Binge eating, body mass index, and gastrointestinal symptoms
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.
References (45)
- et al.
Gastrointestinal disturbances in eating disorders: clinical and neurobiological aspects
Auton Neurosci
(2006) - et al.
Gastric capacity, test meal intake, and appetitive hormones in binge eating disorder
Physiol Behav
(Jul 2004) - et al.
Prevalence and correlates of binge eating disorder in a community sample
Compr Psychiatry
(2007) Eating disorders and obesity
Psychiatr Clin North Am
(2011)- et al.
Psychosocial aspects of the functional gastrointestinal disorders
Gastroenterology
(2006) - et al.
Inflammatory bowel disease: clinical aspects and established and evolving therapies
Lancet
(2007) - et al.
Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome
Gastroenterology
(2004) Experimental studies on the irritable colon
Am J Med
(1951)- et al.
Effect of anger on colon motor and myoelectric activity in irritable bowel syndrome
Gastroenterology
(1988) - et al.
The role of food intolerance in irritable bowel syndrome
Gastroenterol Clin North Am
(2005)
The prevalence and correlates of eating disorders in the national comorbidity survey replication
Biol Psychiatry
Gastroesophageal reflux among different racial groups in the United States
Gastroenterology
Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders
Scand J Gastroenterol
Prevalence of gastrointestinal symptoms in obese and normal weight binge eaters
Am J Gastroenterol
Gut function in anorexia nervosa and bulimia nervosa
Scand J Gastroenterol
Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study
Int J Obes
Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study
Am J Gastroenterol
Gastrointestinal disorders and symptoms: does body mass index matter
Neth J Med
Extra-intestinal manifestations associated with irritable bowel syndrome: a twin study
Aliment Pharmacol Ther
The STAGE cohort: a prospective study of tobacco use among Swedish twins
Nicotine Tob Res
The Swedish Twin Registry in the third millennium: an update
Twin Res Hum Genet
SCID Screen Patient Questionnaire (SSPQ) and SCID SCREEN Patient Questionnaire-Extended (SSPQ-X), computer program for Windows™, software manual
Cited by (29)
Irritable Bowel Syndrome and Eating Disorders: A Burgeoning Concern in Gastrointestinal Clinics
2021, Gastroenterology Clinics of North AmericaCitation Excerpt :However, there are comparatively fewer studies that address bulimia nervosa in comparison with anorexia nervosa. In a cross-sectional study using data from a Swedish twin study, 16.9% (n = 55) of total individuals with binge eating (n = 362) met criteria for IBS compared with 7.4% (n = 548) of total individuals without binge eating behavior (n = 7955).33 This statistically significant result suggested elevated IBS prevalence among those with binge eating behavior.33
Frequency of Eating Disorder Pathology Among Patients With Chronic Constipation and Contribution of Gastrointestinal-Specific Anxiety
2020, Clinical Gastroenterology and HepatologySomatic symptoms and binge eating in women's daily lives
2020, Journal of Psychosomatic ResearchCitation Excerpt :EMA is a particularly well-suited methodology that can aid in determining how somatic symptom-binge eating patterns manifest in individuals' daily lives. To date, however, between-person cross-sectional and, to a lesser degree, traditional longitudinal methods have strictly been used to examine somatic symptom and binge eating associations [1,3–6]. These two methods provide limited information about the functionality of these associations and are subjected to retrospective recall bias that can decrease the validity of ensuing results [15].
Prolonged constipation and diarrhea in childhood and disordered eating in adolescence
2019, Journal of Psychosomatic ResearchCitation Excerpt :Gastrointestinal (GI) problems such as bloating, nausea, and epigastric discomfort commonly occur in individuals with eating disorders including anorexia nervosa, bulimia nervosa, and binge-eating disorder [1–7].
An update on gastrointestinal disturbances in eating disorders
2019, Molecular and Cellular EndocrinologyCitation Excerpt :The association between binge eating disorder and IBS was studied as well in 6827 men and 8841 women that filled in a web-based questionnaire. Binge eating disorder has been associated with IBS in male as well as female patients, a finding remaining significant after adjustment for BMI and psychiatric as well as somatic comorbidities (Peat et al., 2013). Eating disorders are often associated with psychiatric and somatic comorbidities, among those gastrointestinal complaints/disorders are especially frequent.
Disordered eating practices in gastrointestinal disorders
2014, AppetiteCitation Excerpt :Any articles looking at the presence of GI disorders in populations already diagnosed with an eating disorder were excluded. The relationship between eating disorder onset and subsequent GI symptoms has been well documented (Abraham & Kellow, 2013; Peat et al., 2013; Perkins, Keville, Schmidt, & Chalder, 2005); this review concerns the presence of DE in those with diagnosed GI conditions. The articles included in the review were related to the eating patterns of those with IBS, IBD or CD.