The prevalence of obesity is increasing among all age and racial groups in the United States. There is, however, a disproportionate rise in the prevalence of obesity among African-Americans and Hispanic/Mexican Americans. Obesity is a major contributor to the insulin resistant syndrome (IRS), a condition of multiple metabolic abnormalities that is a precursor to type 2 diabetes, and confers a high risk for cardiovascular events. The estimated prevalence of IRS is also greater in Mexican Americans and African-Americans than in Caucasians. The IRS is identifiable in children, and as with adults, there are racial differences in its expression even at a young age. The obesity-associated diseases, including diabetes and hypertension, are found at higher rates within the minority races compared with Caucasians. However, there are differences, in that obesity-related hypertension occurs at higher rates among African-Americans, and obesity-related diabetes occurs at higher rates among Mexican Americans. Race/ethnic differences in lifestyle behaviors and economic disadvantage may account for some of the race disparity in obesity-related diseases and disease outcomes. Environmental factors, however, do not explain all of the race disparity in disease expression, indicating that there are genetic/molecular factors that are operational as well.

ContextTreatment Resistant Depression (TRD) is a significant and burdensome health concern.ObjectiveTo characterize, compare and understand the difference between TRD and non-TRD patients and episodes in respect of their episode duration, treatment patterns and healthcare resource utilization.Design and SettingPatients between 18 and 64 years with a new diagnosis of major depressive disorder (MDD) and without a previous or comorbid diagnosis of schizophrenia or bipolar disease were included from PharMetrics Integrated Database, a claims database of commercial insurers in the US. Episodes of these patients in which there were at least two distinct failed regimens involving antidepressants and antipsychotics were classified as TRD.Patients82,742 MDD patients were included in the analysis; of these patients, 125,172 episodes were identified (47,654 of these were drug-treated episodes).Main Outcome MeasuresComparison between TRD and non-TRD episodes in terms of their duration, number and duration of lines of treatment, comorbidities, and medical resource utilization.ResultsOf the treated episodes, 6.6% (N = 3,134) met the criteria for TRD. The median time to an episode becoming TRD was approximately one year. The mean duration of a TRD episode was 1,004 days (vs. 452 days for a non-TRD episode). More than 75% of TRD episodes had at least four lines of therapy; half of the treatment regimens included a combination of drugs. Average hospitalization costs were higher for TRD than non-TRD episodes: $6,464 vs. $1,734, as were all other health care utilization costs.ConclusionsWhile this study was limited to relatively young and commercially covered patients, used a rigorous definition of TRD and did not analyze for cause or consequence, the results highlight high unmet medical need and burden of TRD on patients and health care resources.

Objective: To estimate binge eating disorder (BED) prevalence according to DSM-5 and DSM-IV-TR criteria in US adults and to estimate the proportion of individuals meeting DSM-5 BED criteria who reported being formally diagnosed. Methods: A representative sample of US adults who participated in the National Health and Wellness Survey were asked to respond to an Internet survey (conducted in October 2013). Assessments included 3-month, 12-month, and lifetime BED prevalence based on DSM-5 and DSM-IV-TR criteria and demographics, psychiatric comorbidities, and self-esteem (Rosenberg Self-Esteem Scale).Descriptive statistics are provided. Prevalence estimates were calculated using poststratification sampling weights. Results: Of 22,397 respondents, 344 (women, n = 242; men, n = 102) self-reported symptoms consistent with DSM-5 BED symptom criteria. The 3-month, 12-month, and lifetime DSM-5 prevalence estimates (95% CIs) projected to the US population were 1.19% (1.04%-1.37%), 1.64% (1.45%-1.85%), and 2.03%(1.83%-2.26%), respectively. The 12-month and lifetime projected DSM-IV-TR prevalence estimates were 1.15% (1.00%-1.32%) and 1.52% (1.35%-1.70%), respectively. Of respondents meeting DSM-5 BED criteria in the past 12 months, 3.2% (11/344) reported receiving a formal diagnosis. Compared with non-BED respondents, respondents meeting DSM-5 BED criteria in the past 12 months were younger (mean ± SD age = 46.01 ± 14.32 vs 51.59 ± 15.80 years; P < .001), had a higher body mass index (mean ± SD = 33.71 ± 9.36 vs 27.96 ± 6.68 kg/m 2 ; P < .001), and had lower self-esteem (mean ± SD score = 16.47 ± 6.99 vs 23.33 ± 6.06; P < .001). Conclusions: DSM-5 BED criteria resulted in higher BEDprevalence estimates than with DSM-IV-TR criteria. Most BED respondents did not report being formally diagnosed, indicating an unmet need in BED recognition and diagnosis. J Clin Psychiatry 2016;77(8) Binge eating disorder (BED), the general symptomatology of which was recognized as early as 1959, 1 was included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as a diagnosis for further study in the early 1990s.2-4 However, it did not receive official recognition as a distinct eating disorder until its inclusion in DSM-5 in 2013. 5 According to DSM-5 diagnostic criteria for BED (Table 1), binge eating must occur at least once a week for ≥ 3 months. These episodes are characterized by the consumption, in a discrete period of time, of a larger amount of food than is typical for most people under similar circumstances, by a sense of lack of control over eating, and by marked distress about binge eating. 5 Unlike bulimia nervosa (BN) and anorexia nervosa (AN), BED is not associated with recurrent inappropriate compensatory behaviors (eg, purging or excessive exercise). 5In the DSM-5, the binge episode frequency criterion was reduced from the DSM-IV Text Revision (DSM-IV-TR) criterion of ≥ 2 days per week for ≥ 6 months, 6 but other criteria were unchanged. Therefore, individuals previously not me...