This research proposal is presented to expound the hypothesis that blood glucose level at the time of a binge-eating episode, defined as eating a larger than normal quantity of food, with feelings of loss of control over food and remorse, has an impact on the prevalence of binge episodes. The proposed research is a multi-variable, cross-sectional study that will elucidate the differences in the impact of blood glucose on individuals as well as the effects on the demographically segregated groups.
Keywords: Binge eating disorder, blood glucose, insulin, research proposal
Blood Glucose Levels Effect on Binge Eating Disorder Episodes
In the USA, binge eating disorder (BED) is the most common eating disorder, with a lifetime prevalence of ~3.5% in adult women, 2.0% in adult men, and 1.6% in adolescents (Brownley, Peat, Via, &Bulik, 2014).The research is drawn from personal experience with BED in the past thirty years. The study further aims to isolate and comprehend the impact of change diabetes medication in enhancing BED. It further proposes to affirm blood glucose levels have a direct correlation to binge eating behaviors. This proposed research will be used to confirm the hypothesis that 10 to 20 points above or below normal blood glucose levels of 70 to 120 mg/dL have an effect on binge eating episodes. The alternative hypothesis will be confirmed by binge eating episodes increasing at a level of greater than 10 to 20 mg/dL. The confirmation of the null hypothesis will be if glucose levels have no effect on participants binge eating behaviors. Any difference would be from chance alone.
Brownley, Boettiger, Young, and Cefalu 2015, state T2DM and binge eating are linked through shared cortical and subcortical neural circuitry and signaling pathways involved in food reward, particularly the dopaminergic system, which is highly sensitive to the actions of insulin (para 4). Further, T2DM, binge eating, and depression are further linked through shared circuits and signaling pathways within the serotonergic system. Like the dopaminergic system, the serotonergic system is highly sensitive to the actions of insulin (para 5).Understanding the systemic effects of insulin has the propensity to shed light on why glucose levels at the time of a binge would have an impact on binge behaviors, and lends itself to additional research.
This study offers an opportunity for further research on diabetic medications as a form of treatment to reduce BED episodes. Brownley, Peat, Via, &Bulik (2014), state,BED is highly co-morbid with obesity and with depression and other psychiatric conditions, and it is associated with substantial role impairment. Currently, there are no US FDA-approved pharmacological treatments for BED (Abstract Para 1). BED is limited in that very few agents have been studied in multiple, confirmatory trials with adequate follow-up, and almost none has been evaluated in large patient samples that are diverse in age, sex, and ethnicity (Para 1).
The sex differences are an important factor to consider when dealing with BED. After all, eating disorders are the most sex-differentiated psychiatric disorders, with female to male ratios ranging from 4:1 to 10:1(Klump, Racine, Hildebrandt, & Sisk, 2013).
The subjects that are to be selected for this study are individuals that are currently involved with treatment for their Binge Eating Disorder at the McCullum Place Eating Disorder Centers (McCullum), in St. Louis, Columbia and Kansas City, MO. At the time of this proposal, there is a population of eighty-six individuals currently enrolled in treatment for BED. A 95% confidence level is desired with a confidence interval of 4. There will be 75 individuals allowed to volunteer for participation. Allowing 75 individuals to participate will provide a more reflective representation of the effects of blood glucose levels on the population of those inflicted with BED. Recruitment will be handled by the McCullum staff. The McCullum treatment regimen includes group sessions; the staff will address the groups as a whole and ask for volunteers.
Ethical considerations center on the need for shielding participants from harm that may emerge from the study. Notably, if the participants exhibit somewhat adverse side effects or outcomes in the course of the research, it is prudent to discontinue. The considerations further have implications on the privacy of individuals. Each participating in the study has a reasonable expectation of privacy. This translates to the safeguarding of personal information.
The researcher is a Certified Professional of Human Resources (PHR) and a Society of Human Resource Certified Professional (SHRM-CP). The researcher also has prior knowledge of the Health Insurance Portability and Accountability Act (HIPAA), of 1996, and sixteen years of experience in employee training, and nine years of training individuals in the regulations of HIPAA. Therefore, the researcher is better placed to provide all persons involved with an HIPAA training and information session. This training is necessary because of the collection of medical diagnosis information of BED andtypes2 diabetes mellitus (T2DM). Additionally, the medical information involved in the collection of blood glucose levels falls under the HIPAA guidelines. Participants will be informed that there is a slight risk of infection at the puncture site; these risks can be mitigated through the use of the provided alcohol pads, Band-Aids, and lancets.
Participants will be given an informed consent and will be required to sign and acknowledge agreement to the research project. To avoid confounds, the participants will not be fully informed of what the research is studying until after the research is completed at which time a debriefing session will be conducted with each participant. A copy of the results will be published, and the McCullum Place will be provided a copy.
The initial assessment will be completed with the use of the BES Scale. Duarte, Pinto-Gouveia, & Ferreira, (2015) studied the effectiveness of the Binge Eating Scale (BES) in assessing individuals with BED.
Results confirmed that the BES presents a sound one-dimensional factorial structure, with excellent construct reliability and convergent validity. Also, the Scale presented very good retest reliability. Research findings also offered proof that the BES has a direct correlation with eating measures, general psychopathology, and BMI. Also, the BES revealed a performance of (96.7%) on discriminating clinically significant cases of binge eating. It also showed a sensitivity of 81.8% and a specificity of 97.8%. Results support the validity and usefulness of BES as an assessment and screening tool for binge eating in women from the general population.
This scale will serve as a unit of measure in delineating those with BED. The nominal definition of BED is when a person binge eats at least once a week for three months and has the following symptoms:
o Repeated episodes of binge eating that is characterized by both eating in a discrete period (such as within 2 hours) a larger amount of food than what most people would eat at the same time. A lack of control over eating during this episode (unable to stop eating or control how much to eat).
o Binge-eating episodes usually involve at least three of the following: eating much faster than normal, eating until feeling uncomfortably full, eating large amounts of food when even not feeling hungry, eating alone because of being ashamed by the amount consumed, feeling disgusted, depressed, or very guilty afterward ("Eating Disorders," 2015).
Indicators of Blood glucose levels, which form an operational definition:
Normal 70 to 120 mg/dL
Hypoglycemia below 70 mg/dL
Hyperglycemia above 120 mg/dL
Data collection methods
Upon initial entrance into the study, participants will be given the BES questionnaire. The BES is a 16-item questionnaire assessing the presence of certain binge eating behaviors that may be indicative of an eating disorder ("Binge Eating Scale," 2015). The Binge Eating Scale was constructed describing both behavioral manifestations (e.g., eating large amounts of food) and feeling/cognitions surrounding a binge episode, e.g., guilt, fear of being unable to stop eating (Gormally, Black, Daston, &Rardin, 1982). In addition to the BES questionnaire, participants will be given a demographic questionnaire. Demographic information on this questionnaire will be utilized in the division of data in appropriate subgroupings based on age, sex, diabetic and non-diabetic.
For eight weeks participants will collect blood glucose information using the OneTouch VerioIQ meter, at 3-hour intervals, and at times they feel they are going to binge eat, the meter will digitally record information of each collection that will be later transferred to an Excel spreadsheet. To protect against lost data via electronic malfunction participants will be required to log information into the provided paper logbook. Additionally, participants will self-report on BED episodes and food intake via the provided logbook.
The participants will be provided with the necessary supplies for blood sample collection, 1000of each, alcohol swabs, One Touch VerioIQ test strips, circular Band-Aids, and lancets. A paper log book created with the Likert rating scales for BGL and BED will also be provided, see Table 1.
This will be a cross-sectional study with participants being divided by gender- male or female. This will allow for a scatter plot comparison.This proposed research will be used to confirm the hypothesis that 10 to 20 points above or below normal blood glucose levels of 70 to 120 mg/dL have an effect on binge eating episodes. The alternative hypothesis will be confirmed by binge eating episodes increasing at a level of greater than 10 to 20 mg/dL above or below normal glucose levels. The confirmation of the null hypothesis will be if glucose levels have no effect on participants binge eating behaviors. Any difference would be from chance alone. ANOVA will be used to analyze variances and to confirm or disconfirm the alternative and null hypothesis.
Binge eating scale. (2015). Retrieved from https://psychology-tools.com/binge-eating-scale/
Brownley, K. A., Boettiger, C. A., Young, L., &Cefalu, W. T. (2015). Dietary chromium supplementation for targeted treatment of diabetes patients with comorbid depression and binge eating. Medical Hypotheses,85(1), 45-48. doi:10.1016/j.mehy.2015.03.020
Brownley, K. A., Peat, C. M., Via, M. L., &Bulik, C. M. (2014). Pharmacological approaches to the management of Binge Eating Disorder. doi:10.1007/s40265-014-0327-0
Eating disorders. (2015). In Understanding mental disorders: Your guide to DSM-5 (First ed., pp. 153-154). Arlington, VA: American Psychiatric Publishing.
Gormally, J., Black, S., Daston, S., &Rardin, D. (1982). The assessment of binge eating severity among obese persons. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7080884
Klump, K. L., Racine, S., Hildebrandt, B., & Sisk, C. L. (2013). Sex differences in binge eating patterns in male and female adult rats. Int. J. Eat. Disord. International Journal of Eating Disorders,46(7), 729-736. doi:10.1002/eat.22139
Orosco, M., Rouch, C., &Gerozissis, K. (2000). Activation of hypothalamic insulin by serotonin is the primary event of the insulinserotonin interaction involved in the control of feeding. Brain Research,872(1-2), 64-70. doi:10.1016/s0006-8993(00)02449-5
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