Obesità e Binge Eating Disorder: nutriamo il corpo o la mente?

This article explores the link between Binge Eating Disorder (BED) and type 2 diabetes mellitus (DM2), focussing on obesity as a clinical bridge. DM2, a steadily growing global issue closely linked to obesity, highlights the relevance of eating disorders such as BED in therapeutic management and long-term outcomes. BED, prevalent in the population, exhibits a significant association with extreme obesity, influencing up to 30% of individuals seeking weight loss interventions. With a prevalence of 1.8% in women and 0.7% in men, BED manifests through episodes of binge eating and loss of control over food. Etiopathogenetic hypotheses of BED underscore a connection with impulsivity, compulsion, and dysfunction in reward mechanisms, involving lesions in cortico-striatal circuits similar to those observed in substance dependence. Individuals with obesity and BED show alterations in brain regions associated with impulse control, influencing the perception of food as a reward. Negative emotions, particularly anger and frustration, play a key role in BED, with heightened sensitivity to stress and reduced emotional regulation capacity. Psychodynamic models of BED highlight maladaptive strategies such as suppression and rumination, affecting the perception of emotions and hindering emotional regulation. The theories of “escape from self- awareness” and “emotional regulation” provide perspectives on how BED may function as a coping mechanism to avoid negative perceptions or alleviate unwanted emotions. In conclusion, taking into consideration the psychodynamic aspects of BED is crucial in the clinical management of obese patients with DM2. A thorough understanding of these aspects can inform more effective therapeutic strategies, addressing the complexity of psychopathology associated with BED and its implications for the long-term management of obesity and its complications.