Biological Aspects of Obesity-Related Eating Disorders: Binge Eating Disorder and the Night Eating Syndrome Allan Geliebter New York Obesity Research Center St. Luke's and Roosevelt Hospitals Columbia University Division of Child and Adolescent Psychiatry Grand Rounds Columbia University February 17, 2010
Obesity NIGHT EATING SYNDROME BINGE EATING DISORDER
Controls of Food Intake Signals Initiation Termination Differences in BED?
Main Criteria for Binge Eating Disorder (BED) Recurrent episodes of binge eating 2 days/wk for 6 mos. objectively large amount of food in a discrete time period (2 hours) sense of loss of control without purging afterwards
Gastric Capacity Estimated by filling a intragastric balloon with water at 100 ml/min through a tube connected to a pump behind the person based on maximum volume tolerated based on volume required to produce a fixed rise in intragastricpressure.
Table 1. Characteristics of Overweight Women (M ± SD) No differences by group. BODPOD Geliebter A, Gluck ME, Hashim SA. J Nutr 2005;135:1326-30.
Leptin is secreted primarily by adipose tissue and rises slowly after meals. Leptin administration decreases food intake and weight in animals (Zhang et al., 1994) and modestly inhumans (Heymsfieldet al., 1999).
Leptin would rise to a lesser extent postprandially in BED.
CCK, is secreted primarily by the duodenum, and rises after meals. CCK administration decreases food intake in animals (Gibbs et al., 1973) and humans (Kissileff et al., 1981).
Evidence that postmeal CCK rises less in Bulimia Nervosa (Devlin et al., 1997), perhaps contributing to larger meal intake.
CCK would also rise to a less post meal in BED.
Ghrelin, is secreted primarily by the stomach and stimulates food intake in animals (Tschöp et al., 2000) and humans (Wren et al., 2001).
Ghrelin is elevated before meals and falls afterwards (Cummings et al, 2002), unlike other peripheral appetite hormones, which rise after meals.
Hypothesis Obese individuals with BED would have high ghrelin levels given their excess meal intake.
Ghrelin Findings BED S’s had lower fasting ghrelin levels than non-BED S’s, contrary to hypothesis. In BED S’s, ghrelin levels declined less after meal. Results extend and are consistent with findings of lower ghrelin levels in obese individuals. Ghrelin may be down-regulated in obese BED S’s due to overeating possibly via stomach capacity. Geliebter A, Gluck ME, Hashim SA. J Nutr 2005;135:1326-30
Several studies have examined cortisol in eating disorders after a laboratory stressor:
--Exaggerated plasma cortisol response in AN (Abell et al, 1987), BN (Koo-Loeb et al, 2000), and BED (Gluck et al., 2004) --Higher 24-h urinary cortisol following a stressor in BN (Koo-Loeb et al, 2000)
No studies have examined:
--cortisol in response to laboratory stress in NES --or ghrelin, which has recently been shown to increase in response to a laboratory stressor
Timing of Sleep Onset and Offset NES Control Sleep onset time (Lab) 23:38 ± 1:5922:52 ± 1:04 Sleep onset time (home) 23:57 ± 1:3323:32 ±1:06 Sleep offset time (Lab) 7:04 ± 0:48 7:06 ± 0:41 Sleep offset time (home) 7:35 ± 1:11 6:59± 1:12 NES and Control Ss did not differ in sleep periods in the laboratory (Rogers et al., 2006 ) or at home (diary and actigraphy) (O ’Reardon et al., 2004).
Food Intake NES > Controls Inpatient study reflects night eating (20 h- 08 h) in NES subjects (Allison et al,. 2005) Outpatient study shows shifted calorie intake curve in NES (O’Reardon et al., 2004)
Proposed Research Diagnostic Criteria for NES(First International Night Eating Symposium, April 26, 2008, Minneapolis, MN) I. The daily pattern of eating demonstrates a significantly increased intake in the evening and/or nighttime, as manifested by one or both of the following: A. > 25% of food consumed after the evening meal B. > 2 episodes of nocturnal eating per week II. Awareness and recall of evening and nocturnal eating episodes III. > 3 of the following: A. Lack of desire to eat in the morning and/or breakfast is omitted on four or more mornings per week B. Presence of a strong urge to eat between dinner and sleep onset and/or during the night C. Sleep onset and/or sleep maintenance insomnia are present four or more nights per week D. Presence of a belief that one must eat in order to initiate or return to sleep E. Mood is frequently depressed and/or mood worsens in the evening IV. The disorder is associated with significant distress and/or impairment in functioning. V. The disordered pattern of eating has been maintained for at least 3 months. VI. The disorder is not secondary to substance abuse or dependence, medical disorder, medication, or another psychiatric disorder. Allison et al, 2009
Acknowledgements Co-Investigators Marci Gluck, Sami Hashim, Eric Yahav, Dennis Gage, Joy Hirsch, Susan Carnell Resources NY Obesity Research Center provided hormone assays and body composition measurements Grant Support NIH Grants RO1 DK 554318, R01 DK074046, R03 DK068392, and MO1 RR0064529