Although food addiction is a controversial construct, the most widely used tool for assessing self-reported addictive symptoms in relation to food is the Yale Food Addiction Scale (YFAS)-which was developed by modeling the DSM-IV criteria for substance abuse. Often seen co-morbid with BED are food addiction symptoms of cravings and lack of control. According to the DSM-5, the key diagnostic features of BED include recurrent and persistent episodes of binge eating, marked distress regarding binge eating, absence of regular compensatory behaviors, and binge eating episodes associated with a variety of physical and psychological symptoms. Re-introduction of normal dietary patterns is accompanied by an increase in binge eating, however the severity does not reach pre-treatment levels and many patients no longer meet criteria for BED. For example, although dietary restriction may play a causal role in the development and maintenance of disordered eating in bulimia nervosa, studies specifically examining the effects of strict dieting in binge eating disorder (BED) have reported significant reductions and even remission of binge eating. These inconsistencies are partly as a result of a lack of consensus regarding definitions of dietary restriction as well as diagnostic differences among study populations. Further research should seek to reproduce the observed effects in controlled trials as well as to explore potential etiologies.ĭietary restriction in individuals with obesity who report binge eating and wish to lose weight is associated with mixed outcomes. ConclusionsĪlthough the absence of control cases precludes conclusions regarding the specific role of ketogenic diets versus other forms of dietary restriction, this is the first report to demonstrate the feasibility of prescribing a ketogenic diet for patients with obesity who report binge eating and food addiction symptoms. Participants reported maintenance of treatment gains (with respect to weight, binge eating, and food addiction symptoms) to date of up to 9–17 months after initiation and continued adherence to diet. Additionally, the patients lost a range of 10–24% of their body weight. Patients reported significant reductions in binge eating episodes and food addiction symptoms including cravings and lack of control as measured by the Binge-Eating Scale, Yale Food Addiction Scale, or Yale-Brown Obsessive-Compulsive Scale modified for Binge Eating, depending on the case.
All patients tolerated following the ketogenic diet (macronutrient proportion 10% carbohydrate, 30% protein, and 60% fat at least 5040 kJ) for the prescribed period (e.g., 6–7 months) and none reported any major adverse effects.
We report on the feasibility of a low-carbohydrate ketogenic diet initiated by three patients (age 54, 34, and 63) with obesity (average BMI 43.5 kg/m 2) with comorbid binge eating and food addiction symptoms. The effect of a particular type of dieting on binge eating, the ketogenic diet (a high fat, moderate protein, very low carbohydrate diet), is not known. Although some studies suggest that dietary restriction can exacerbate binge eating, others show dietary restriction is associated with significant reductions in binge eating. Many patients with obesity and comorbid binge eating symptoms present with the desire to lose weight.