Obesity with Comorbid Eating Disorders: Associated Health Risks and Treatment Approaches

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obesity 955 disorders are each associated with severe physical and mental health consequences, and individuals with obesity as well as comorbid eating disorders are at higher risk of these than individuals with either condition
obesity 1084 eating disorders are at higher risk of these than individuals with either condition alone. Moreover, obesity can contribute to eating disorder behaviors and vice-versa. Here, we comment on the health complications
obesity 1240 vice-versa. Here, we comment on the health complications and treatment options for individuals with obesity and comorbid eating disorder behaviors. It appears that in order to improve the healthcare provided
obesity 1496 greater exchange of experiences and specialized knowledge between healthcare professionals working in the obesity field with those working in the field of eating disorders, and vice-versa. Additionally, nutritional
obesity 1744 simultaneously addressing weight management and reduction of eating disorder behaviors in individuals with obesity and comorbid eating disorders may be required. Future research investigating the effects of integrated
obesity 1998 treatment programs addressing weight management and eating disorder psychopathology in individuals with obesity and comorbid eating disorder behaviors—such as binge eating—is necessary.1. IntroductionObesity
obesity 2173 necessary.1. IntroductionObesity is commonly associated with health complications. Individuals with obesity are at high risk of several physical diseases, such as certain cancers, diabetes, hypertension, heart
obesity 2490 also often associated with mental health problems and psychosocial difficulties. Indeed, women with obesity tend to report worse mental health than women without obesity [[8]]. Moreover, women tend to experience
obesity 2552 psychosocial difficulties. Indeed, women with obesity tend to report worse mental health than women without obesity [[8]]. Moreover, women tend to experience more mental health complications associated with obesity than
obesity 2651 obesity [[8]]. Moreover, women tend to experience more mental health complications associated with obesity than men [[9]], albeit mental health problems associated with obesity (e.g., anxiety) occur in both
obesity 2721 complications associated with obesity than men [[9]], albeit mental health problems associated with obesity (e.g., anxiety) occur in both women and men [[9]]. One factor that can be detrimental to the mental
obesity 2856 both women and men [[9]]. One factor that can be detrimental to the mental health of individuals with obesity is exposure to well-documented discriminatory attitudes and behaviors in different areas, such as employment,
obesity 3374 disorder behaviors [[11]].The eating disorders that have been most frequently studied in individuals with obesity are binge eating disorder and bulimia nervosa. Binge eating disorder is defined in the current Diagnostic
obesity 4676 the past 3 months [[12]]. In addition to binge eating disorder and bulimia nervosa, individuals with obesity can also experience “other specified feeding or eating disorder” when presentations cause significant
obesity 5421 Latin America, for example, the prevalence of binge eating disorder was 16–52% in individuals with obesity (BMI ≥ 30 kg/m2) attending weight loss programs [[13]]. In the United States, a study with a nationally-representative
obesity 5694 2001–2003 found that 42% of individuals that had had a binge eating disorder at any stage in their life had obesity at the time of the survey [[14]]. A more recent study in the United States, with a sample of 36,306
obesity 6059 disorder in the last 12 months, or at any time in their lives, had significantly increased odds of having obesity or extreme obesity [[15]]. On the flip side, a study with a clinical sample of 1383 individuals with
obesity 6078 months, or at any time in their lives, had significantly increased odds of having obesity or extreme obesity [[15]]. On the flip side, a study with a clinical sample of 1383 individuals with current eating disorders,
obesity 6381 of individuals with binge eating disorder, and 33% of individuals with bulimia nervosa, had also had obesity at some point in their lives [[16]]. These studies show a significant co-occurrence of obesity and eating
obesity 6476 had obesity at some point in their lives [[16]]. These studies show a significant co-occurrence of obesity and eating disorders, and are consistent with the hypothesis that these conditions can potentially contribute
obesity 6641 hypothesis that these conditions can potentially contribute to and/or exacerbate each other. Additionally, obesity with comorbid eating disorder behaviors, such as binge eating, may be a growing problem. In a population-representative
obesity 6893 Australia between the years of 1995 to 2015, there were significant increases in the prevalence of obesity and eating disorder behaviors independently; however, the greatest increases were in the prevalence
obesity 7021 behaviors independently; however, the greatest increases were in the prevalence of individuals with obesity and comorbid binge eating or very strict dieting (7.3 fold and 11.5 fold, respectively) [[17]]. The
obesity 7160 very strict dieting (7.3 fold and 11.5 fold, respectively) [[17]]. The increases in the prevalence of obesity and comorbid eating disorder behaviors mentioned above may be related to a potential contribution of
obesity 7285 eating disorder behaviors mentioned above may be related to a potential contribution of binge eating to obesity [[14],[18],[19]], as well as to the social expectancy for people with obesity to lose excess weight
obesity 7363 contribution of binge eating to obesity [[14],[18],[19]], as well as to the social expectancy for people with obesity to lose excess weight [[17]]. The potentially growing prevalence of individuals with obesity and comorbid
obesity 7456 people with obesity to lose excess weight [[17]]. The potentially growing prevalence of individuals with obesity and comorbid eating disorder behaviors is concerning due to the medical and psychosocial risks that
obesity 7671 individuals are exposed to.2. Health Risks of Obesity with Comorbid Eating DisordersIndividuals with obesity and comorbid eating disorders are at high risk of several medical and psychosocial complications. A
obesity 7829 several medical and psychosocial complications. A study with 152 treatment-seeking individuals with obesity found that those with binge eating disorder had higher BMIs, more severe levels of depression and obsessive-compulsive
obesity 8852 surgery candidates without binge eating disorder [[22]]. Not only is binge eating in individuals with obesity associated with poor mental health and poor quality of life, but binge eating can also hinder weight
obesity 8993 health and poor quality of life, but binge eating can also hinder weight loss in individuals with morbid obesity . For instance, a systematic review found that individuals submitted to bariatric surgery that had clinically
obesity 9324 pre-surgical binge eating, or than those who stopped binge eating after the surgery [[23]]. The occurrence of obesity in individuals with eating disorders is also associated with greater mental health complications. For
obesity 9491 with greater mental health complications. For instance, individuals with eating disorders that had had obesity at any stage in their lives had higher eating disorder severity and greater general psychopathology
obesity 9651 disorder severity and greater general psychopathology than those with eating disorders that had never had obesity [[16]]. Finally, obesity with comorbid binge eating can be functionally detrimental. For example, individuals
obesity 9676 general psychopathology than those with eating disorders that had never had obesity [[16]]. Finally, obesity with comorbid binge eating can be functionally detrimental. For example, individuals with obesity and
obesity 9774 Finally, obesity with comorbid binge eating can be functionally detrimental. For example, individuals with obesity and comorbid binge eating had greater work-related impairment in productivity than those with obesity
obesity 9876 obesity and comorbid binge eating had greater work-related impairment in productivity than those with obesity only, or binge eating only, or than those of normal weight without binge eating [[24]]. Thus, individuals
obesity 9995 binge eating only, or than those of normal weight without binge eating [[24]]. Thus, individuals with obesity and comorbid eating disorders are at higher risk of medical and psychosocial complications than individuals
obesity 10529 amongst healthcare professionals regarding the most appropriate treatment approaches for individuals with obesity and comorbid eating disorders. The most controversial aspect of this debate relates to potential benefits
obesity 10721 to potential benefits and harms of dieting to lose weight. Healthcare professionals specializing in obesity often recommend dieting to their patients or clients with overweight or obesity, encouraging them to
obesity 10801 professionals specializing in obesity often recommend dieting to their patients or clients with overweight or obesity , encouraging them to reduce and then maintain a healthy weight. Conversely, healthcare professionals
obesity 12746 restriction (i.e., the consumption of certain foods in moderation) may be necessary for individuals with obesity or for those at risk of developing weight-related health problems in order to reduce the health consequences
obesity 14593 [[32]]. Finally, a systematic review showed that clinically supervised severe energy restriction to treat obesity —as in that used with total meal replacement diets such as very low energy diets—mostly did not cause
obesity 16048 amongst healthcare professionals regarding the most appropriate treatment approaches for individuals with obesity and comorbid eating disorders.4. Treatments for Obesity with Comorbid Eating DisordersPrevious studies
obesity 16214 with Comorbid Eating DisordersPrevious studies have examined the effects of treating individuals with obesity and comorbid eating disorders with weight loss or eating disorder treatments, alone or in combination
obesity 17378 loss therapy was relatively small (i.e., −2.1 kg/m2) [[38]], and the combination of CBT with other obesity treatments could potentially induce greater weight loss. In line with this, another study found significant
obesity 17807 serotonin reuptake inhibitor) and topiramate (an anti-convulsant sometimes used in the treatment of obesity ) [[35]].This same study did not show any significant change in body weight or binge eating in the comparison
obesity 18431 addition of CBT to 16 sessions of group behavioral weight loss therapy in 116 women with overweight/ obesity and comorbid binge eating disorder [[36]]. In this study, the serotonin reuptake inhibitor fluoxetine
obesity 19820 order to reduce body weight and binge eating. Indeed, in another study involving 50 individuals with obesity and comorbid binge eating disorder, participants were randomized to CBT + a diet of low energy density,
obesity 20332 in the two groups [[37]]. Overall, the above-mentioned studies showed that certain combinations of obesity treatments with CBT for eating disorders can induce significant reduction of binge eating and weight
obesity 20466 eating disorders can induce significant reduction of binge eating and weight loss in individuals with obesity and comorbid eating disorders.While some scientific studies have examined the effects of combining obesity
obesity 20573 and comorbid eating disorders.While some scientific studies have examined the effects of combining obesity treatments with eating disorder treatments [[35],[36],[37]], most of the current treatment programs
obesity 20685 treatments with eating disorder treatments [[35],[36],[37]], most of the current treatment programs for obesity or eating disorders still target only one or the other condition. For example, CBT-E is suitable for
obesity 20896 use in binge eating disorder, however, it does not encourage weight loss for those with overweight or obesity and comorbid binge eating disorder [[11]], nor does it result in substantial weight loss [[38],[39]].
obesity 21842 binge eating disorder concluded that weight loss treatments should be offered only to individuals with obesity that do not engage in binge eating [[40]]. This contrasts with a study which found that behavioral weight
obesity 22118 eating disorder psychopathology, concomitantly reduced binge eating and body weight in individuals with obesity and comorbid binge eating disorder [[38]]. Additionally, a systematic review and meta-analyses found
obesity 22355 to simultaneously assist weight management and reduce eating disorder behaviors in individuals with obesity and comorbid bulimia nervosa [[41]]. According to that systematic review and meta-analysis, it is necessary
obesity 22517 systematic review and meta-analysis, it is necessary to develop and test integrated treatments for obesity with bulimia nervosa due to the rise in prevalence of individuals with obesity and comorbid bulimia
obesity 22596 integrated treatments for obesity with bulimia nervosa due to the rise in prevalence of individuals with obesity and comorbid bulimia nervosa [[41]]. In line with this, we have been involved with the development of
obesity 22982 a moderate to slow rate of weight loss) and to reduce eating disorder behaviors in individuals with obesity and comorbid eating disorders [[42]]. The feasibility and acceptability of this intervention was shown
obesity 23533 investigated [[44]].Integrated treatments, such as HAPIFED, may be particularly attractive to individuals with obesity and comorbid eating disorders. For instance, a systematic review found that only an estimated 23% of
obesity 23816 disorder, whereas 30–73% of individuals with eating disorders sought treatments for their overweight or obesity (13). This tendency for individuals with eating disorders to seek weight loss treatments instead of
obesity 24094 treatment of a significant proportion of individuals with eating disorders that are overweight or have obesity . In addition to potentially improving treatment adherence, integrated treatments for obesity with comorbid
obesity 24187 or have obesity. In addition to potentially improving treatment adherence, integrated treatments for obesity with comorbid eating disorders may also promote greater physical and mental health benefits than treatments
obesity 24863 disorder behaviors and to discuss these studies with healthcare professionals working with clients with obesity or eating disorders. This is especially important given that healthcare professionals working in the
obesity 24982 disorders. This is especially important given that healthcare professionals working in the fields of obesity or eating disorders frequently have different professional backgrounds (i.e., psychological versus medical
obesity 25148 backgrounds (i.e., psychological versus medical versus nutritional).5. ConclusionsIndividuals with obesity and comorbid eating disorders are at higher risk for several medical and psychosocial complications
obesity 25323 medical and psychosocial complications than individuals with either condition alone. The co-occurrence of obesity with comorbid eating disorders, particularly binge eating disorder, requires attention of healthcare
obesity 25540 professionals working with clients with either of these conditions. Healthcare professionals specialized in obesity treatment and not addressing eating disorder behaviors of their clients—when these are present—will
obesity 25909 eating disorders and not addressing weight management with their clients with comorbid overweight or obesity may see a reduced interest from their clients, potentially resulting in disengagement from (or lack
obesity 26375 recommending weight loss diets to their clients, healthcare professionals working in either of these fields of obesity or eating disorders can acknowledge the common goal of promoting healthy eating behaviors, healthy relationships
obesity 26724 test innovative medical, psychological, and nutritional treatment options that simultaneously address obesity as well as comorbid eating disorders. Such integrated treatments can potentially induce greater improvements

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