Overeating Behavior Can Lead to Risks Unrelated to Obesity: Review
Excessive eating in Prader-Willi syndrome (PWS) increases the risk of mortality not only by making patients prone to obesity and its associated health problems, but also by raising the risk of accidents like choking, a new study indicates.
“There are the longer-term problems that arise through obesity and the more acute issue around access to food and the risk of choking, aspiration, and the possibility of major life-threatening events, such as stomach rupture,” the researchers wrote.
“These observations raise important questions for the support of people with PWS as to their ability to make choices that can balance the various risks associated with excess food intake and to act accordingly, particularly in the context of the freedoms we have as adults and the ready availability of food in many countries,” they added.
The study, “The consequences of hyperphagia in people with Prader-Willi Syndrome: A systematic review of studies of morbidity and mortality,” was published in the European Journal of Medical Genetics.
Hyperphagia, or excessive eating, is one of the characteristic symptoms of PWS, and is closely associated with obesity. The vast majority of PWS patients are overweight or obese, and obesity is thought to be a driving force behind morbidity and mortality in PWS.
Little is known about whether there is any direct connection between hyperphagia and PWS-related morbidity/mortality, outside of the indirect connection due to obesity. A quintet of scientists at the University of Cambridge in the U.K. conducted a review of published scientific studies to better understand these relationships.
In total, the team reviewed 110 studies, most of which were from relatively affluent countries such as the U.S., Japan, Australia, and several nations in Europe. Mortality data suggested that the average age of death for PWS patients was about 22 years.
From the studies, the team identified 500 cases where a person with PWS died from a known cause. The majority of these patients were obese, and the most common causes of death — such as breathing and heart problems — have well-established connections with obesity.
However, in addition to these common obesity-linked causes of death, a smaller number of patients died due to choking (30 patients), drowning in the bath (4 patients), or accidents (18 patients).
“These causes of death were not directly linked to obesity per se, although several of the people with PWS were obese, but the cause was more directly related to the behaviour of hyperphagia,” the researchers wrote.
For example, the team noted that eating more often may make patients more prone to choking, and binge eating can put strain on the digestive track that may lead to life-threatening ruptures.
There also was evidence that people with PWS are more likely to accidentally ingest poisons, “again possibly highlighting the consequences of the behaviour of hyperphagia itself,” the scientists wrote.
The overall review focused on adults, but additional analyses on pediatric data also revealed “a pattern of unexplained death and accidental death,” the team added, which they said suggests “an increased risk of death throughout life from the behaviours associated with hyperphagia, notably choking.”
The researchers noted that, at present, management of hyperphagia in PWS is limited mainly to trying to control when food is available. This may be easier to manage for children who are under parental supervision, but may be more challenging as people with PWS grow into adulthood and attain greater independence, they said, stressing the need to provide support to patients.
“Support at meals is not only important to reduce the risk of obesity but also to reduce the risks of causes of mortality that are hyperphagia related but not directly due to obesity, such as choking,” the team concluded.