nursing.elitecme.com Page 97 Complete Your CE Test Online - Click Here Cardiovascular disease Obesity has long been recognized as a contributing factor for the development of heart disease. Hypertension and elevated cholesterol, already mentioned as part of the pathophysiology of obesity due to binge eating, contribute to the risk for cardiovascular disease. Research shows that abdominal fat deposits increase this risk even more. Risk is correlated with a waist measurement greater than 40 inches in men and greater than 35 inches in women[23] . Type 2 diabetes Type 2 diabetes, formerly referred to as non-insulin dependent diabetes, is the more prevalent form of diabetes. Research shows that this type of diabetes may develop as a consequence of obesity[23] . Gallbladder disease The development of gallbladder disease is associated with obesity as well. Intake of high-fat, high-calorie foods may precipitate or trigger various types of gallbladder disease[9,23] . Additional factors that may be looked upon as pathophysiology related to binge eating include the following issues: ● ● Diet concerns: Binge eating may involve the intake of foods that are high in saturated fats, carbohydrates, and salts. All of these kinds of foods contribute to weight gain. They also contribute to heart disease and elevate the risk of developing type 2 diabetes. Dental problems may also occur if high-fat, high-carbohydrate foods are frequently ingested without proper dental hygiene[9,23] . ● ● Sleep disorders: Feelings of concern about weight and physical appearance, disgust with their own binge-eating behaviors, and the stress extra weight can put on respiratory muscles all combine to make sleep disorders a possibility[9,22,23] . ● ● Suicidal ideation and depression: Clients with binge-eating disorder should be assessed and monitored for depression. Increases in appetite and weight gain are included in the criteria for major depressive disorder, as previously noted. Feelings of depression and self-disgust are quite common in persons who suffer from binge-eating disorder[1,20,22] . Diagnostic criteria The following statements summarize the diagnostic criteria for binge- eating disorder as identified by the DSM-5[1] : ● ● There are recurrent episodes of binge-eating. Binge-eating is defined as eating in a specific period of time an amount of food that is definitely larger than what most people would eat in a similar period of time and under similar circumstances. Affected persons feel a lack of control over their binge-eating behaviors. They believe that they cannot stop eating or control what or how much they eat. ● ● The episodes of binge-eating must be associated with at least three or more of the following: ○ ○ Eating much more quickly than normal. ○ ○ Eating until feeling uncomfortably full. ○ ○ Eating large amounts of food when not feeling physically hungry. ○ ○ Eating alone because of feelings of embarrassment over how much is being eaten. ○ ○ Feeling disgusted, depressed, or very guilty after binge-eating. ○ ○ Affected persons feel marked distress regarding their binge- eating. ● ● Binge-eating occurs, on average, at least once a week for three months. ● ● Binge-eating is not associated with the repeated use of compensatory behaviors as is found in bulimia nervosa. Binge- eating does not occur exclusively during the course of bulimia nervosa or anorexia nervosa. ● ● In addition to meeting the preceding diagnostic criteria, it is important to determine if the disease is in remission, and if it is, is the remission partial or full. The DSM-5 describes remission in the following ways[1] : ○ ○ Partial remission: After full criteria for binge-eating disorder were previously met, episodes of binge-eating occur at an average frequency of less than one episode per week for a sustained period of time. ○ ○ Full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time. The DSM-5 also describes levels of severity based on the frequency of binge-eating episodes[1] : ● ● Mild: There are one to three binge-eating episodes per week. ● ● Moderate: There are four to seven binge-eating episodes per week. ● ● Severe: There are eight to 13 binge-eating episodes per week. ● ● Extreme: There are 14 or more binge-eating episodes per week. Nursing consideration: Characteristically, persons with binge- eating disorder are ashamed of their eating behaviors and try to conceal their symptoms[1] . This concealment can make recognition of the disease a challenge. Healthcare professionals must be on the alert for behaviors, signs and symptoms that indicate the existence of binge-eating disorder. Treatment The treatment goals for persons suffering from binge-eating disorder are to reduce eating binges, improve emotional well-being and self- esteem, and, as needed, to lose weight. Because binge-eating is so often linked to negative self-image and other psychosocial issues, it is important to address the emotional as well as the physical impact of binge eating[22] .