1. Cortisol,Hunger, and Desire to Binge Eat Following a Cold Stress Test in Obese Women with Binge Eating Disorder
Gluck ME, Geliebter A, Hung J, and Yahav E.
Psychosom Med Nov-Dec;66(6):
Nick Bello
ED Journal Club Dec-2008

2. Introduction Binge eating disorder (BED)
Frequent and regular intake large amount of food twice a week for 6 months
Sense of “loss of control” over eating
No inappropriate compensatory behaviors
BED is 2% of the nonpatient general community
~ 30% obese people seeking medical treatment

3. Introduction (continue)
Stress and binge eating
Stress and negative affect precursors to binge eating
Cortisol is the major hormonal component to stress response.
Exogenous glucocorticoids induce obesity by increasing food intake.
Elevated cortisol levels associated with energy intake in health individuals.

4. HPA Axis and dexamethasone test (DST)

5. Cold Pressor Test (CPT)
Life, December 1955

6. Hypothesis Obese women with BED compared with non-BED
Increase CORT after CPT
More hungry and desire to binge eat after CPT
Less CORT suppression after DST

7. Methods (Participants)
Obese women (n=38) were recruited by local advertisements
Exclusion Criteria
Significant health problem other than obesity
Unstable weight (± 5%) for the past 3 months
Dieting or smoking current or in the past 3 months
Most prescribed medication or substance abuse within the past 6 months
Pregnant or lactating, not oral contraceptives

8. Methods (Participants)
Inclusion Criteria
PE (medical history, ECG and blood tests)
Questionnaire on Eating and Weight Patterns
BED if they met the full criteria of DSM IV
Non-BED if they denied episodes of overeating
BED (n=11)
non-BED (n=11)

9. Procedures Body Composition (first day) Psychological Scales
Waist and hip circumferences (WHR)
% Body Fat by underwater weighing
Psychological Scales
Zung Depression Rating Scales
CPT ( second day)
12 hour fast and then a fixed meal
First blood 8-9 am
Immersed non-dominant hand in 2 min of 0° C ice water
Rated Pain, Stress, Hunger and Desire to Binge Eat
Blood draws at –10 , 0, 5,15, 30, 45 and 60 min
Blood pressure and heart rate

10. Procedures (More) DST (third day) 1 mg oral dexamethasone @ 11 pm
Blood ~8am for CORT

11. Results

12. Results

13. Results

14. Results Insulin DST VAS Ratings No differences
No difference between BED and non-BED
BED compared with morning CORT relative greater reduction
VAS Ratings
BED had greater AUC hunger, desire to binge eat, pain, stress

15. Results

16. Results Sympathetic Activity Correlations No Differences
AUC for CORT was correlated w/ AUC pain
AUC for Stress was correlated w/ AUC “desire to binge eat” and Pain
AUC Pain was correlated Hunger and “desire to binge eat”

17. Results