Binge eating disorder among obese/overweight in Pakistan: Under-diagnosed, undertreated and misunderstood

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Most of the eating disorders in Pakistan go undiagnosed. Though, early diagnosis and assessment of eating disorder can provide chances for improved treatment and recovery [9]. However, it will be challenging for the healthcare system of Pakistan for providing eating disorder treatment services with the current infrastructure, facilities, and human resources in the future. Global statistics show a high prevalence of obesity in Pakistan but unfortunately, strategies to control and tackle it are not integrated into the annual healthcare plans [8]. Thus, the general objective of the study was
to assess binge eating disorder among overweight/ obese in two major cities of Pakistan.

 

 

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Please find below a current study from Pakistan ‘Binge eating disorder among obese/overweight in Pakistan: Under-diagnosed, undertreated and misunderstood’. We hope you’ll find the study below informative. We share this study for information purpose only.

 

 

Binge eating disorder among obese/overweight

in Pakistan: Under-diagnosed, undertreated

and misunderstood

 

Madeeha Malik*, Waseem Shaukat, Azhar Hussain Hamdard Institute of Pharmaceutical
Sciences, Hamdard University Islamabad, Pakistan

*Author for correspondence: madeehamalik15@gmail.com

Abstract

Introduction: Obese persons with BED have compromised functioning mostly in psycho-social aspects of Health-Related Quality of Life (HRQoL) as poor physical functioning is related to obesity. Despite the higher prevalence of BED compared with other eating disorders, lack of understanding of BED by physicians and inadequate physician-patient communication regarding BED may result in it’s under diagnosis.

Objective: The objective of the study was to assess binge eating disorder among overweight/obese in two major cities of Pakistan.

Method: A descriptive cross-sectional study design was used. A pre-validated data collection tool Binge Eating Disorder Screener-7 (BEDS-7) was distributed to a sample of 382 obese/overweight individuals. Binge Eating Disorder Screener-7 (BEDS-7) questionnaires is comprised of seven questions that directly evaluate the patient’s eating patterns and behaviors for binge eating disorder. Convenient sampling technique was used to select the respondents. After data collection, the data was cleaned, coded and entered in SPSS version-21. Chi-square test (p ≥ 0.05) was performed to find out the association between different variables.

Results: The results revealed that nearly half of the respondents of the overweight/obese had an eating disorder among them. Out of the total sample 35.1% (n=134) respondent, agreed that they had episodes of excessive overeating during the last 3 months. The results highlighted that 64.9% (n=248) had no binge eating disorder while 15.7% (n=60) of the respondents had moderate binge eating disorder and 14.9% (n=57) had severe binge eating disorder.

 

Conclusion: The current study concluded that moderate binge eating disorder was seen among most of the obese individuals but BED in most of the cases goes undiagnosed. Binge eating disorder was more common among students and non-smokers. Early detection and evidence-based treatment strategies can help the patients to recover on initial stages and prevent from a further complication of binge eating disorder.

Keywords: binge eating disorder • obese • overweight • occurrence • Pakistan

 

 

Introduction

Binge Eating Disorder (BED) is characterized by regular episodes of binge eating. An individual with
Binge Eating Disorder (BED) has compensatory behaviors, such as self-induced vomiting or doing
over-exercising after binge eating. This disorder involves two key features; firstly, eating a very large
amount of food within a relatively short period of time e.g. within two hours and secondly, loss of
control while eating e.g. feeling unable to stop oneself from eating [1]. Despite the higher prevalence of BED compared with other eating disorders, lack of understanding of BED by physicians and inadequate physician-patient communication regarding BED may result in its under-diagnosis [2]. Obese persons with BED have compromised functioning mostly in psycho-social aspects of Health-Related Quality of Life (HRQoL) as poor physical functioning is related to obesity [3]. Beside this eating disorder also influences the mental health of the patients and they seek for treatment interventions focusing on improving mental health domain of HRQoL [4]. Physical activity has been reported as an important treatment target for individuals with BED [5]. Pakistan has been ranked 9th among 188 countries facing obesity challenge around the globe [6]. One quarter of the Pakistani population has been classified as overweight/obese with alarming prevalence among women and youth [7]. The BDNF rs6265, in the presence of obesity, has been reported to be associated with elevated risk of anomalous metabolic, behavioral and physical traits and obesity-related co-morbidities in Pakistani population [8]. Risk of developing eating disorders indicating females more prone than males has been reported in Pakistan. Most of the eating disorders in Pakistan go undiagnosed. Though, early diagnosis and assessment of eating disorder can provide chances for improved treatment and recovery [9]. However, it will be challenging for the healthcare system of Pakistan for providing eating disorder treatment services with the current infrastructure, facilities, and human resources in the future. Global statistics show a high prevalence of obesity in Pakistan but unfortunately, strategies to control and tackle it are not integrated into the annual healthcare plans [8]. Thus, the general objective of the study was
to assess binge eating disorder among overweight/ obese in two major cities of Pakistan. The study
findings provide baseline data regarding the current prevalence of binge eating disorder. It will help
relevant stakeholders to design effective strategies to evade the incidence of eating disorders as well as improve diagnosis of such disorders, especially among obese/overweight people.

 

Methodology

The descriptive cross-sectional study design was used to assess binge eating disorder among overweight/ obese in relation to BMI in two major cities of Pakistan. Research approval for the current study was obtained from the Ethical Committee of Hamdard University (Ref. No. HU/DRA/2017/554). Beside this approval was taken from Medical Supretendent of hospitals (OPDs), owner of clinics, fitness centers, and community pharmacies. Written/verbal consent was taken from every respondent. Likewise, the respondents were guaranteed for the secrecy of information. Study sites for this research included OPDs of different health care facilities, community pharmacies, fitness centers and obesity clinics located in twin cities of Pakistan. Study respondents included adults having BMI ≥ 25 or ≥ 30 and categorized as overweight or obese persons respectively, between 18-65 years old; both genders (male vs. female) and who could easily read and write. While a person with physical limitations; bodybuilders; pregnant ladies and those on treatment for a psychological disorder were excluded. A sample size of the study population was calculated with the help of Raosoft® sample size calculator which came to be 382 to achieve a 95% confidence interval with a 5% margin of error. Convenience sampling technique was used to select the respondents. Data was collected directly from the respondents at their respective facility. A pre-validated data collection tool Binge Eating Disorder Screener-7 (BEDS-7) was used. Binge Eating Disorder Screener-7 (BEDS-7) questionnaires is comprised of seven questions that directly evaluate the patient’s eating patterns and behaviors for binge eating disorder. It is proposed for the screening of BED patients only. The first question is related to the eating pattern while remaining all questions are related to eating behavior. BEDS7 scores are weighted sums of only the last five questions. The composite scores range from 0-20 with 0-5 indicating mild disorder; 6-10 moderate; 11-15 severe and 16-20 extreme. Pilot testing was conducted
at 10% of the sample size to test the reliability of the tool. The value of Cronbach’s alpha was 0.82
which was satisfactory and considering that 0.68 is the acceptable cut off value. The questionnaires were self-administered to the respondents and collected back on the same day to avoid any biases. After data collection, the data was cleaned, coded and entered in SPSS version-21. Descriptive statistics comprising frequency and percentages were calculated. Chisquare test (p ≥ 0.05) was performed to find out the association between different variables.

 

Results

Out of 382 respondents, 63.6% (n=243) were males while 36.4% (n=139) were females. Likewise, 43.2%
(n=165) were having an undergraduate qualification and were students. Of the total respondents, 52.9% (n=202) were overweight while 47.1% (n=180) were obese. On the other hand, 31.9% (n=122) of the total respondents had a family history of overweight/ obesity while 68.1% (n=260) had no family history of overweight/obesity. Of the total respondents, 47.9% (n=183) were taking carbohydrates and 32.7% (n=125) were taking proteins as weekly major diet portion in their daily lifestyle. A detailed description of demographic characteristics is given in (Table 1). The results revealed that nearly half of the respondents of the overweight/obese had an eating disorder among them. Out of the total sample 35.1% (n=134) respondent, agreed that they had episodes of excessive overeating during the last 3 months Table 2. To View Table Click Here

Binge eating disorder among obese/overweight in Pakistan: Under-diagnosed, undertreated and misunderstood

Of the total respondents having binge eating disorder, 12% (n=46) often had no control on
overeating and 12.8% (n=49) sometimes continued eating though they were not hungry. It was also
reported that 12.3% (n=47) never felt disgusted with their self or guilty afterward of overeating and 22.5% (n=86) never make their self-vomit, that is a means to control their body shape/weight (Table 3).

The results highlighted that 64.9% (n=248) had no binge eating disorder while 15.7% (n=60) of the
respondents had moderate binge eating disorder and 14.9% (n=57) had severe binge eating disorder
(Table 4).

Results indicated a significant association (p=0.001) was reported between respondents of different
occupations as 6.3% (n=24) students had moderate binge eating disorder. Moreover, a significant
association (p=0.027) was found among respondents having no smoking habit as 11.8% (n=45) reported moderate binge eating disorder (Table 5).

 

Discussion

Binge Eating Disorder is the most common eating disorder found in obese people. The prevalence of BED ranges from approximately 0.3 to 7% in community samples to between 9% and 30% in obesity clinics [9]. The results of the present study showed that the prevalence of binge eating disorder was less among obese/overweight people in twin cities of Pakistan. The respondents suffering from binge eating disorder had no control of overeating and continue eating even if they were not hungry. The disorder was seen common among both genders. Similar findings were reported from a study conducted in USA which also indicated that BED possesses unique characteristics including loss of control on overeating and feel of guilt and shame, which do not more often happen with overeating. BED prevails among both gender frequently associated with overweight [10]. BED represents a public health problem equally important as bulimia nervosa. However, BED remains underdiagnosed in the majority of the patients. This highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints [11]. The results of the present study reported that most of the respondents had moderate binge eating disorder. The disorder was most commonly observed among students. Similar findings were reported from another study which reported a high prevalence of BED among students. The study also highlighted the need for assessment of self-esteem, child abuse and neglect, and family functions in detail as they are risk
factors for EDs and affect the course of treatment [12].

Smoking has been reported as an appetite and weight control method in eating disorders.
Smoking in individuals with eating disorders could be motivated more by desires for weight control
than nicotine dependence [13]. The results of the present study showed that moderate binge eating
disorder was more commonly seen among nonsmokers. In contrary to the current study findings
smoking history or status was not associated with eating disorder psychopathology in BED but was
significantly associated with depressive symptoms in participants with BED [14,15].

 

Conclusion

The current study concluded that the occurrence of binge eating disorder is less among obese/overweight people in twin cities of Pakistan. Although, moderate binge eating disorder was seen among most of the obese individual’s BED in most of the cases goes misunderstood, undiagnosed and untreated. Binge eating disorder was more common among students
and non-smokers. Early detection and evidence-based treatment strategies can help the patients
to recover on initial stages and prevent from a further complication of binge eating disorder. Thus,
interventions focused on the psychopathology associated with BED could reduce the influence of
emotional nods on binge eating.

 

References

1. http://www.nedc.com.au/binge-eating-disorder

2. Herman BK, Deal LS, Kando JC, et al. Use and value of the 7-item binge eating disorder screener in clinical practice. Prim Care Companion CNS Disord 19 (2017).

3. Rieger E, Wilfley DE, Stein RI, Marino V, Crow SJ. A comparison of quality of life in obese individuals with and without binge eating disorder. Int J Eat Disord 37: 234-240 (2005).

4. Sandberg RM, Dahl JK, Vedul-Kjelsas E, et al. Healthrelated quality of life in obese presurgery patients with and without binge eating disorder, and subdiagnostic binge eating disorders. J Obes 2013: 878310 (2013).

5. Carr MM, Lydecker JA, White MA, Grilo CM. Examining physical activity and correlates in adults with healthy weight, overweight/obesity, or binge‐eating disorder. Int J Eat Disord 52: 159-165 (2019).

6. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 384: 766-781 (2014).

7. Jafar TH, Chaturvedi N, Pappas G. Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population. CMAJ 175: 1071-1077 (2006).

8. Kolotkin RL, Westman EC, Ostbye T, Crosby RD, Eisenson HJ, Binks M. Does binge eating disorder impact weight‐ related quality of life? Obes Res 12: 999-1005 (2004).

9. Memon AA, Adil SE, Siddiqui EU, Naeem SS, Ali SA, Mehmood K. Eating disorders in medical students of Karachi, Pakistan-a cross-sectional study. BMC Res Notes 5: 84 (2012).

10. Rana S, Mirza S, Rahmani S. The BDNF rs6265 variant may interact with overweight and obesity to influence obesityrelated physical, metabolic and behavioural traits in Pakistani individuals. Ann Hum Biol 45: 496-505 (2018).

11. Annagur BB, Orhan O, Ozer A, Yalcin N, Tamam L. The effects of depression and impulsivity on obesity and binge eating disorder. Clinic Psychopharmacol Bull 25: 162-170 (2015).

12. Citrome L. A primer on binge eating disorder diagnosis andmanagement. CNS Spectr 20: 41-51 (2015).

13. Manwaring JL, Hilbert A, Wilfley DE, et al. Risk factors and patterns of onset in binge eating disorder. Int J Eat Disord 39: 101-107 (2006).

14. Chao AM, White MA, Grilo CM. Smoking status and psychosocial factors in binge eating disorder and bulimia nervosa. Eat Behav 21: 54-58 (2016).

15. Anzengruber D, Klump KL, Thornton L, et al. Smoking in eating disorders. Eat Behav 7: 291-299 (2006)

 

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Islam and Eating Disorders founded in 2012 – run by Maha Khan, the blog creates awareness of Eating Disorders in the Muslim world, offers information and support for sufferers and their loved ones.

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