Binge eating, body mass index, and gastrointestinal symptoms

https://doi.org/10.1016/j.jpsychores.2013.08.009Get rights and content

Abstract

Objective

Symptoms of both gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are frequently reported by individuals who binge eat. Higher body mass index (BMI) has also been associated with these disorders and with binge eating (BE). However, it is unknown whether BE influences GERD/IBS and how BMI might affect these associations. Thus, we examined the potential associations among BE, GERD, IBS, and BMI.

Methods

Participants were from the Swedish Twin study of Adults: Genes and Environment (STAGE) and provided information on disordered eating behavior, BMI, gastrointestinal (GI) disorders, and commonly comorbid psychiatric and somatic illnesses. Key features of GERD and IBS were identified to create modified definitions of both disorders that were used as primary outcome variables. Logistic regression models were applied to determine the association between BE and each GERD/IBS both independently and in the context of BMI and other commonly comorbid psychiatric and somatic morbidities.

Results

Prevalence estimates for GERD and IBS were higher among women than men (all p-values < .001). Only the association between BE and IBS was significant in both men and women after adjustment for BMI and the psychiatric/somatic morbidities.

Conclusion

BE appears to be an important consideration in the presence of IBS symptoms in both men and women, even when considering the impact of BMI and other commonly comorbid conditions. This association underscores the importance of routine assessment of BE in patients presenting with IBS to effectively manage the concurrent presentation of these problems.

Introduction

The association between the behavior of binge eating (BE) and gastrointestinal (GI) complaints is not well understood. BE is the hallmark feature of two eating disorders—bulimia nervosa (BN) and binge eating disorder (BED). BN, characterized by recurrent binge eating and compensatory behaviors (e.g., self-induced vomiting, laxative abuse) has been associated with several GI symptoms including acid regurgitation, upper abdominal pain, bloating, and constipation or diarrhea [1], [2]. It is not clear whether the observed GI symptoms result from these compensatory behaviors or from the increased volume or composition of food consumed during BE. Further, eating disorder patients with a history of BE commonly report GI symptoms such as impairment of esophageal motility, delayed gastric emptying, bloating, and constipation [1], [2].

Two GI disorders frequently reported by individuals with eating disorders (particularly BN and BED) are gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) [3], [4]. Preliminary studies suggest that individuals who engage in BE are more likely to report upper and lower GI symptoms than individuals who do not have episodes of BE [5]. Additionally, the increased stomach capacity among those who report BE [6] may also negatively impact GI system burden.

The association between BE and GI symptoms is further complicated by increased body mass index (BMI) in both individuals with BE [7] and in those with a GI disorder [5], [8]. BE [9], GERD [10], and IBS [11] are all frequently reported in obese individuals. Given the associations of BE with both obesity and GI disorders, it is plausible that BE could influence the relationship between BMI and GI disorders.

Thus, the objective of the present study was to investigate the association between BE and GI symptoms, after controlling for BMI. Based on previous studies, we hypothesized that BE would be positively associated with the GERD and IBS even when controlling BMI.

Section snippets

Participants

Participants were from the Swedish Twin study of Adults: Genes and Environment (STAGE; http://ki.se/ki/jsp/polopoly.jsp?d=9610&l=en), a large population based study. STAGE is a subset of the Swedish Twin Registry (STR; http://ki.se/twinreg) and includes data collected in 2005 from over 25,000 male and female twins between the ages of 20 and 47 years at time of interview (overall response rate = 59.6%). Using web-based questionnaires with a computer assisted phone option, participants provided

Prevalence of GI symptom clusters, covariates, and BMI categories

In the current sample, the prevalence estimates were: GERD broad (men = 15.7%; women = 28.9%; x2 = 352.12, df = 1, p < .001), GERD sleep (men = 5.5%; women = 12.3%; x2 = 207.65, df = 1, p < .001), IBS broad (men = 3.7%; women = 8.1%; x2 = 115.06, df = 1, p < .001), IBS narrow (men = 1.7%; women = 4.2%; x2 = 78.78, df = 1, p < .001) and IBS cumulative (men = 3.1%; women = 7.6%; x2 = 135.13, df = 1, p < .001). Due to these significant sex differences, all analyses were conducted separately by sex. Table 1, Table 2 provide descriptive information

Discussion

Prevalence estimates of GERD and IBS symptom clusters in the current study are somewhat lower than those reported in previous studies in the Western world (in both men and women) [26], [27]. The dissimilarities in these prevalence estimates may be suggestive of true differences among individuals reporting GI symptoms in Sweden; however, it is possible that the lower prevalence was influenced by an overall lower BMI among participants in this cohort. The majority of individuals in the current

Conflict of interest

All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and they declare that there are no competing interests to report.

Acknowledgments

We would like to thank all participants for their time and effort.

Funding: Drs. Peat and Trace were supported by the National Institute of Mental Health grant T32MH076694 (PI: Bulik). The Swedish Twin Registry is supported by grants from the Swedish Department of Higher Education, and the Swedish Research Council. All authors reported no biomedical financial interests or potential conflicts of interest. We thank all participants for their time and efforts.

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