Prevalence of binge eating disorder in obese adults seeking weight loss treatment

Reliability of the Brazilian version of the questionnaire on eating and weight patterns-5 (QEWP-5)

PURPOSE

The Questionnaire on Eating and Weight Patterns-5 (QEWP-5) is a self-report instrument developed to screen individuals for binge eating disorder (BED) and bulimia nervosa (BN) as diagnosed by the DSM-5. This instrument was cross-culturally adapted for the Brazilian Portuguese and well understood by the target sample. The present study aimed to assess the test-retest reliability of the Brazilian version of QEWP-5 in a sample of undergraduate students from Dietitian and Psychology courses.

METHODS

The Brazilian version of QEWP-5 was administered to a sample of 345 male and female undergraduate students, from dietitian (n = 179) and psychology (n = 166) courses. The instrument was applied twice with a time interval of 2 weeks between the applications. The kappa coefficient was used to assess the temporal stability of the questionnaire in the screening of BED and BN.

RESULTS

Overall, the kappa coefficient for the screening of BED was .48, and for the screening of BN was .71. In the dietitian course, the temporal stability was .60 (for the assessment of BED) and .80 (for BN). In the psychology course, the kappa values for the assessment of BED and BN were .27 and .60, respectively. All values were statistically significant (p < .001).

CONCLUSION

In general, the stability of the Brazilian version of QEWP-5 was considered moderate to assess BED and substantial for the screening of BN in undergraduate students. Stratifying by course, the questionnaire had higher stability for the assessment of BED and BN in dietitian students.

LEVEL OF EVIDENCE

Level V, descriptive study.

Obsessed with Healthy Eating: A Systematic Review of Observational Studies Assessing Orthorexia Nervosa in Patients with Diabetes Mellitus

Orthorexia nervosa (ON) is an unspecified feeding or eating disorder (USFED) characterized by an exaggerated, unhealthy obsession with healthy eating. Τypical eating disorders (EDs) and USFEDs are common among patients with diabetes mellitus (DM), which complicates metabolic control and disease outcomes. The present systematic review summarizes the evidence on the prevalence of ON symptomatology among patients with DM. PubMed, Web of Science, Scopus, and grey literature were searched, and relevant observational studies were screened using the Rayyan software. The quality of the studies was assessed using the appraisal tool for cross-sectional studies (AXIS) and the Newcastle–Ottawa scale (NOS). Out of 4642 studies, 6 fulfilled the predefined criteria and were included in the qualitative synthesis. Most studies relied on the ORTO-15 or its adaptations to identify ON among patients with DM. No apparent sex or age differences exist regarding the prevalence of ON symptoms. None of the studies compared the prevalence of ON in patients with type 1 and type 2 DM. Most of the research was of average to good methodological quality. In conclusion, patients with DM often exhibit ON tendencies, although research is still limited regarding the etiology or mechanistic drivers behind ON and the characteristics of patients with a dual ON–DM diagnosis.

The association of obesity with eating disorders risk: online survey of a large cohort of Russian-speaking individuals seeking medical weight correction assistance

BACKGROUND

Eating Disorders pose a serious health risk to individuals. Often, eating disorder symptoms are overlooked when assessing obesity risk. The current cross-sectional study was focused on the search of association between disordered eating behaviors evaluated by Eating Attitudes Test 26 (EAT-26) and obesity in a large cohort of Russian-speaking adults seeking online assistance with medical weight correction.

METHODS

The web-based cross-sectional study evaluated the data of online Eating Attitudes Test 26 (EAT-26) completed by 13,341 registered adult visitors of weight loss clinic website. The EAT-26 provides an overall score for potential eating disorders risk, as well as scores for three subscales: Bulimia, dieting, and oral control. Additional self-reported information about sex, weight, height, and age of respondents was used for analysis. The nonparametric analysis of variance and binominal logistic regression modeling were applied to search for an association between obesity and EAT-26 total score and subscales scores. The critical level of the significance was considered as α = 0.05.

RESULTS

Women (94%) had lower BMI values but higher EAT-26 total score than men, which was indicated as statistically significant by a Wilcoxon Signed-Ranks Test (Z = - 11.80, p < 0.0001). Logistic regression for the whole cohort revealed that Bulimia subscale score was associated with higher risk of obesity (OR = 1.03, 95% CI 1.02-1.05) whereas higher score of EAT-26 oral control subscale was associated with decreased risk of obesity (OR = 0.93, 95% CI 0.91-0.95). Separate analysis for men and women showed that in men higher obesity risk was associated with higher oral control subscale scores (OR = 1.08, 95% CI 1.06-1.11); while in women both dieting and bulimia subscales scores were associated with higher obesity risk (OR = 1.02, 95% CI 1.01-1.03 and OR = 1.03, 95% CI 1.02-1.05, respectively). Older age was associated with obesity risk for both women and men.

CONCLUSIONS

In a large cohort of individuals seeking medical weight correction assistance, the risk of obesity was associated with the higher EAT-26 scores, age, and sex. Moreover, different eating disorder risk profiles were associated with obesity in men and women. Higher oral control subscale score was associated with decreased risk of obesity in women, but with higher risk in men. Older age was a shared obesity risk factor for both sexes. Therefore, the use of EAT-26 would facilitate individual diagnostic assessment for specific eating disorders in different sub-cohorts. Further assessment of separate EAT-26 subscales may be important to predict sex-/age-specific risks of obesity that implies their study in the future. Obesity is a significant health problem. Different factors (e.g. social, biological, and behavioral) are important for their successful treatment. Abnormal eating behaviors may be one of the most likely predictors of increased body weight. This study aims to determine whether there is a significant association between obesity and scores on the eating behavior questionnaire-Eating Attitudes Test-26 (EAT-26)-in a large cohort of adults seeking medical weight correction assistance at a private weight loss clinic web-site. According to the study results, the association was shown for the male sex, older age, and higher Bulimia scores as measured on the EAT-26. Moreover, different EAT-26 scales were associated with obesity risks in women and men subgroups, while older age was a shared risk factor for obesity in both sexes. The findings may suggest sex-/age-specific diagnostic approach and treatment strategies for individuals with obesity.

Psychometric proprieties of the Italian version of the questionnaire on eating and weight patterns (QEWP-5) and its accuracy in screening for binge-eating disorder in patients seeking treatment for obesity

PURPOSE

The aim of the current study was to assess the psychometric proprieties of the Italian version of the latest edition of the Questionnaire of Eating and Weight Patterns (QEWP-5), evaluating its accuracy in screening patients with binge-eating disorder (BED).

METHODS

The Italian translation of the tool was administered to 604 Italian-speaking adults seeking treatment for obesity. The clinical sample was given the Eating Disorder Examination interview to assess for BED. Participants also completed the Symptom Checklist 90, the Obesity-Related Well-Being and the Binge-Eating Scale.

RESULTS

The sensitivity of the QEWP-5 was 0.49, and its specificity 0.93. The positive and negative predictive values were 0.34 and 0.96, respectively. Agreement between QEWP-5 and EDE using Cohen's kappa was 0.35. Nevertheless, among patients with an EDE diagnosis of no BED, those 'QEWP-5-positive' for BED displayed higher eating-disorder and general psychopathology scores, poorer weight-related quality of life, and greater severity of binge-eating behaviours than those 'QEWP-5-negative' for BED.

CONCLUSION

Despite the low concordance with the EDE interview in terms of detecting the presence of BED, the QEWP-5 may be a useful initial screening tool for the clinical assessment of adults seeking treatment for obesity.

LEVEL OF EVIDENCE

Level V, Descriptive study.

Specific gut microbial, biological, and psychiatric profiling related to binge eating disorders: A cross-sectional study in obese patients

BACKGROUND & AIMS

Binge eating disorder (BED) is a frequent eating disorder associated with obesity and co-morbidities including psychiatric pathologies, which represent a big health burden on the society. The biological processes related to BED remain unknown. Based on psychological testing, anthropometry, clinical biology, gut microbiota analysis and metabolomic assessment, we aimed to examine the complex biological and psychiatric profile of obese patients with and without BED.

METHODS

Psychological and biological characteristics (anthropometry, plasma biology, gut microbiota, blood pressure) of 101 obese subjects from the Food4Gut cohort were analysed to decipher the differences between BED and Non BED patients, classified based on the Questionnaire for Eating Disorder Diagnosis (Q-EDD). Microbial 16S rDNA sequencing and plasma non-targeted metabolomics (liquid chromatography-mass spectrometry) were performed in a subcohort of 91 and 39 patients respectively.

RESULTS

BED subjects exhibited an impaired affect balance, deficits in inhibition and self-regulation together with marked alterations of eating behaviour (increased emotional and external eating). BED subjects displayed a lower blood pressure and hip circumference. A decrease in Akkermansia and Intestimonas as well as an increase in Bifidobacterium and Anaerostipes characterized BED subjects. Interestingly, metabolomics analysis revealed that BED subjects displayed a higher level of one food contaminants, Bisphenol A bis(2,3-dihydroxypropyl) ether (BADGE.2H(2)O) and a food derived-metabolite the Isovalerylcarnitine.

CONCLUSIONS

Non-targeted omics approaches allow to select specific microbial genera and two plasma metabolites that characterize BED obese patients. Further studies are needed to confirm their potential role as drivers or biomarkers of binge eating disorder. Food4gut, clinicaltrial.gov:NCT03852069, https://clinicaltrials.gov/ct2/show/NCT03852069.

The Symptom-Checklist-K-9 (SCL-K-9) Discriminates between Overweight/Obese Patients with and without Significant Binge Eating Pathology: Psychometric Properties of an Italian Version

A general personality and psychopathology evaluation is considered to be crucial part of the multidisciplinary assessment for weight-related problems. The Symptom Checklist-90-Revised (SCL-90-R) is commonly used to assess general psychopathology in both overweight and obese patients seeking weight-loss treatment. The main purpose of the present research was to investigate the psychometric properties of the brief form of the SCL-90-R (i.e., the SCL-K-9) in a clinical sample (N = 397) of patients seeking weight-loss treatment (i.e., bariatric surgery and a nutritional weight-loss program). The results of the confirmatory factor analysis supported a one-factor solution of the SCL-K-9, with all nine items loading significantly on the common latent factor (lambdas ≥ 0.587). The ordinal α (= 0.91), the inter-item mean indices of correlation (r_ii = 0.53), and the convergent validity were also satisfactory. A receiver operating characteristic curves procedure showed that both SCL-90-R and SCL-K-9 were able to classify patients with and without significant binge eating pathology according to the Binge Eating Scale (BES) total score. Overall, our results suggest that the SCL-K-9 has adequate psychometric properties and can be applied as a short screening tool to assess general psychopathology in overweight/obese individuals seeking weight-loss treatment and at follow-up interviews when time restraints preclude the use of the full-length form.

Links between traumatic experiences in childhood or early adulthood and lifetime binge eating disorder

OBJECTIVES

To evaluate the association between childhood or early adulthood traumatic experiences and adulthood binge eating disorder (BED) in 326 male and 1158 female patients. A structured clinical interview for the DSM-IV (SCID-I/P)-adapted to lifetime exploration for the diagnosis of BED and for DSM-IV Childhood Disorders was conducted by the psychiatrist.

RESULTS

Emotional neglect was the most frequent event experienced (77.8% of females vs. 63.5% of males, p < 0.0001), ahead of physical abuse (23.3%), witnessed domestic violence (17.7%) and sexual abuse (11.8% of females vs. 2.8% of males (p < 0.0001)). The prevalence rate for BED in the whole population was 34.9%. The independent predictors for BED were emotional neglect in male obese patients (OR = 3.49; IC95% (1.94-6.29); p < 0.0001) and physical abuse (OR = 1.56; IC95% (1.14-2.12); p = 0.0047), emotional neglect (OR = 1.83; IC95% (1.37-2.44); p < 0.0001), and sexual abuse (OR = 1.80; IC95% (1.22-2.65); p = 0.0029) in female patients. With a cut-off value of 17, the sensitivity of the Binge Eating Scale for BED during lifetime was 50.8% with 74.7% specificity.

CONCLUSIONS

This study shows that early psychological events are independent predictors of BED in obese female and male adults. The BES questionnaire is a poor predictor of BED during lifetime and a structured clinical interview should be recommended.

BARIATRIC SURGERY AND BINGE EATING DISORDER: SHOULD SURGEONS CARE ABOUT IT? A LITERATURE REVIEW OF PREVALENCE AND ASSESSMENT TOOLS

BACKGROUND

Eating pathologies among bariatric surgery candidates are common and associated with adverse surgical outcomes, including weight regain and low quality of life. However, their assessment is made difficult by the great variety and inconsistent use of standardized measures.

OBJECTIVE

The purpose of this review was to synthesize current knowledge on the prevalence of binge eating disorder (BED) in presurgical patients and to make a critical appraisal of assessment tools for BED.

METHODS

A search was conducted on PubMed, Scopus, and Web of Science databases from January 1994 to March 2017. Data were extracted, tabulated and summarized using a narrative approach.

RESULTS

A total of 21 observational studies were reviewed for data extraction and analysis. Prevalence of BED in bariatric populations ranged from 2% to 53%. Considerable variation in patient characteristics and in BED assessment measures was evident among the studies. In addition, several methodological weaknesses were recognized in most of the studies. Ten different psychometric instruments were used to assess BED. Clinical interviews were used in only 12 studies, though this is the preferred tool to diagnose BED.

CONCLUSION

Study heterogeneity accounted for the variability of the results from different centers and methodological flaws such as insufficient sample size and selection bias impaired the evidence on the magnitude of BED in surgical settings. For the sake of comparability and generalizability of the findings in future studies, researchers must recruit representative samples of treatment-seeking candidates for bariatric surgery and systematically apply standard instruments for the assessment of BED.

Psychological, pharmacological, and combined treatments for binge eating disorder: a systematic review and meta-analysis

Objective

To systematically review the efficacy of psychological, pharmacological, and combined treatments for binge eating disorder (BED).

Method

Systematic search and meta-analysis.

Results

We found 45 unique studies with low/medium risk of bias, and moderate support for the efficacy of cognitive behavior therapy (CBT) and CBT guided self-help (with moderate quality of evidence), and modest support for interpersonal psychotherapy (IPT), selective serotonin reuptake inhibitors (SSRI), and lisdexamfetamine (with low quality of evidence) in the treatment of adults with BED in terms of cessation of or reduction in the frequency of binge eating. The results on weight loss were disappointing. Only lisdexamfetamine showed a very modest effect on weight loss (low quality of evidence). While there is limited support for the long-term effect of psychological treatments, we have currently no data to ascertain the long-term effect of drug treatments. Some undesired side effects are more common in drug treatment compared to placebo, while the side effects of psychological treatments are unknown. Direct comparisons between pharmaceutical and psychological treatments are lacking as well as data to generalize these results to adolescents.

Conclusion

We found moderate support for the efficacy of CBT and guided self-help for the treatment of BED. However, IPT, SSRI, and lisdexamfetamine received only modest support in terms of cessation of or reduction in the frequency of binge eating. The lack of long-term follow-ups is alarming, especially with regard to medication. Long-term follow-ups, standardized assessments including measures of quality of life, and the study of underrepresented populations should be a priority for future research.

Pharmacological interventions for obesity: current and future targets

PURPOSE OF REVIEW

Obesity in the United States has been on a constant rise since the Center for Disease Control and Prevention (CDC) began tracking it over 50 years ago. Despite focused attention on this epidemic, pharmacological treatments aimed at obesity are lacking. Here, we briefly give perspective on the central and peripheral mechanisms underlying feeding behaviors and describe the existing pharmacological treatments for obesity. With this lens, I suggest future targets for the treatment of obesity.

RECENT FINDINGS

Given the development of genetic and molecular tools, understanding of how energy expenditure is modulated is becoming more nuanced. There is growing evidence for a link between obesity and addiction, which should be utilized in the development of new pharmacological treatments.

SUMMARY

More focus is needed on identifying targets for anti-obesity pharmacology. In doing so, research should include intensive investigation of the brain's reward circuitry.

Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities

Binge-eating disorder (BED) and night-eating syndrome (NES) are two forms of disordered eating associated with overweight and obesity. While these disorders also occur in nonobese persons, they seem to be associated with weight gain over time and higher risk of diabetes and other metabolic dysfunction. BED and NES are also associated with higher risk of psychopathology, including mood, anxiety, and sleep problems, than those of similar weight status without disordered eating. Treatments are available, including cognitive behavior therapy (CBT), interpersonal psychotherapy, lisdexamfetamine, and selective serotonin reuptake inhibitors (SSRIs) for BED; and CBT, SSRIs, progressive muscle relaxation, and bright light therapy for NES.

Motives for eating tasty foods associated with binge-eating. Results from a student and a weight-loss seeking population

The aim of this study was to use the Palatable Eating Motives Scale (PEMS) to determine if and what motives for eating tasty foods (e.g., junk food, fast food, and desserts) are associated with binge-eating in two diverse populations. BMI and scores on the PEMS, Yale Food Addiction Scale (YFAS), and Binge-eating Scale (BES) were obtained from 247 undergraduates at the University of Alabama at Birmingham (UAB) and 249 weight-loss seeking patients at the UAB EatRight program. Regression analyses revealed that eating tasty foods to forget worries and problems and help alleviate negative feelings (i.e., the 4-item Coping motive) was associated with binge-eating independently of any variance in BES scores due to sex, age, ethnicity, BMI, other PEMS motives, and YFAS scores in both students (R² = .57) and patients (R² = .55). Coping also was associated with higher BMI in students (p < 0.01), and in patients despite their truncated BMI range (p < 0.05). Among students, the motives Conformity and Reward Enhancement were also independently associated with binge-eating. For this younger sample with a greater range of BES scores, eating for these motives, but not for Social ones, may indicate early maladaptive eating habits that could later develop into disorders characterized by binge-eating if predisposing factors are present. Thus, identifying one's tasty food motive or motives can potentially be used to thwart the development of BED and obesity, especially if the motive is Coping. Identifying one's PEMS motives should also help personalize conventional treatments for binge-eating and obesity toward improved outcomes.

Screening for DSM-5 Other Specified Feeding or Eating Disorder in a Weight-Loss Treatment-Seeking Obese Sample

OBJECTIVE

To evaluate the effectiveness of specific self-report questionnaires in detecting DSM-5 eating disorders identified via structured clinical interview in a weight-loss treatment-seeking obese sample, to improve eating disorder recognition in general clinical settings.

METHOD

Individuals were recruited over a 3-month period (November 2, 2011, to January 10, 2012) when initially presenting to a hospital-based weight-management center in the northeastern United States, which offers evaluation and treatment for outpatients who are overweight or obese. Participants (N = 100) completed the Structured Clinical Interview for DSM-IV eating disorder module, a DSM-5 feeding and eating disorders interview, and a battery of self-report questionnaires.

RESULTS

Self-reports and interviews agreed substantially in the identification of bulimia nervosa (DSM-IV and DSM-5: tau-b = 0.71, P < .001) and binge-eating disorder (DSM-IV and DSM-5: tau-b = 0.60, P < .001), modestly for subthreshold binge-eating disorder (tau-b = 0.44, P < .001), and poorly for other subthreshold conditions (night-eating syndrome: tau-b = -0.04, P = .72, r = 0.06 [DSM-5]).

DISCUSSION

Current self-report assessments are likely to identify full syndrome DSM-5 eating disorders in treatment-seeking obese samples, but unlikely to detect DSM-5 other specified feeding or eating disorders. We propose specific content changes that might enhance clinical utility as suggestions for future evaluation.

A randomized trial comparing two approaches to weight loss: differences in weight loss maintenance

This study compared treatment outcomes for a new weight loss program that emphasized reducing unhealthy relationships with food, body image dissatisfaction, and internalized weight bias (New Perspectives) to a weight loss program that emphasizes environmental modification and habit formation and disruption (Transforming Your Life). Fifty-nine overweight and obese adults (body mass index ≥ 27 kg/m(2)) were randomly assigned to either a 12-week New Perspectives or Transforming Your Life intervention. Despite equivalent outcomes at the end of treatment, the Transforming Your Life participants were significantly more effective at maintaining their weight loss than New Perspectives participants during the 6-month no-treatment follow-up period.

From disordered eating to addiction: the "food drug" in bulimia nervosa

The high prevalence of substance abuse in individuals with bulimia nervosa (BN) and the pervasive symptom substitution in many types of drug addiction suggest that a number of substances--including food--can impair an individual's self-control, even in the presence of negative consequences. Nonetheless, the neurobiological similarities between BN and drug addiction are not clearly established. This review explores how the specific eating patterns seen in BN (binge eating and purging, with intermittent dietary restriction) are particularly addictive and differentiate BN from other eating disorders and obesity. A number of peripheral and central biological aberrations seen in BN may result in altered reward sensitivity in these individuals, particularly through effects on the dopaminergic system. Neurobiological findings support the notion that BN is an addictive disorder, which has treatment implications for therapy and pharmacological manipulations.

Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study

BACKGROUND

The psychological symptoms associated with binge eating disorder (BED) have been well documented. However, the physical symptoms associated with BED have not been explored. Gastrointestinal (GI) symptoms such as heartburn and diarrhea are more prevalent in obese adults, but the associations remain unexplained. Patients with bulimia have increased gastric capacity. The objective of the study was to examine if the severity of binge eating episodes would be associated with upper and lower GI symptoms.

METHODS

Population-based survey of community residents through a mailed questionnaire measuring GI symptoms, frequency of binge eating episodes and physical activity level. The association of GI symptoms with frequency of binge eating episodes was assessed using logistic regression models adjusting for age, gender, body mass index (BMI) and physical activity level.

RESULTS

In 4096 subjects, BED was present in 6.1%. After adjusting for BMI, age, gender, race, diabetes mellitus, socioeconomic status and physical activity level, BED was independently associated with the following upper GI symptoms: acid regurgitation (P<0.001), heartburn (P<0.001), dysphagia (P<0.001), bloating (P<0.001) and upper abdominal pain (P<0.001). BED was also associated with the following lower GI symptoms: diarrhea (P<0.001), urgency (P<0.001), constipation (P<0.01) and feeling of anal blockage (P=0.001).

CONCLUSION

BED appears to be associated with the experience of both upper and lower GI symptoms in the general population, independent of the level of obesity. The relationship between increased GI symptoms and physiological responses to increased volume and calorie loads, nutritional selections and rapidity of food ingestion in individuals with BED deserves further study.

The assessment of binge eating disorder in obese women: a comparison of the binge eating scale with the structured clinical interview for the DSM-IV

The purpose of the present study was to evaluate the clinical usefulness of the Portuguese version of the Binge Eating Scale (BES) to assess binge eating disorder (BED) in a clinical sample. The BES is a self-reported instrument developed to identify binge eaters within the obese population. The scale, at the cutoff point of 17, was compared with the Structured Clinical Interview for the DSM-IV-Patient version (SCID-I/P). It was administered to 178 obese Brazilian women, aged 18 to 60 years, seeking treatment for obesity at an outpatient clinic. To assess the test-retest reliability, 121 individuals filled the instrument again 15 days later. The Portuguese version of BES showed a sensitivity of 97.8%, a specificity of 47.7%, a positive predictive value of 66.7% and a negative predictive value of 95.3%. The test-retest reliability, measured by kappa statistics, was 0.66. Cronbach's alpha was 0.89. These results suggest that the BES is valid as a screening instrument for BED in obese Brazilian women seeking treatment for obesity.

Predictive factors of binge eating disorder in women searching to lose weight

METHODS

The aim of this study was to detect predictive factors of binge eating disorder (BED) in an out-patient obesity clinic. Eating behaviour, weight history and body composition were assessed in 138 consecutive patients. BED was diagnosed according to the criteria of appendix B of the Diagnostic and Statistical Manual of Mental Disorders.

RESULTS

The body mass index (BMI; p < 0.005) and the waist circumference (p < 0.05) were significantly higher in binge patients than in patients without eating disorders. Similar differences were observed between patients who regularly went through weight loss programmes and patients who consulted for the first time. The prevalence of BED increases with the degree of obesity and especially with the number of previous intentional weight loss programmes. A positive and significant correlation was found between the weight cycling syndrome and BMI (p < 0.0001), waist circumference (p < 0.0001) and body fat (p < 0.001).

DISCUSSION

The patients with BED present a specific anthropometric profile and a typical behavioural pattern characterized by a higher degree of central obesity and a weight history with a higher number of attempts of weight loss.

Eating behavior and thyroid disease in female obese patients

It has been suggested that preexisting thyroid disease (TD) could be a risk factor for the development of eating disorders. The aim of this study was to compare eating attitudes and behavior in female obese patients with and without TD. Thyrotropin (TSH) was determined in 256 patients aged 44.9+/-14.7 years with body mass index (BMI) >30 kg/m(2); eating attitudes and behavior were assessed with the Eating Disorder Examination (EDE). EDE Shape Concern score was significantly higher in patients with previous or current hypothyroidism (N=30) than in the rest of the sample. Among patients without known TD, no difference in eating attitudes was observed between patients with elevated TSH (N=24; 11%) and those with normal thyroid function. The prevalence of binge eating disorder (BED) in the total sample was 9.7%; no difference in prevalence was observed between patients with and without a history of hypothyroidism, and between those with and without previously unknown hypothyroidism. In conclusion, known hypothyroidism is associated with increased shape concern; this does not appear to be related to differences in current levels of thyroid hormones or related hormones.

Prevalence of binge-eating disorder in obese children and adolescents seeking weight-loss treatment

OBJECTIVE

The aim of the present study was to examine the extent to which a population of obese children and adolescents developed binge-eating disorder (BED).

METHOD

A sample of 196 obese children and adolescents (aged 10-16 y) seeking weight-loss treatment at two treatment facilities (inpatient and outpatient treatment) was screened using the eating disorder examination.

RESULTS

: Only 1% of the subjects met the criteria for BED and 9% were found to have objective bulimic episodes (OBEs, overeating with loss of control), but did not endorse all of the other DSM-criteria that are required for a diagnosis of BED. OBEs were more common in girls than in boys. Episodic overeating was more common than binge eating. Compared to children without OBEs, children engaging in OBEs were more overweight and showed a greater eating-related psychopathology. The age of the first OBE was 10.88 y (s.d.=2.60). It appears that overweight precedes binge eating.

DISCUSSION

A subgroup of girls and boys seeking treatment for obesity shows considerable eating difficulties. The results highlight the importance of considering binge-eating symptoms when devising treatment programmes for children and adolescents suffering from obesity.

Binge eating disorder: a review

Binge eating disorder (BED) is a new proposed eating disorder in the DSM-IV. BED is not a formal diagnosis within the DSM-IV, but in day-to-day clinical practice the diagnosis seems to be generally accepted. People with the BED-syndrome have binge eating episodes as do subjects with bulimia nervosa, but unlike the latter they do not engage in compensatory behaviours. Although the diagnosis BED was created with the obese in mind, obesity is not a criterion. This paper gives an overview of its epidemiology, characteristics, aetiology, criteria, course and treatment. BED seems to be highly prevalent among subjects seeking weight loss treatment (1.3-30.1%). Studies with compared BED, BN and obesity indicated that individuals with BED exhibit levels of psychopathology that fall somewhere between the high levels reported by individuals with BN and the low levels reported by obese individuals. Characteristics of BED seemed to bear a closer resemblance to those of BN than of those of obesity.A review of RCT's showed that presently cognitive behavioural treatment is the treatment of choice but interpersonal psychotherapy, self-help and SSRI's seem effective. The first aim of treatment should be the cessation of binge eating. Treatment of weight loss may be offered to those who are able to abstain from binge eating.

A study of the attribution style, self-efficacy, and dietary restraint in female binge and non-binge eaters

The purpose of this study was to identify the role that attribution style and self-efficacy expectations have in overweight binge and non-binge eaters. The subjects were women (n=210) enrolled for weight control treatment, who completed a questionnaire to assess attribution style and self efficacy expectations. They were categorized into three binge eating disorder (BED) groups: non-BED, borderline BED and BED. The results of the ANOVA analysis indicated that the borderline and BED groups were significantly similar in terms of all measures of attribution and self-efficacy; and logistic regression analysis that the odds of being borderline BED or BED were greater if an individual had internal attributions, and more likely in the presence of diminished self-efficacy expectations. The subjects with low levels of eating self-efficacy and internal, global, and uncontrollable attributions were also more likely to have borderline BED and BED. The implications of the borderline BED category are discussed in relationship to the DSM-IV BED diagnosis.

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.

Binge eating disorder: a review of the literature after publication of DSM-IV

Binge eating disorder (BED) is a syndrome marked by recurrent episodes of binge eating, in the absence of the regular use of inappropriate compensatory behaviors. Since the inclusion of BED in DSM-IV as a Diagnostic Category in Need of Further Research, a great deal of research has been conducted. This paper reviews research on BED since publication of DSM-IV in 1994. We conclude that questions about the definition of BED persist. Furthermore, recent studies which have strictly used the DSM-IV definition of BED have found that the full syndrome is found in less than 3% of obese adults seeking weight loss treatment and occurs in less than 1% of the general adult population. Binge eating is a common symptom associated with obesity, however. BED may be conceptualized as a psychiatric syndrome or it may be viewed as a behavioral symptom associated with obesity. We conclude that clarification of this conceptual issue is needed if research on BED is to progress.