Prevalence and Associations of Binge Eating Disorder in a Multiethnic Population With Type 2 Diabetes

Binge eating disorder (BED) is a syndrome characterized by recurrent uncontrollable overeating (1,2), with prevalence rates of ∼3% in the general population and 10- to 20-fold higher in patients seeking treatment for obesity (1,3). There are limited reports of BED in subjects with type 2 diabetes, particularly in minorities (4,5).

We conducted a pilot study to assess BED and its association with obesity, metabolic control, and depression in a tri-ethnic (37% Hispanic, 40% non-Hispanic white, and 19% African American) population with type 2 diabetes (n = 140). We used the nine-item Questionnaire of Eating and Weight Patterns (QEWP), the Binge Eating Scale (BES), and the Beck Depression Inventory (BDI) to assess our study population.

On average, patients were (mean ± SD) 59.1 ± 11.1 years old and had a mean BMI of 34.5 ± 6.2 kg/m², diabetes duration of 10 ± 7.8 years, and HbA_1c (A1C) 7.7 ± 2.0%. Abnormal eating (one or more positive responses) as per QEWP scoring criteria (based on DSM-IV) was 40% overall. When analyzed according to binge-eating status (present or absent), subjects positive for binge eating were younger (55.8 ± 11.2 vs. 61.3 ± 10.5 years, P = 0.008), had a greater BMI (36 ± 6.6 vs. 33.6 ± 5.8 kg/m², P = 0.039), and had a higher A1C (8.2 ± 2.2 vs. 7.3 ± 1.8%, P = 0.027) compared with those with negative responses. Furthermore, BES score, which assesses binge eating severity on a continuous scale, was significantly associated with A1C (r = 0.24, P = 0.021), BMI (r = 0.36, P = 0.001), and diastolic blood pressure (r = 0.22, P = 0.018). BES scores were higher in those with BDI scores ≥19 (suggestive of moderate to severe depression), regardless of BMI and degree of glycemic control. Logistic regression analysis showed that age <60 years (odds ratio 3.4, P = 0.018) and African-American ethnicity (6.20, P = 0.004) were independently associated with abnormal eating using the QEWP.

The prevalence of binge-eating behaviors appears to be elevated in overweight patients with type 2 diabetes, particularly when subjects are younger or African American. Acknowledging the limitations of questionnaires when compared with structured interviews, we suggest using the QEWP as a quick screening tool to detect abnormal eating habits in patients with type 2 diabetes. Patients may then be referred to the appropriate health provider, who can implement more comprehensive diagnostic evaluation and appropriate interventions (6).