New guidelines offer hope for those with binge-eating disorder

04/02/2013 5:15 AM

08/08/2014 10:16 AM

At one time or another, Jana Begor has tried most of the commercially advertised diets, not to mention the grapefruit diet and the cabbage soup diet. She became a vegan. She tried the raw food diet.

Sometimes, she lost weight. And then she regained it.

“I need to learn how to eat,” said Begor, 68, a real estate agent who lives in Calaveras County, Calif. “Why am I not able to control my eating? What is going on that I can’t put my fork down or step away from the refrigerator?

“I start eating, and I don’t stop.”

She was recently diagnosed with binge-eating disorder, a condition involving compulsive, out-of-control episodes of eating followed by deep shame, guilt and depression.

It’s the country’s most prevalent eating disorder, shared by more than 8.5 million Americans: Binge-eating disorder affects more people than do bulimia and anorexia combined, yet experts say it has long been underdiagnosed as a mental health issue.

That’s likely to change this spring, when the new edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5 – the so-called bible of psychiatric treatment – for the first time lists binge-eating disorder as a specific diagnosis.

Unlike most eating disorders, it affects men in large numbers: More than 40 percent of binge eaters are male, according to Harvard University research.

And unlike other eating disorders, it can develop in middle age and beyond, when retirement, care-giving, widowhood and other midlife stresses can trigger eating issues.

Now advocates hope DSM-5 recognition for binge-eating disorder as a treatable behavior pattern will put it on par in the public’s mind with better-known conditions such as anorexia – and open new avenues to insurance coverage.

“Too often, people with binge-eating disorder are referred inaccurately to weight-loss loss programs or clinics,” said Susie Roman, National Eating Disorder Association program director. “What they need is binge-eating disorder treatment.

“Having new insurance coverage standards can be helpful in getting people more access to treatment earlier.”

As it is, binge-eating disorder often falls between the health plan cracks.

Although the previous edition of the Diagnostic and Statistical Manual describes binge-eating disorder in an appendix, it’s not a distinct diagnosis – and it’s not included on the parity law list.

As a result, mental health professionals have ended up lumping the condition into a catch-all diagnostic category called “eating disorder not otherwise specified,” which many health plans don’t cover.

“You can have a patient who’s extremely ill, but we have to give them the (catch-all) diagnosis,” said Jennifer Lombardi, executive director of Sacramento’s Summit Eating Disorders and Outreach Program. “That might mean they don’t receive sufficient care.

“From the clinician’s perspective, the change of DSM-5 diagnostic criteria is a very good thing. We see patients like this all the time, but there have been gaps in access to treatment and services.”

Research shows that binge-eating disorder accounts for up to 15 percent of cases of extreme obesity and increases the risk of high cholesterol, high blood pressure, heart disease and type 2 diabetes.

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