Sweet taste preference in binge-eating disorder: A preliminary investigation

Comparing body composition between the sweet-liking phenotypes: experimental data, systematic review and individual participant data meta-analysis

BACKGROUND

Legislation aimed at reducing sugar intake assumes that sweet-liking drives overconsumption. However, evidence that a greater liking for sweet taste is associated with unhealthier body size is mixed and complicated by relatively small samples, an overreliance on body mass index (BMI) and lack of classification using sweet-liking phenotypes.

METHODS

We first examined body size data in two larger samples with sweet-liking phenotyping: extreme sweet-likers, moderate sweet-likers and sweet-dislikers. Adults (18-34yrs), attended a two-session lab-based experiment involving phenotyping for sweet-liking status and a bioelectrical impedance body composition measurement (Experiment One: N = 200; Experiment Two: N = 314). Secondly, we conducted an individual participant data (IPD) meta-analysis: systematic searches across four databases identified 5736 potential articles. Of these, 53 papers met our search criteria: a taste assessment that measured liking using sucrose (>13.7% w/v), which allowed sweet-liking phenotyping and included either BMI, body fat percentage (BF%), fat-free mass (FFM) or waist-circumference.

RESULTS

A significant effect of sweet-liking phenotype on FFM was found in both Experiment One and Two, with extreme sweet-likers having significantly higher FFM than sweet-dislikers. In Experiment One, sweet-dislikers had a significantly higher BF% than extreme sweet-likers and moderate sweet-likers. However, as these data are from one research group in a young, predominantly westernised population, and the results did not perfectly replicate, we conducted the IPD meta-analyses to further clarify the findings. Robust one-stage IPD meta-analyses of 15 studies controlling for sex revealed no significant differences in BF% (n = 1836) or waist-circumference (n = 706). For BMI (n = 2368), moderate sweet-likers had slightly lower BMI than extreme sweet-likers, who had the highest overall BMI. Most interestingly, for FFM (n = 768), moderate sweet-likers and sweet-dislikers showed significantly lower FFM than extreme sweet-likers.

CONCLUSION

The higher BMI often seen in sweet-likers may be due to a larger FFM and questions the simple model where sweet liking alone is a risk factor for obesity.

Dietary intake of adults with eating disorders: A systematic review and meta-analysis

Studies have confirmed the link between altered dietary intake and eating disorders (EDs), although no systematic assessment of this research exists. Rigorous synthesis of dietary intake in anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and similar EDs is needed to explore similarities and differences. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we conducted a systematic review and quantitative synthesis of studies of dietary intake. Searches of three electronic databases resulted in thirty-nine included studies. Meta-analyses of subsets of these studies were undertaken to summarise macronutrient intake across AN, BN, and BED. Study quality was assessed using the American Academy of Nutrition and Dietetics Quality Criteria Checklist, with ratings either Positive (k = 27) or Neutral (k = 12). Adults with AN had low energy intake and those with BED reported elevated macronutrient intake. Individuals with BN reported wide variation in energy intake, including some of the highest estimates. Individuals with AN were likely to under-consume key micronutrients, with sodium potentially over-consumed in BN and BED. Vitamin D was under-consumed across all disorders. This meta-analysis highlights important diagnostic differences and synthesises dietary intake in EDs, with particular relevance to risk assessment and treatment.

Indirect Effects of Body Mass Index and Sweet Taste Responsiveness on E-Cigarette Dependence: The Role of E-Cigarette Motives

Background: Recent research has shown obesity to be associated with e-cigarette use and appeal, but models have yet to examine how weight status may be related to e-cigarette dependence among e-cigarette users. Objectives: To increase our understanding of pathways from body mass index (BMI) to e-cigarette dependence, the present cross-sectional observational study investigated a model in which BMI, sweet taste responsiveness, and the interaction of BMI and sweet taste responsiveness are associated with e-cigarette dependence indirectly via seven conceptually-distinct motives for e-cigarette use. Data from several e-cigarette clinical laboratory research studies were pooled and analyzed; only current e-cigarette users were included in the analyses (N=330). Structural equation modeling was used to analyze the hypothesized model. Results: BMI was positively associated with lower social/environmental goad motives and higher weight control motives, and BMI x sweet taste interaction terms found that sweet taste responsiveness strengthened the association of BMI and weight control motives. BMI was not directly or indirectly associated with e-cigarette dependence nor was there a bivariate association between BMI and e-cigarette dependence. Sweet taste responsiveness was positively associated with greater affiliative attachment motives, cognitive enhancement motives, cue exposure-associative process motives, weight control motives, and affect enhancement motives. Sweet taste responsiveness was bivariately associated with e-cigarette dependence and mediation paths show indirect relations to e-cigarette dependence via three of the seven motives. Conclusions: The findings suggest that sweet taste responsiveness, opposed to BMI, is associated with a wider range of e-cigarette use motives and indirectly relates to e-cigarette dependence via several e-cigarette use motives.

Reactive hypoglycemia in binge eating disorder, food addiction, and the comorbid phenotype: unravelling the metabolic drive to disordered eating behaviours

BACKGROUND

Impaired metabolic response such as blood glucose fast fluctuations may be hypothesized in binge eating disorder (BED) and food addiction (FA) by virtue of the repetitive consumption of highly processed food. Conversely, rapid changes in plasma glucose (i.e., hypoglycemia) may trigger craving for the same food products. The investigation of early glycemic disturbances in BED and FA could enhance the understanding of the metabolic mechanisms involved in the maintenance of the disorders. Present study investigated hypoglycemia events during a 5-h-long oral glucose tolerance test (OGTT) in people with BED, FA, and the comorbid phenotype. Further, the association between the severity of eating psychopathology and the variability in hypoglycaemia events was explored.

METHODS

Two-hundred participants with high weight and no diabetes completed the extended OGTT and were screened for BED, FA, BED-FA, or no-BED/FA. The four groups were compared in hypoglycemia events, OGTT-derived measures, and eating psychopathology. The association between predictors (eating psychopathology), confounders (demographics, metabolic features), and the outcomes (hypoglycemia, early/late hypoglycemia, severe hypoglycemia, reactive hypoglycemia) was examined through logistic regression.

RESULTS

Hypoglycemia in general, and reactive hypoglycemia were highly frequent (79% and 28% of the sample, respectively). Hypoglycemia events (< 70 mg/dL) were equally experienced among groups, whilst severe hypoglycemia (< 54 mg/dL) was more frequent in BED at the late stage of OGTT (5 h; χ2 = 1.120, p = .011). The FA and BED groups exhibited significantly higher number of reactive hypoglycemia (χ2 = 13.898, p = .003), in different times by diagnosis (FA: 210'-240'; BED: at the 270'). FA severity was the only predictor of early and reactive hypoglycemia.

CONCLUSIONS

People with BED or FA are prone to experiencing reactive hypoglycemia; FA severity may predict early and symptomatic hypoglycemia events. This can further reinforce disordered eating behaviours by promoting addictive responses, both biologically and behaviourally. These results inform professionals dealing with eating disorders about the need to refer patients for metabolic evaluation. On the other hand, clinicians dealing with obesity should screen for and address BED and FA in patients seeking care for weight loss.

Comparison of binge-eating disorder and food addiction

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, binge-eating disorder (BED) is classified as episodes of binge eating while not being hungry, eating too fast until feeling uncomfortably full, or eating in solitude with feelings of shame and disgust after eating, without compensatory mechanisms. The controversial disorder food addiction (FA) is characterized by overconsumption, cravings, failure to cut down on amounts of food, and withdrawal and tolerance to overeating. In this narrative review, we aimed to comprehensively characterize and compare BED and FA. We searched PubMed using the keywords "binge-eating disorder" and "food addiction." We finally included 51 publications according to topic specificity, credibility, the authors' reputation, and non-bias criteria. BED is characterized by concerns about dietary issues, body shape, and weight as well as depressive symptoms and brooding rumination. FA can be divided into substance addiction and behavioral addiction, which can be differentiated using a list of criteria including hunger, taste, pleasure, function of food, loss of social connections, weight concerns, and awareness about the disorder. Further research is needed to further characterize and distinguish BED and FA.

Study protocol of the sweet tooth study, randomized controlled trial with partial food provision on the effect of low, regular and high dietary sweetness exposure on sweetness preferences in Dutch adults

BACKGROUND

Several health organizations recommend lowering the consumption of sweet-tasting foods. The rationale behind this recommendation is that a lower exposure to sweet foods may reduce preferences for sweet tasting foods, thus lowering sugar and energy intake, and in turn aiding in obesity prevention. However, empirical data supporting this narrative are lacking. In fact, relatively little is known about the contribution of long-term sweet taste exposure on one's sweetness preferences.

METHODS

The primary objective of this randomized controlled trial is to assess the effect of low, regular and high dietary sweetness exposure on preference for sweet foods and beverages, and to compare these effects between intervention groups. One hundred and eighty adults aged 18-65 years with a BMI of 18.5-30.0 kg/m² will be recruited and randomly allocated to either: low dietary sweetness exposure (LSE) (10-15% daily energy from sweet tasting foods), regular dietary sweetness exposure (RSE) (25-30% daily energy from sweet tasting foods), or high dietary sweetness exposure (HSE) (40-45% daily energy from sweet tasting foods), for 6 months, followed by a 4-month follow up. Intervention foods are provided ad libitum, covering approximately 50% of the daily number of food items, to include sugar-sweetened, low-calorie-sweetener-sweetened and non-sweet foods. The primary outcome measure is the difference in change in sweetness preference from baseline to 6 months between intervention groups. Secondary outcomes include: change in sweet taste preferences at different time-points; taste intensity perception; behavioral outcomes: food choice and intake, sweet-liker type, food cravings, dietary taste preferences and dietary taste patterns; anthropometric outcomes: body composition, waist-hip circumference, body weight; and biochemical outcomes: glucose variability and biomarkers related to CVD and diabetes.

DISCUSSION

This study will generate important data on the effect of dietary sweetness exposure on sweetness preferences in terms of effect size and change, duration of change and its impact on food intake, body weight status and associated health outcomes.

TRIAL REGISTRATION

The study protocol has been registered on ClinicalTrials.gov (ID no. NCT04497974, Registered 4 August 2020, https://clinicaltrials.gov/ct2/show/NCT04497974 ) and approved by Wageningen's Medical Ethical Committee (ABR no. NL72134).

Body Dissatisfaction and Binge Eating: The Moderating Roles of Sweet Taste Reward Sensitivity and Dietary Restraint among Tobacco Product Users

Body dissatisfaction is a key predictor of binge eating, yet less is known about factors that may potentiate the association between body dissatisfaction and binge eating. This study examined self-reported dietary restraint and sweet taste reward sensitivity as candidate moderators of the association between body dissatisfaction and binge eating in adults. A convenience sample of 221 tobacco product users completed measures of eating disorder pathology and sweet taste reward sensitivity. Results revealed that elevated sweet taste reward sensitivity strengthened the positive association between higher body dissatisfaction and binge eating. However, there was no main effect, or moderation effect, of dietary restraint on binge eating. The findings of this study demonstrate the key role of sweet taste reward sensitivity in potentiating the association between body dissatisfaction and binge eating. Sweet taste reward sensitivity may serve as a key dispositional factor for uncontrolled eating.

Ultra-processed food intake and eating disorders: Cross-sectional associations among French adults

Background and aims

Data regarding the association between ultra-processed food (UPF) consumption and eating disorders (ED) are scarce. Our aim was to investigate whether UPF intake was associated with different ED types in a large population-based study.

Methods

43,993 participants (mean age = 51.0 years; 76.1% women) of the French NutriNet-Santé web-cohort who were screened for ED in 2014 via the Sick-Control-One stone-Fat-Food (SCOFF) questionnaire, were included in the analysis. The clinical algorithm Expali TM tool was used to identify four ED types: restrictive, bulimic, binge eating, and other (not otherwise specified). Mean dietary intake was evaluated from at least 2 self-administered 24-h dietary records (2013-2015); categorization of food as ultra-processed or not relied on the NOVA classification. The associations between UPF intake (as percent and reflecting mean daily UPF quantity (g/d) within the dietary intake, %UPF) and ED types were evaluated using polytomous logistic regression models.

Results

5,967 participants (13.6%) were categorized as likely ED (restrictive n = 444; bulimic n = 1,575; binge eating n = 3,124; other ED n = 824). The fully-adjusted analyses revealed a positive association between UPF intake and bulimic, binge eating, and other ED: ED risk (odds ratio, OR) for an absolute 10-percentage point incremental increase in %UPF intake were 1.08 (1.01-1.14; P = 0.02), 1.21 (1.16-1.26; P < 0.0001), and 1.11 (1.02-1.20; P = 0.02), respectively. No significant association was detected for restrictive ED.

Discussion and Conclusion

This study revealed an association of UPF intake with different ED types among French adults. Future research is needed to elucidate the direction of the observed associations.

Inter-Individual Differences in Cognitive Tasks: Focusing on the Shaping of Decision-Making Strategies

In this paper, we review recent (published and novel) data showing inter-individual variation in decision-making strategies established by mice in a gambling task (MGT for Mouse Gambling Task). It may look intriguing, at first, that congenic animals develop divergent behaviors. However, using large groups of mice, we show that individualities emerge in the MGT, with about 30% of healthy mice displaying risk-averse choices while about 20-25% of mice make risk-prone choices. These strategies are accompanied by different brain network mobilization and individual levels of regional -prefrontal and striatal- monoamines. We further illustrate three ecological ways that influence drastically cognitive strategies in healthy adult mice: sleep deprivation, sucrose or artificial sweetener exposure, and regular exposure to stimulating environments. Questioning how to unmask individual strategies, what are their neural/neurochemical bases and whether we can shape or reshape them with different environmental manipulations is of great value, first to understand how the brain may build flexible decisions, and second to study behavioral plasticity, in healthy adult, as well as in developing brains. The latter may open new avenues for the identification of vulnerability traits to adverse events, before the emergence of mental pathologies.

A population-based study of macronutrient intake according to mental health status with a focus on pure and comorbid anxiety and eating disorders

PURPOSE

Eating disorders (ED) and anxiety impact food choices. In addition, comorbid anxiety seems to increase ED symptoms and severity. However, the association between such comorbidity and dietary intake is unknown. This population-based, cross-sectional study aimed to assess macronutrient intake according to mental health status (i.e., no disorder, pure and comorbid anxiety and ED).

METHODS

The study included N = 24,771 participants (74% female, mean age = 53.2 ± 13.7 years) in the NutriNet-Santé cohort, who completed once the trait subscale of the State-Trait Anxiety Inventory (STAI-T; high anxiety: ≥ 40 points) between 2013 and 2016 and the SCOFF questionnaire screening for ED in 2014. The Expali algorithm was applied to categorize ED (no ED; restrictive: RS; bulimic: BL; hyperphagic: HP; other ED). Participants were divided into ten groups by crossing their anxiety status (two groups: low or high) and their ED status (five groups). Macronutrient intakes were evaluated from ≥ 3 24-h dietary records. Analyses of covariance (ANCOVA) and Dunnett-Hsu tests (reference = no disorder) were performed.

RESULTS

Significant differences in macronutrient intake were seen between the pure and comorbid forms, especially for RS and HP. Compared to the "no disorder" group, a significantly higher percentage of energy from carbohydrates, higher intakes of total carbohydrates, simple sugars, and plant-based protein, lower intakes of total fat, saturated and monounsaturated fatty acids, and cholesterol were observed in the comorbid anxiety + RS group, but not in the pure RS group. In contrast, significantly lower intakes of added sugar and plant-based protein, and a higher intake of cholesterol were observed in the pure HP group, but not in the comorbid anxiety + HP group. For BL and other ED, similar results were observed between the pure and comorbid forms.

CONCLUSION

This large epidemiological study provided some support for differences in macronutrient intake between individuals with pure or comorbid anxiety and ED. Differences in intake were largely dependent on ED type. Future prospective studies and studies using clinically defined anxiety and ED are needed to elucidate causality as well as potential effect modification of the observed associations.

Dysfunctional Patterns of Food Intake by Anxiety during Isolation by COVID-19 in Chile, Colombia and Mexico

The aim of this research was to compare food intake dysfunctional patterns score with the subjective perception of anxiety and sociodemographic characteristics of the participants in isolation by COVID-19 from Chile, Colombia, and Mexico. A cross-sectional research was carried out, with a virtual questionnaire of subjective perception of anxiety and the questionnaire of three 18-item feeding factors. 958 people of both sexes participated (F = 83%, M = 17%), mainly in the 18 to 35 age range. Dysfunctional eating patterns presented high scores in people who perceived anxiety, as well as in participants from Chile. Additionally, it was found that women present greater cognitive restriction and emotional intake, and college students showed greater disinhibition. In conclusion, the scores of the three dysfunctional eating patterns were higher in people with subjective perception of anxiety during social isolation due to COVID-19, and there were also differences according to country, sex, and educational level.

Breaking It Down: Investigation of Binge Eating Components in Animal Models to Enhance Translation

Binge eating (BE) is a core eating disorder behavior that is present across nearly all eating disorder diagnoses (e. g., bulimia nervosa, binge eating disorder, anorexia nervosa binge/purge subtype), and is also widely present in the general population. Despite the prevalence of BE, limited treatment options exist and there are often high rates of relapse after treatment. There is evidence showing that genetic factors contribute to the heritability of BE and support for biological contributions to BE. However, more work is needed to fully understand neurobiological mechanisms underlying BE. One approach to target this problem is to separate BE into its distinct clinical components that can be more easily modeled using pre-clinical approaches. To date, a variety of animal models for BE have been used in pre-clinical studies; but there have been challenges translating this work to human BE. Here, we review these pre-clinical approaches by breaking them down into three clinically-significant component parts (1) consumption of a large amount of food; (2) food consumption within a short period of time; and (3) loss of control over eating. We propose that this rubric identifies the most frequently used and effective ways to model components of BE behavior using pre-clinical approaches with the strongest clinical relevance. Finally, we discuss how current pre-clinical models have been integrated with techniques using targeted neurobiological approaches and propose ways to improve translation of pre-clinical work to human investigations of BE that could enhance our understanding of BE behavior.

Effects of Sweet-Liking on Body Composition Depend on Age and Lifestyle: A Challenge to the Simple Sweet-Liking-Obesity Hypothesis

Taste hedonics drive food choices, and food choices affect weight maintenance. Despite this, the idea that hyper-palatability of sweet foods is linked to obesity development has been controversial for decades. Here, we investigate whether interpersonal differences in sweet-liking are related to body composition. Healthy adults aged 18–34 years from the UK (n = 148) and the US (n = 126) completed laboratory-based sensory tests (sucrose taste tests) and anthropometric measures (body mass index; BMI, body fat; fat-free mass; FFM, waist/hips circumferences). Habitual beverage intake and lifestyle and behavioural characteristics were also assessed. Using hierarchical cluster analysis, we classified participants into three phenotypes: sweet liker (SL), sweet disliker (SD), and inverted-U (liking for moderate sweetness). Being a SD was linked to higher body fat among those younger than 21 years old, while in the older group, SLs had the highest BMI and FFM; age groups reflected different levels of exposure to the obesogenic environment. FFM emerged as a better predictor of sweet-liking than BMI and body fat. In the older group, sweetened beverage intake partially explained the phenotype–anthropometry associations. Collectively, our findings implicate underlying energy needs as an explanation for the variation in sweet-liking; the moderating roles of age and obesogenic environment require additional consideration.

Determinants of Sweetness Preference: A Scoping Review of Human Studies

Factors associated with sweetness preference are multi-faceted and incredibly complex. A scoping review was undertaken to identify determinants of sweetness preference in humans. Using an online search tool, ProQuest ™, a total of 99 publications were identified and subsequently grouped into the following categories of determinants: Age, dietary factors, reproductive hormonal factors, body weight status, heritable, weight loss, sound, personality, ethnicity and lifestyle, previous exposure, disease, and 'other' determinants. Methodologies amongst studies were heterogenous in nature (e.g., there was variability across studies in the sweetness concentrations tested, the number of different sweetness concentrations used to assess sweetness preference, and the methods utilized to measure sweetness preference), rendering interpretation of overall findings challenging; however, for certain determinants, the evidence appeared to support predictive capacity of greater sweetness preference, such as age during certain life-stages (i.e., young and old), being in a hungry versus satiated state, and heritable factors (e.g., similar sweetness preferences amongst family members). Recommendations for the design of future studies on sweetness preference determinants are provided herein, including an "investigator checklist" of criteria to consider.

Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.

Quantifying Sweet Taste Liker Phenotypes: Time for Some Consistency in the Classification Criteria

Taste hedonics is a well-documented driver of food consumption. The role of sweetness in directing ingestive behavior is largely rooted in biology. One can then intuit that individual differences in sweet-liking may constitute an indicator of variations in the susceptibility to diet-related health outcomes. Despite half a century of research on sweet-liking, the best method to identify the distinct responses to sweet taste is still debated. To help resolve this issue, liking and intensity ratings for eight sucrose solutions ranging from 0 to 1 M were collected from 148 young adults (29% men). Hierarchical cluster analysis (HCA) revealed three response patterns: a sweet-liker (SL) phenotype characterized by a rise in liking as concentration increased, an inverted U-shaped phenotype with maximum liking at 0.25 M, and a sweet-disliker (SD) phenotype characterized by a decline in liking as a function of concentration. Based on sensitivity and specificity analyses, present data suggest the clearest discrimination between phenotypes is seen with 1.0 M sucrose, where a liking rating between -15 and +15 on a -50/+50 scale reliably distinguished individuals with an inverted U-shaped response from the SLs and the SDs. If the efficacy of this approach is confirmed in other populations, the discrimination criteria identified here can serve as the basis for a standard method for classifying sweet taste liker phenotypes in adults.

Anxiety symptoms and emotional eating are independently associated with sweet craving in young adults

Sweet craving (SC), defined as a strong desire for sweet foods, seems to be closely related to negative emotions, such as anxiety and unhealthy eating behaviors. The objective was to investigate factors that are associated with SC and to assess the relationships among SC, anxiety symptoms, and eating behavior in university students. This was a cross-sectional study involving 300 students of both sexes (20.5 ± 4.4 years) who were freshmen in a Brazilian public university. Eating behavior was evaluated using the Three Factor Eating Questionnaire, anxiety symptoms were assessed using the Beck Anxiety Inventory, SC was identified by a yes/no question ("Have you had a very strong desire to eat sweet food over the last three months?"), and characterized by the Questionnaire for Assessment of Sweet Substance Dependence. Individuals with SC scored significantly higher for uncontrolled eating (UE), emotional eating (EE), and anxiety symptoms. Logistic regression analysis revealed that anxiety symptoms are independently associated with SC. In conclusion, negative emotions, like anxiety, and eating guided by these emotions can contribute to the SC phenomenon.

A reconceptualization of the definition of binge eating for African American women: A concept analysis

AIM

The aim of this analysis is to develop a better understanding of the concept of binge-eating behavior among African American women (AAW).

BACKGROUND

Obesity is a major public health concern that is disproportionately prevalent among AAW. Among the factors that contribute to obesity development, binge eating may be of significant concern to AAW.

DESIGN

A critical analysis and synthesis of the empirical literature using Walker and Avant's model for concept analysis. The databases MEDLINE, Cumulative Index to Nursing Health Literature (CINAHL) Complete, PsycINFO, and PsycARTICLES were used. Keywords included binge eating AND African American women or Black women race or ethnicity or minority.

RESULTS

Binge eating is a behavior that exists on a continuum that involves the overconsumption of food, with or without loss of control (LOC), whereas binge eating with LOC is related to increased impairment and severity. While the main attribute of binge eating involves the consumption of a large amount of food, the LOC component of binge eating definition may not be culturally relevant criteria to include as a requirement, as it may exclude AAW in diagnostics and subsequent treatment as well as overlook the health implications of binge eating regardless of LOC endorsement.

CONCLUSION

Including LOC in defining binge-eating behavior among AAW is significant, but should not be necessitated. This concept analysis illustrates the complexities related to binge-eating behavior among AAW, enumerating the characteristics of binge eating that may be unique to certain populations. The definition for binge eating among AAW developed from this concept analysis needs to be further explored in future studies.