Ultra-processed foods and binge eating: A retrospective observational study

There is increasing evidence of the impact of ultra-processed foods on multiple metabolic and neurobiological pathways, including those involved in eating behaviors, both in animals and in humans. In this study we aimed to explore ultra-processed foods and their link with disordered eating in a clinical sample. This was a single site, retrospective observational study in a specialist eating disorder service using self-report on the electronic health records. Patients with a Diagnostic and Statistical Manual of Mental Disorders (fifth edition) diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) were randomly selected from the service database in Oxford from 2017 to 2019. The recently introduced NOVA classification was used to determine the degree of industrial food processing in each patient's diet. Frequencies of ultra-processed foods were analyzed for each diagnosis at each mealtime and during episodes of binging. A total of 70 female and 3 male patients were included in the study; 22 had AN, 25 BN, and 26 BED. Patients with AN reported consuming 55% NOVA-4 foods, as opposed to approximately 70% in BN and BED patients. Foods that were consumed in a binge pattern were 100% ultra-processed. Further research into the metabolic and neurobiological effects of ultra-processed food intake on disordered eating, particularly on binging, is needed. •There has been exponential growth in the consumption of ultra-processed products, which have gradually been displacing minimally processed foods and freshly prepared meals. Recent studies have shown that ultra-processed foods stimulate overeating by affecting multiple neuroendocrine and metabolic pathways.•We explored the frequency of ultra-processed food choices in a clinical sample of people with eating disorders. The consumption of ultra-processed foods ranged from 55% in patients with anorexia nervosa to 72% in bulimia nervosa and 69% in binge eating disorder. These included a mixture of diet foods and drinks and binge foods.•Regardless of the diagnostic categories, patients who reported binge eating binged on 100% of ultra-processed foods, which were most commonly high in both carbohydrates and fats and low in protein.•Our observation is consistent with animal and human experiments that have demonstrated that ultra-processed foods alter the neurobiological reward pathways involved in eating behaviors and suggests that the loss of control in binge eating may be driven by biologic