Childhood Maltreatment in Extremely Obese Male and Female Bariatric Surgery Candidates**

OBJECTIVE

To examine rates of self-reported childhood maltreatment in extremely obese bariatric surgery candidates and to explore associations with sex, eating disorder features, and psychological functioning.

RESEARCH METHODS AND PROCEDURES

Three hundred forty (58 men and 282 women) extremely obese consecutive candidates for gastric bypass surgery completed a questionnaire battery. The Childhood Trauma Questionnaire was given to assess childhood maltreatment.

RESULTS

Overall, 69% of patients self-reported childhood maltreatment: 46% reported emotional abuse, 29% reported physical abuse, 32% reported sexual abuse, 49% reported emotional neglect, and 32% reported physical neglect. Except for higher rates of emotional abuse reported by women, different forms of maltreatment did not differ significantly by sex. Different forms of maltreatment were generally not associated with binge eating, current BMI, or eating disorder features. At the Bonferonni-corrected significance level, emotional abuse was associated with higher eating concerns and body dissatisfaction, and emotional neglect was associated with higher eating concerns. In terms of psychological functioning, at the Bonferonni-corrected level, emotional abuse and emotional neglect were associated with higher depression and lower self-esteem, and physical abuse was associated with higher depression.

DISCUSSION

Extremely obese bariatric surgery candidates reported rates of maltreatment comparable with those reported by clinical groups and roughly two to three times higher than normative community samples. Reported experiences of maltreatment differed little by sex and were generally not significantly associated with current BMI, binge eating, or eating disorder features. In contrast, maltreatment-notably emotional abuse and neglect-were significantly associated with higher depression and lower self-esteem.

Interpersonal problems and developmental trajectories of binge eating disorder

OBJECTIVE

The aim of the present study was to explore associations between specific interpersonal constructs and the developmental progression of behaviors leading to binge eating disorder (BED).

METHOD

Eighty-four consecutively evaluated, treatment-seeking obese (body mass index ≥30 kg/m(2)) men and women with BED were assessed with structured diagnostic and clinical interviews and completed a battery of established measures to assess the current and developmental eating- and weight-related variables as well as interpersonal functioning.

RESULTS

Using the interpersonal circumplex structural summary method, amplitude, elevation, the affiliation dimension, and the quadratic coefficient for the dominance dimension were associated with eating- and weight-related developmental variables. The amplitude coefficient and more extreme interpersonal problems on the dominance dimension (quadratic)-that is, problems with being extremely high (domineering) or low in dominance (submissive)-were significantly associated with a younger age at onset of binge eating, BED, and overweight as well as accounted for significant variance in age at binge eating, BED, and overweight onset. Greater interpersonal problems with having an overly affiliative interpersonal style were significantly associated with and accounted for significant variance in a younger age at diet onset.

DISCUSSION

Findings provide further support for the importance of interpersonal problems among adults with BED and converge with recent work highlighting the importance of specific types of interpersonal problems for understanding heterogeneity and different developmental trajectories of individuals with BED.

12-month follow-up of fluoxetine and cognitive behavioral therapy for binge eating disorder

OBJECTIVE

The longer term efficacy of medication treatments for binge-eating disorder (BED) remains unknown. This study examined the longer term effects of fluoxetine and cognitive behavioral therapy (CBT) either with fluoxetine (CBT + fluoxetine) or with placebo (CBT + placebo) for BED through 12-month follow-up after completing treatments.

METHOD

81 overweight patients with BED within a randomized double-blind placebo-controlled acute treatment trial allocated to fluoxetine-only, CBT + fluoxetine, and CBT + placebo were assessed before treatment, during treatment, posttreatment, and 6 and 12 months after completing treatments. Outcome variables comprised remission from binge eating (0 binge-eating episodes for 28 days) and continuous measures of binge-eating frequency, eating disorder psychopathology, depression, and weight.

RESULTS

Intent-to-treat remission rates (missing data coded as nonremission) differed significantly across treatments at posttreatment and at 6- and 12-month follow-ups. At 12-month follow-up remission rates were 3.7% for fluoxetine-only, 26.9% for CBT + fluoxetine, and 35.7% for CBT + placebo. Mixed-effects models of all available continuous data (without imputation) at posttreatment and at 6- and 12-month follow-ups (controlling for baseline scores) revealed the treatments differed on all clinical outcome variables, except for weight, across time. CBT + fluoxetine and CBT + placebo did not differ and both were significantly superior to fluoxetine-only on the majority of clinical outcomes.

CONCLUSIONS

This represents the first report from any randomized placebo-controlled trial for BED that has reported follow-up data after completing a course of medication-only treatment. CBT + placebo was superior to fluoxetine-only, and adding fluoxetine to CBT did not enhance findings compared to adding placebo to CBT. The findings document the longer term effectiveness of CBT, but not fluoxetine, through 12 months after treatment completion.

Appearance vs. Health Reasons for Seeking Treatment Among Obese Patients with Binge Eating Disorder

OBJECTIVE

This study examined reasons for seeking treatment reported by obese patients diagnosed with binge eating disorder (BED).

RESEARCH METHODS AND PROCEDURES

Participants were 248 adults (58 men and 190 women) who met DSM criteria for BED. Participants were recruited through advertisements for treatment studies looking for persons who wanted to "stop binge eating and lose weight." Patients' reasons for seeking treatment were examined with respect to demography (gender and age), obesity (BMI and age of onset), features of eating disorders, and associated psychological functioning (depression and self-esteem).

RESULTS

Of the 248 participants, 64% reported health concerns and 36% reported appearance concerns as their primary reason for seeking treatment. Reasons for seeking treatment did not differ significantly by gender. Patients seeking treatment because of appearance-related reasons had lower BMIs than those reporting health-related reasons (34.8 vs. 38.5, respectively), but they reported greater body dissatisfaction, more features of eating disorders, and lower self-esteem.

DISCUSSION

Reasons that prompt treatment seeking among obese individuals with BED reflect meaningful patient characteristics and, therefore, warrant assessment and consideration during treatment planning. Further research is needed to determine whether reasons for treatment seeking among different obese patient groups affect treatment outcomes.

Accuracy of self-reported weight and height and resulting body mass index among obese binge eaters in primary care: relationship with eating disorder and associated psychopathology

OBJECTIVE

This study assessed the accuracy of self-reported weight, height, and body mass index in obese patients with binge-eating disorder (DSM-IV-TR criteria) presenting at primary care clinics and tested whether the degree of inaccuracy was associated with demographic factors or eating disorder and depressive features.

METHOD

Sixty-six participants were interviewed using the Eating Disorder Examination interview, completed the Eating Disorder Examination Questionnaire and the Beck Depression Inventory, and had their height and weight measured between November 2007 and May 2009.

RESULTS

Self-reported and measured weight did not differ significantly, but participants significantly overestimated their height (P < .01), and this discrepancy resulted in a significantly lower self-reported than measured body mass index (P < .05). Discrepancy scores did not differ by eating disorder or depressive symptoms, sex, or ethnicity, although increasing age was associated with overestimation of height and underestimation of body mass index.

CONCLUSIONS

The findings suggest that obese patients with binge-eating disorder in primary care settings are reasonably accurate reporters of weight and height and that the degree of inaccuracy does not appear to be systematically related to eating disorder psychopathology or depressive features.

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

OBJECTIVE

Research 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.

METHODS

Participants 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.

RESULTS

Social 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.

DISCUSSION

Our 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.

An examination of the food addiction construct in obese patients with binge eating disorder

OBJECTIVE

This study examined the psychometric properties of the Yale food addiction scale (YFAS) in obese patients with binge eating disorder (BED) and explored its association with measures of eating disorder and associated psychopathology.

METHOD

Eighty-one obese treatment-seeking BED patients were given the YFAS, structured interviews to assess psychiatric disorders and eating disorder psychopathology, and other pathology measures.

RESULTS

Confirmatory factor analysis revealed a one-factor solution with an excellent fit. Classification of "food addiction" was met by 57% of BED patients. Patients classified as meeting YFAS "food addiction" criteria had significantly higher levels of depression, negative affect, emotion dysregulation, eating disorder psychopathology, and lower self-esteem. YFAS scores were also significant predictors of binge eating frequency above and beyond other measures.

DISCUSSION

The subset of BED patients classified as having YFAS "food addiction" appear to represent a more disturbed variant characterized by greater eating disorder psychopathology and associated pathology.

Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning

OBJECTIVE

Widespread bias against obese individuals may lead to the internalization of weight bias in obese persons. This study examined correlates of internalized weight bias (IWB) in obese patients with binge eating disorder (BED).

METHOD

One hundred treatment-seeking obese patients with BED were administered with the eating disorders examination interview and questionnaires assessing IWB, fat phobia, depression, and self-esteem.

RESULTS

The mean IWB score in this group of patients with BED was significantly greater than the mean IWB score observed previously in a community sample of overweight adults. IWB was positively associated with eating disorder psychopathology, fat phobia, and depression, and negatively associated with self-esteem. IWB made significant independent contributions to the variance in eating disorder psychopathology even after accounting for fat phobia, depression, and self-esteem.

DISCUSSION

Treatment-seeking obese patients with BED demonstrate high levels of IWB. IWB may contribute to the variance in eating disorder psychopathology in BED patients, beyond the contributions of fat phobia, depression, and self-esteem.

Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications

BACKGROUND

We examined rapid response in obese patients with binge-eating disorder (BED) in a clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL).

METHOD

Altogether, 90 participants were randomly assigned to CBT or BWL. Assessments were performed at baseline, throughout and post-treatment and at 6- and 12-month follow-ups. Rapid response, defined as 70% reduction in binge eating by week four, was determined by receiver operating characteristic curves and used to predict outcomes.

RESULTS

Rapid response characterized 57% of participants (67% of CBT, 47% of BWL) and was unrelated to most baseline variables. Rapid response predicted greater improvements across outcomes but had different prognostic significance and distinct time courses for CBT versus BWL. Patients receiving CBT did comparably well regardless of rapid response in terms of reduced binge eating and eating disorder psychopathology but did not achieve weight loss. Among patients receiving BWL, those without rapid response failed to improve further. However, those with rapid response were significantly more likely to achieve binge-eating remission (62% v. 13%) and greater reductions in binge-eating frequency, eating disorder psychopathology and weight loss.

CONCLUSIONS

Rapid response to treatment in BED has prognostic significance through 12-month follow-up, provides evidence for treatment specificity and has clinical implications for stepped-care treatment models for BED. Rapid responders who receive BWL benefit in terms of both binge eating and short-term weight loss. Collectively, these findings suggest that BWL might be a candidate for initial intervention in stepped-care models with an evaluation of progress after 1 month to identify non-rapid responders who could be advised to consider a switch to a specialized treatment.

Racial/ethnic differences in adults in randomized clinical trials of binge eating disorder

OBJECTIVE

Recent studies suggest that binge eating disorder (BED) is as prevalent among African American and Hispanic Americans as among Caucasian Americans; however, data regarding the characteristics of treatment-seeking individuals from racial and ethnic minority groups are scarce. The purpose of this study was to investigate racial/ethnic differences in demographic characteristics and eating disorder symptoms in participants enrolled in treatment trials for BED.

METHOD

Data from 11 completed randomized, controlled trials were aggregated in a single database, the Clinical Trials of Binge Eating Disorder (CT-BED) database, which included 1,204 Caucasian, 120 African American, and 64 Hispanic participants assessed at baseline. Age, gender, race/ethnicity, education, body mass index (BMI), binge eating frequency, and Eating Disorder Examination (EDE) Restraint, Shape, Weight, and Eating Concern subscale scores were examined.

RESULTS

Mixed model analyses indicated that African American participants in BED treatment trials had higher mean BMI than Caucasian participants, and Hispanic participants had significantly greater EDE shape, weight, and eating concerns than Caucasian participants. No racial or ethnic group differences were found on the frequency of binge eating episodes. Observed racial/ethnic differences in BED symptoms were not substantially reduced after adjusting for BMI and education. Comparisons between the CT-BED database and epidemiological data suggest limitations to the generalizability of data from treatment-seeking samples to the BED community population, particularly regarding the population with lower levels of education.

CONCLUSIONS

Further research is needed to assess alternative demographic, psychological, and culturally specific variables to better understand the diversity of treatment-seeking individuals with BED.

Cognitive-behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: a randomized controlled trial

OBJECTIVE

Cognitive-behavioral therapy (CBT) is the best established treatment for binge-eating disorder (BED) but does not produce weight loss. The efficacy of behavioral weight loss (BWL) in obese patients with BED is uncertain. This study compared CBT, BWL, and a sequential approach in which CBT is delivered first, followed by BWL (CBT + BWL).

METHOD

125 obese patients with BED were randomly assigned to 1 of the 3 manualized treatments delivered in groups. Independent assessments were performed posttreatment and at 6- and 12-month follow-ups.

RESULTS

At 12-month follow-up, intent-to-treat binge-eating remission rates were 51% (CBT), 36% (BWL), and 40% (CBT + BWL), and mean percent BMI losses were -0.9, -2.1, and 1.5, respectively. Mixed-models analyses revealed that CBT produced significantly greater reductions in binge eating than BWL through 12-month follow-up and that BWL produced significantly greater percent BMI loss during treatment. The overall significant percent BMI loss in CBT + BWL was attributable to the significant effects during the BWL component. Binge-eating remission at major assessment points was associated significantly with greater percent BMI loss cross-sectionally and prospectively (i.e., at subsequent follow-ups).

CONCLUSIONS

CBT was superior to BWL for producing reductions in binge eating through 12-month follow-up, while BWL produced statistically greater, albeit modest, weight losses during treatment. Results do not support the utility of the sequential approach of providing BWL following CBT. Remission from binge eating was associated with significantly greater percent BMI loss. Findings support BWL as an alternative treatment option to CBT for BED.

Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder

OBJECTIVE

To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED).

METHOD

108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors, psychiatric and personality disorder comorbidity, eating disorder psychopathology, psychological features, and 2 subtyping methods (negative affect, overvaluation of shape/weight) were tested as predictors and moderators for the primary outcome of remission from binge eating and 4 secondary dimensional outcomes (binge-eating frequency, eating disorder psychopathology, depression, and body mass index). Mixed-effects models analyzed all available data for each outcome variable. In each model, effects for baseline value and treatment were included with tests of both prediction and moderator effects.

RESULTS

Several demographic and clinical variables significantly predicted and/or moderated outcomes. One demographic variable signaled a statistical advantage for medication only (younger participants had greater binge-eating reductions), whereas several demographic and clinical variables (lower self-esteem, negative affect, and overvaluation of shape/weight) signaled better improvements if receiving CBT. Overvaluation was the most salient predictor/moderator of outcomes. Overvaluation significantly predicted binge-eating remission (29% of participants with vs. 57% of participants without overvaluation remitted). Overvaluation was especially associated with lower remission rates if receiving medication only (10% vs. 42% for participants without overvaluation). Overvaluation moderated dimensional outcomes: Participants with overvaluation had significantly greater reductions in eating disorder psychopathology and depression levels if receiving CBT. Overvaluation predictor/moderator findings persisted after controlling for negative affect.

CONCLUSIONS

Our findings have clinical utility for prescription of CBT and medication and implications for refinement of the BED diagnosis.

Food thought suppression: a matched comparison of obese individuals with and without binge eating disorder

Preliminary studies of non-clinical samples suggest that purposely attempting to avoid thoughts of food, referred to as food thought suppression, is related to a number of unwanted eating- and weight-related consequences, particularly in obese individuals. Despite possible implications for the treatment of obesity and eating disorders, little research has examined food thought suppression in obese individuals with binge eating disorder (BED). This study compared food thought suppression in 60 obese patients with BED to an age-, gender-, and body mass index (BMI)-matched group of 59 obese persons who do not binge eat (NBO). In addition, this study examined the associations between food thought suppression and eating disorder psychopathology within the BED and NBO groups and separately by gender. Participants with BED and women endorsed the highest levels of food thought suppression. Food thought suppression was significantly and positively associated with many features of ED psychopathology in NBO women and with eating concerns in men with BED. Among women with BED, higher levels of food thought suppression were associated with higher frequency of binge eating, whereas among men with BED, higher levels of food thought suppression were associated with lower frequency of binge eating. Our findings suggest gender differences in the potential significance of food thought suppression in obese groups with and without co-existing binge eating problems.

A randomized controlled trial for obesity and binge eating disorder: low-energy-density dietary counseling and cognitive-behavioral therapy

The present study examined a dietary approach - lowering energy density - for producing weight loss in obese patients with binge eating disorder (BED) who also received cognitive-behavioral therapy (CBT) to address binge eating. Fifty consecutive participants were randomly assigned to either a six-month individual treatment of CBT plus a low-energy-density diet (CBT+ED) or CBT plus General Nutrition counseling not related to weight loss (CBT+GN). Assessments occurred at six- and twelve-months. Eighty-six percent of participants completed treatment, and of these, 30% achieved at least a 5% weight loss with rates of binge remission ranging from 55% to 75%. The two treatments did not differ significantly in weight loss or binge remission outcomes. Significant improvements were found for key dietary and metabolic outcomes, with CBT+ED producing significantly better dietary outcomes on energy density, and fruit and vegetable consumption, than CBT+GN. Reductions in energy density and weight loss were significantly associated providing evidence for the specificity of the treatment effect. These favorable outcomes, and that CBT+ED was significantly better at reducing energy density and increasing fruit and vegetable consumption compared to CBT+GN, suggest that low-energy-density dietary counseling has promise as an effective method for enhancing CBT for obese individuals with BED.

Metabolic syndrome in obese patients with binge-eating disorder in primary care clinics: a cross-sectional study

BACKGROUND

The distribution and nature of metabolic syndrome in obese patients with binge-eating disorder (BED) are largely unknown and require investigation, particularly in general internal medicine settings. The objectives of this study were to (1) examine the frequency of metabolic syndrome and (2) explore its eating- and weight-related correlates in obese patients with BED.

METHOD

This was a cross-sectional analysis of 81 consecutive treatment-seeking obese (body mass index ≥ 30 kg/m(2)) patients (21 men, 60 women) who met DSM-IV-TR research criteria for BED (either subthreshold criteria: ≥ 1 binge weekly, n = 19 or full criteria: ≥ 2 binges weekly, n = 62). Participants were from 2 primary care facilities in a large university-based medical center in an urban setting. Patients with and without metabolic syndrome were compared on demographic features and current and historical eating- and weight-related variables. Data were collected from December 2007 through March 2009.

RESULTS

Forty-three percent of patients met criteria for metabolic syndrome. A significantly higher proportion of men (66%) than women (35%) met criteria for metabolic syndrome (P = .012). Patients with versus without metabolic syndrome did not differ significantly in ethnicity or body mass index. Patients with versus without metabolic syndrome did not differ significantly in binge-eating frequency, severity of eating disorder psychopathology, or depression. Analyses of covariance controlling for gender revealed that patients without metabolic syndrome started dieting at a significantly younger age (P = .037), spent more of their adult lives dieting (P = .017), and reported more current dietary restriction (P = .018) than patients with metabolic syndrome.

CONCLUSIONS

Metabolic syndrome is common in obese patients with BED in primary care settings and is associated with fewer dieting behaviors. These findings suggest that certain lifestyle behaviors, such as increased dietary restriction, may be potential targets for intervention with metabolic syndrome.

An examination of eating patterns in community women with bulimia nervosa and binge eating disorder

OBJECTIVE

To better understand the eating patterns of persons with eating disorders.

METHOD

This study investigated typical eating behavior (meal frequency and snacking) and atypical eating behavior among 311 community women with on-line questionnaires. Participants were classified with bulimia nervosa (BN; n =39), binge eating disorder (BED; n = 69), or controls (CON; n = 203).

RESULTS

In terms of typical eating behaviors, the BN group ate significantly fewer meals, particularly lunches, than the other two groups. Atypical eating, such as nibbling, eating double meals and nocturnal eating, was significantly more common in the eating disorder groups. More frequent breakfast consumption was associated with lower BMI in the BED and CON groups, and more frequent meal consumption was associated with less binge eating in the BED group only.

DISCUSSION

Our study revealed differences in typical and atypical eating patterns, and associations with weight and eating disorder behaviors among eating disorder and control groups.

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.

Physical activity in gastric bypass patients: associations with weight loss and psychosocial functioning at 12-month follow-up

BACKGROUND

This study examined self-reported frequency and intensity of physical activity in gastric bypass patients, and the relationship between physical activity and weight loss and psychosocial outcomes during 12-month postoperative follow-up.

METHODS

Participants were 131 obese patients who underwent gastric bypass surgery and completed psychometrically established measures assessing physical activity, depression, and physical and mental health preoperatively and at a 12-month follow-up assessment.

RESULTS

Preoperatively, 62.6% of patients reported at least one episode of a minimum of 15 minutes of physical activity per week. This figure increased to 92.4% at 12-month postoperative follow-up. Both the frequency and intensity levels of physical activity episodes increased significantly from preoperative to 12-month postoperative assessments. Hierarchical regression analyses, controlling for demographic variables and preoperative body mass index (BMI), revealed that the intensity of physical activity was significantly associated with postoperative weight loss at 12-month follow-up. Both the frequency and intensity of physical activity were significantly associated with depression, and physical and mental well-being at the 12-month postoperative follow-up.

CONCLUSION

Gastric bypass patients increase both the frequency and intensity of their physical activity during the first 12 months postoperatively. Higher postoperative intensity levels of physical activity are associated with better weight loss outcomes while both increased frequency and intensity levels of physical activity are associated with better psychosocial outcomes.

Exploring weight gain in year before treatment for binge eating disorder: a different context for interpreting limited weight losses in treatment studies

OBJECTIVE

To examine weight changes in obese patients with binge-eating disorder (BED) during the year before seeking treatment and to explore correlates of weight changes.

METHOD

Seventy-eight consecutive, treatment-seeking, obese BED patients were assessed with structured interviews and self-report questionnaires.

RESULTS

Overall, participants reported a mean weight gain of 15.1 pounds during the 12 months before treatment. This overall weight gain comprised remarkable heterogeneity, ranging from a 30-pound loss to a 53-pound gain. The subgroup of participants who reported gaining weight (76% of sample) reported gaining an average of 22.2 pounds during the 12 months before treatment. Weight change was associated with significantly more frequent binge eating and overeating during breakfasts.

DISCUSSION

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 by treatment studies of BED.

Comparison of methods for identifying and assessing obese patients with binge eating disorder in primary care settings

OBJECTIVE

Given the prevalence and health significance of binge eating disorder (BED) it is important to determine if time-efficient self-reports can adequately assess BED and its features in primary care settings. We compared the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire for Eating and Weight Patterns-Revised (QEWP-R), administered to obese patients with BED in primary care setting to the Eating Disorder Examination (EDE) interview.

METHOD

Sixty-six participants completed the questionnaires and were interviewed.

RESULTS

The EDE interview was significantly correlated with the EDE-Q (binge eating, four subscales, and global score) and the QEWP-R (binge eating, distress, and body image). The EDE-Q yielded significantly lower estimates of binge eating and significantly higher scores on the EDE subscales. The QEWP-R yielded significantly higher scores on the behavioral indicators and distress about binge eating and body image variables.

DISCUSSION

These findings suggest that these two self-report measures have potential utility for identifying BED in obese patients in primary care.

Binge eating, purging, or both: eating disorder psychopathology findings from an internet community survey

OBJECTIVE

This study aimed to compare bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) on clinically significant variables and examine the utility of once versus twice-weekly diagnostic thresholds for disturbed eating behaviors.

METHOD

234 women with BN, BED, or PD were identified through self-report measures via an online survey and categorized based on either once-weekly or twice-weekly disturbed eating behaviors.

RESULTS

BN emerged as a more severe disorder than BED and PD. The three groups differed significantly in self-reported restraint and disinhibition and the BN and BED groups reported higher levels of depression than PD. For BN, those engaging in behaviors twice-weekly versus once-weekly were more symptomatic.

DISCUSSION

The BN, BED, and PD groups differed in clinically meaningful ways. Future research need to clarify the relationship between mood disturbances and eating behaviors. Reducing the twice-weekly behavior threshold for BN would capture individuals with clinically significant eating disorders, though the twice-weekly threshold may provide important information about disorder severity for both BN and BED.

Psychological and behavioral correlates of excess weight: misperception of obese status among persons with Class II obesity

OBJECTIVE

This study examined psychological and behavioral correlates of weight status perception in 173 Class II obese adult community volunteers.

METHOD

Participants completed the Eating Disorder Examination-Self-Report (EDE-Q), Three Factor Eating Questionnaire (TFEQ), Beck Depression Inventory, and Rosenberg Self-Esteem Scale online. Key items assessed dieting frequency, weight history, and perceived current weight status (normal weight, overweight, or obese). Actual weight status was determined using NIDDK/CDC classification schemes.

RESULTS

Among participants with Class II obesity, 50.9% incorrectly classified their weight as overweight versus obese, whereas 49.1% accurately perceived their weight status as obese. Inaccurate participants reported significantly less binge eating and less eating disorder psychopathology. Despite similar BMI, inaccurate participants reported less distress regarding overeating and loss of control over eating.

DISCUSSION

Our findings suggest that obesity status underestimation is associated with less eating disorder psychopathology. Underestimation of obesity status may exacerbate risk for negative health consequences because of a failure to recognize and respond to excess weight.

Self-reported weight gain following smoking cessation: a function of binge eating behavior

OBJECTIVE

This study investigated patterns of self-reported weight gain following smoking cessation among overweight individuals with and without binge eating.

METHOD

Participants were 103 overweight (BMI ≥ 25) community volunteers who completed a battery of questionnaires online. Key items queried smoking cessation history and weight gain in the year following cessation. Participants were classified as nonbinge eating overweight (NBO, n = 56) or binge eating disorder (BED, n = 47).

RESULTS

BED participants were significantly more likely to report weight gain in the year following smoking cessation than NBO participants. After controlling for current BMI, the amount of self-reported weight gain following smoking cessation differed significantly between groups, with the NBO group reporting an average gain of 5.0 kg and the BED group reporting 11.2-kg gain.

DISCUSSION

Since many individuals resume smoking due to cessation-associated weight gain, these findings highlight the need for targeted interventions for overweight individuals particularly those who also binge eat.

Attitudes toward obesity in obese persons: a matched comparison of obese women with and without binge eating

No research has compared expressions of weight bias across different subgroups of obese individuals. This study compared attitudes toward and beliefs about obesity in women with and without binge eating disorder (BED) and examined whether these attitudes are related to psychological factors. Fifty obese women with BED were compared with an age- and body mass index (BMI)-matched group of 50 obese women without BED on a battery of established measures of anti-fat attitudes and beliefs about weight controllability and psychological factors (self-esteem, depression, and eating disorder features). The ageand BMI-matched groups did not differ with respect to beliefs about obesity or attitudes toward obese persons, or in self-esteem or depression. Correlational analyses conducted separately within each group revealed that women with BED who reported more favorable attitudes towards obese persons had higher self-esteem and lower levels of depression, whereas there were no significant associations between these variables among women without BED. In addition, weight controllability beliefs and eating disorder features were unrelated to self-esteem and depression in both groups. These findings suggest that stigmatizing attitudes endorsed by obese persons are neither tempered nor worsened by psychological distress or eating pathology. Given that stigmatizing attitudes did not differ between obese women with and without BED, it may be that obesity itself, rather than psychological features or disordered eating, increases vulnerability to negative weight-based attitudes. Potential implications for stigma reduction efforts and clinical practice are discussed.

Accuracy of self-reported weight and height in binge eating disorder: misreport is not related to psychological factors

This study examined the degree of misreport in weight, height, and BMI among overweight adults (n = 392) with binge eating disorder (BED) and tested whether the degree of misreport was associated with eating disorder psychopathology and psychological variables. Male (n = 97) and female (n = 295) participants self-reported height and weight, and were subsequently measured by clinic staff. Participants also completed a series of diagnostic interviews and self-report assessments. Discrepancies between self-reported and measured values were modest. The degree of misreport for weight, height, and BMI was not related to eating disorder features, depression, and self-esteem. Overall, the errors in self-reported weight and height by overweight patients with BED were very slight. The degree of discrepancy between self-reported and measured values was not related to eating disorder or psychological features, suggesting that such data are not biased or systematically related to individual differences in overweight patients with BED.