Presentations & Learning Objectives

An Introduction to Binge-Eating Disorder

Kate Craigen, PhD

Day 1: 8:10 am PST / 11:10 am EST (35 minutes, including Q&A)

Overview:

In this presentation, Dr. Craigen will review the important clinical features of this population of patients, national and international demographics data, and the role of shame and weight stigma in clinical interactions.

Learning Objectives:

• List the specific diagnostic criteria for binge eating disorder.
• Identify four common precursors to binge eating episodes.
• Describe two differences between loss of control eating and other types of eating episodes.

References:

– Thompson-Brenner, H. et al. (2013). Race/Ethnicity, Education, and Treatment Parameters as Moderators and Predictors of Outcome in Binge Eating Disorder. Journal of Consulting and Clinical Psychology, 81 (4), 710–721.
– Kessler, R. et al. (2013). The Prevalence and Correlates of Binge Eating Disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry, 73, 904–914.
– Duarte, C. & Pinto-Gouveia, J. (2017). Self-Defining Memories of Body Image Shame and Binge Eating in Men and Women: Body Image Shame and Self-Criticism in Adulthood as Mediating Mechanisms. Sex Roles, 77, 338-351.

The Functional & Integrative Medicine Model for Binge-Eating Disorder: Neurotransmitters, Amino Acids & More

James Greenblatt, MD

Day 1: 8:45 am PST / 11:45 am EST (75 minutes, including Q&A)

Overview:

In this presentation, Dr. Greenblatt will explore the clinical challenges of treating Binge-Eating Disorder and illuminate an evidence-based functional medicine model for treatment. The New Hope Model integrates lab testing, nutritional supplementation, dietary modifications, and
medication, and targets biochemical pathways that regulate appetite, allowing clinicians to address imbalances that perpetuate hunger and cravings and bring patients back into balance.

Learning Objectives:

• Describe one way that neurotransmitter regulation affects hunger and satiety signaling.
• List three common causes of functional amino acid deficiency.
• Discuss one example of how 5-HTP can affect appetite regulation.

References:

– Zepf, F.D. (2013). Acute tryptophan depletion–A translational research method for studying the impact of central nervous system serotonin function. Acta Psychiatr Scand. Aug;128(2):105-6. doi: 10.1111/acps.12162. PMID: 23829231.
– van de Wouw, M., Schellekensm H., Dinan, T.G., Cryan, J.F. (2017). Microbiota-gut-brain axis: Modulator of host metabolism and appetite. J Nutr. May;147(5):727-745. doi: 10.3945/jn.116.240481. Epub 2017 Mar 29. PMID: 28356427.
– Gearhardt et al. (2011). Neural correlates of food addiction. Arch Gen Psychiatry. Aug;68(8):808-16. doi: 10.1001/archgenpsychiatry.2011.32. Epub 2011 Apr 4. PMID: 21464344; PMCID: PMC3980851.

The Etiology & Treatment of Co-Morbid Sleep, Circadian Rhythm Dysfunction & Night Eating Syndrome

Ralph Carson, LD, RD, PhD

Day 1: 10:30 am PST / 1:30 pm EST (60 minutes, including Q&A)

Overview:

Night eating syndrome (NES) is listed in the DSM-5 as an OFSED, but it was first described as long ago as 1955. There are varying operational definitions that categorize the syndrome as a combination of eating, sleeping and mood disorders. Too often NES is not identified nor treated by healthcare professionals despite its prevalence which is estimated to be as high as 25% of the loss of control (BED) population. Failure to address the condition can result in significant detriment to health and well-being. This talk will focus on the dysregulation of the circadian rhythm and provide insights into sleep improvement. Interventions for treating NES will touch on medications, nutritional therapy, psychotherapy, phototherapy and behavioral approaches.

Learning Objectives:

• Discuss five possible causes of night eating syndrome.
• List three medications that have been useful in the treatment of night eating syndrome.
• Describe the dietitian’s role in treating night eating syndrome.
• Explain how to correct a dysfunctional circadian rhythm pattern.
• Compare how binge eating disorder differs from night eating syndrome.
• Name five cues that reset the body’s internal clocks.
• Identify three messengers that are cued by light dark cycles and show a characteristic 24-hour pattern.

References:

– Braun, R. et al. Universal method for robust detection of circadian state from gene expression PNAS (2018) 115: E9247 – E9.
– Cedernaes, J. et al Acute sleep loss induces tissue-specific epigenetic and transcriptional alterations to circadian clock genes in men. The Journal of Clinical Endocrinology & Metabolism, (2015) 100(9):E1255-61
– Longo, V.D. and Panda, S. Fasting, Circadian Rhythms, and Time-Restricted Feeding in Healthy Lifespan Cell Metabolism (2016) 14: 1049 – 1058

CBT and BED: Cognitive Behavioral Strategies to Decrease Binge Eating

Kate Craigen, PhD

Day 1: 11:30 am PST / 2:30 pm EST (75 minutes, including Q&A)

Overview:

In this presentation, Dr. Craigen will review the foundations of the cognitive behavioral treatment of binge eating and the supporting scientific evidence. She will also provide details on some of the most efficacious interventions with case examples. She will also discuss the role of diet culture in the maintenance of binge eating and the challenges of integrating weight loss goals that could compromise treatment goals.

Learning Objectives:

• List two specific cognitive behavioral therapy (CBT) interventions that can be used in clinical practice.
• Utilize the CBT-E formulation to guide case conceptualization of binge eating disorder.
• Explain two in-session interventions that help challenge eating disordered thought patterns.
• Describe a multi-step, graduated approach to the establishment of a pattern of regular eating.
• Explain the importance of increased variety and the utility of food exposures in the treatment of binge eating disorder.

References:

– Turner, H., Marshall, E.M., Stopa, L., & Waller, G. (2015). Cognitive-behavioural therapy for outpatients with eating disorders: Effectiveness for a transdiagnostic group in a routine clinical setting. Behaviour Research and Therapy, 68, 70-75.
– Waller, G. et al. (2018). A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: Outcomes from a case series of nonunderweight adult patients. Int J Eat Disord, 51, 262–269.
– Wilson, G.T., & Zandberg, L. J. (2012). Cognitive–behavioral guided self-help for eating disorders: Effectiveness and scalability. Clinical Psychology Review 32, 343–357.

The Science of Sugar Addiction: How our Brain and Behavior are Impacted by Processed Food

Nicole Avena, PhD

Day 1: 1:15 pm PST / 4:15 pm EST (75 minutes, including Q&A)

Overview:

In this presentation, Dr. Avena will review the latest empirical research on food addiction from clinical and preclinical neuroscience and psychology studies. She will also discuss how processed foods can lead to signs of addiction, how we can characterize this, and how we can mitigate it.

Learning Objectives:

• List three criteria for addiction, and how processed foods have met each of them.
• Describe what happens in the brain in response to overeating highly-palatable foods.
• Summarize the latest research studies on food addiction in both pre-clinical and clinical models.
• Discuss three core features of addictive foods, and how to recognize them in the food environment.
• Explain two ways in which the modern food environment can contribute to addictive overeating, and which methods can be used to mitigate or prevent this.

References:

– Murray S.M., Tweardy S., Geliebter A., Avena N.M. (2019) A Longitudinal Preliminary Study of Addiction-Like Responses to Food and Alcohol Consumption Among Individuals Undergoing Weight Loss Surgery. Obes Surg, 29(8), 2700-2703. 
– Criscitelli K., Avena N.M. (2016) The neurobiological and behavioral overlaps of nicotine and food addiction. Prev Med, 92, 82-89.
– Murray S., Tulloch A., Criscitelli K., Avena N.M. (2016) Recent studies of the effects of sugars on brain systems involved in energy balance and reward: Relevance to low calorie sweeteners. Physiol Behav, 164(Pt B), 504-508. 

The Case for and Against Food Addiction: A Scientific and Legal Analysis

Robert Lustig, MD, MSL

Day 1: 2:30 pm PST / 5:30 pm EST (75 minutes, including Q&A)

Overview:

While many in academia and clinical medicine who believe in food addiction,” there are factions who favor the concept of “eating addiction.” This is not semantic, because it defines culpability and addresses where efforts should be placed. We will address the biochemical and legal definitions of addiction, to determine what about food is addictive, and what can be done about it.

Learning Objectives:

• Explain two differences between “food addiction” and “eating addiction”.
• Describe the scientific precepts of addiction, and the physiology of dopamine.
• Discuss two aspects of the evolution of the criteria of addiction, from withdrawal to dependence.
• List two addictive properties of macronutrients and micronutrients.
• Explain the legal difference between “food” and “food additive.”

References:

– Gordon, E. L., Ariel-Donges, A. H., Bauman, V., & Merlo, L. J. (2018). What Is the Evidence for “Food Addiction?” A Systematic Review. Nutrients, 10(4), 477.
– Lindgren, E., Gray, K., Miller, G., Tyler, R., Wiers, C. E., Volkow, N. D., & Wang, G. J. (2018). Food addiction: a common neurobiological mechanism with drug abuse. Front. Biosci., 23, 811-836.
– Lustig, R. H. (2020). Ultraprocessed food: addictive, toxic, and ready for regulation. Nutrients, 12(11), 3401.

Pharmacology for BED and Food Addiction: Mastering Balance

James Greenblatt, MD

Day 2: 9:00 am PST / 12:00 pm EST (30 minutes, including Q&A)

Overview:

In this presentation, using his experience as a medical director of a Binge-Eating Disorder program, Dr. Greenblatt will review the research on medications commonly used to treat BED, including one that is FDA approved.  He will also discuss the impact of food additives like MSG and exorphins (like those in wheat and dairy) in food addiction.

Learning Objectives:

• Name one medication that is currently FDA approved for BED.
• Describe how to use naltrexone to treat BED.
• List two exorphins that may contribute to food addiction via morphine analogs.

References:

– Appolinario, J. C., Nardi, A. E., & McElroy, S. L. (2019). Investigational drugs for the treatment of binge eating disorder (BED): an update. Expert opinion on investigational drugs, 28(12), 1081–1094. https://doi.org/10.1080/13543784.2019.1692813
– Hudson, J. I., McElroy, S. L., Ferreira-Cornwell, M. C., Radewonuk, J., & Gasior, M. (2017). Efficacy of Lisdexamfetamine in Adults With Moderate to Severe Binge-Eating Disorder: A Randomized Clinical Trial. JAMA psychiatry, 74(9), 903–910. https://doi.org/10.1001/jamapsychiatry.2017.1889
– Guerdjikova, A. I., Walsh, B., Shan, K., Halseth, A. E., Dunayevich, E., & McElroy, S. L. (2017). Concurrent Improvement in Both Binge Eating and Depressive Symptoms with Naltrexone/Bupropion Therapy in Overweight or Obese Subjects with Major Depressive Disorder in an Open-Label, Uncontrolled Study. Advances in therapy, 34(10), 2307–2315. https://doi.org/10.1007/s12325-017-0613-9