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House ET, Lister NB, Seidler AL, Li H, Ong WY, McMaster CM, Paxton SJ, Jebeile H. Identifying eating disorders in adolescents and adults with overweight or obesity: A systematic review of screening questionnaires. Int J Eat Disord 2022; 55:1171-1193. [PMID: 35809028 PMCID: PMC9545314 DOI: 10.1002/eat.23769] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/15/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This review aimed to examine the validity of self-report screening questionnaires for identifying eating disorder (ED) risk in adults and adolescents with overweight/obesity. METHOD Five databases were searched from inception to September 2020 for studies assessing validation of self-report ED screening questionnaires against diagnostic interviews in adolescents and adults with overweight/obesity. The review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013). RESULTS Twenty-seven papers examining 15 questionnaires were included. Most studies validated questionnaires for adults (22 of 27 studies), and most questionnaires (12 of 15) screened for binge eating or binge-eating disorder (BED). The Eating Disorder Examination Questionnaire (sensitivity = .16-.88, specificity = .62-1.0) and Questionnaire on Eating and Weight Patterns (sensitivity = .07-1.0, specificity = .0-1.0) were most frequently validated (six studies each). Five studies of three questionnaires were in adolescents, with the Adolescent Binge-Eating Disorder Questionnaire having highest sensitivity (1.0) but lower specificity (.27). Questionnaires designed to screen for BED generally had higher diagnostic accuracy than those screening for EDs in general. DISCUSSION Questionnaires have been well validated to identify BED in adults with overweight/obesity. Validated screening tools to identify other EDs in adults and any ED in adolescents with overweight/obesity are lacking. Thus, clinical assessment should inform the identification of patients with co-morbid EDs and overweight/obesity. PUBLIC SIGNIFICANCE Individuals with overweight/obesity are at increased risk of EDs. This review highlights literature gaps regarding screening for ED risk in this vulnerable group. This work presents possibilities for improving care of individuals with overweight/obesity by reinventing ED screening tools to be better suited to diverse populations.
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Affiliation(s)
- Eve T. House
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia,Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadNew South WalesAustralia
| | - Natalie B. Lister
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia,Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadNew South WalesAustralia
| | - Anna L. Seidler
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Haozhen Li
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Faculty of ScienceThe University of SydneyCamperdownNew South WalesAustralia
| | - Wee Yee Ong
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Faculty of ScienceThe University of SydneyCamperdownNew South WalesAustralia
| | - Caitlin M. McMaster
- Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadNew South WalesAustralia,Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Hiba Jebeile
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia,Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadNew South WalesAustralia
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Globus I, Kissileff HR, Hamm JD, Herzog M, Mitchell JE, Latzer Y. Comparison of Interview to Questionnaire for Assessment of Eating Disorders after Bariatric Surgery. J Clin Med 2021; 10:jcm10061174. [PMID: 33799746 PMCID: PMC7999484 DOI: 10.3390/jcm10061174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
The Eating Disorder Examination Interview Bariatric Surgery Version (EDE-BSV) assesses eating pathology after bariatric surgery but requires significant training and time to administer. Consequently, we developed a questionnaire format called the Eating Disorders After Bariatric Surgery Questionnaire (EDABS-Q). This study evaluates the consistency of responsiveness between the two formats. After surgery, 30 patients completed the EDE-BSV and EDABS-Q in a restricted randomized design. Patient reported behavior for each item which was converted to a score following the Eating Disorder Examination-Questionnaire (EDE-Q) scoring scheme. Responses fell into three distributions: (1) dichotomous, (2) ordinal, or (3) unimodal. Distributions of items were not different between the two formats and order did not influence response. Tests of agreement (normal approximation of the binomial test) and association (χ2 analyses on binary data and spearman rank order correlations on ordinal items) were performed. Percent concordance was high across items (63-100%). Agreement was significant in 31 of 41 items (Bonferroni-P < 0.001). Association was significant in 10 of 21 in χ2-appropriate items (Bonferroni-P < 0.002), and the ordinal items had highly significant correlations between formats (Bonferroni-P < 0.0125). The EDABS-Q is an adequate substitute for the EDE-BSV and may be useful for research and clinical evaluation of eating pathology after bariatric surgery.
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Affiliation(s)
- Inbal Globus
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa 3498838, Israel;
- Maccabi Healthcare Services, Hamered 27, Tel-Aviv 6812509, Israel
| | - Harry R. Kissileff
- Mount Sinai Morningside Hospital, 1111 Amsterdam Avenue, New York, NY 10025, USA; (H.R.K.); (J.D.H.)
- Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Jeon D. Hamm
- Mount Sinai Morningside Hospital, 1111 Amsterdam Avenue, New York, NY 10025, USA; (H.R.K.); (J.D.H.)
- Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
- Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University, 630 W 168th Street #1512, New York, NY 10032, USA
| | - Musya Herzog
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, 525 W 120th Street, New York, NY 10027, USA;
| | - James E. Mitchell
- University of North Dakota School of Medicine, 1244 Wildwood Way, Chaska, MN 55318, USA;
| | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Avenue, Mount Carmel, Haifa 3498838, Israel
- Eating Disorders Institution, Rambam Health Care Campus, HaAliya HaShniya St. 8, Haifa 3109601, Israel
- Correspondence: ; Tel.: +972-54-4736673 or +1-917-935-1824
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Wiedemann AA, Ivezaj V, Lawson JL, Lydecker JA, Cooper Z, Grilo CM. Interrater reliability of the Eating Disorder Examination among postbariatric patients. Surg Obes Relat Dis 2020; 16:1988-1993. [PMID: 32933867 DOI: 10.1016/j.soard.2020.07.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/15/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical assessment of eating behaviors with patients who undergo bariatric surgery is challenging because of the complexity of symptom presentation postoperatively. The Eating Disorder Examination (EDE) is a widely-used semistructured clinical interview of eating-disorder psychopathology, yet no studies have examined the interrater reliability among postoperative bariatric surgery patients. OBJECTIVES The present study aimed to examine the interrater reliability of the EDE, and an alternative classification of size-specific thresholds of binge-eating episodes in a postoperative bariatric surgery sample. SETTING University School of Medicine, United States. METHODS Participants interviewed were a randomly selected subset (n = 20) from a consecutive series of adults seeking treatment for eating concerns after bariatric surgery. Audio-taped interviews were rated independently by 1 of 4 expert raters. Interrater reliability was assessed using intraclass correlation coefficients (ICC) and kappa statistic. RESULTS ICCs for the original 4 EDE subscales were excellent, ranging from .88 to .98. ICCs for the alternative brief 3 subscales were also excellent, with a range of .78 to .97. ICCs for bariatric loss-of-control eating episodes were in the good to excellent range, with a range of .66 to .99. Kappa agreement for bariatric overeating episodes was moderate (.60). CONCLUSIONS These findings, based on 4 expert raters, suggest that complex eating-disorder psychopathology, as well as the newly proposed eating behavior with size thresholds relevant to bariatric patients, can be reliably assessed. To our knowledge, this is the first study to provide initial evaluation and support for the interrater reliability of the original EDE with additional modified eating categories developed for postbariatric surgery patients.
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Affiliation(s)
- Ashley A Wiedemann
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jessica L Lawson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, Orange, New Haven, Connecticut
| | - Janet A Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Psychology, Yale University, New Haven, Connecticut
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Emery RL, Grace JL, Kolko RP, Levine MD. Adapting the eating disorder examination for use during pregnancy: Preliminary results from a community sample of women with overweight and obesity. Int J Eat Disord 2017; 50:597-601. [PMID: 28543865 PMCID: PMC5839101 DOI: 10.1002/eat.22646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Eating Disorder Examination (EDE) is a structured clinical interview that is widely used for assessing disordered eating. Although the EDE has been used in pregnant women, no standard pregnancy version has been developed. Accordingly, the present study aimed to document adaptations made to a pregnancy version of the EDE (EDE-PV) and to describe the internal reliability of this adapted version. METHOD Three major modifications were made in the development of the EDE-PV. First, disordered eating was assessed during and prior to pregnancy to account for changes across the perinatal period. Second, items were adapted and rules governing ratings were altered to distinguish eating attitudes and behaviors that are considered normative during pregnancy from disordered eating. Third, several items were omitted. RESULTS The EDE-PV was administered to 129 women with overweight and obesity who were between 12 and 20 weeks gestation. Women were 27.25 (SD = 5.48) years of age and 56% were African American. Women endorsed low levels of disordered eating on the EDE-PV, and the internal reliability was similar to previous reports. CONCLUSION These findings provide support for use of the EDE-PV to assess disordered eating among pregnant women with overweight and obesity. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:597-601).
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Affiliation(s)
- Rebecca L. Emery
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer L. Grace
- Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rachel P. Kolko
- Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michele D. Levine
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Correspondence to: M. D. Levine,
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Novelle JM, Alvarenga MS. Cirurgia bariátrica e transtornos alimentares: uma revisão integrativa. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo Realizar revisão sobre transtornos alimentares e comportamentos alimentares transtornados relacionados à cirurgia bariátrica. Métodos Revisão integrativa da literatura nas bases de dados PubMed, Lilacs, Bireme, portal SciELO com descritores indexados com critérios de inclusão: oferecer dado sobre a presença ou frequência de transtorno alimentar e/ou comportamentos alimentares disfuncionais previamente e/ou após a cirurgia. Resultados Foram selecionados 150 estudos (14 nacionais e 136 internacionais): 80,6% eram com avaliação de pacientes pré-/pós-cirúrgicos; 12% eram estudos de caso e 7,3% eram estudos de revisão. Diferentes instrumentos foram usados para avaliação, principalmente o Questionnaire on Eating and Weight Patterns, a Binge Eating Scale e Eating Disorders Examination Questionnaire. A compulsão alimentar foi o comportamento mais avaliado, com frequências/prevalências variando de 2% a 94%; no caso do transtorno da compulsão alimentar as frequências/prevalências variaram de 3% a 61%. Houve também a descrição de anorexia e bulimia nervosa, síndrome da alimentação noturna e comportamento beliscador. Alguns estudos apontam melhora dos sintomas no pós-cirúrgico e/ou seguimento enquanto outros apontam surgimento ou piora dos problemas. Conclusão Apesar da variabilidade entre métodos e achados, comportamentos alimentares disfuncionais são muito frequentes em candidatos à cirurgia bariátrica e podem ainda surgir ou piorar após a intervenção cirúrgica. Profissionais de saúde devem considerar de maneira mais cuidadosa tais problemas neste público, dadas às consequências para o resultado cirúrgico e qualidade de vida.
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Barclay KS, Rushton PW, Forwell SJ. Measurement properties of eating behavior self-assessment tools in adult bariatric surgery populations: a systematic review. Obes Surg 2015; 25:720-37. [PMID: 25691348 DOI: 10.1007/s11695-015-1593-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The present study aims to identify the range of eating behavior self-assessment tools reported in the adult bariatric surgery literature and evaluate the measurement properties of these tools using pre-established criteria. This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This review revealed the use of 20 distinct tools; however, evidence for measurement properties specific to bariatric surgery populations was limited to only ten of these tools, as reported in 14 papers. Validity varied extensively and there was a widespread lack of information regarding measurement of change over time and patient burden. According to the evaluation criteria, there was adequate support for two tools. Several other tools show potential but would benefit from additional investigation of their measurement properties prior to continued use with bariatric surgery patients.
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Affiliation(s)
- Karen S Barclay
- Mental Health and Addictions, Vancouver Coastal Health, Vancouver, British Columbia, Canada,
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Parker K, O'Brien P, Brennan L. Measurement of disordered eating following bariatric surgery: a systematic review of the literature. Obes Surg 2015; 24:945-53. [PMID: 24744189 DOI: 10.1007/s11695-014-1248-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Disordered eating is elevated in bariatric surgery patients and is a risk factor for poor surgical outcomes. A systematic review evaluated the definitions and measurement methods used to identify and assess disordered eating in patients following bariatric surgery. One hundred articles were identified featuring 35 questionnaires and 23 interviews. There were numerous variations to diagnostic criteria and amendments to measures to account for the post-surgical eating context. Only 20% of questionnaires and 4% of interviews had reported psychometric evaluation in post-surgery samples. Results highlight the need for a consistent definition of disordered eating and for current assessment measures to be (a) adapted to account for the altered gastrointestinal system in patients following surgery and (b) psychometrically evaluated in bariatric surgery patients.
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Affiliation(s)
- Katrina Parker
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, VIC, Australia,
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8
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Meany G, Conceição E, Mitchell JE. Binge eating, binge eating disorder and loss of control eating: effects on weight outcomes after bariatric surgery. EUROPEAN EATING DISORDERS REVIEW 2014; 22:87-91. [PMID: 24347539 PMCID: PMC4420157 DOI: 10.1002/erv.2273] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 11/09/2022]
Abstract
There is increasing evidence that patients who have problems with binge eating (BE) or BE disorder (BED) are quite common among the severely obese, including bariatric surgery candidates. The literature suggests that in many cases such eating behaviours improve after bariatric surgery, although this is not uniformly true. The current paper reviews the data on the development of BE, BED and loss of control (LOC) eating after bariatric surgery and the impact of these problems on long-term weight outcome. A search was made of various databases regarding evidence of BE, BED and LOC eating post-operatively in bariatric surgery patients. The data extracted from the literature suggests that 15 research studies have now examined this question. Fourteen of the available 15 studies suggest that the development of problems with BE, BED or LOC eating post-bariatric surgery is associated with less weight loss and/or more weight regain post-bariatric surgery. These data suggests that it is important to identify individuals at high risk for these problems, to follow them post-operatively, and, if appropriate interventions can be developed if such behaviours occur in order to maximize weight loss outcomes.
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Affiliation(s)
- Gavin Meany
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | | | - James E. Mitchell
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
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Grilo CM, Henderson KE, Bell RL, Crosby RD. Eating disorder examination-questionnaire factor structure and construct validity in bariatric surgery candidates. Obes Surg 2013; 23:657-62. [PMID: 23229951 DOI: 10.1007/s11695-012-0840-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The Eating Disorder Examination-Questionnaire (EDE-Q) is increasingly used in studies with bariatric surgery patients although little is known about psychometric properties of this self-report measure in this clinical group. The current study evaluated the factor structure and construct validity of the EDE-Q in bariatric surgery candidates. METHODS Participants were a consecutive series of 174 obese bariatric surgery candidates who completed the EDE-Q and a battery of behavioral and psychological measures. RESULTS Confirmatory factor analysis (CFA) revealed an inadequate fit for the original EDE-Q structure but revealed a good fit for an alternative structure suggested by recent research with obese samples. CFA supported a seven-item, three-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. The three factors converged with other relevant collateral measures. CONCLUSIONS These factor analytic findings, which replicate recent findings from studies with diverse obese samples, demonstrated convergent validity. Implications of these findings for clinical assessment and research with bariatric surgery patients are discussed.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, 301 Cedar Street, New Haven, CT 06519, USA.
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Berg KC, Stiles-Shields EC, Swanson SA, Peterson CB, Lebow J, Le Grange D. Diagnostic concordance of the interview and questionnaire versions of the eating disorder examination. Int J Eat Disord 2012; 45:850-5. [PMID: 21826696 PMCID: PMC3213320 DOI: 10.1002/eat.20948] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The diagnostic concordance of the interview (EDE) and questionnaire (EDE-Q) versions of the Eating Disorder Examination was examined. METHOD Two-hundred seventeen patients seeking eating disorder treatment completed the EDE and EDE-Q before beginning treatment. Diagnostic algorithms were generated for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) and proposed Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria using data first from the EDE and then from the EDE-Q; thus, each participant received four diagnoses. RESULTS The sensitivity of the EDE-Q for individual diagnoses ranged from 27.8% to 84.3% (DSM-IV-TR) and from 36.8% to 80.8% (DSM-5). The specificity of the EDE-Q for individual diagnoses ranged from 71.1% to 98.5% (DSM-IV-TR) and from 77.3% to 98.0% (DSM-5). The overall diagnostic concordance was moderate (κ = .57-.60). DISCUSSION The proposed DSM-5 criteria improved the diagnostic concordance of the two instruments and reduced the prevalence of Eating Disorder Not Otherwise Specified (EDNOS). However, concordance improvement was modest and both instruments still diagnosed most respondents with EDNOS.
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Affiliation(s)
- Kelly C. Berg
- Department of Psychiatry, University of Minnesota, Minneapolis, MN,Department of Psychiatry, The University of Chicago, Chicago, IL
| | | | - Sonja A. Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | | | - Jocelyn Lebow
- Institute of Psychology, Illinois Institute of Technology, Chicago, IL
| | - Daniel Le Grange
- Department of Psychiatry, The University of Chicago, Chicago, IL
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Roberto CA, Sysko R, Bush J, Pearl R, Puhl RM, Schvey NA, Dovidio JF. Clinical correlates of the weight bias internalization scale in a sample of obese adolescents seeking bariatric surgery. Obesity (Silver Spring) 2012; 20:533-9. [PMID: 21593805 PMCID: PMC3481186 DOI: 10.1038/oby.2011.123] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to evaluate psychometric properties and clinical correlates of the Weight Bias Internalization Scale (WBIS) in a sample of obese adolescents seeking bariatric surgery. Sixty five adolescents enrolled in a bariatric surgery program at a large, urban medical center completed psychiatric evaluations, self-report questionnaires including the WBIS and other measures of psychopathology and physical assessments. The WBIS had high internal consistency (Cronbach's α = 0.92). As in previous research with adults, the one underlying factor structure was replicated and 10 of the original 11 items were retained. The scale had significant partial correlations with depression (r = 0.19), anxiety (r = 0.465), social, and behavioral problems (r = 0.364), quality of life (r = -0.480), and eating (r = 0.579), shape (r = 0.815), and weight concerns (r = 0.545), controlling for BMI. However, WBIS scores did not predict current or past psychiatric diagnosis or treatment or past suicidal ideation. Overall, the WBIS had excellent psychometric properties in a sample of obese treatment-seeking adolescents and correlated significantly with levels of psychopathology. These findings suggest that the WBIS could be a useful tool for healthcare providers to assess internalized weight bias among treatment-seeking obese youth. Assessment of internalized weight bias among this clinical population has the potential to identify adolescents who might benefit from information on coping with weight stigma, which in turn may augment weight loss efforts.
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Barnes RD, Masheb RM, White MA, Grilo CM. Comparison of methods for identifying and assessing obese patients with binge eating disorder in primary care settings. Int J Eat Disord 2011; 44:157-63. [PMID: 20143322 PMCID: PMC3197249 DOI: 10.1002/eat.20802] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
| | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine
| | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine,Department of Psychology, Yale University
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13
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Slane JD, Burt SA, Klump KL. The road less traveled: Associations between externalizing behaviors and eating pathology. Int J Eat Disord 2010; 43:149-60. [PMID: 19350646 DOI: 10.1002/eat.20680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Few studies have examined associations between externalizing behaviors and eating disorders in either sex. The current study investigated sex differences in associations between internalizing and externalizing symptoms and disordered eating. METHOD A sample of 541 men and women completed self-reported measures of disordered eating (e.g., binge eating), internalizing symptoms (e.g., anxiety), and externalizing behaviors (e.g., delinquency). Hierarchical linear modeling was used to examine sex differences in associations between these symptoms and disordered eating. RESULTS Internalizing symptoms showed the strongest associations with disordered eating in both sexes. Hyperactivity and aggression were more strongly associated with disordered eating in men, whereas alcohol use was more strongly associated with disordered eating in women. DISCUSSION Results indicated several sex similarities in associations between internalizing symptoms and disordered eating, but some important sex differences among externalizing behaviors. Externalizing behaviors may play a significant role in the development of disordered eating uniquely within men and women.
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Affiliation(s)
- Jennifer D Slane
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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14
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Hrabosky JI, White MA, Masheb RM, Rothschild BS, Burke-Martindale CH, Grilo CM. Psychometric evaluation of the eating disorder examination-questionnaire for bariatric surgery candidates. Obesity (Silver Spring) 2008; 16:763-9. [PMID: 18379561 PMCID: PMC3671755 DOI: 10.1038/oby.2008.3] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Despite increasing use of the Eating Disorder Examination-Questionnaire (EDE-Q) in bariatric surgery patients, little is known about the utility and psychometric performance of this self-report measure in this clinical group. The primary purpose of the current study was to evaluate the factor structure and construct validity of the EDE-Q in a large series of bariatric surgery candidates. METHODS AND PROCEDURES Participants were 337 obese bariatric surgery candidates. Participants completed the EDE-Q and a battery of behavioral and psychological measures. RESULTS Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) produced a 12-item, 4-factor structure of the EDE-Q. The four factors, interpreted as Dietary Restraint, Eating Disturbance, Appearance Concerns, and Shape/Weight Overvaluation, were found to be internally consistent and converged with other relevant measures of psychopathology. DISCUSSION Factor analysis of the EDE-Q in bariatric surgery candidates did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE-Q in this and other diverse populations and consider means of improving this measure's ability to best assess eating-related pathology in bariatric surgery patients.
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Affiliation(s)
- Joshua I. Hrabosky
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bruce S. Rothschild
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, St. Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | | | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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15
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Hrabosky JI, White MA, Masheb RM, Rothschild BS, Burke-Martindale CH, Grilo CM. Psychometric Evaluation of the Eating Disorder Examination-Questionnaire for Bariatric Surgery Candidates. Obesity (Silver Spring) 2008. [DOI: 10.1038/oby.2008.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Leal CW, Baldin N. O impacto emocional da cirurgia bariátrica em pacientes com obesidade mórbida. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0101-81082007000300013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A cirurgia bariátrica é um método que tem sido utilizado para o emagrecimento e resgate da saúde. Em muitos casos, porém, o emagrecimento súbito incorre em quadros psiquiátricos, tais como: sintomas depressivos, ansiedade, uso de substâncias, alterações comportamentais e ideação suicida, dentre outras situações, associadas às mudanças emocionais que o paciente vivencia com o novo estado físico e psíquico. O atual estudo teve como objetivo analisar as expectativas, fantasias, resultados, dificuldades e frustrações enfrentadas após o procedimento cirúrgico. Realizou-se um relato de caso das informações colhidas com seis pacientes em acompanhamento num hospital público de Santa Catarina e que desenvolveram sintomas de sofrimento psíquico após a cirurgia bariátrica. Cada paciente participou de duas sessões de entrevistas semi-estruturadas. A pesquisa foi submetida e aprovada pela comissão de ética da Universidade de Joinville. Os resultados obtidos demonstram que as mudanças psicológicas decorrentes da cirurgia foram marcantes. Em determinados casos, as entrevistadas expressaram expectativas além do emagrecimento, como a resolução dos conflitos interpessoais e conjugais, assim como mudanças de traços definidos de suas personalidades. Constatou-se, também, o uso de substâncias (álcool e tabaco) associado a comportamentos de risco (envolvimento extraconjugal e direção perigosa). O problema da obesidade ficou evidenciado como parte de uma complexa situação que envolve o estado físico e emocional das pessoas, e sua resolução, por vezes, expõe as dificuldades e as limitações psíquicas dos pacientes.
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Rosenberger PH, Henderson KE, Bell RL, Grilo CM. Associations of weight-based teasing history and current eating disorder features and psychological functioning in bariatric surgery patients. Obes Surg 2007; 17:470-7. [PMID: 17608259 DOI: 10.1007/s11695-007-9082-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The study investigated associations between childhood history of being negatively teased (i.e., being made fun of) about weight with psychiatric history, weight and eating concerns, and psychological functioning in 174 bariatric surgery candidates. METHODS Bariatric surgery candidates participating in a comprehensive psychiatric evaluation completed a structured diagnostic interview, a psychosocial history interview, and a battery of established self-report measures assessing broad aspects of functioning. Patients who reported a history of being teased during childhood about weight were compared with those who denied having been teased in demographic features, obesity history, dietary and eating patterns and psychological functioning. RESULTS Of the study group, 88 participants (50.6%) reported a weight-based childhood teasing history and 86 (49.4%) denied such a history. Teasing was not significantly associated with demographic features or current obesity level. As expected, analyses revealed that teasing was associated with younger age of onset of both obesity and dieting. Teasing was significantly associated neither with the frequency of lifetime psychiatric disorders, including eating disorder diagnoses, nor with binge eating. Analyses of covariance controlling for childhood onset of obesity, however, revealed that teasing history was associated with significantly higher current levels of weight and shape concerns, depression, body dissatisfaction, and shame, and with lower levels of self-esteem. CONCLUSION Health-care providers should recognize the importance of a history of having been teased or made fun of about weight in bariatric surgery candidates. Although the prognostic significance of a history of such negative teasing for bariatric surgery outcomes is unknown, our findings suggest that such experiences are prevalent in this patient group and are associated with negative sequelae.
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Affiliation(s)
- Patricia H Rosenberger
- Connecticut Healthcare System, Psychology 116B, 950 West Campbell Ave., West Haven, CT 06516, USA.
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18
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Hilbert A, Tuschen-Caffier B, Karwautz A, Niederhofer H, Munsch S. Eating Disorder Examination-Questionnaire. DIAGNOSTICA 2007. [DOI: 10.1026/0012-1924.53.3.144] [Citation(s) in RCA: 239] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Der Eating Disorder Examination-Questionnaire von Fairburn und Beglin (EDE-Q; 1994) ist die Fragebogenversion des strukturierten Essstörungsinterviews Eating Disorder Examination (EDE). Der EDE-Q erfasst die spezifische Essstörungspsychopathologie mithilfe von vier Subskalen zum gezügelten Essverhalten, zu Sorgen über das Essen, Gewicht und Figur. Die in diesem Beitrag vorgestellte deutschsprachige Übersetzung des EDE-Q wurde in Stichproben mit Anorexia nervosa, Bulimia nervosa und atypischen Essstörungen, sowie nicht-klinischen, subklinischen und psychiatrischen Vergleichsgruppen teststatistisch untersucht (N = 706). Der EDE-Q erwies sich als intern konsistent und stabil. Seine faktorielle Struktur wurde teilweise reproduziert. Die Kennwerte des EDE-Q waren signifikant mit denen des EDE korreliert, fielen erwartungsgemäß jedoch teilweise höher aus. Weitere Hinweise für die konvergente Validität ergaben sich durch Korrelationen mit konzeptverwandten Fragebögen. Der EDE-Q zeigte eine gute diskriminative Validität und war sensitiv in der Erfolgsmessung therapeutischer und präventiver Maßnahmen.
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Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology 2007; 132:2253-71. [PMID: 17498516 DOI: 10.1053/j.gastro.2007.03.057] [Citation(s) in RCA: 279] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 02/26/2007] [Indexed: 12/19/2022]
Abstract
The prevalence of obesity has increased in recent decades, and obesity is now one of the leading public health concerns on a worldwide scale. There is accumulating agreement that bariatric surgery is currently the most efficacious and enduring treatment for clinically severe obesity, and as a result, the number of bariatric surgery procedures performed has risen dramatically in recent years. This review will summarize historic and contemporary bariatric surgical techniques, including gastric bypass (open and laparoscopic), laparoscopic adjustable gastric banding, and biliopancreatic diversion (with or without duodenal switch). Data are presented on bariatric surgery outcomes, focusing on weight loss and obesity-related comorbidities. We also review possible complications from surgery. Bariatric surgery patients undergo many dramatic lifestyle changes, and comprehensive presurgical screening conducted by a multidisciplinary team is important to prepare patients for the numerous changes necessary for successful outcome. In addition, comprehensive presurgical screening can aid the treatment team in identifying patients who would benefit from additional services prior to or following surgery. Further research focused on presurgical variables that predict outcome-especially the longer term outcome-of bariatric surgery is needed. At present, approximately 1% of eligible individuals with morbid obesity receive bariatric surgery. In addition, there appears to be inequity in access to weight loss surgery. Given the accumulating evidence that bariatric surgery is efficacious in producing significant and durable weight loss, improving obesity-related comorbidities, and extending survival, the U.S. healthcare system should examine ways to improve access to this treatment for obesity.
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Affiliation(s)
- Katherine A Elder
- Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA
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Elder KA, Grilo CM. The Spanish language version of the Eating Disorder Examination Questionnaire: comparison with the Spanish language version of the eating disorder examination and test-retest reliability. Behav Res Ther 2006; 45:1369-77. [PMID: 17014823 DOI: 10.1016/j.brat.2006.08.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 08/11/2006] [Accepted: 08/18/2006] [Indexed: 11/19/2022]
Abstract
This study compared the Spanish language questionnaire (S-EDE-Q) and interview (S-EDE) versions of the Eating Disorder Examination and examined the short-term test-retest reliability of the questionnaire version. Seventy-seven monolingual Spanish-speaking Latina women recruited from the community completed the S-EDE-Q and were then administered the S-EDE by fully bilingual doctoral-level research clinicians. The same assessment was repeated after approximately one week (5-14 days). The S-EDE-Q and the S-EDE were significantly correlated on frequencies of binge eating and all four subscales. Mean differences in the frequency of binge eating and the Restraint subscale were not significant, but scores on the Eating Concern, Weight Concern, and Shape Concern subscales differed significantly, with the S-EDE-Q yielding higher scores. Test-retest reliability for the S-EDE-Q was modest for binge eating but was excellent for the subscales (Spearman rho ranged 0.71-0.81), albeit somewhat variable for the individual items. Overall, the acceptable convergence between the S-EDE-Q and the S-EDE for many features of eating disorders and the good short-term test-retest findings provide preliminary support for the use of the S-EDE-Q. These findings, derived using a non-clinical sample of monolingual Spanish-speaking Latina women, require replication and extension. Evaluation with a clinical sample is necessary to further establish the reliability of the S-EDE-Q with an eating disordered group.
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Affiliation(s)
- Katherine A Elder
- Department of Psychiatry, Yale Psychiatric Research, Yale University School of Medicine, PO Box 208098, 301 Cedar Street (2nd Floor), New Haven, CT 06520, USA.
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Elder KA, Grilo CM, Masheb RM, Rothschild BS, Burke-Martindale CH, Brody ML. Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates. Behav Res Ther 2006; 44:545-60. [PMID: 15993381 DOI: 10.1016/j.brat.2005.04.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Revised: 02/18/2005] [Accepted: 04/11/2005] [Indexed: 11/16/2022]
Abstract
This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.
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Affiliation(s)
- Katherine A Elder
- Department of Psychiatry, Yale University School of Medicine, P.O. Box 208098, 301 Cedar Street, New Haven, CT 06520, USA
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