Could Binge Eating Be Behind Weight Gain in HIV?

Almost 1 in 10 patients receiving HIV care may have binge eating disorder (BED), a significantly higher rate than the 0.3% reported in the general population, according to a cross-sectional study. Individuals with possible BED were six times more likely than others to have clinical obesity and twice as likely to be overweight.

Authors of the study, conducted at a university hospital in northeast Italy, suggest that binge eating has not previously been studied in a modern cohort of people living with HIV, and the possibility that it is an underlying cause of weight gain has not been explored.

“The rationale for the study was born in the clinic because I saw that some people with severe obesity disclosed overnight eating,” first author Maria Mazzitelli, MD, PhD, told Medscape Medical News. A psychiatrist colleague suggested that this could be a symptom of BED.

BED is characterized by recurrent episodes of consuming large quantities of food in a short period, accompanied by a sense of loss of control over eating. Behaviors may include eating until feeling uncomfortably full, eating when not physically hungry, and eating alone due to embarrassment. In contrast to bulimia nervosa, BED does not involve compensatory behaviors such as purging.

Mazzitelli and colleagues recruited 1204 patients attending routine visits at Padua University Hospital, Padua, Italy, where she works as an infectious disease physician. As reported in the journal AIDS, the cohort was predominantly male (75.2%), with a median age of 53 years. Almost all participants had undetectable viral load, but 67.7% had multiple comorbidities, including dyslipidemia, hypertension, and mental health issues.

When assessed by body mass index, 35.1% were overweight and 19.4% had obesity. Based on the Binge Eating Scale, a validated 16-item self-completion questionnaire, BED was very likely in 7.6% of participants (score, > 27), and BED was possible in a further 1.9% (score, 17-26).

While the study did not include a direct comparison with an HIV-negative cohort, reported prevalence of BED in the general population is 0.3% among men and 1.5% among women.

After adjustment for potential confounders, including depression, antiretroviral regimen, and exercise, those with possible or likely BED had greater odds of obesity (odds ratio [OR], 6.21) and being overweight (OR, 2.21). Binge eating was not linked to the use of any specific antiretroviral.

The study is “really original,” José I. Bernardino, MD, who was not involved in the study, told Medscape Medical News. “This article gives us a new perspective and new data about what is driving weight gain in people living with HIV,” said the physician, who is based at the Instituto de Salud Carlos III, Madrid, Spain.

He noted that eating disorders are more prevalent in marginalized groups. Studies conducted in the general population suggest that social factors including food insecurity, stigma, and racism are linked to eating disorders. “Binge eating is highly related with many social determinants of health, and these social determinants of health are highly related with HIV,” said Bernardino.

While binge eating was more common among women and people of Black ethnicity in univariate analysis in the Italian study, few social factors were examined. Other limitations include its cross-sectional design and limited data on people with psychiatric disorders other than depression and anxiety.

The study did show that — as would be expected from general population studies — binge eating was more common among those who experienced depression. The authors suggest that psychological distress associated with HIV may be a catalyst for binge eating episodes.

Physicians have typically focused on the potential role of antiretrovirals in weight gain among people with HIV, “but sometimes it’s not only the drugs,” Mazzitelli said. “You have to see the person in a holistic way and consider all the possible things they may be experiencing.”

She said that holistic, integrated care models that incorporate mental health screening, counselling, and nutritional support have shown promise in addressing the needs of those with HIV and BED.

In a commentary published alongside the study, Bernardino argued that future studies of weight gain in people with HIV must include assessments of binge eating and also of social determinants of health.

The study received no external funding. Mazzitelli reported receiving grants and speaker fees from Gilead Sciences, ViiV Healthcare, and MSD. Bernardino reported no relevant financial relationships.

Roger Pebody is a freelance journalist based in Paris, France.