Binge Eating Disorder Is a Social Justice Issue: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts’ Opinions 

Why is this research important?  
This research highlights the complex environmental factors that particularly influence the development or maintenance of Binge Eating Disorder (BED) in adults. These include: 

• Systems of oppression, e.g. weight/shape/size discrimination, racism, sexism, sociocultural ideals related to diet culture, health system barriers including cost and discrimination, and unequal distribution of resources. Many of these factors intersect with homelessness, unemployment, poverty and food insecurity, and the authors note that experiencing more than one of these factors is likely to exponentially increase risk for BED;
• The experience of marginalization or under-representation, where people most likely to be impacted by BED but overlooked in terms of assessment and treatment include people with low socioeconomic status, people who are black, indigenous or people of colour (BIPOC), people who are LGBTIQA+;  
• Economic precarity and food insecurity, where food or nutritional scarcity or insecurity can disrupt a person’s relationship with food and eating and lead to a pattern of forced restriction and binge eating; 
• Stigma and its psychological impact, where stigma may relate to body weight/shape/size, having a diagnosis of an eating disorder or other health or mental health issue, or perfectionistic ideas regarding food and/or eating; 
• Trauma and adversity, including adverse childhood experiences, adverse food experiences in childhood (i.e. food scarcity/insecurity), other food-related trauma, trauma related to movement (e.g. being ridiculed when forced to exercise), trauma related to body weight/shape/size, interpersonal trauma, and abuse; 
• Interpersonal factors, e.g. social sensitivity, limited social skills, specifical socialisation around food or eating as a problem; 
• Social messaging, such as reinforcement of body, food and fitness ideals which contribute to stigma, social ranking and issues related to self-esteem and valuation; 
• Predatory food industry practices, such as the engineering of foods to promote particular reward and behavioural responses; 
• Gaps in research and clinical directives, including under-representation of eating disorders in distribution of research funding, standardized health advice regarding food and movement which may be insensitive or traumatic for a person with BED, implicit weight bias within the eating disorder field, and the need to include the voices of people who have been historically overlooked. 

The authors highlight the above factors as social justice issues and call for policy responses to systemic issues, improved public awareness of BED and the people it can affect, and greater attention to the stories and experiences of people with BED. This study may contribute to greater understanding of the role that systemic and intersecting social inequalities can play in precipitating or maintaining BED, as well as pointing to several important areas for further investigation. 
  
Authors:  Brenna Bray, Chris Bray, Ryan Bradley, Heather Zwickey 
  
Abstract/Summary:  
Background: Binge eating disorder is an autonomous DSM-V diagnosis characterized by discrete rapid consumption of objectively large amounts of food without compensation, associated with loss of control and distress. Environmental factors that contribute to binge eating disorder continue to evolve. This mixed-methods cross-sectional study assessed whether there is consensus among experts in the field about environmental factors that influence adult binge eating disorder pathology.
Methods: Fourteen expert binge eating disorder researchers, clinicians, and healthcare administrators were identified internationally based on federal funding, PubMed-indexed publications, active practice in the field, leadership in relevant societies, and/or clinical and popular press distinction. Semi-structured interviews were recorded anonymously and analyzed by ≥2 investigators using reflexive thematic analysis and quantification.
Results: Identified themes included: (1) systemic issues and systems of oppression (100%); (2) marginalized and under-represented populations (100%); (3) economic precarity and food/nutrition insecurity/scarcity (93%); (4) stigmatization and its psychological impacts (93%); (5) trauma and adversity (79%); (6) interpersonal factors (64%); (7) social messaging and social media (50%); (8) predatory food industry practices (29%); and (9) research/clinical gaps and directives (100%).
Conclusions: Overall, experts call for policy changes around systemic factors that abet binge eating and for greater public education about who can have binge eating disorder. There is also a call to take and account for the narratives and life experiences of individuals with binge eating disorder to better inform our current understanding of the diagnosis and the environmental factors that impact it. 

  
Access:  Open 
  
Link:  https://doi.org/10.3390/ijerph19106243 
  
Citation: Bray, B., Bray, C., Bradley, R., & Zwickey, H. (2022). Binge Eating Disorder Is a Social Justice Issue: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts’ Opinions. International Journal of Environmental Research and Public Health, 19(10), 6243. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph19106243