Weight dysregulation, positive energy balance, and binge eating in eating disorders

Abstract

Determinants of binge eating are usually understood in terms of cognitive, behavioral, and affective disturbances. However, many of those with eating disorders (EDs) experienced elevated premorbid weights, lost substantial weight as their disorder developed and/or are currently at low weight. We review evidence that these three aspects of weight regulation are related to binge eating, to loss of control eating in the absence of objective binge eating and/or to positive energy balance and weight gain over time (an outcome that is greatly feared in those with EDs). Thus, there appear to be powerful reciprocal influences between psychological and biological aspects of binge eating but until recently only the psychological features have been incorporated into models of ED psychopathology and treatment. Further, several studies have shown that weight suppression is also related to eating symptoms in nonclinical groups, which indicates that elevated weight suppression can accelerate weight regain and have other negative impacts in the absence of an ED. In sum, the impact of weight history on the perpetuation of EDs indicates that treatment researchers should consider this impact as they try to improve treatment outcomes.