Exploring pretreatment weight trajectories in obese patients with binge eating disorder

Treatments for obese patients with binge eating disorder (BED) typically report modest weight losses despite substantial reductions in binge eating. Although the limited weight losses represent a limitation of existing treatments, an improved understanding of weight trajectories before treatment may provide a valuable context for interpreting such findings. The current study examined the weight trajectories of obese patients in the year before enrollment in primary care treatment for BED. Participants were a consecutive series of 68 obese patients with BED recruited from primary care centers. Doctoral-level clinicians administered structured clinical interviews to assess participants' weight history and eating behaviors. Participants also completed a self-report measure assessing eating and weight. Overall, participants reported a mean weight gain of 9.5 lb in the past year, although this overall average comprised remarkable heterogeneity in patterns of weight changes, which ranged from losing 40 lb to gaining 62 lb. Most participants (65%) gained weight, averaging 22.5 lb. Weight gain was associated with more frequent binge eating episodes and overeating at various times. Most obese patients with BED who present to treatment in a primary care setting reported having gained substantial amounts of weight during the previous year. Such weight trajectory findings suggest that the modest amounts of weight losses typically reported by treatment studies for this specific patient group may be more positive than previously thought. Specifically, although the weight losses typically produced by treatments aimed at reducing binge eating seem modest, they could be reinterpreted as potentially positive outcomes given that the treatments might be interrupting the course of recent and large weight gains.     

Mood,eating attitudes,and anger in obese women with and without Binge Eating Disorder

Objective: The aim of this study was to evaluate the anger levels and their management in obese patients. Methods: A total of 103 obese women [51 with Binge Eating Disorder (BED) and 52 without BED] were included in the study and compared to 93 healthy controls. They were assessed with the State–Trait Anger Expression Inventory (STAXI), Beck Depression Inventory (BDI), and Eating Disorder Inventory-2 (EDI-2). Results: The BDI score is higher in obese subjects than in controls and obese binge eaters have higher levels of depression than obese patients without BED. Differences among the three groups can be found in almost all subscales of the EDI-2, even after controlling for the variable depression (BDI). For STAXI, the only difference among the three groups, which remains significant after controlling for depression, is the tendency to express anger outside (AX-OUT), which is higher in obese binge eaters. The correlation study highlights the importance of impulsivity in the group of obese binge eaters, whereas in obese patients without BED, the tendency toward anger suppression (AX-IN) is seen. Discussion: Obese patients with BED might be considered a subgroup deserving greater psychiatric interest, both for the greater severity of the eating disorder and for the comorbidity with subthreshold depressive symptoms and with borderline personality traits. In obese patients without BED, eating behavior seems more correlated to the psychological functioning typical of psychosomatic disorders. Implications for treatment are discussed.     

Screening for binge eating disorder in obese outpatients

The prevalence of binge eating disorder (BED) in clinical samples of obese patients is controversial, and sensitive diagnostic protocols for use in routine clinical practice need to be further defined. Three hundred forty-four obese (body mass index [BMI] > or =30 kg/m2) patients were studied with the Structured Clinical Interview for DSM-III-R to investigate the lifetime prevalence of mental disorders. The current prevalence of BED was assessed using DSM-IV criteria. Eating attitudes and behavior were investigated with the Bulimic Investigation Test, Edinburgh (BITE) and the Binge Eating Scale (BES). The Beck Depression Inventory (BDI) and Spielberg's State-Trait Anxiety Inventory (STAI) were also applied. The prevalence of BED was 7.5%. Patients with BED had a higher BMI compared with obese patients without BED. Differences in the lifetime prevalence of mental disorders in patients with and without BED were not statistically significant. Using the BES as a screening instrument for BED with a threshold of 17, the sensitivity was 84.8%, specificity 74.6%, positive predictive value 26.2%, and negative predictive value 97.9%. Using the BITE with a threshold of at least 10, the sensitivity was 91%, specificity 51.4%, positive predictive value 71.8%, and negative predictive value 98.2%. The BITE can be a valid alternative to the BES as a screening method for BED in obese patients.     

A randomized, double-blind, placebo-controlled study of sibutramine in the treatment of binge-eating disorder

BACKGROUND: Although antidepressants are the pharmacological agents most often studied in the treatment of binge-eating disorder (BED), preliminary evidence from an open trial suggests that the antiobesity agent sibutramine hydrochloride may be effective. The objective of this study was to evaluate the efficacy and tolerability of sibutramine in obese patients with BED. METHODS: After a 2-week run-in period, 60 obese outpatients (body mass index [calculated as weight in kilograms divided by the square of height in meters] 30-45), who met DSM-IV criteria for BED were randomly assigned to receive sibutramine hydrochloride (n = 30), 15 mg/d, or placebo (n = 30) in a 12-week double-blind study at 2 centers. The primary outcome measure was binge frequency, expressed as the number of days with binge-eating episodes during the past week. Secondary outcome measures included Binge Eating Scale, Beck Depression Inventory scores, weight, and treatment responder status (remission and response). For each efficacy outcome, an intent-to-treat analysis was performed using random regression methods. RESULTS: There was a significant reduction in the number of days with binge episodes in the sibutramine group compared with the placebo group (t203 = 2.14; P =.03); this was associated with an important and significant weight loss (-7.4 kg) compared with a small weight gain in the placebo group (1.4 kg) (t147 = 4.88; P<.001). Sibutramine was also associated with a significantly greater rate of reduction in Binge Eating Scale (t202 = 3.64; P<.001) and Beck Depression Inventory (t201 = 3.72; P<.001) scores. Dry mouth (P =.01) and constipation (P<.001) were more common adverse reactions with sibutramine than placebo. CONCLUSIONS: Sibutramine is effective and well tolerated in the treatment of obese patients with BED. Its effects address 3 main domains of the BED syndrome, ie, binge eating, weight, and related depressive symptoms.     

Validation de la version française de la Binge Eating Scale : étude de sa structure factorielle,de sa consistance interne et de sa validité de construit en population clinique et non clinique

ObjectiveThe Binge Eating Scale is a widely used scale to assess binge eating disorder in obese patients. Until now, this scale has not been validated on a French population, and no psychometrically sound tool assesses binge eating disorder in the French. This study aimed to test the psychometric properties of a French version of the Binge Eating Scale by establishing its factor structure, internal consistency, and construct validity in both a non-clinical population and a clinical population (obese patients who are candidates for bariatric surgery).MethodsA total of 553 non-clinical subjects and 63 morbidly obese patients who were candidates for bariatric surgery were assessed with the BES and the Bulimic Investigatory Test, Edinburgh or BITE (which assesses both binge eating behaviours and use of inappropriate compensatory behaviours). We tested the factor structure of the instrument, its internal consistency, its construct validity with measures of binge eating, and its construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In 47 out of the 63 obese patients, we assessed binge eating disorder (SCID).ResultsIn the non-clinical population, the BES had a one-factor structure (which accounted for 61% of the variance), excellent internal consistency (α = 0.93), and high construct validity with measures of binge eating. In this population, construct validity with measures of inappropriate compensatory behaviours was confirmed in overweight and obese subjects (P = 0.42), but not in underweight and optimal weight subjects (P < 0.001). In obese patients candidates for bariatric surgery, we demonstrated that the BES had a one-factor structure (which accounted for 46% of the variance), had high internal consistency (α = 0.88) and high construct validity with measures of binge eating and good construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In the subpopulation of 47 obese patients, sensitivity, specificity, positive predictive value and negative predictive value were respectively 75%, 88.4%, 37.5% and 97.4% (BES threshold = 18).DiscussionIn this study, we validated a psychometrically sound French version of the Binge Eating Scale, both in a non-clinical and a clinical sample. The psychometric properties of the French version of the BES are comparable to its original version with a one-factor structure. The BES is a useful tool to assess binge eating disorder in obese patients (e.g., bariatric surgery candidates), but might not differentiate between binge eating disorder and bulimia nervosa in underweight and optimal weight subjects.     

An open-label trial of sibutramine in obese patients with binge-eating disorder

BACKGROUND: Binge-eating disorder was recently included in Appendix B of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Binge-eating disorder is a common diagnosis among patients who seek treatment for obesity. There are scant data about the efficacy of the novel antiobesity agents for binge-eating disorder. The objective of this article is to present data from an open-label study of the efficacy and tolerability of sibutramine in a group of obese binge eaters. METHOD: Ten obese patients with DSM-IV binge-eating disorder and no medical comorbidity were consecutively selected from individuals seeking treatment for obesity in our clinic. Treatment with sibutramine, 15 mg/day, was administered for 12 weeks. The number of days with binge episodes per week, the number of binge episodes per week, the Binge Eating Scale (BES), the Beck Depression Inventory, and body weight evaluation were employed for outcome assessment. RESULTS: Seven patients completed the trial. They showed a complete resolution of binge-eating disorder with no binge-eating episodes at the end of the treatment. The mean +/- SD number of days with binge episodes per week changed significantly from 5.2 +/- 1.8 at baseline to 0.8 +/- 1.9 at the end of the study (p < .001), and the mean BES score fell from 31.2 +/- 6.2 to 15.2 +/- 8.2. There was a reduction of body weight (mean = 4.0 kg [8.9 lb]) from baseline to the end of the study. No serious adverse effects were observed. CONCLUSION: Sibutramine might be an effective and well-tolerated agent in the treatment of binge-eating disorder in obese patients.     

Parental substance use history of overweight men and women with binge eating disorder is associated with distinct developmental trajectories and comorbid mood disorder

Objective

To examine the significance of parental histories of substance use disorders (SUDs) in the expression of binge eating disorder (BED) and associated functioning.

Method

Participants were 127 overweight patients with BED assessed using diagnostic interviews. Participants were administered a structured psychiatric history interview about their parents (N = 250) and completed a battery of questionnaires assessing current and historical eating and weight variables and associated psychological functioning (depression and self-esteem).

Results

Patients with BED with a parental history of SUD were significantly more likely to start binge eating before dieting, had a significantly earlier age at BED onset, and reported less time between binge eating onset and meeting diagnostic criteria for BED than did patients without a parental history of SUD. For psychiatric comorbidity, patients with BED with a parental history of SUD were significantly more likely to meet the criteria for a mood disorder. A parental history of SUD was not significantly associated with variability in current levels of binge eating, eating disorder psychopathology, or psychological functioning.

Discussion

Our findings suggest that a parental history of SUD is associated with certain distinct trajectories in the development of binge eating (earlier binge onset predating dieting onset) and with elevated rates of comorbidity with mood disorders in patients with BED.     

Psychiatric comorbidity in binge-eating disorder as a function of smoking history

OBJECTIVE: To examine the comorbidity of psychiatric disorders in obese women with binge-eating disorder (BED) as a function of smoking history. METHOD: A consecutive series of 103 obese treatment-seeking women with current DSM-IV diagnoses of BED were administered structured diagnostic interviews to assess all DSM-IV Axis I psychiatric disorders. Participants were classified as "never" or "daily" smokers, and lifetime rates of comorbid psychopathology were compared across smoking groups using logistic regression. The study was conducted from February 2003 to March 2005. RESULTS: Smokers were significantly more likely to meet criteria for co-occurring diagnoses of major depressive disorder (p = .03), panic disorder (p = .01), posttraumatic stress disorder (p < .05), and substance abuse or dependence (p = .01). Even after excluding participants with substance use disorders, significant differences remained, with lifetime smokers having significantly higher rates of co-occurring anxiety disorders. CONCLUSIONS: It is possible that for some obese women with BED, binge eating and cigarette smoking share common functions, i.e., both behaviors may serve to modulate negative affect and/or anxiety. Although the current findings are consistent with a view of a common diathesis for the development of impulsive eating, cigarette or other substance use, and additional Axis I psychopathology, prospective longitudinal studies are needed to elucidate the nature of potential pathways.     

The cDNA 385C to A missense polymorphism of the endocannabinoid degrading enzyme fatty acid amide hydrolase (FAAH) is associated with overweight/obesity but not with binge eating disorder in overweight/obese women

Endocannabinoids are involved in the modulation of eating behavior; hence, alterations of this system may play a role in obesity. Recently, a single nucleotide polymorphism (cDNA 385C to A) of the gene coding for fatty acid amide hydrolase (FAAH), the major degrading enzyme of endocannabinoids, has been found to be associated with obesity. However, the possibility that the FAAH gene cDNA 385C to A single nucleotide polymorphism (SNP) is associated to binge eating disorder (BED), a condition that frequently occurs in obese individuals, has not been investigated. In order to address this issue, we assessed the distribution of the cDNA 385C to A SNP in 115 overweight/obese subjects with BED, 74 non-BED patients with obesity and 110 normal weight healthy controls. As compared to healthy controls, the whole group of overweight/obese BED and non-BED patients had a significantly higher frequency of the CA genotype and the A allele of the FAAH gene cDNA 385C to A SNP. Moreover, the SNP resulted significantly correlated to the presence of overweight/obesity (F(2, 296)=3.58, P=0.02), but not to the occurrence of BED (F(2, 296)=0.98; P=0.3). The present study confirms previously published significant over-representations of the FAAH 385 A allele in overweight/obese subjects and presents new data in BED patients that the 385 mutation is not significantly associated with BED-related obesity.     

Emotion regulation model in binge eating disorder and obesity - a systematic review

Deficits in emotion regulation processes are a common and widely used explanation for the development and maintenance of binge eating disorder (BED). It is assumed that BED patients – as they have difficulty regulating their negative emotions – use binge eating to cope with these emotions and to find relief. However, the number of experimental studies investigating this assumption is scarce and the differentiation of obese individuals with and without BED regarding the emotion regulation model is not verified.We reviewed literature for experimental studies investigating the emotion regulation model in obese patients (OB) with and without BED. Our search resulted in 18 experimental studies examining the triggering effect of negative emotions for binge eating or its effects on subsequent relief.We found evidence indicating that negative emotion serves as a trigger for binge eating in the BED group unlike the obese group without BED. Considering the small number of studies, we found evidence for a (short-term) improvement of mood through food intake, irrespective of group.     

Psychiatric comorbidity in a Brazilian sample of patients with binge-eating disorder

We compared sociodemographic characteristics and psychiatric status in obese Brazilian patients who did (n=32) and did not (n=33) meet DSM-IV criteria for binge-eating disorder (BED). The sample's mean age was 35.0 years (+/-10.5), with 92.3% of individuals being female and 41.5% having some higher education. Obese binge eaters (OBE) were significantly more likely than obese non-binge eaters to meet criteria for a current diagnosis of any axis I disorder, any mood disorder and any anxiety disorder. Specifically, OBE patients were characterized by significantly higher rates of current and lifetime histories of major depressive disorder. Similar to patients from developed countries, Brazilian patients with BED display increased rates of psychiatric comorbidity, particularly mood and anxiety disorders.     

Metabolic syndrome in obese men and women with binge eating disorder: developmental trajectories of eating and weight-related behaviors

Metabolic syndrome (MetSyn), characterized by vascular symptoms, is strongly correlated with obesity, weight-related medical diseases, and mortality and has increased commensurately with secular increases in obesity in the United States. Little is known about the distribution of MetSyn in obese patients with binge eating disorder (BED) or its associations with different developmental trajectories of dieting, binge eating, and obesity problems. Furthermore, inconsistencies in the limited data necessitate elucidation. This study examined the frequency and correlates of MetSyn in a consecutive series of 148 treatment-seeking obese men and women with BED assessed with structured clinical interviews. Almost half of the participants met the criteria for MetSyn. Participants with MetSyn did not differ from those without MetSyn on demographic variables or disordered eating psychopathology. However, our findings suggest that MetSyn is associated with a distinct developmental trajectory, specifically a later age at BED onset and shorter BED duration. Although the findings from this study shed some light on MetSyn and its associations with developmental trajectories of eating and weight-related behaviors, notable inconsistencies characterize the limited literature. Prospective studies are needed to examine causal connections in the development of the MetSyn in relation to disordered eating in addition to excess weight.     

Circulating ghrelin is decreased in non-obese and obese women with binge eating disorder as well as in obese non-binge eating women, but not in patients with bulimia nervosa

Ghrelin is a peripheral gastric peptide involved in the regulation of eating behavior and energy homeostasis. While changes in ghrelin plasma levels have been found in anorexia nervosa, bulimia nervosa (BN) and obesity, no study has assessed circulating ghrelin in binge eating disorder (BED). Therefore, we measured plasma levels of this peptide in women with BED as compared to women with BN, obesity and healthy controls. One hundred and eighty-two drug-free women (56 bulimics, 13 non-obese and 34 obese BED subjects, 28 obese non-binge eating women and 51 non-obese healthy women) underwent psychopathological and nutritional assessments and blood sample collection for glucose and ghrelin assays in the morning. As compared to non-obese healthy women, both non-obese and obese BED women as well as obese non-binge eating women had significantly increased values of body weight, body mass index and body fat mass. Moreover, plasma ghrelin concentrations were significantly decreased in both non-obese (P<0.01) and obese (P<0.0001) BED women as well as in obese non-binge eating women (P<0.001) but not in women with BN. No significant correlations emerged between plasma ghrelin values and the frequency of binge/vomiting in BN subjects or the frequency of bingeing in BED individuals. The reduction of plasma ghrelin in non-obese and obese binge eaters as well as in obese non-binge eaters may represent a secondary change aiming to counteract their positive energy imbalance.     

Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study.

BACKGROUND: In a single-center, placebo-controlled study, topiramate reduced binge eating and weight in patients with binge eating disorder (BED) and obesity. The current investigation evaluated the safety and efficacy of topiramate in a multicenter, placebo-controlled trial. METHODS: Eligible patients between 18 and 65 years with >or= 3 binge eating days/week and a body mass index (BMI) between 30 and 50 kg/m2 were randomized. RESULTS: A total of 407 patients enrolled; 13 failed to meet inclusion criteria, resulting in 195 topiramate and 199 placebo patients. Topiramate reduced binge eating days/week (-3.5 +/- 1.9 vs. -2.5 +/- 2.1), binge episodes/week (-5.0 +/- 4.3 vs. -3.4 +/- 3.8), weight (-4.5 +/- 5.1 kg vs. .2 +/- 3.2 kg), and BMI (-1.6 +/- 1.8 kg/m2 vs. .1 +/- 1.2 kg/m2) compared with placebo (p < .001). Topiramate induced binge eating remission in 58% of patients (placebo, 29%; p < .001). Discontinuation rates were 30% in each group; adverse events (AEs) were the most common reason for topiramate discontinuation (16%; placebo, 8%). Paresthesia, upper respiratory tract infection, somnolence, and nausea were the most common AEs with topiramate. CONCLUSIONS: This multicenter study in patients with BED associated with obesity demonstrated that topiramate was well tolerated and efficacious in improving the features of BED and in reducing obesity.     

Predictors for treatment outcome of binge eating with obesity: a naturalistic study

This study examines predictors of short-term treatment outcome for obese individuals with binge eating disorder (BED). A battery of assessment questionnaires was given to 212 patients on admission of a CBT day-treatment program for BED. Treatment outcome assessed by changes in eating disorder symptomatology was measured in 182 completers. Linear regression analyses indicated that a combination of variables at baseline predicted 26% of the variance in treatment outcome. High social embedding and higher scores on openness (NEO-PI-R) were significantly related to more improvement after treatment. Higher scores on depressive symptoms (BDI), agoraphobia (SCL-90) and extraversion (NEO-PI-R) were significantly related to less improvement. The analyses show that the level of social embedding and psychopathological comorbidity (state and trait) are predictors for treatment outcome. This study confirms the notion that social context and comorbidity need to be taken into account as described in treatment guidelines of NICE and APA for BED.     

Substantial weight gains are common prior to treatment-seeking in obese patients with binge eating disorder

This study examined weight trajectories in obese patients with binge eating disorder (BED) during the year prior to treatment initiation and explored potential correlates of these weight changes. One hundred thirty (N = 130) consecutive, treatment-seeking, obese patients with BED were assessed with structured interviews and self-report questionnaires. Eighty-three percent (83%; n = 108) of treatment seeking obese BED patients gained weight, and 65% (n = 84) gained a clinically significant amount of weight (greater than or equal to 5% body weight), in the year preceding treatment. Overall, participants reported a mean percent weight gain of 8% (16.6 pounds) during the 12 months prior to treatment with a wide range of weight changes across participants (from a 52% weight gain to a 13% weight loss). A substantial proportion of patients (35%), categorized as High Weight Gainers (defined as gaining more than 10% of body weight during previous year), reported gaining an average of 16.7% of body weight. Low Weight Gainers (defined as gaining greater than 5%, but less than 10%) comprised 29% of the sample and were characterized by a mean gain of 6.9% of body weight. Weight Maintainers/Losers (defined as having maintained or lost weight during the 12 months prior to treatment) comprised 17% of the sample and reported losing on average 2.8% of body weight. These three groups did not differ significantly in their current weight and eating behaviors or eating disorder psychopathology. The majority of treatment-seeking obese patients with BED reported having gained substantial amounts of weight during the previous year. These findings provide an important context for interpreting the modest weight losses typically reported in treatment studies of BED. Failure to produce weight loss in these studies may be reinterpreted as stabilization of weight and prevention of further weight gain.     

Predictors for Treatment Outcome of Binge Eating With Obesity: A Naturalistic Study

This study examines predictors of short-term treatment outcome for obese individuals with binge eating disorder (BED). A battery of assessment questionnaires was given to 212 patients on admission of a CBT day-treatment program for BED. Treatment outcome assessed by changes in eating disorder symptomatology was measured in 182 completers. Linear regression analyses indicated that a combination of variables at baseline predicted 26% of the variance in treatment outcome. High social embedding and higher scores on openness (NEO-PI-R) were significantly related to more improvement after treatment. Higher scores on depressive symptoms (BDI), agoraphobia (SCL-90) and extraversion (NEO-PI-R) were significantly related to less improvement. The analyses show that the level of social embedding and psychopathological comorbidity (state and trait) are predictors for treatment outcome. This study confirms the notion that social context and comorbidity need to be taken into account as described in treatment guidelines of NICE and APA for BED.     

Social anxiety and self-consciousness in binge eating disorder: associations with eating disorder psychopathology

ObjectiveResearch has consistently shown that anxiety disorders are common among individuals with eating disorders. Although social phobia has been found to be highly associated with eating disorders, less is known about social anxiety in individuals with binge eating disorder (BED). The present study examined associations between social anxiety and self-consciousness with body mass index (BMI) and eating disorder psychopathology in BED.MethodsParticipants were 113 overweight or obese treatment-seeking men and women with BED. Participants were administered semistructural diagnostic clinical interviews and completed a battery of self-report measures.ResultsSocial anxiety was positively and significantly correlated with shape and weight concerns and binge eating frequency. After accounting for depressive levels, social anxiety and self-consciousness accounted for significant variance in eating, shape, and weight concerns and overall eating disorder global severity scores (Eating Disorder Examination). Social anxiety also accounted for significant variance in binge eating frequency after covarying for depressive levels. Social anxiety and self-consciousness were not significantly associated with BMI or dietary restraint.DiscussionOur findings suggest that greater social anxiety and heightened self-consciousness are associated with greater eating disorder psychopathology, most notably with greater shape and weight concerns and binge eating frequency in patients with BED. Social anxiety and self-consciousness do not appear to be merely functions of excess weight, and future research should examine whether they contribute to the maintenance of binge eating and associated eating disorder psychopathology.     

Characteristics of morbidly obese patients before gastric bypass surgery

The prevalence of binge eating disorder (BED) was assessed in a sample of 110 morbidly obese presurgery patients by means of self-report (Questionnaire on Eating and Weight Patterns [QEWP]). Subsequently, patients with (n = 19, 17.3%) and without BED (n = 91, 82.7%) were compared on several eating-related and general psychopathological instruments, as well as an obesity-specific health-related quality-of-life measure. Patients with BED exhibited higher scores than non-BED patients on most of the subscales of two questionnaires measuring eating behavior and attitudes towards eating, shape, and weight (Three Factor Eating Questionnaire [TFEQ], Eating Disorders Examination-questionnaire version [EDE-Q4]) with the exception of the respective restraint subscales. The two groups also differed significantly on the disease-specific quality-of-life measure (Impact of Quality of Life Questionnaire-Lite [IWQOL-Lite]). No differences were found for measures of severity of depressive symptoms (Inventory of Depressive Symptoms [IDS]) and impairment of self-esteem (Rosenberg Self-Esteem Questionnaire [RSE]). Our findings replicate the results of other studies comparing patients with and without BED in samples with different degrees of obesity and extend the results to an obesity-specific quality-of-life measure. Further research needs to investigate the short- and long-term impact of presurgery BED on surgery outcome, as well as the impact of surgery on binge eating and eating-related psychopathology.