Binge Eating Spectrum Treatment in Older Women (BESTOW): An Investigation and Intervention-Tailoring Project

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PROJECT ABSTRACT This Beeson Emerging Leaders in Aging Career Development Award (K76) seeks to equip Dr. Lisa Kilpela with the expertise and professional skill set needed to become a leading gerontological expert in disordered eating and nutrition pathology, and to advance this emerging and important field. As women age, biological, psychological, and lifestyle changes can contribute to nutritional disorders and associated health problems. Among older women, an increasingly recognized factor that can exacerbate these concerns is eating disorder pathology, which constitutes a group of complex psychiatric disorders characterized by dysregulated and abnormal eating behaviors. When left untreated, eating disorders can cause significant morbidity and mortality. Historically conceptualized as disorders of youth, a rapidly evolving body of research suggests that eating disorder symptoms are surprisingly prevalent in older women. Dr. Kilpela’s preliminary research as a Pepper Center RL5 Scholar found that the most common form of disordered eating in older women is binge eating (BE; defined as eating an unusually large amount of food while feeling a loss of control), with 26.5% of women aged 60+ reporting at least weekly BE episodes. BE is closely linked to obesity and depression and, even independent of these comorbidities, is associated with metabolic dysfunction, sleep problems, disability, and poorer quality of life. Therefore, BE appears to represent a significant health problem for older women with greater prevalence than once thought. Although evidence-based treatments for BE exist for younger women, these treatments need to be tailored for older women in order to address aging-related factors not present in younger women that have implications for treatment (e.g., cognitive decline, menopausal symptoms). As such, the proposed research aims to: (1) identify factors that uniquely impact older women in relation to BE, (2) utilize information gathered in Aim 1 to guide development of a theory-driven, behavioral intervention tailored for older women with BE and pilot implementation to determine its feasibility, and (3) integrate work completed in Aims 1 and 2 within a career development program to advance the Dr. Kilpela’s knowledge and expertise in (a) clinical gerontology, (b) women’s health in aging, and (c) their integration in the context of BE, to support an R01 application for a full-scale trial. Complementary to the proposed research, Dr. Kilpela will complete a program of career development to gain the scientific and professional development skills to transition to an independent investigator. This proposal is supported by a mentorship team of renowned scientists in aging research (Drs. Musi and Espinoza), women’s health (Dr. LaCroix), and eating disorders (Dr. Keel), and advisors in geriatric medicine education (Dr. Sanchez-Reilly) and biostatistics (Dr. Gelfond). This team, along with resources available through the San Antonio Pepper Center and Barshop Institute for Longevity and Aging Studies, comprise an ideal environment for Dr. Kilpela to successfully reach her goal to promote healthy aging in older women by addressing disordered eating and nutrition pathology.