Timing and sequence of the onset of overweight, dieting, and binge eating in overweight patients with binge eating disorder

OBJECTIVE: To examine the self-reported sequence and timing of onset of overweight, binge eating, and dieting in adult patients diagnosed with binge eating disorder (BED). METHOD: Participants were 284 treatment-seeking adults (73 men and 211 women) who met DSM-IV research criteria for BED. Patients were interviewed with structured diagnostic interviews and were queried regarding history of overweight, dieting, and binge eating behaviors. Questionnaires were also administered to assess current eating disturbances, body dissatisfaction, and general functioning. Participants were classified as Overweight First, Binge First, or Diet First, and the three groups were compared on developmental sequence and using the battery of measures. RESULTS: Sixty-three percent of the 284 participants reported becoming overweight prior to the onset of dieting or binge eating. Participants who reported they were overweight first had significantly greater BMI at the time of assessment. The 16% of the participants who reported binge eating first were significantly younger at the onset of BED diagnosis and reported significantly less dietary restraint. Onset order differed significantly by gender; proportionally more women (25%) than men (11%) reported that dieting preceded overweight or binge eating. CONCLUSION: Weight problems preceded dieting and binge eating behaviors for a majority of treatment-seeking overweight participants diagnosed with BED.     

Prevalence and correlates of binge eating in white and African American adolescents

OBJECTIVE: This study examined the prevalence and correlates of binge eating in a biracial sample of adolescent males and females. METHOD: White and African American students in Grades 6-12 (N=822) completed measures of social economic status (SES), body mass index (BMI), depression, current-ideal body image discrepancy, eating attitudes, dieting frequency, dietary intake, and activity level. RESULTS: Binge eating prevalence was highest among African American boys relative to the other demographic groups: 26% African American boys, 17% African American girls, 19% white boys, 18% white girls. Binge eating rates increased with age for white participants and decreased with age for African American participants. Depressive symptoms and consumption of high-fat foods predicted binge status among adolescents, whereas SES, BMI, eating attitudes, body image discrepancy, dieting, and low activity level failed to add predictive value. DISCUSSION: The observation of developmental differences in binging between whites and African Americans corresponds to their physical maturational divergence. These findings underscore the need for population-based surveys that sample binge eating across age, gender, and ethnicity.     

Gender differences in patients with binge eating disorder

OBJECTIVE: This study examined gender differences in patients with binge eating disorder (BED). METHOD: Participants were 182 adults (35 male, 147 female) who were consecutively evaluated for outpatient clinical trials and met criteria for BED as outlined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. They were administered a battery of measures to examine developmental, eating and weight-related disturbances, and psychological features associated with BED. RESULTS: Men and women did not differ significantly on several developmental variables (age at first overweight, age at first diet, age at onset of regular binge eating, or number of weight cycles). Men had significantly higher current body mass index (BMI), highest adult BMI, and were significantly more likely to be classified as obese. Men and women did not differ significantly on measures of current eating disorder features (binge eating, eating concerns, weight or shape concerns) but women reported significantly greater body image dissatisfaction and drive for thinness. Men and women did not differ significantly on current depression or self-esteem but men reported a greater frequency of past drug abuse problems. DISCUSSION: Although men and women who present for treatment for BED show many similarities in current eating disorder features, we observed a number of gender differences on important developmental and physical variables as well as associated psychological features.     

A comparison of the binge eating scale, questionnaire for eating and weight patterns-revised, and eating disorder examination questionnaire with instructions with the eating disorder examination in the assessment of binge eating disorder and its symptoms

OBJECTIVE: The current study assesses concordance between self-administered measures and a diagnostic standard for assessment of binge frequency and diagnosis of binge eating disorder (BED) in a sample of binge eaters. METHOD: The Questionnaire for Eating and Weight Patterns-Revised (QEWP-R), Binge Eating Scale (BES), two items from the Eating Disorder Examination Questionnaire with Instructions (EDE-Q-I), and the Eating Disorder Examination (EDE) were administered. Participants were 157 adults volunteering for a clinical study, of whom 129 (79%) were diagnosed with BED using the EDE as the diagnostic standard. RESULTS: In the identification of BED, the QEWP-R yielded a sensitivity value of .74 and a specificity value of .35. The BES yielded a sensitivity value of .85 and a specificity value of .20. Frequency of binge eating days and episodes on the EDE-Q-I correlated highly with the EDE (.65 and .48, respectively; p < .001). DISCUSSION: The accuracy of diagnosis and symptomatology among self-administered questionnaires is variable. The BES and the QEWP-R performed satisfactorily as initial screens for the diagnosis of BED, but were less accurate in identifying non-BED individuals and the frequency of binge eating. The EDE-Q-I most accurately assessed the frequency of binge eating.     

Symptom severity in obese women with binge eating disorder as a function of smoking history

OBJECTIVE: To compare obese female former smokers with binge eating disorder (BED) to women with BED with no smoking history in the severity of binge eating and associated symptoms. METHOD: A consecutive series of 91 obese women with current diagnoses of BED were administered structured diagnostic and investigator-based interviews and self-report questionnaires to assess symptoms associated with eating disorders. Participants were classified as "never" or "former" smokers and symptom profiles were compared across smoking groups. RESULTS: Former and never-smoking groups did not differ in age, body mass index, or current binge frequency. Former smokers reported significantly higher levels of dietary restraint, rigid dieting strategies, and avoidance of eating. CONCLUSION: Former smokers were significantly more likely than never-smokers to endorse specific symptoms of eating pathology (i.e., rigid dieting strategies). Despite the average 15-year interval since smoking cessation, the former smokers in this patient group resembled current smokers with other eating disorders in terms of rigid and restrictive weight control methods. Obese patients with a smoking history may benefit from treatment to address rigid/pathological dieting and strategies.     

Body dissatisfaction and dietary restraint influence binge eating behavior

As binge eating is a common behavior throughout the general population, we hypothesized that body dissatisfaction would produce binge eating via its prediction of dieting. Six hundred eight individuals were nonrandomly recruited from the community. The mean age and body mass index of participants were 34.76 years (SD, 14.41) and 27.82 kg/m² (SD, 9.54), respectively. Participants were asked to complete several self-report questionnaires, which included measures of dieting status, binge eating behavior, body dissatisfaction, overvaluation of weight and shape, and self-esteem. The results showed that dieting was a common behavior; 38.1% of participants reported dieting during the past year. Binge eating during the previous 6 months was reported by 9.9% of the sample and was associated with a higher body mass index as well as more frequent dieting. A model including dieting status, overvaluation of weight and shape, shape satisfaction, and self-esteem showed the best fit for the prediction of binge eating behavior. Moreover, those who dieted and overvalued their weight and shape were 2.01 and 2.31 times more likely, respectively, to binge eat. Structural equation modeling revealed that body dissatisfaction caused dietary restraint, thus triggering binge eating. Both dieting and overvaluation of weight and shape are important risk factors for the development of binge eating disorders. Dieting and binge eating are common behaviors that represent a risk for the development of both excess weight and eating disorders. The structural model proposed in this study could be beneficial in understanding this causal relationship.     

Eating Disorder Examination-Questionnaire with and without instruction to assess binge eating in patients with binge eating disorder

OBJECTIVE: The current study examined whether adding written definitions and examples of binge eating to the Eating Disorder Examination-Questionnaire enhances its utility to assess binge frequency in patients with binge eating disorder (BED). METHOD: Eighty-nine women and men with BED completed the EDE-Q (without instruction; n = 37) or the EDE-Q-I (with instruction; n = 52) before receiving the EDE interview. Binge frequency was measured as the number of binge days (days on which one or more objective binge episodes occurred) over the past 28 days. RESULTS: Binge frequency correlations between the EDE and EDE-Q-I were strongly significant (r = .543, p = .000), whereas correlations between the EDE and EDE-Q were not significant (r = .197, p = .242). DISCUSSION: Providing brief detailed instructions improves the performance of the EDE-Q when evaluating binge eating in patients with BED. This suggests that, with relatively minor modifications, the EDE-Q may be a viable alternative to the EDE in assessing binge frequency in this population.     

Body checking and avoidance in overweight patients with binge eating disorder

OBJECTIVE: Repetitive body checking and avoidance are viewed as behavioral manifestations of the core psychopathology of eating disorders (EDs). We examined select body checking and avoidance behaviors in overweight patients with binge eating disorder (BED). METHOD: Three hundred seventy-seven overweight (body mass index [BMI] > or = 25) treatment-seeking BED patients (80 men and 297 women) were administered measures to assess body checking and avoidance, other key behavioral features of EDs (binge eating, dietary restraint, and disinhibition), and the core psychopathology of EDs (overevaluation of weight and shape). RESULTS: The majority of participants reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations emerged between checking and restraint, and conversely, between avoidance and binge eating. Both checking and avoidance were positively and significantly associated with overevaluation of weight and shape, even after controlling for their unique effects. DISCUSSION: These findings offer support to the potential role of checking and avoidance behaviors in the maintenance of BED.     

Body Checking Questionnaire: psychometric properties and clinical correlates in obese men and women with binge eating disorder

OBJECTIVE: Body checking is considered a behavioral manifestation of the overevaluation of shape and weight, which is characteristic of patients with eating disorders. We examined the initial psychometric properties of the Body Checking Questionnaire (BCQ) and the frequency and nature of body checking behaviors in obese men and women with binge eating disorder (BED). METHOD: Participants were a consecutive series of 73 (22 men, 51 women) treatment-seeking obese adults who met research criteria for BED as defined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). Participants were administered measures to assess body checking, body image concerns, and the core psychopathology of eating disorders, and general psychological functioning. Semistructured interviews were used to establish the diagnosis of BED. RESULTS: Psychometric evidence was found to support the reliability and validity of the BCQ in patients with BED. Women reported significantly greater levels of body checking than men. Participants with greater body dissatisfaction reported more frequent checking than participants with less dissatisfaction. Among women, the frequency of checking was related to younger age, lower body mass index (BMI), body dissatisfaction, overevaluation of body shape and weight, greater depression, and lower self-esteem. CONCLUSION: There exist significant gender and age-related differences in both the frequency and correlates of body checking behaviors. Among obese women with BED, body checking is related to the overevaluation of shape as well as with associated psychopathology.     

Maintenance of binge eating through negative mood: a naturalistic comparison of binge eating disorder and bulimia nervosa

OBJECTIVE: To examine negative mood as a proximal antecedent and reinforcing condition of binge eating in binge eating disorder (BED) and bulimia nervosa (BN). METHOD: Using an ecological momentary assessment design, 20 women with BED, 20 women with BN, and 20 nonclinical control women were recruited from the community, provided with a portable minicomputer, and asked to rate their mood and list their thoughts at randomly-generated beep sounds and before, during, and after episodes of eating. RESULTS: In both eating disorder groups mood before binge eating was more negative than before regular eating and at random assessment. Binge eating was followed by a deterioration of mood. The BED group revealed less antecedent negative mood than the BN group and less concomitant negative cognitions about food/eating and stress. CONCLUSION: Affect regulation difficulties likely lead to binge eating in both disorders, but binge eating may not be effective for regulating overall mood.     

Onset of binge eating,dieting, obesity,and mood disorders among subjects seeking treatment for binge eating disorder

Binge eating disorder (BED) identified in adulthood is often clinically associated with obesity and a lifetime history of affective disorders. Several authors have suggested that dieting may predispose individuals to binge eating which then may lead to obesity. However, few BED studies have examined the chronology of the onset of binge eating, dieting, obesity, and mood disorders. This study evaluated retrospective reports from 30 women participating in a BED treatment study. Although the majority of subjects in this adult sample were obese, initiation of binge eating behavior usually occurred during adolescence at a time when most subjects reported being of normal weight. Obesity developed several years after the age of onset of meeting BED criteria. Onset of binge eating usually predated that of dieting or major depressive disorder in the majority of subjects. The results support the importance of early intervention for binge eating. © 1995 by John Wiley & Sons, Inc.     

On the relation of flexible and rigid control of eating to body mass index and overeating in patients with binge eating disorder

OBJECTIVE: To examine the relationship of flexible and rigid dimensions of restrained eating to body mass index (BMI) and overeating in outpatients with binge eating disorder (BED). METHOD: Participants were 148 consecutive outpatients who met criteria for BED. The Three-Factor Eating Questionnaire (TFEQ) was administered to assess Cognitive Restraint, Hunger, and Disinhibition. The TFEQ also contains two Cognitive Restraint subscales--Flexible Control and Rigid Control. The Eating Disorder Examination-Questionnaire version (EDE-Q) was administered to assess frequency of different forms of overeating during the past 28 days and the attitudinal features of eating disorders. RESULTS: Flexible Control and Rigid Control were significantly correlated with each other. They were both negatively correlated with BMI, but neither was significantly correlated with the frequency of binge eating or other forms of overeating. In addition, Flexible Control and Rigid Control predicted almost the same amount of variance in BMI. DISCUSSION: BED patients exhibit flexible and rigid control of eating that is related to BMI, but not to the frequency of binge eating or other forms of overeating. Results of the present study provide preliminary evidence that flexible and rigid control of eating may not be a useful distinction in BED patients. However, increased restraint, regardless of type, may prove to be of benefit with regard to weight control and may not have adverse effects on binge eating in obese BED patients.     

Ethnicity and sampling bias in binge eating disorder: Black women who seek treatment have different characteristics than those who do not

OBJECTIVE: The current study investigated sampling bias as it affects recruited clinic samples of Black and White women with binge eating disorder (BED). METHODS: Clinical characteristics of a recruited clinic sample (35 Black and 302 White consecutively evaluated women) with BED were compared with a community sample of Black and White women with BED drawn from the New England Women's Health Project. The clinic and community groups met the same definition of BED and were assessed with identical methods. RESULTS: Among White women, the clinic and community samples differed on some features (higher body mass index [BMI], and greater eating concerns and shape concerns in the clinic sample) but these differences reflected small to moderate effects sizes. In contrast, among Black women, the clinic sample had substantially higher levels (large effect sizes) of several features of eating disorders (eating concerns, dietary restraint, and shape concern), higher (moderate effect size) BMI, but lower frequency of binge eating (moderate effect size) than the community sample. A comparison of Black and White women within the clinic sample revealed little difference in clinical presentation, except for the significantly higher BMI among Black women. CONCLUSION: A sampling bias appears to exist between both White and Black recruited clinic samples of women with BED, although the bias appears to be substantially greater for Black women. Black women with BED who seek treatment have significantly different characteristics than those who do not.     

Evaluating binge eating disorder in children: development of the children's binge eating disorder scale (C-BEDS)

OBJECTIVE: Binge eating disorder (BED) may manifest itself differently in children than adults. Recently researchers have proposed provisional criteria for measuring BED in children. The purpose of this study was to develop a brief, simple, structured, interviewer-administered scale (C-BEDS) to measure BED in children according to the provisional criteria and to compare diagnostic results with SCID diagnoses. METHOD: A total of 55 children between the ages of 5 and 13 were interviewed with both the SCID and the C-BEDS. RESULTS: There was a significant association between the two measures (p = .001). Both measures adequately identified children with binge eating behaviors. CONCLUSION: Both the provisional criteria and the C-BEDS may be developmentally appropriate for use with children, although the C-BEDS may be a better screening instrument as it quickly identified children with subsyndromal BED. If used by physicians and other health providers, this brief measure may assist with identifying early onset binge eating behaviors and avoiding the associated consequences, including adult BED, obesity, and other comorbidities.     

Physical activity and its correlates in treatment-seeking obese patients with binge eating disorder

OBJECTIVE: This study examined the physical activity levels reported by obese individuals with binge eating disorder (BED), as well as the relationships between physical activity and body mass index (BMI), features of eating disorders, and associated psychological variables. METHOD: A series of 166 obese treatment-seeking adults (121 women and 45 men) with BED were administered structured diagnostic interviews and self-report questionnaires. RESULTS: This clinical group was found to be extremely sedentary. Self-reported physical activity levels, measured by the Paffenbarger Physical Activity Questionnaire, were comparable with those reported by obese samples with or without binge eating in other studies, but were considerably lower than those reported by a community sample. Lifestyle physical activity (e.g., amounts of walking and stair climbing) and sports and recreational physical activity were unrelated to most clinical characteristics. BMI was significantly, albeit weakly, associated with reported sports and recreational activities in women, but not in men. CONCLUSION: Our findings highlight the degree to which obese patients with BED are inactive. Physical activity was largely uncorrelated with measures of eating disorder and psychological functioning in both men and women but was significantly, but weakly, correlated with BMI in women. Additional research is needed to determine the clinical value of physical activity for this patient group.     

Relation of binge eating age of onset to functional aspects of binge eating in binge eating disorder

OBJECTIVE: This study examined whether age of binge eating onset in binge eating disorder (BED) is related to affective binge eating antecedents and consequences. METHOD: Participants included women (N = 44) with BED who participated in a group cognitive-behavioral therapy (CBT) study. Measures included the Eating Hedonics Questionnaire, Beck Depression Inventory, Multidimensional Personality Questionnaire Negative Emotionality factor, Restraint Scale, Three-Factor Eating Questionnaire Restraint factor, and Eating Behaviors-IV. Participants were classified according to reported age of binge eating onset, with early onset defined as 13 years (LOB; n = 19). RESULTS: Compared with LOB, EOB was associated with reductions in postbinge subjective anxiety, but not depression. DISCUSSION: This study suggested that EOB in BED may be associated with binge eating as an affective means of coping, particularly with anxiety, and further supported age of binge eating onset as a clinically meaningful way to delineate BED subclassifications.     

Alexithymia and body image in adult outpatients with binge eating disorder

OBJECTIVE: The current study elucidates the relations between alexithymia and body image in patients with binge eating disorder (BED). METHOD: One hundred one patients with BED were evaluated. Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20). The severity of BED was measured with the Binge Eating Scale (BES). Body concerns were assessed with the Body Shape Questionnaire-Short Version (BSQ-S), the Body Uneasiness Test (BUT), and the Body Attitude Test (BAT). Additional measures were the Rosenberg Self-Esteem Scale (RSES) and the Beck Depression Inventory (BDI). RESULTS: The prevalence of alexithymia in our sample was 39.6% (n = 40) and individuals with alexithymia showed higher scores on all rating scales. Higher body dissatisfaction, lower self-esteem, depressive symptoms, and the Difficulty in Identifying Feelings/Difficulty in Describing Feelings subscales of the TAS-20 were predictors of the severity of BED in the linear regression analysis. CONCLUSION: Alexithymia was associated with more severe BED. Individuals with alexithymia and BED exhibited significantly poorer appearance evaluation and body satisfaction as well as higher depressive symptoms than individuals without alexithymia.     

Binge Eating Disorder: What Is the Role of Physical Activity Associated with Dietary and Psychological Treatment?

Binge eating patients present lower physical activity levels, which could be associated with lower exercise capacity. Specific physical activity can ensure broad beneficial results relating to eating disorders, depression, and body mass index (BMI) in bulimia; however, research on binge eating disorder (BED) is scarce. Our study aimed to investigate the effects of specific training as an addition to conventional treatment of eating disorder symptoms, anthropometric characteristics, and physical performance. Nineteen women with BED were included in a dietary and cognitive-behavioral therapy program. After medical examination, 10 women carried out Combined Aerobic and Anaerobic Exercise Training in addition to conventional treatment (CAAET group), whereas the remaining 9 followed the conventional treatment alone (CTRL group). All of the measurements were assessed before and after six months of treatment. In both groups, we observed a significant decrease in binge episodes, weight, and body mass index, and an increase in exercise capacity. Moreover, the CAAET group presented a greater improvement in aerobic performance than that observed in the CTRL group. Our results suggest that both interventions similarly improved BED symptoms. The addition of physical activity could be important in the long-term maintenance of both weight loss and reduction in binge episodes in BED patients.     

Binge eating disorder: current knowledge and future directions

Binge eating disorder (BED) is a newly characterized eating disorder that encompasses individuals who have severe distress and dysfunction due to binge eating, but who do not regularly engage in inappropriate compensatory behaviors. While relatively uncommon in the general community, BED becomes more prevalent with increasing severity of obesity. BED is associated with early onset of obesity, frequent weight cycling, body shape disparagement, and psychiatric disorders. These associations occur independent of the degree of obesity. Although many individuals with BED have good short-term weight loss regardless of treatment modality, as a group they may be prone to greater attrition during weight-loss treatment and more rapid regain of lost weight. Current treatments geared toward binge eating behaviors include antidepressant medications, cognitive behavioral psychotherapy, and interpersonal psychotherapy; however, these treatments have little efficacy in promoting weight loss, and only modest success in long-term reduction of binge eating. As a significant proportion of obese individuals entering weight-loss treatment and research programs are likely to meet criteria for BED, those conducting clinical research should be aware of this distinct subgroup and determine the contribution of BED to outcome measures.     

Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: implications for DSM-5

Objective:

We assessed the impact of reducing the binge eating frequency and duration thresholds on the diagnostic criteria for bulimia nervosa (BN) and binge eating disorder (BED).

Method:

We estimated the lifetime population prevalence of BN and BED in 13,295 female twins from the Swedish Twin study of Adults: Genes and Environment employing a range of frequency and duration thresholds. External validation (risk to cotwin) was used to investigate empirical evidence for an optimal binge eating frequency threshold.

Results:

The lifetime prevalence estimates of BN and BED increased linearly as the frequency criterion decreased. As the required duration increased, the prevalence of BED decreased slightly. Discontinuity in cotwin risk was observed in BN between at least four times per month and at least five times per month. This model could not be fit for BED.

Discussion:

The proposed changes to the DSM‐5 binge eating frequency and duration criteria would allow for better detection of binge eating pathology without resulting in a markedly higher lifetime prevalence of BN or BED. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)