Editorial on the Research Topic.
Extreme Eating Behaviours

Himmerich, Hubertus

Krügel, Ute

Saedisomeolia, Ahmad

English

Qucosa - Publikationsserver der Universität Leipzig

EDITORIALpublished: 25 January 2021doi: 10.3389/fpsyt.2020.639219Frontiers in Psychiatry | www.frontiersin.org 1 January 2021 | Volume 11 | Article 639219Edited and reviewed by:Stephan Zipfel,University of Tübingen, Germany*Correspondence:Hubertus Himmerichhubertus.himmerich@kcl.ac.ukSpecialty section:This article was submitted toPsychosomatic Medicine,a section of the journalFrontiers in PsychiatryReceived: 08 December 2020Accepted: 28 December 2020Published: 25 January 2021Citation:Himmerich H, Saedisomeolia A andKrügel U (2021) Editorial: ExtremeEating Behaviours.Front. Psychiatry 11:639219.doi: 10.3389/fpsyt.2020.639219Editorial: Extreme Eating BehavioursHubertus Himmerich 1*, Ahmad Saedisomeolia 2 and Ute Krügel 31Department of Psychological Medicine, King’s College London, London, United Kingdom, 2 School of Nutritional Sciencesand Dietetics, Tehran University of Medical Sciences, Tehran, Iran, 3Medical Faculty, Rudolf Boehm Institute of Pharmacologyand Toxicology, University of Leipzig, Leipzig, GermanyKeywords: eating disorders, anorexia nervosa, bulimia nervosa, binge eating disorder, obesityEditorial on the Research TopicExtreme Eating BehavioursIMPORTANCE OF EXTREME EATING BEHAVIORSExtreme eating behaviors are an increasing global health threat, as their prevalence is rising (1). Ifwe take a look at both ends of the spectrum,∼650 million people are obese according to the WorldHealth Organization (WHO) (2), and anorexia nervosa (AN) is one of the most common chronicdisorders in adolescence. It is also the most lethal psychiatric disorder with a risk of death that isfive times higher compared to people of the same age and gender without AN (3, 4).In recent decades, our diagnostic knowledge of various eating disorders (EDs) hasincreased. These disorders include AN, bulimia nervosa (BN), binge eating disorder (BED),avoidant-restrictive food intake disorder (ARFID), pica and rumination. The latest edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM-5) provides clinically useful anddistinct diagnostic criteria for these disorders (5). Nonetheless, treatment options are still limited.For example, the only psychopharmacological treatment options for all EDs approved in somecountries are fluoxetine for BN and lisdexamfetamine for BED (6).We are currently increasing our understanding of how obesity and EDs are associated withchanges in the composition of gut microbiota, in the intake of macro- or micro-nutrients, theimmune, endocrine and nervous systems, and how these changes lead to physical andmental healthconsequences (7–10). However, the treatment outcome for EDs and their physical and mentalhealth consequences is still unsatisfactory. A recent cohort study showed that only 30% of patientswith AN recovered after 9 years (11).This special collection is dedicated to disorders associated with extreme eating behaviors—theEDs and obesity. It consists of a variety of articles and study types including a historical study,an animal study, a case series, a feasibility study, cross-sectional and longitudinal clinical studies,surveys, meta-analyses, and systematic reviews; and it addresses historical, social, psychological,and biological aspects as well as symptoms and therapeutic options for extreme eating behaviors.CONTENT OF THE SPECIAL COLLECTIONHistorical Aspects of Extreme Eating BehaviorsBergner et al. performed an in-depth historical review of the most significant German-languagepsychiatric textbooks throughout the past 200 years, regarding ED diagnoses and descriptions ofdisordered eating behavior. Interestingly, the authors found that nineteenth and early twentiethcentury psychiatrists such as Kraepelin, Bumke, Hoff, Bleuler, and Jaspers reported symptomclusters of extreme eating behavior such as food refusal and vomiting which show strikingsimilarities to the description of specific eating disorder subtypes in current diagnostic manualssuch as DSM-5. However, these historic psychiatrists partly classed those behavioral symptomHimmerich et al. Editorial: Extreme Eating Behaviorsclusters as features of diagnoses which are no longer used bythemajority of psychiatrists, such as neurasthenia, hypochondria,and hysteria (Bergner et al.).Social and Psychological Aspects ofExtreme Eating BehaviorsFive articles in this special collection focus on significant socialand psychological factors of extreme eating: culture change,executive functions, temporal discounting, loss aversion, andTheory of Mind (ToM).Shekriladze et al. conducted a survey on culture change andeating patterns, which showed that moving to Western countries(UK, USA) increased dietary restriction among Georgianwomen. They concluded that integration problems in the newhost culture predict elevated eating, shape and weight concernsamong women and that acculturation conditions may be linkedwith integration and well-being outcomes.Gisbert Cury et al. conducted a systematic review and meta-analysis on executive functions in BED and ascertained that,based on current scientific literature, BED patients had worseperformance on working memory tasks compared to obeseindividuals without BED. Kekic et al. reported data derivedfrom an online survey that examined temporal discounting,which is the tendency to act on immediate pleasure-drivendesires, due to the devaluation of future rewards. Their datarevealed that temporal discounting correlated with the frequencyof compulsive overeating, food addiction, ED psychopathology,and body mass index (BMI). Sagiv et al. performed a clinicalstudy which revealed that loss aversion scores were lower amongparticipants with EDs (AN, BN) compared to healthy controlsand that this feature was related to non-suicidal self-injury andsuicidal ideations. Sedgewick et al. focused on ToM in a cross-sectional clinical study involving healthy controls and patientswith ANwith andwithout autistic features. Interestingly, they didnot find any quantifiable ToM difference between these groups asone would have expected from autism studies in people withoutAN. Studies in people with an autism spectrum disorder butwithout an ED usually indicate difficulties with ToM.Biological Aspects of Extreme EatingBehaviorsObesity and AN are the two ends of the spectrum of extremeeating behaviors with manifold biological causes includinggenetic factors, the microbiome, metabolic and endocrinemechanisms, the immune system, and the brain, which areinfluenced by environmental and nutritional factors (12). Wereceived three articles mainly concerned with the immune andthe endocrine systems. Schmidt et al. conducted a longitudinalclinical study in normal weight, overweight and obese people(BMI range: 18.3–61.4 kg/m2) on depressiveness, body weight,physical activity, and cytokine levels. They confirmed previousresults from human (13) and animal studies (14, 15) showingthat depressiveness was positively associated with certain pro-inflammatory cytokine levels. Furthermore, physical activitywas negatively associated with interleukin (IL)-4, IL-5, IL-10,granulocyte-macrophage colony-stimulating factor (GM-CSF),interferon (IFN)-γ, and tumor necrosis factor (TNF)-α; andBMI predicted IL-12 and IL-13 levels. Stanikova et al. reporteddata from an epidemiological cohort study that included 3,124adult women. They found higher testosterone levels in obesevs. normal-weight women and in women with vs. womenwithout anxiety symptomatology. Tyszkiewicz-Nwafor et al.looked at growth factors and hormonal changes in people withAN in a longitudinal clinical study. In their sample, brain-derived neurotrophic factor (BDNF) serum levels were decreasedin malnourished AN patients, which normalized with weightrecovery. Oxytocin serum levels, however, were increased inmalnourished AN patients and did not normalize with partialweight recovery.Symptoms Related to EDs and ObesityBaldofski et al. analyzed data from two large European multi-center studies: MooDFOOD and NESDA. In their sampleof more than 500 people, somatic and vegetative depressivesymptoms such as pain, changes in appetite and weight,gastro-intestinal symptoms and arousal-related symptoms wereassociated with both a higher BMI and a higher waist-to-hipratio (WHR). In a clinical study by Minkwitz et al., subjectivesleepiness did not differ much between obese and non-obesepeople, whereas depressed and non-depressed people differedsignificantly with regard to subjective sleepiness. Objectivesleepiness measures, however, did not differ significantly betweenpeople with obesity, people with depression, people with bothobesity and depression, and healthy controls.A systematic review and quantitative analysis by Riedlingeret al. deduced that gastrointestinal (GI) symptoms and impairedgastric transit are frequent features of EDs and that serious GIcomplications such as gastric dilatation have been observed. Steinet al. provided a case series describing risk-taking behavior infour female patients with long-standing binge-purge type AN.The description of these patients and their history, course of thedisease and risky behaviors expound important environmentalvulnerabilities, purging behavior as well as other impulsive andnon-impulsive comorbidities.Therapies for EDs and ObesityThis special collection on extreme eating behaviors also shedslight on experimental and potential future treatment strategies.Kan et al. contributed a systematic review and meta-analysis ofdropout and metabolic effects of antipsychotics used in AN. Intheir analysis, drug-related factors, such as side effects, playeda lesser role than personal reasons for the discontinuation ofantipsychotic treatment under trial conditions. This highlightsthe importance of patients’ personal motivation for drugtreatment in AN. Lu et al. reported in an experimental animalstudy that electroacupuncture reduced food intake and bodyweight, and improved laboratory parameters in obese mice.Thus, electroacupuncture might be an innovative approach totreat extreme eating behaviors and their health consequences.An innovative psychotherapeutic approach was presented byRudolph and Hilbert. Their clinical pilot study tested a short-term cognitive behavior therapy (CBT) approach, which wasbased on manuals for BED and depressive disorders. ThisFrontiers in Psychiatry | www.frontiersin.org 2 January 2021 | Volume 11 | Article 639219Himmerich et al. Editorial: Extreme Eating Behaviorstreatment for patients following bariatric surgery led to asignificant reduction of body weight, improvement of EDpsychopathology, depressive symptoms, and self-esteem.THANKS TO ALL AUTHORS, REVIEWERS,EDITORS AND FRONTIERSThe articles in this Research Topic provide a comprehensive,cutting-edge and inspiring view on research and clinical practicein the field of extreme eating behaviors. We would like toexpress our thanks to all authors for their hard work, excellentmanuscripts, and for submitting work to this special collection.The call attracted authors from Australia, Brazil, China, Georgia,Germany, Ireland, Israel, the Netherlands, Poland, Slovakia,Spain, Sweden, and the United Kingdom. We also thank all thereviewers and editors involved in the preparation of this specialissue as well as the publisher Frontiers and their team for alwaysbeing supportive. We hope that this special collection presentsa useful and appealing overview of current knowledge aboutextreme eating behaviors, which will reach many readers andinspire future research.AUTHOR CONTRIBUTIONSAll authors drafted the manuscript together, discussed it, andapproved its final version.ACKNOWLEDGMENTSThis work was supported by the DeutscheForschungsgemeinschaft (DFG) AOBJ: 624810 to UK.REFERENCES1. Darby A, Hay P, Mond J, Quirk F, Buttner P, Kennedy L. The risingprevalence of comorbid obesity and eating disorder behaviors from1995 to 2005. Int J Eat Disord. (2009) 42:104–8. doi: 10.1002/eat.206012. WHO. Obesity and Overweight Fact Sheet. (2020). Available online at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight3. Schmidt U, Adan R, Böhm I, Campbell IC, Dingemans A, Ehrlich S,et al. Eating disorders: the big issue. Lancet Psychiatry. (2016) 3:313–5.doi: 10.1016/S2215-0366(16)00081-X4. Himmerich H, Hotopf M, Shetty H, Schmidt U, Treasure J, Hayes RD,et al. Psychiatric comorbidity as a risk factor for mortality in people withanorexia nervosa. Eur Arch Psychiatry Clin Neurosci. (2019) 269:351–9.doi: 10.1007/s00406-018-0937-85. American Psychiatric Association. Diagnostic and Statistical Manual ofMental Disorders (DSM-5). 5th ed. Washington, DC: American PsychiatricPublishing (2013).6. Himmerich H, Treasure J. Psychopharmacological advances ineating disorders. Expert Rev Clin Pharmacol. (2018) 11:95–108.doi: 10.1080/17512433.2018.13838957. Stanislawski MA, Dabelea D, Lange LA, Wagner BD, Lozupone CA. Gutmicrobiota phenotypes of obesity. NPJ Biofilms Microbiomes. (2019) 5:18.doi: 10.1038/s41522-019-0091-88. Monteleone AM, Troisi J, Fasano A, Dalle Grave R,Marciello F, Serena G, et al.Multi-omics data integration in anorexia nervosa patients before and afterweight regain: a microbiome-metabolomics investigation. Clin Nutr. (2020).doi: 10.1016/j.clnu.2020.07.021. [Epub ahead of print].9. Astrup A, Bügel S. Overfed but undernourished: recognizingnutritional inadequacies/deficiencies in patients with overweightor obesity. Int J Obes. (2019) 43:219–32. doi: 10.1038/s41366-018-0143-910. Himmerich H, Kan C, Au K, Treasure J. Pharmacological treatmentof eating disorders, comorbid mental health problems, malnutritionand physical health consequences. Pharmacol Ther. (2021) 217:107667.doi: 10.1016/j.pharmthera.2020.10766711. Eddy KT, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, et al.Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. JClin Psychiatry. (2017) 78:184–9. doi: 10.4088/JCP.15m1039312. Himmerich H, Bentley J, Kan C, Treasure J. Genetic risk factorsfor eating disorders: an update and insights into pathophysiology.Ther Adv Psychopharmacol. (2019) 9:2045125318814734.doi: 10.1177/204512531881473413. Himmerich H, Fulda S, Linseisen J, Seiler H, Wolfram G, Himmerich S, et al.Depression, comorbidities and the TNF-alpha system. Eur Psychiatry. (2008)23:421–9. doi: 10.1016/j.eurpsy.2008.03.01314. Krügel U, Fischer J, Bauer K, Sack U, Himmerich H. The impact of socialisolation on immunological parameters in rats. Arch Toxicol. (2014) 88:853–5.doi: 10.1007/s00204-014-1203-015. Himmerich H, Fischer J, Bauer K, Kirkby KC, Sack U, Krügel U. Stress-induced cytokine changes in rats. Eur Cytokine Netw. (2013) 24:97–103.doi: 10.1684/ecn.2013.0338Conflict of Interest: The authors declare that the research was conducted in theabsence of any commercial or financial relationships that could be construed as apotential conflict of interest.Copyright © 2021 Himmerich, Saedisomeolia and Krügel. This is an open-accessarticle distributed under the terms of the Creative Commons Attribution License (CCBY). The use, distribution or reproduction in other forums is permitted, providedthe original author(s) and the copyright owner(s) are credited and that the originalpublication in this journal is cited, in accordance with accepted academic practice.No use, distribution or reproduction is permitted which does not comply with theseterms.Frontiers in Psychiatry | www.frontiersin.org 3 January 2021 | Volume 11 | Article 639219

Editorial: Extreme Eating Behaviours

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