have recently been established [2], to address

DOI: 10.1007/s40519-017-0386-9

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@article{Dakanalis2017TheNO, title={The nature of the association between binge-eating severity and metabolic syndrome.}, author={Antonios Dakanalis and Massimo Clerici}, journal={Eating and weight disorders : EWD}, year={2017} }