Applying Harm Reduction to Binge Eating Disorder: An Investigation of Protective Behavioral Strategies Against Uncontrolled Eating

PROJECT SUMMARY/ ABSTRACT
Binge eating disorder (BED) is the most diagnosed eating disorder, characterized by eating objectively large
amounts of food one feels unable to refrain from or stop consuming (i.e., binge eating; BE). Recurrent BE must
be present at least once a week on average over the past three months and co-occur with significant
psychological distress. BED is notoriously difficult to treat, with some estimates concluding that more than one
half of patients do not maintain remission from binge eating six months after treatment discontinuation.
BE is often onset by momentary factors, such as a desire to reduce negative affect, or as a response to food
cravings. Less understood is what differentiates individuals with BED and those without eating pathology when
experiencing cravings or negative affect, and if there are strategies that prevent BE for the latter population.
Increasingly, there has been a call for assessment of the efficacy of a harm reduction approach in
addressing eating disorders. Harm reduction, primarily utilized in the substance use disorder field, is a
framework in which lowering risk of use is promoted in those who are unable or unwilling to completely abstain
from a harmful behavior. Experiences shared across substance use disorders and binge eating (e.g., cravings)
may account for the high co-occurrence of BED and substance use, and salience of similar treatment targets
and intervention strategies. Protective behavioral strategies (PBS) are actions one can take while engaging in a
potentially harmful behavior to decrease risk of serious consequences. Characteristics of highly palatable foods
(e.g., high sugar/ fat) and frequency at which they are consumed are associated with serious morbidity and
mortality implications, and thus these foods are commonly recognized as risky to over-consume. The proposed
study will utilize a PBS framework to assess how PBS may apply to reducing the frequency and intensity of BE
and specifically, whether there are differences between healthy controls (HC) and individuals with BED regarding
their momentary-level behavior that leads to differential eating outcomes. First, using an online screener to recruit
from a national sample, an estimated 10-15 HC and 10-15 individuals with BE will engage in interviews to
qualitatively assess presence of BE and eating-related PBS (Aim 1). Next, a measure of eating-related PBS will
be developed from qualitative responses and cognitive interviews will be used to refine and ascertain
comprehension of the developed measure. The measure will then be validated among 500 with BE and 500 HC
in an online survey (Aim 2). Finally, 25 HC and 25 individuals with BED will participate in an ecological
momentary assessment study where they report daily-level PBS to assess for group differences in PBS use in
response to real-life BE precedents (Aim 3). The proposed study will implement a mixed methods approach
utilizing technology for real-time assessment to investigate PBS against BE. Findings will inform
potential efficacy of PBS for eating behavior in line with a harm reduction approach and may bolster
existing BED interventions.

Grant Number: 5F31MH135713-02
NIH Institute/Center: NIH
Principal Investigator: Emily Burr