Biological Aspects Of Obesity Related Eating Disorders111
1. 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
4. Controls of Food Intake Signals Initiation Termination Differences in BED?
5. 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
9. Stomach capacity could limit meal intake and influence satiation. Stomach
10. 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.
11. 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.
23. 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.
24.
25. Meal was provided at time 0 and consumed at constant rate from graduated beaker in 5 min.
30. 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
42. It is unlikely that this was due to swallowing as the primary motor area was not activated.
43.
44. Controls of Food Intake Signals Stomach PeptidesStress Hormone Initiation Ghrelin Cortisol TerminationCapacity CCK, Leptin Emptying Differences found in BED
85. Cold Pressor Test HAND IMMERSION HAND WITHDRAWAL I I I I I I I 0 2 15 5 30 60 45 -10 min Blood Draws for Cortisol, Ghrelin, Hunger Ratings
86. Cortisol g/dL Main effect, p<.05 Group diff , n.s. Baseline (mean of -10 and 0 min) NE > Norm, p<.05 AUC, NE > Norm,p=.02, (n.s. after controlling for baseline.)
87. Ghrelin pg/mL Main effect, p<.05 Group diff , n.s. Baseline (mean of -10 and 0 min), n.s. AUC, n.s.
96. 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)
118. 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