Eliminating Barriers to Binge Eating Disorder Diagnoses for Asian American Women

A Research Brief by: Renny Ma 

RMWhat are the barriers that hinder the diagnosis of BED in Asian American women, and what type of interventions can be implemented to mitigate the barriers?

Binge eating disorder (BED), a disorder characterized by repeatedly uncontrolled and excessive eating, has a lifetime prevalence of 1.5% among non-Latino Whites and Asians. However, 1 in every 21 Asian Americans, versus 1 in every 40 non-Latino Whites, experience any binge eating (ABE) episodes, a similar phenomenon that does not quite meet the diagnostic criteria of distress and loss of control that are characteristic of BED. As a result, due to a reduced endorsement of BED symptoms, Asian Americans are 33% less likely to be diagnosed with BED than non-Latino Whites, but are still likely to experience the decline in health related to undiagnosed binge eating. Symptoms include diabetes, hypertension, arthritis, metabolic syndrome, chronic pain, gastrointestinal problems, sleep problems, and an overall impaired quality of life. Underdiagnosis specifically affects Asian American women, whom are more likely to develop BED and ABE than Asian American men. Because the available mental health resources are often inconsistent with Asian values, barriers arise directly due to a lack of cultural competency in healthcare, making underdiagnosis of BED in Asian Americans a health equity issue.

Both practical and cultural barriers can hinder the diagnosis of BED in Asian American women. Cost, duration of treatment, recognition of need, as well as stigma and confidentiality are obstacles to initiating the treatment process6. Many Asian Americans have lamented the ineffectiveness of traditional talk therapy models and clinicians who disregard the stigma of psychiatric treatment in the Asian community. Furthermore, for individuals who are highly enculturated to Asian values such as avoidance of shame, emotional self-control, and conformity to norms, rates of professional psychiatric help-seeking are low.

The Beth Israel Deaconess Digital Psychiatry Program currently focuses on using digital initiatives to eliminate barriers to mental health services. The program is currently testing MIND LAMP, a mobile application that collects real-time psychiatric data through surveys, exercises, and fitness tracking, in order to deliver cognitive behavioral therapy modules. The Healthy Minds Network (HMN) at the University of Michigan has also developed an electronic platform to provide feedback and online counseling, which has increased students' readiness for seeking psychiatric treatment. Given the cost-effectiveness of online interventions, the diagnostic timeliness of real-time psychiatric data collection, the ability of passive surveillance to recognize treatment need in patients who do not recognize it themselves, and the privacy feature of mobile apps, digital interventions have enormous potential to remove the main barriers to BED diagnoses for Asian American women. It would be valuable to assess the impact of a combination of successful components from each model.

Measuring the success of a mobile application capable of assessing, diagnosing, and treating BED would involve monitoring application traffic and surveying patients' satisfaction on affordability, user-friendliness, efficacy, and accessibility. Ultimately, the goal is to reduce barriers to eating disorder services, and to improve binge eating-related health outcomes for Asian American women.

Enormous acknowledgments to Dr. Ebbin Dotson for the thought-provoking conversations surrounding health equity, to Mr. Christopher Clarke for his unwavering support and encouragement, and to Ms. Sharonda Simmons for the endless enthusiasm and guidance.