A Vagus Nerve Review

In the past months, the vagus nerve has been showing up quite a lot in the media. Before moving on to consider more recent theories and claims connected with this anatomical feature, it will be useful to recollect some past mentions of it in Childhood Obesity News and other sources. The vagus nerve connects the brain to the heart, lungs, digestive tract, and several other entities.

This quotation from technology writer Aaron Mamiit gives a basic explanation of what the nerve does:

Functions of the vagus nerve involve the enabling of several mechanisms in the human metabolic and gastrointestinal systems, including stomach expansion, stomach contraction, gastric acid release, stomach content release into the small intestine, digestive pancreatic enzyme secretion and the sensations of both hunger and fullness.

Some have gone so far as to call the human gut the “second brain.” It is full of the same neurotransmitters as the brain, and the vagus nerve hooks the brain and gut together as definitively as a pair of conjoined twins. Even if either party objected to such a close and codependent association, they have no choice in the matter.

When the microbiome is out of balance, it can act locally, to cause inflammatory bowel disease complete with pain, vomiting, and diarrhea. Thanks to the vagus nerve, it apparently also has the power to reach all the way up into the brain and cause reactions there, that are the loftier equivalents of pain, vomiting, and diarrhea. It has even been suggested that the “addictive personality” originates not in the mind, but in the intestines.

What’s down there anyway?

The microbiome is made up of several different kinds of organisms. Scientific efforts to sort out the bad from the good became laughable when researchers realized that disease-causing strains can, on occasion, be useful and helpful. Conversely, the most seemingly benign sorts can, under the wrong conditions, damage us.

Our tenants, the gut bugs, can manipulate behavior and mood by altering the neural signals in the vagus nerve. Their tricks include the ability to produce toxins that make us feel bad, and release chemical rewards to make us feel good, and change taste receptors (making certain foods “taste better”). Oh, and release hunger-inducing hormones.

The small intestine is also inhabited by enteroendocrine cells, or EECs, which are important in ways not yet fully comprehended, but we do know they influence obesity. They differentiate into about 15 kinds of cells, and each one only lives from three to five days, so they are constantly being replaced. (Their dead bodies feed the gut bugs.)

The sub-category called L cells makes glucagon-like peptide-1, more familiarly known as GLP-1, which has received a lot of publicity lately. It regulates appetite and consumption by accessing the vagus nerve to influence the brainstem and hypothalamus. Other L cells are responsible for GLP-2, active in the inflammation associated with obesity. The EECs live cheek-by-jowl with the microbiota with whom they interact in ways that are, as yet, not fully comprehended.

Your responses and feedback are welcome!

Source: “Appetite Pacemaker: Here’s How this Weight Loss Implant Works,” TechTimes.com, 01/15/15
Image by Beth Scupham/ATTRIBUTION 2.0 GENERIC

Why Is the Most Recommended Childhood Obesity Treatment Not Readily Available?

For many U.S. parents seeking help for a child with obesity, the most widely endorsed treatment is out of reach — and it’s not the popular GLP-1 agonists like Wegovy, used for weight loss and managing diabetes.

What is the recommended childhood obesity treatment?

Leading medical groups recommend intensive behavioral counseling, spanning 26 hours within one year, to teach children and their families practical ways to eat healthier and be more active. Sounds good, right? A recent Reuters article digs into the reasons these touted programs aren’t easy to find.

And why is not widely available?

These programs are not widely accessible, with wait lists often stretching for several months. They are frequently not covered by health insurance and require a time commitment that many families find challenging, according to interviews with over a dozen doctors and parents.

No treatment option improvement is expected

Consequently, fewer than 1% of the nearly 15 million U.S. children with obesity receive this type of structured care, the U.S. Centers for Disease Control and Prevention (CDC) told Reuters. Efforts by the CDC and other organizations to expand insurance coverage have stalled, doctors involved in the process also told Reuters.

“The coverage for these programs was never good, and we’re not seeing any movement toward improvement,” said Dr. Joseph Skelton, a professor of pediatrics and obesity medicine specialist at Wake Forest University School of Medicine.

No end in sight for curbing childhood obesity

The prevalence of obesity among U.S. children has steadily increased, from 5% in 1980 to nearly 20% now, according to the CDC. It’s also a global issue. New research published by JAMA Pediatrics and based on a review of global studies revealed that the prevalence of obesity increased by 150% in the period covering 2012–2023 compared to 2000–2011, indicating that pediatric obesity and overweight conditions are increasingly common. The problem is getting worse.

This is where the GLP-1 drugs come in

According to new research, the number of young people in the US prescribed GLP-1 agonist drugs, such as Wegovy and Ozempic, for weight loss and diabetes increased by 594.4% over the past three years. The most notable increase in prescriptions was observed among young women and adolescent girls.

Last year, the American Academy of Pediatrics updated its obesity management guidelines, recommending that in addition to behavior and lifestyle interventions for the entire family, weight loss medications are suitable for children aged 12 and older.

Clinical trials involving intensive behavioral programs for children and found that, on average, children lost 5.7 pounds. In contrast, Wegovy and similar drugs have resulted in a more dramatic weight loss — 15% or more of body weight in clinical trials. This significant weight loss, coupled with a lack of insurance coverage for counseling, may lead more families to consider these medications in the future.

Are GLP-1 medications safe for children?

In short, more research is needed. Many doctors and parents are cautious about using the medication due to the lack of data on its potential impact on a child’s development and other long-term risks.

Some doctors argue that increased use of Wegovy among youth will make it even more critical for children to learn healthy eating habits for the long term. They are concerned that relying solely on the drugs could lead to nutritional deficiencies or eating disorders.

Dr. Thomas Robinson, a professor of pediatrics and director of the Center for Healthy Weight at Stanford Medicine Children’s Health in Palo Alto, California, said:

Many of us believe it would make sense to offer behavioral counseling along with the drug. These drugs are very effective at reducing weight and health risks, but you don’t all of a sudden adopt a healthy diet or become more physically active.

Your responses and feedback are welcome!

Source: “Weight-loss options for children are hard to come by,” Reuters, 6/17/24
Source: “Prescriptions for weight loss, diabetes drugs for young people leaped 600% since 2020, study says,” CNN, 5/23/24
Image by Omar Lopez on Unsplash

A Birds-Eye View of BED

VeryWellHealth.com started off the current year with an extremely detailed overview of the current state of treatment for Binge Eating Disorder (BED), including a perspective on which approaches are likely to be most effective.

(Bear in mind that simple binge eating does not include behaviors intended to cancel out the inappropriate consumption. If the person pursues a counteractive strategy like vomiting or doing exhaustive exercise, that’s a different disorder.)

Showing thorough professionalism by resisting any temptation toward sensationalism, author Heather Jones did not position the most shocking aspect right up front, but left it for the end:

[E]ating disorder treatment can range from $1,500 to $2,000 a day, depending on whether it’s outpatient or inpatient.

Fortunately, there are more affordable self-help options, to be discussed. Altogether, we are looking at a wide range of possibilities, including psychotherapy, lifestyle changes, and medication. Because eating disorders encompass so many complexities, it is recommended that a person obtain the most specialized help available.

Psychotherapy is the most common treatment, possibly because guilt is one of the most common symptoms driving people to seek help. Nobody wants to live in a perpetual state of self-disgust, and even if psychotherapy cannot immediately end the behavior, the exploration of interior states (such as the tendency toward guilt) will certainly be of overall benefit to the patient.

Branching out

As things stand, a less Freudian method — one that does not delve into the murky past — is widely regarded as the first resort. That is cognitive behavioral therapy (CBT), which Jones explains as “a type of psychotherapy that focuses on disordered or negative thinking patterns.”

Not surprisingly, the description is reminiscent of the expression “stinking thinking,” which originated with another widely used and often effective program, Alcoholics Anonymous. In addition to identifying such aberrations, CBT helps to change the wonky thoughts into positive and productive ones.

Then, there is CBT-E, or Enhanced CBT, which narrows down the general usefulness of the technique to a state of maximal helpfulness for eating disorders. Jones says that a therapist “can tailor the treatment to the specific eating disorder that a person has, as well as the unique factors in a person’s life that are contributing to the disorder.”

Here, as in so many aspects of life, the personal touch is very effective:

In one study, CBT-E had a success rate of about 66% in treating multiple eating disorders. A 2014 study showed that participants with binge eating disorder showed improvement during short-term CBT treatment and continued to improve or were stable during the four years after treatment.

It gets even better, with the added benefit that although CBT-E was formulated for adults, it is very amenable to adaptation for use with younger people. For them, as well as for other generations, there is even more good news, in the form of another variation called CBTgsh, where the three small initials stand for guided self-help.

Furthermore, the author notes that “mental health professionals can provide it even if they do not specialize in eating disorders.” It also comes with a caveat:

[R]esearchers are still unsure about the effectiveness of CBTgsh. Older studies suggested that participants with binge eating disorder had positive results from treatment with CBTgsh and that it may be beneficial for some people.

Still, we can’t have everything, and what we do have is quite a lot.

(To be continued…)

Your responses and feedback are welcome!

Source: “What is the Best Binge Eating Disorder Treatment Approach?,” VeryWellHealth.com, 01/10/24

Beware the Coax Coach

July 4 and many other holidays share common traits, such as being the occasion of much overconsumption of not only food but other substances that encourage people to drop their inhibitions and do foolish things, like eat until the cows come home.

That ancient colloquialism has deep significance, implying both duration and inevitability. First, cows don’t come home until it is dark, and sometimes not even then. Second, the cows will eventually return home. The point being, holiday celebrations give a lot of people the opportunity to disappoint themselves once again, be shamed by family members and alleged friends, and make promises they will be unable to keep.

Sure, we get off on the neurochemical effects of carbs and fats, but something else is going on at these times, as we become particularly susceptible to this formulation:

Emotional eating is always symbolic eating and among the chief architects of compulsive and binge eating.

To a vulnerable individual, a cake might as well be cocaine. Billi Gordon, Ph.D., had a lot of insights about the particular type of binge eating that occurs during holidays, and even more to say about how people unwittingly aid and abet the harmful behavior.

This is a very flexible talent that allows humans to convince both ourselves and others that, just because some decorations are hanging from the walls, it is perfectly okay to do things that are not good for us. But we can’t help it. Our brains reliably connect symbols with ideas, so when we see festive holiday paraphernalia, the rational mind is no longer in control.

As if things were not bad enough already, Dr. Gordon observed that compulsive eaters are also more prone than some other types of people to experience inappropriate reactions, read social cues inaccurately, misinterpret interpersonal situations, and so forth. It gets worse. There are multiple layers of meaning, with the potential to grow progressively darker. Speaking from personal experience, Dr. Gordon wrote in Psychology Today,

Some badly abused children use chewing and compulsive eating to symbolically destroy the mother, while other abuse survivors use chewing and compulsive eating as a symbolic replacement for maternal love.

Gordon holds that basically everybody is capable of eating to drown and bury feelings. It’s part of our basic equipment. The behavior is potentially in everyone’s repertoire, even if they rarely feel the inclination. Some people manage to sail through life without ever becoming enmeshed in that particular trap.

Other lucky people only respond on rare occasions to the symbolic and emotional lure of eating. A compulsive overeater is one who employs the mechanism far too often, because their emotional center is burdened with far too many cues, both external and internal, that they are unable to either ignore or overcome.

The traps

It is very difficult to resist family members and other close people who urge us to eat more. They do it on their own behalf, as in, “What’s wrong, I didn’t whip the potatoes soft enough for you?” They need to score some kind of point off you, because of their own emotional difficulties. Or, they do it by proxy, as in, “Take some gravy. Don’t hurt your mother’s feelings.” A family gathering is an ideal time for fakers and posers to try and impress the crowd with how much they care.

But even fakers and posers are relatively easy to overcome when compared to coaxers. This individual purports to not care about their own feelings or other people’s feelings. No, no — the coax coach is all about you. “Oh just have one little bite, it won’t hurt you.” They wheedle and tempt and cajole as if they have some personal stake in fattening you up like some kind of sacrificial lamb. Who knows what twisted motives impel people to tempt sober alcoholics and faithful spouses and people who really simply do not want or need “just one little bite.”

The takeaway

The best holiday advice is, “Drive responsibly.”
The next most important holiday advice is, “Don’t listen to a coax coach.”
And for goodness’ sake, please don’t be one.

Your responses and feedback are welcome!

Source: “Christmas Cookie Blue,” PsychologyToday.com, 12/06/13
Source: “Symbolic Eating,” PsychologyToday.com, 11/23/13
Image by Johan Lange/ATTRIBUTION 2.0 GENERIC

Everything You Know About Binge Eating Is Wrong

This post title is facetious, of course. There might even be a world-beating research genius out there, of whom it could be said that everything they know about this stubborn condition is right. Meanwhile, the average person is pretty much in the dark — even the average sufferer of Binge Eating Disorder (BED). They tend to have very little insight into what drives them, or how to bring their self-sabotage to an end. One surprising thing is their ability to eat a whole lot of something they don’t even like… just because…

As Dr. Pretlow and others in the field have pointed out, although a person with BED has preferences and favorites, if the choice is between eating and not eating, they will eat anything. The onset of an “acute emotional upset” can induce a willingness to consume even boring nutritious stuff like apples, or conversely, something dreadfully unhealthful — or even something they normally hate. Stress does this to humans. We feel stressed and seek comfort.

Myproana.com once asked its readers whether they ever binged on foods they didn’t even like. (That address no longer exists and a search query is forwarded to a similar site.)

At any rate, at one point, some anonymous respondents named the shameful causes of their slips. Confessions about what they had eaten included:

— disgusting biscuit
— [low quality] ice cream or chocolate or mayo or stale bread or jam
— all sorts of sausages that I didn’t really like
— a lot of bread stuff I’m never too excited about
— tasteless pre-made supermarket sandwiches
— jelly beans and candy corn. Hate. Tasted like rubber. Ew.
— crappy store-bought icing that tasted like play-doh
— I don’t even have time to recognize the taste.

When the binge mood hits, discrimination, discretion, and discernment go out the door. So does sanity. People recall experiences that inspired such self-realizations as…

— No food is off-limits.
— If I really need to b/p and there’s nothing I like I’ll literally just go with whatever’s going.
— Nothing is safe.
— I’d eat almost anything, even if I didn’t like it, if nothing else was around.
— I’ll eat everything in sight.
— I even started craving certain foods I hated.

One person wrote, “I have no idea why I crave to stuff myself with it when I don’t really like it,” while another said she binged mostly on foods she didn’t like because “it’s a sort of a punishment.”

Binge eating is the ugly stepchild

It seems like the biggest problem should get the most attention — but nooooo! Here is another weird observation made just a few years back:

Services often only cater to anorexics who are severely underweight (which is not the majority of anorexics), despite the fact that only 8% of eating disorder sufferers are anorexic.

The writer Róisín points out how eating disorders that cause people to become fat, despite being “far more prevalent and just as punitive,” are routinely ignored in favor of the ones that lead to glamorous thinness. She goes so far as to say, “Anorexia has a monopoly on eating disorder representation, portrayed with morbid fascination as an exaggerated diet or desirable suffering.” Some activists have a sneaky suspicion that the medical profession does not view overweight patients as legitimate victims who are worthy of resources.

Similarly, in a piece discussing the patients labeled “super morbidly obese,” Dr. Mark Warren wrote,

As a society, we often think of anorexia nervosa when we think of eating disorders. However, it is crucial that we widen our collective perspective to remember that binge eating disorder is a source of tremendous psychological and physical suffering for so many people. Their suffering is all too often overlooked. Increased awareness and understanding are important first steps toward providing effective care to those struggling with this difficult illness.

Your responses and feedback are welcome!

Source: “Do you ever binge on food you don’t like?,” Myproana.com, 4/12/15
Source: “Eating Disorder Treatment is Broken, and Only Abolition Can Fix It,” Medium.com, 08/30/20
Source: “The Challenges of Going Through Life “Super Morbidly Obese,” EmilyProgram.com, 01/05/18
Image by Junior REIS on Unsplash

GLP-1 Drugs Prompt New Food Offerings

The success of new obesity and diabetes drugs is evident in grocery store aisles. We’ve written before about how the rise of GLP-1 medications is reshaping consumer habits and posing challenges to various sectors of the food and beverage industry.

For one, a Morgan Stanley report predicted that the consumption of sweet and salty snacks could drop by as much as 3% through 2035, causing concern in the food industry. Food companies are reacting accordingly by launching new and reformulated products to cater to the growing number of people using drugs like Novo Nordisk’s Ozempic and Wegovy. Experts believe this trend could significantly alter American diets.

How GLP-1 drugs can lead to nutritional deficiencies

GLP-1 medications, which help reduce hunger and increase feelings of fullness, can lead to nutritional deficiencies because people on these drugs tend to eat less overall. This decreased appetite can result in insufficient intake of essential vitamins, minerals, fiber, and protein.

Specifically, reduced protein intake can lead to muscle loss, while lower consumption of fruits, vegetables, whole grains, beans, seeds, and nuts can limit the intake of important antioxidants, vitamins, and minerals, as well as fiber, which is crucial for blood sugar stabilization, cholesterol management, and digestive health.

To counteract these potential deficiencies, it is important for patients on GLP-1 medications to follow a well-balanced and nutrient-dense eating plan. This includes ensuring adequate intake of macronutrients (proteins for muscle preservation and satiety, carbohydrates for energy and fiber, and fats for vitamin absorption and brain function) and micronutrients (vitamins and minerals). Healthcare professionals recommend tailoring your dietary needs based on personal factors such as age, weight, medical history, and activity levels.

GLP-1-friendly food offerings

Several big food manufacturers stand out. Nestlé, owner of brands like Stouffer’s and DiGiorno Pizza, recently introduced a new line of frozen foods with smaller portions and more protein to counteract muscle loss associated with GLP-1s. This move is seen as a “logical reaction” to the GLP-1 boom, and competitors are expected to follow suit.

The line, called Vital Pursuit, is “high in protein, a good source of fiber, contain[s] essential nutrients, and they are portion-aligned to a weight-loss medication user’s appetite,” the company said. It’s also affordable as it’s sold for $4.99 or less. Items include sandwich melts, pizzas, and bowls with whole grains or protein pasta.

According to Reuters, General Mills is already offering high-protein versions of Annie’s Mac and Cheese and Betty Crocker baking mixes with lower sugar and sodium. And Conagra, which owns brands like Healthy Choice and Slim Jim, is considering smaller-portion frozen foods and sees potential in its protein- and fiber-rich snacks.

Nutrition experts say these new products cater well to GLP-1 users’ needs. These products may also benefit those who stop taking GLP-1s within a year and struggle to maintain weight loss, as well as consumers who are not on GLP-1s but want to reduce calories and sugar or increase protein intake.

A smaller-portion trend

Writer Tina Reed, in her recent article for Axios, reported that Hank Cardello, a former food executive and now a consumer health expert at Georgetown University, suggested that changing perceptions of portion sizes could positively impact American diets. This trend was evident at the recent Sweets & Snacks Expo, where many products were marketed as “minis” or “bites.”

Hank Cardello said:

Once it gets up in that neighborhood, food companies have to pay attention. They have to, otherwise they’re walking away from business. You can’t sell king-size X, Y, and Z to this crowd.

The caveat

Consumers might be misled by marketing claims and assume products labeled for GLP-1 users are inherently “healthy.” Experts emphasize that these drugs should be paired with exercise and a proper diet.

Whether these new products and food trends associated with the increasing use of GLP-1 drugs are here to stay, time will tell. One thing is for sure: Food manufacturers will adapt.

Your responses and feedback are welcome!

Source: “Weight-loss drugs are forcing changes to grocery store offerings,” Axios, 6/4/24
Source: “Changes in food preferences and ingestive behaviors after glucagon-like peptide-1 analog treatment: techniques and opportunities,” Nature.com, 3/7/24
Source: “Nestlé Launches Frozen Food Line for People Using GLP-1 Drugs,” Healthline.com, 5/27/24
Image by Alan Hardman on Unsplash

BED, a Friend, and You

A previous post described the problem. The search for solutions is of course more complicated. Solutions are needed because BED is a disorder that seriously affects the quality of life for millions of humans. An individual who suspects a problem in the self might start by reaching out to a trusted friend, relative, clergy member, or an online community. Even if this is a difficulty not faced by the reader of this page, any one of us might be the trusted friend that someone reaches out to. What then?

Even if we are not experts, and even if we are not sure whether the upset person’s alarm is justified, this much is true: When someone we care about wonders whether their stubborn habit is a problem, the fact that they even suspect a problem is, in and of itself, a problem. The least we can do is validate their autonomy in some way, with verbal reassurances that they are correct to care about potential health conditions that might call for intervention.

Of course, depending on our own position and circumstances, we can offer practical help, like a ride to a clinic, or the money to pay for an appointment. Or we might do a little preliminary research to nudge them into action.

The particulars

For instance, we might sneak a peak at the Mayo Clinic’s very thorough page on binge-eating disorder and garner some facts to pass along. The object here is for the patient to feel more in control, and eventually, to actually be more in control. This sounds boring, but the key to control is the banishment of randomness, and the acquisition of healthy, regular habits.

The patient can probably expect to be dealing with a whole team of experts, including a mental health professional and a sleep disorder specialist (regular habits, remember?). Any large and respected medical institution will offer similar information and advice, along with both standard methods and specialized possibilities.

There will be blood and urine tests, and various other measurements of this and that. The prospective patient will be asked a ton of questions, both objective (“How often are you physically active?”) and subjective (“How often do you think about food?”). As the honest friend who is urging this person to seek help it might, depending on what kind of relationship you two have, be useful to remind them that in order to be effectively helpful, every professional they encounter will need accurate, up-to-date information.

Whoever conducts this interview will want to know about the patient’s typical daily intake of food, and how large the servings tend to be. They will be curious about whether the person tends to eat past the point of discomfort. Does consumption take place even when there is no actual hunger? Have they made previous efforts to lose weight, and of what did those efforts consist of?

Does the person subjectively feel that things are out of control? What about eating secretly, hiding food, lying to family members about what and how much they take in? Is the eating itself the larger concern, or is it the body weight and size? Does the person experience depression, shame or guilt related to eating? Is vomiting ever involved? What about laxatives or pharmaceuticals, prescribed or otherwise?

What’s out there

Speaking of drugs, Vyvanse, or lisdexamfetamine dimesylate (which was developed to alleviate ADHD) has been prescribed to treat moderate-to-severe binge-eating disorder, but it is only approved for adults. Of course as always, before prescribing anything the doctor must be told about any other drugs the patient is already taking, along with any supplements, herbs, etc. The Mayo Clinic page notes that a few other meds (officially approved to control depression and seizures) are sometimes prescribed, but interestingly, makes no mention of the recently fashionable GLP-1 drugs.

There are support groups designed for individuals and for families, and a painfully hesitant person might consider attending a meeting first just to dip a toe into the water. Even more distance can initially be maintained by making the first contact with any such organization online. Of course, there is talk therapy, both individual and group, in several different forms.

Cognitive behavioral therapy is of course mentioned, along with an enhanced variety called CBT-E that is “specifically designed to treat eating disorders.” Other formats are also mentioned:

Integrative cognitive-affective therapy (ICAT). This type of talk therapy may be helpful for adults with binge-eating disorder. This therapy can help you change the emotions and behaviors that trigger binge eating.

Dialectical behavior therapy. This type of talk therapy can help you learn behavioral skills to help you deal with stress, manage your emotions and improve your relationships with others. These skills can lessen the desire to binge eat.

Your responses and feedback are welcome!

Source: “Binge-eating disorder,” MayoClinic.org, undated
Image by thekirbster/ATTRIBUTION 2.0 GENERIC

Can Web-Based Self-Help Interventions Help With BED?

A recent JAMA Network Open study assessed the effectiveness of web-based self-help interventions in alleviating binge eating disorder (BED). Here are some details, including the findings and the conclusions.

Why BED?

We’ve covered it many times before, but let’s recall that BED is defined as uncontrolled overeating that can lead to obesity, type 2 diabetes, and hypertension. Prolonged BED can reduce the affected person’s quality of life, negatively impact social relationships, and compromise their ability to perform their job well. Without a timely intervention, BED can become chronic and even lead to premature death.

CBT and its barriers

Some studies have demonstrated that cognitive behavioral therapy (CBT) can serve as an effective BED intervention, as well as positively affect the eating disorders bulimia nervosa and anorexia nervosa.

Unfortunately, some people with BED don’t seek in-person psychotherapy because of such barriers as treatment costs, lack of availability, and sociocultural stigma.

This is where web-based cognitive behavioral interventions come in, thanks to their ease of implementation, availability, reduced social stigma, and cost-effectiveness. This avenue has been growing in popularity for these reasons, making BED treatment more accessible.

About the study

The study involved a randomized clinical trial (RCT) to evaluate the effectiveness of a web-based cognitive behavioral self-help intervention for BED. Researchers measured changes in eating disorder symptoms, well-being, co-morbid psychopathology, self-esteem, emotion regulation, and clinical impairment. Weekly symptom monitoring and ecological momentary assessment (EMA) were used to track real-time changes in binge eating.

Participants were recruited from Germany and other German-speaking regions in Europe. Eligible participants were 18-65 years old, owned a smartphone, and were diagnosed with BED according to the DSM-5 criteria. They were randomly assigned to either a control group (waiting list) or a web-based treatment group. Assessments were conducted at baseline, six weeks (mid-treatment), and 12 weeks (post-treatment).

The intervention consisted of six mandatory modules covering psychoeducation, self-monitoring of binge eating, emotion regulation, and interactive exercises. A sequential module-access strategy was employed to engage participants in a personalized manner.

Study findings

The study found significant changes in BED patterns from baseline to 12 weeks in the intervention group. Out of 1,602 patients, 154 met the eligibility criteria and were recruited, with 77 participants in each group. The intervention group reported fewer binge-eating episodes and showed significant improvements in global eating psychopathology and clinical impairment.

Dr. Priyom Bose, Ph.D., discussing the study results, writes:

“The intervention’s efficacy exceeded or was similar to previously documented digital interventions, as well as in-person guided and unguided self-help interventions for BED.

Notably, the levels of improvement observed in the intervention group were consistent with or surpassed those associated with in-person CBT interventions, thus confirming the clinical applicability of web-based cognitive behavioral self-help interventions.”

The study noted that participants’ motivation, attitudes towards online interventions, demographic characteristics, and treatment expectations influenced the positive effects of the web-based intervention.

The bottom line

The study demonstrates that web-based cognitive behavioral self-help interventions can significantly improve the well-being of people with BED, offering a promising alternative to traditional treatments. However, the study had some limitations, including the under-representation of males and older adults, and potential biases due to the self-report design. Future research can address these limitations through methodologies like double-blind designs.

Your responses and feedback are welcome!

Source: “Web-based self-help program proves effective in treating binge eating disorder,” News-Medical.net, 5/19/24
Source: “Effectiveness of a Web-Based Cognitive Behavioral Self-Help Intervention for Binge Eating Disorder,” JAMA Network Open, 5/16/24
Image by Glenn Carstens-Peters on Unsplash

Binge-Eating Disorder and the Mayo Clinic

Strangely, for such a prevalent disorder, binge eating retains an aura of mystery. Even the esteemed Mayo Clinic can only offer guesses as to its cause. Certain constants are of course observable, including the fact that more women than men are victims. Other genetic factors are also suspected. Whether genetic or purely behavioral in origin, family history is a red flag.

People in their late teens and early 20s are vulnerable, along with those who have adopted the lifestyle variant known as “dieting,” or formalized restrictions imposed either by an outside program or a self-created plan.

Another predisposing condition is some kind of mental health problem, and this is a tough one because it feeds upon itself. The mental health element includes negative self-regard, and this works both ways because when one feels hostile toward oneself, and toward one’s own abilities and accomplishments, the answer always seems to be “Go eat a lot.”

Of course, this offers no alleviation at all, because afterward, the person is assailed by even more self-hate, and rushes to go eat another pile of food. Binge eating is in fact the legendary perpetual-motion machine, tirelessly maintaining itself through endless cycles of cause and effect, which then becomes the next cause, leading to the next effect, and so on into infinity. What can stop such an elegantly designed chain reaction?

A world of triggers

Certain situations will guarantee a binge, and depending on the individual, the trigger may be any size or shape, and wear any disguise. The binge reaction can be set off by an event as traumatic as a romantic breakup. Or it might be based on something as trivial as the habitual pairing of entertainment with eating — the conviction that watching a movie on TV must always be accompanied by a snack session that somehow winds up lasting for an hour and a half.

The trigger can be a certain food, which causes the person to apologetically or facetiously declare, “I’m addicted to chocolate-chip cookies, almost straight from the oven, with the chips still all melty.” Whether or not cookie addiction is recognized by the medical establishment, it becomes a fact in that person’s life.

There are social consequences of course, which include avoiding certain people who might identify the binge pattern and urge the eater to seek help. While social ramifications can be very upsetting, the real trouble starts when the body begins to break down. There is, obviously, weight gain.

But even if the person is not bothered by that, there are also, says the Mayo Clinic, “joint problems, heart disease, type 2 diabetes, gastroesophageal reflux disease (GERD), poor nutrition and some sleep-related breathing disorders.” On the mental side, watch out for depression, anxiety, substance abuse, and even suicidal ideation and behavior.

In the emotional equation, actual bulk is almost irrelevant. No matter what shape the body is in, the average binge-eater is dissatisfied with it.

This condition is defined by compulsion — the conviction of a simple inability to stop eating — and, generally, by excess. It is characterized by periods of resistance, alternating with episodes of simply giving in and letting the disorder have its way. Symptoms vary, but may include:

Eating even when you’re full or not hungry.
Eating very fast during eating binges.
Eating until you’re uncomfortably full.
Often eating alone or in secret.

(To be continued…)

Your responses and feedback are welcome!

Source: “Binge-eating Disorder,” MayoClinic.org, undated
Image by Fabrice Florin/CC BY-SA 2.0

The Support Matrix for Mental Health Diagnostics

The world has a lot to say about binge eating. Sometimes the search for a more precise definition leads off into fascinating side roads.

In its 5th edition, the Diagnostic and Statistical Manual of Mental Disorders decided to file BED, or Binge Eating Disorder, under OSFED, or “Other Specified Feeding or Eating Disorder.” Additionally, BED itself has been broken down into “low frequency and/or limited duration” and “higher frequency and duration;” and then it might be further categorized as mild, moderate, or severe.

Within those parameters, it is still important to understand that not all obese people suffer from BED, nor are all people with BED obese. But they do mostly tend to be moody and anxious.

Classification problems have haunted the field for a long time — not just in the realm of eating disorders, but in everything connected with mental health. To get a grip on this topic, it is apparently necessary to keep track of a lot of initials. For instance, the cluster of letters DSM-ICD. Spelled out, that stands for “Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases.”

A 2016 paper explicated the basis of that school of thought, classified as “an Aristotelian view.” From this angle, mental disorders are seen as “largely discrete entities that are characterized by distinctive signs, symptoms, and natural histories.”

And, as far back as 1989, there had been mumbles and grumbles, an example of which came from psychiatrist R. E. Kendell:

One important possibility is that the discrete clusters of psychiatric symptoms we are trying to delineate do not actually exist.

Then, along came a contrary modality, in fact, a paradigm shift, described as “a Galilean view of psychopathology as the product of dysfunctions in neural circuitry.” This is the RDoC (Research Domain Criteria) initiative, which strives to make sense of what were called the “accumulating anomalies” that troubled professionals when contemplating the older system. Many factors contributed to the restlessness that inspired leaders in the field to call for change.

Remedies made to order

For instance, the authors cited “precision medicine” or “personalized medicine” which translates lab results directly into an individually tailored plan of action. As an example, they mentioned a targeted drug treatment that works for 4% of cystic fibrosis patients, and went on to describe another advance that has “stirred hopes for a similar revolution in psychiatry and clinical psychology.”

Also in the conversation is Oncotype testing, which has revolutionized the treatment of breast cancer by “permitting physicians to move from a ‘one size fits all’ intervention approach to treatment geared to specific genetic profiles.”

They go on to explain the analogy to the Research Domain Criteria:

Rather than base psychiatric diagnosis on presenting signs and symptoms […] RDoC strives to anchor psychiatric classification and diagnosis in a scientifically supported model of neural circuitry. RDoC conceptualizes mental disorders as dysfunctions in brain systems that bear important adaptive implications, such as systems linked to reward responsiveness and threat sensitivity.

Of course, this fundamental declaration branches out into several “crucial assumptions,” some of which are explained in detail. Other experts added depth and breadth to the many dimensions of this expanded worldview.

One was neuroscientist and psychiatrist Thomas R. Insel, who was for more than a decade in charge of the National Institute of Mental Health. Even though in most areas of medicine the public has come to expect a high degree of specificity, he warned, we might as well not anticipate anything of the sort in the field of psychiatric diagnostics.

Because behavioral symptoms are multidetermined (our old friend “multifactorial“), he wrote, “[…] diagnoses based only on presenting complaints are unavoidably heterogeneous in terms of pathophysiology.” Along with this unavoidable truth comes a danger:

[W]hen diagnosis is limited to symptoms, treatments may be limited to symptom relief, precluding cures or preventive interventions.

Your responses and feedback are welcome!

Source: “Clashing Diagnostic Approaches: DSM-ICD versus RDoC,” NIH.gov, 02/03/16
Source: “The NIMH Research Domain Criteria (RDoC) Project: Precision Medicine for Psychiatry,” PsychiatryOnline.org, 04/01/14
Image by Tatinauk/CC BY-ND 2.0 DEED

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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