Overvaluation of shape and weight in binge eating disorder

Depressive Symptoms among Bariatric Surgery Candidates: Associations with Stigmatization and Weight and Shape Concern

Bariatric surgery candidates (BSC) are a highly vulnerable group for mental health impairments. According to the theoretical model of weight stigma, weight-related experienced stigmatization (ES) negatively influences mental health through weight bias internalization (WBI). This study tested this model among BSC and investigated whether this association depends on a negative body image in terms of weight and shape concern as a potential moderator. As part of a German multicenter study, ES, WBI, weight and shape concern, and depressive symptoms were assessed via self-report questionnaires among n = 854 BSC. Simple and moderated mediation analyses were applied to analyze whether WBI influences the relationship between ES and depressive symptoms, and whether this influence depends on weight and shape concern. WBI significantly mediated the relationship between ES and depressive symptoms by partially reducing the association of ES with depressive symptoms. Weight and shape concern emerged as significant moderators in the overall model and specifically for associations between WBI and depressive symptoms. The results suggest that the association between ES and depressive symptoms among BSC is stronger in those with high WBI. This association is strengthened by weight and shape concern, especially at low and mean levels. Studies evaluating longitudinal associations between weight-related stigmatization and mental health are indicated, as well as intervention studies targeting WBI in order to reduce adverse effects of ES on mental health in BSC.

Which Symptoms Bridge Symptoms of Depression and Symptoms of Eating Disorders?: A Network Analysis

ABSTRACT

Depression is a common comorbid mental illness in eating disorders (EDs). Network theory focuses on interactions between symptoms, but findings from network analyses of EDs and depression need to be replicated to make reliable claims about the nature of symptomatic interplay. We used cross-sectional data of 366 online-recruited participants with clinically elevated ED symptomatology and constructed a regularized partial correlation network with ED and depression symptoms. To determine each symptom's influence, we calculated expected influence (EI) and bridge EI to identify symptoms that bridged symptoms of depression and ED. Concerns that others see one eat, fear of weight gain, and fear of loss of control over eating were especially important among the ED symptoms. Loss of interest and feeling sad were the key depression symptoms. Eating in secret and low self-esteem emerged as potential bridge symptoms between clusters. These findings regarding bridge symptoms partially overlap with prior network analyses in nonclinical and clinical samples. Future studies that investigate symptom interplay via a longitudinal design to deduce causality are needed.

Eating Attitudes of Patients with Celiac Disease in Brazil: A Nationwide Assessment with the EAT-26 Instrument

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. In this sense, a gluten-free diet is the only safe treatment available. Due to the restrictions resulting from this eating pattern, this treatment may impair the relationship of the people with CD with food, increasing the risk of a disordered eating attitude, which is associated with eating disorders. The EAT-26 is a validated instrument already applied worldwide in different populations, and higher scores are suggestive of eating attitudes prone to evolve into eating disorders. Studies carried out in other countries have already shown that people with CD are prone to developing eating disorders; however, no study has been carried out with this theme in the population with CD in Brazil. We carried out a nationwide cross-sectional study in three steps: (i) study design and instrument; (ii) recruitment of participants and ethics; (iii) statistical analysis. A total of 385 participants were included in our sample, 96.36% of them being women. The internal consistency of the applied self-administered Brazilian version of the EAT-26 online questionnaire presented a satisfactory Cronbach's alpha of 0.812, and in total, 36.1% of the respondents were classified with a disordered eating attitude. No differences were found among the scores of participants when divided by categories regarding gender, average monthly income, age, and educational level. However, scores classified as a disordered eating attitude were found in respondents with a body mass index classified as overweight and obese. Our study highlights that disordered eating attitudes are present in overweight and obese women with celiac disease; thus, public health politics are needed to prevent and treat these attitudes.

Examining changes in binge-eating disorder network centrality and structure in patients treated with cognitive-behavioral therapy versus interpersonal psychotherapy

OBJECTIVE

A sizeable minority of patients with binge-eating disorder (BED) do not fully respond to evidence-based treatments. Evidence to guide refinements of treatments is needed. Conceptualizing BED as arising from a network of symptom-to-symptom interactions allows for identification of the most strongly connected symptoms, which could inform intervention targets. This study estimated networks of BED features at pretreatment and posttreatment to assess whether cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) differentially impacted the interrelationships of BED symptoms/features.

METHODS

Participants were 392 adults (83% women, 88% white) with BED who received CBT (n = 236) or IPT (n = 156) and assessed at pretreatment and posttreatment. Networks were estimated across timepoints and treatments. Expected influence (EI) was calculated; symptoms with the highest EI have the most strong and frequent associations with other symptoms. We also assessed whether the symptoms with the highest and lowest EI predicted posttreatment remission indicators.

RESULTS

In the CBT and IPT networks, shape concern, weight concern, and eating concern had the highest EI at pretreatment and posttreatment. EI significantly increased from pretreatment to posttreatment for some symptoms in CBT but did not change for any symptoms in IPT. Shape concern significantly and positively predicted BED remission indicators in CBT and IPT.

CONCLUSIONS

CBT and IPT similarly impacted interrelations among BED features. Pretreatment EI predicted posttreatment remission indicators, indicating that pretreatment centrality could signal meaningful intervention targets. Clinical implications and avenues for future research are discussed including how personalized network analysis may advance the understanding of the clinical utility of centrality.

PUBLIC SIGNIFICANCE

Cognitive behavioral therapy and interpersonal therapy for binge-eating disorder, which are two leading evidence-based treatments for binge-eating disorder that are quite different in their models and approaches, similarly impacted interrelations among binge-eating disorder symptoms. In addition, the most strongly interconnected symptom predicted indicators of remission. Studying the interrelations among symptoms may provide new insight on how treatments impact symptom relationships and inform intervention targets.

Epidemiology of eating disorders among US adults

PURPOSE OF REVIEW

Public policy efforts for prevention of and intervention upon eating disorders is severely limited in the United States due to the paucity of population-based data. This review article summarizes findings regarding eating disorders based on the National Epidemiological Studies on Alcohol and Related Conditions, Third Wave. The studies reviewed provide the most recent epidemiological indicators of anorexia nervosa, bulimia nervosa, and binge-eating disorder (BED) in the United States and demonstrate the utility of population-based data for validating the generalizability of findings from clinical samples.

RECENT FINDINGS

Anorexia nervosa, bulimia nervosa, and BED are widely distributed across sociodemographic characteristics, with substantially elevated risks for a variety of serious psychiatric, medical, and functional impairments, including heighted suicidality over the lifespan. Sexual minorities and individuals with adverse childhood experiences may be particularly vulnerable. Yet, many adults with eating disorders do not seek help, particularly professional help. National Epidemiological Studies on Alcohol and Related Conditions, Third Wave studies also validated some important clinical observations (e.g., overvaluation of shape/weight and physical inactivity in BED, more severe anorexia nervosa with onset prior to 14 years old).

SUMMARY

More rigorous population-based studies are needed to further advocate for appropriate resources and policies for eating disorders in the United States.

The role of body image in obese identity changes post bariatric surgery

PURPOSE

Body image is a multidimensional construct that encompasses perceptions about body size, emotions, and cognition about physical appearance. Obese identity is related to body image in the lifetime, and according to scientific literature body image dissatisfaction among obese patient persist after bariatric surgery. The objective of this review is to examine the body image changes in patients with obesity pre-and post-bariatric surgery.

METHODS

We have carried out a systematic review of literature on PubMed. Initially, 169 publications have been identified, but in total, in compliance with inclusion and exclusion criteria, 15 studies have been analyzed.

RESULTS

According to the examined literature, body image does not change after bariatric surgery. These patients will be difficult to adapt for a new body, because there is a persistent obese view of self. Furthermore, ex-obese patients are dissatisfied with the excessive skin after bariatric surgery. Excessive body weight, and negative self-image are replaced with dissatisfaction with excessive skin, and the factors associated with body image stability are still unknown.

CONCLUSION

Literature examination raises the issue of body image dissatisfaction, but does not explain why it varies so widely across bariatric patients. Obese identity is related to body image across the lifetime and is an important factor of post-surgical outcomes. Longitudinal studies based on ideal body image pre- and post- bariatric surgery and evidence-based controlled studies on psychotherapeutic treatment for body image dissatisfaction are strongly recommended. Psychotherapy could improve body image quality and wellbeing.

LEVEL I

Evidence obtained from: systematic reviews of experimental studies.

Using shape and weight overvaluation to empirically differentiate severity of other specified feeding or eating disorder

BACKGROUND

Although no severity specifiers are noted in the Diagnostic and Statistical Manual of Mental Disorders - 5 for other specified feeding or eating disorder (OSFED), shape/weight overvaluation is a proposed eating disorder (ED) severity specifier. We used structural equation modeling (SEM) Trees to empirically determine values of shape/weight overvaluation that differentiate OSFED severity. We additionally tested whether the SEM Tree-defined thresholds or a clinical cutoff for shape/weight overvaluation differentiated severity more meaningfully.

METHODS

Participants were 690 females with OSFED presenting to residential ED treatment. SEM Tree analyses specified an outcome model of OSFED severity and then recursively partitioning the outcome model into severity groups. The SEM Tree-defined and clinical cutoff severity groups were compared on clinical characteristics.

RESULTS

SEM Trees identified one split that occurred at value 5.12 on our shape/weight overvaluation items from the Eating Disorder Examination Questionnaire. The subgroup with higher overvaluation had significantly greater intensity of ED and depressive symptoms and longer lengths of stay. The subgroups created from the shape/weight overvaluation clinical-cut off value of 4 differed on the same clinical characteristics as the SEM Tree-derived groups, with the exception of laxative use frequency. Effect sizes were larger for the clinical cutoff as compared to the SEM Tree severity specification scheme.

LIMITATIONS

These cross-sectional data were used from a predominately white and female residential treatment sample; this likely skewed the subgroups and may limit generalizability.

CONCLUSIONS

Shape/weight overvaluation can meaningfully differentiate OSFED severity. The clinical cutoff slightly outperformed the empirically determined thresholds for shape/weight overvaluation.

Binge eating behavior in a sample of Lebanese Adolescents: Correlates and Binge Eating Scale validation

BACKGROUND

Binge eating disorder is a common eating disorder among the adolescent population. The available literature in the Middle East in general, and Lebanon specifically, is relatively scarce and/or outdated. The objectives of this study were to (1) validate the Binge Eating Scale (BES) for use in Lebanese adolescents, and (2) assess correlates of binge eating behavior among this population.

METHODS

A cross-sectional study conducted between May and June 2020, enrolling 555 adolescents between the ages of 15-18 years old from all Lebanese governorates. The Binge Eating Scale was used to screen for the presence/absence of binge eating.

RESULTS

A confirmatory factor analysis revealed that the one-factorial model fits the data best. The results of a linear regression, taking the binge eating score as the dependent variable, showed that higher body dissatisfaction, more alcohol use disorder, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Higher self-esteem was significantly associated with less binge eating.

CONCLUSION

The Arabic Version of the BES scale seems to be a reliable tool to be used in Lebanese adolescents for the assessment of binge eating. More body dissatisfaction, lower self-esteem, increased depressive symptoms were associated with more binge eating. We hope this tool will be a reliable one to be used in epidemiological studies and research about eating behaviors/disorders. The results showed that higher body dissatisfaction, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Our study also showed that the Binge Eating Scale is an adapted and validated tool to be used among Lebanese adolescents for the assessment of binge eating. We hope that the study results will help clinicians in the screening and management of Binge Eating behaviors among Lebanese adolescents.

Getting a head start: identifying pretreatment correlates associated with early weight loss for individuals participating in weight loss treatment

Early weight loss is associated with greater weight loss following treatment cessation and years later. The present study aimed to identify pretreatment correlates associated with early weight loss in adults participating in weight-loss treatment in primary care. Participants (N = 89) were in the overweight/obesity range seeking weight-loss treatment in primary-care settings and randomized to one of three treatments: Motivational Interviewing and Internet Condition (MIC), Nutrition Psychoeducation and Internet Condition (NPC), or Usual Care (UC). At baseline, participants were assessed with the Eating Disorder Examination (EDE) interview and completed self-report measures of emotional overeating, exercise, exercise self-efficacy, and depression. Percent weight loss at week six was used as the Early Weight Loss variable. MIC/NPC groups had significantly greater Early Weight Loss than UC. Among MIC/NPC participants only, greater Early Weight Loss was associated with significantly lower pretreatment disordered eating and depressive symptoms. Participants in MIC/NPC who achieved clinically meaningful weight loss (>2.5%) by week six compared with those who did not (<2.5%) reported lower pretreatment disordered eating. Demographic factors and binge-eating disorder diagnosis were unrelated to Early Weight Loss. Our findings suggest that greater early weight loss may be associated with less pretreatment disordered eating and depressive symptoms.

CLINICAL TRIALS

NCT01558297.

Associations between weight/shape overvaluation, sociodemographic features and BMI: 10-year time trends

PURPOSE

To investigate the prevalence of overvaluation across sociodemographic features and weight status over time.

METHODS

The data included sequential cross-sectional surveys with representative samples of the adolescent and adult (15 years or older) population in South Australia. Five surveys that assessed overvaluation were conducted in the years 2005 (n = 3047), 2008 (n = 3034), 2009 (n = 3007), 2015 (n = 3005) and 2016 (n = 3047). Overvaluation was assessed by structured interview based on the Eating Disorder Examination. To examine unique effects of demographic variables on the likelihood to report overvaluation, and also to examine whether this varied as a function of time, a multivariate binary logistic regression was computed.

RESULTS

Across survey years, participants who were more likely to endorse overvaluation were female (2005: OR 2.85, CI 2.04-3.99; 2008/9: OR 1.74, CI 1.50-2.01; 2015/6: OR 1.54, CI 1.34-1.76), had a BMI > 30 (2005: OR 3.93, CI 1.49-10.34; 2008/9: OR 2.22, CI 1.31-3.78; 2015/6: OR 2.09, CI 1.19-3.67), had left school (2015/6: OR 1.36, CI 1.14-1.63), and lived in the country (2015/6: OR 1.95, CI 1.69-2.24). Being in the oldest age group was protective against endorsing overvaluation in each survey year. There was also a main effect of survey year, with participants in the 2015/6 survey more likely to endorse overvaluation (p < 0.001).

CONCLUSIONS

Female, young and obese people were more likely to endorse overvaluation; however, the prevalence of overvaluation increased significantly in all sociodemographic and BMI groups in since 2005-2016.

EVIDENCE-BASED MEDICINE

Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.

The effect of cognitive symptoms in binge eating disorder on depression and self-esteem: a cross-sectional study

PURPOSE

To compare individuals with class II and III obesity with and without binge eating disorder (BED) in terms of sociodemographic characteristics, depressive symptoms, self-esteem, eating behaviors, and cognitive variables thought to be involved in the pathophysiology of the disease.

METHODS

The participants were selected from volunteer patients with body mass index ≥ 35 applying to the Ondokuz Mayıs University Medical Faculty, Turkey, for bariatric surgery between 01.07.2016 and 31.05.2019. The Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES), and Eating Disorder Examination Questionnaire (EDE-Q) were administered to all participants.

RESULTS

Binge eating disorder (BED) was determined in 95 (34%) of the 278 individuals applying for bariatric surgery. The frequency of previous psychiatric diseases was higher in the BED group than in the non-BED group. BDI, RSES, total EDE-Q, weight concern, shape concern, and eating concern EDE-Q subscale scores were also higher in the BED group. Correlation analysis revealed positive low correlation between depression scores and total EDE-Q scores and all subscales scores, with the exception of restraint. Positive low correlation was determined between decreased self-esteem and body weight and shape concern. At multivariate regression analysis, cognitive variables explained 28.6% of variance in depressive symptoms in the BED group, and 21.5% of variance in self-esteem.

CONCLUSION

The study results showed elevation in cognitive factors in patients with BED compared to the controls. Among these variables, eating and weight concern were shown to be associated with depressive symptoms, while eating concern was linked to self-esteem.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Relationships between nonappearance self-discrepancy, weight discrepancy, and binge eating disorder symptoms

PURPOSE

Self-discrepancy (i.e., perceived differences between one's actual self and personal standards) has been associated with binge eating disorder (BED) symptoms. However, little is known about how weight discrepancy (i.e., the difference between one's actual and ideal weights) interacts with or is distinguished from nonappearance self-discrepancy (discrepancy unrelated to weight or shape) in predicting BED severity. The current study examined how these two forms of discrepancy independently and interactively relate to BED and associated symptoms to elucidate how facets of self-discrepancy may operate to precipitate and maintain BED.

METHODS

Adults with BED (N = 111) completed questionnaires and interviews prior to treatment that assessed self-discrepancy (computerized selves) and weight discrepancy (assessed during the Eating Disorder Examination [EDE]) as predictors of global eating disorder (ED) symptomatology (EDE Global score), depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), self-esteem (Rosenberg Self-Esteem Scale), and ED-related impairment (Clinical Impairment Assessment).

RESULTS

Multivariate regression models indicated nonappearance self-discrepancy and weight discrepancy were not significantly related to the severity of global ED symptoms, but both independently predicted impairment (ps < 0.05). Nonappearance self-discrepancy, but not weight discrepancy, was also associated with higher depression (p = 0.001), anxiety (p < 0.001), and lower self-esteem (p < 0.001).

CONCLUSION

These findings suggest distinct associations of weight discrepancy and nonappearance self-discrepancy with ED and related symptoms, as well as each of these constructs' relevance to everyday functioning in BED. The results also highlight potential avenues for future research to examine mechanistic pathways by which self-discrepancy influences BED severity.

LEVEL OF EVIDENCE

V, descriptive cross-sectional study.

The association between separation individuation process and binge eating disorder in adolescents aged 12-18

PURPOSE

To evaluate the associations between separation individuation (SI) process and binge eating disorder (BED) in adolescence aged 12-18 years old, as most challenges related to SI process and eating disorders (EDs) tend to arise in this age group.

METHODS

This is a cross-sectional study of 30 adolescents diagnosed with BED and 332 healthy adolescents as a control group. All adolescents diagnosed with BED underwent clinical interviews and all adolescents in the study filled in self-reported questionnaires.

RESULTS

Our results highlighted higher levels of need denial (p = 0.014) and rejection expectancy (p = 0.008) of SI difficulties in adolescents with BED as compared to the ones without BED.

CONCLUSION

This is the first study of its nature providing good evidence for the association between SI process and BED in adolescents. Although these difficulties in SI process by themselves are not evidence of causative link, these results can contribute to the understanding of the causative factors in BED and underpin further research. The correlation can be used as a consideration in the prevention and treatment of BED.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Characterizing rates of physical activity in individuals with binge eating disorder using wearable sensor technologies and clinical interviews

OBJECTIVE

Research suggests physical activity (PA) improves behavioural, psychological and behavioural symptoms in individuals with binge eating disorder (BED), yet self-reported PA is notably low. Little remains known about objective rates of PA and subclinical levels of maladaptive PA (i.e., compensatory or driven PA), and few studies have attempted to understand the role that dissatisfaction and overvaluation with shape and weight plays in promoting PA in individuals with BED. We sought to characterize PA and investigate whether elevated rates of shape and weight concerns contribute to rates of PA in individuals with BED.

METHOD

Individuals meeting DSM-5 diagnosis of BED (N = 56) completed the Eating Disorder Examination and wore a Fitbit Flex 2 for 1 week.

RESULTS

On average, participants recorded 7621.12 (SD = 3034.20) daily steps and 194.30 (SD = 161.45) weekly moderate-to-vigorous PA minutes. About 21% of participants reported subclinical levels of maladaptive PA. Greater shape and weight overvaluation predicted lower duration of compensatory PA.

CONCLUSION

A small percentage of individuals with BED are engaging in subclinical levels of maladaptive PA, and there is a need to identify factors that influence rates of PA in individuals with BED.

Overvaluation of Shape and Weight and Associated Features in Patients Without Eating Disorders Seeking Treatment for Obesity

OBJECTIVE

This study aimed to evaluate the presence of the overvaluation of shape and weight and its associated features in patients with obesity but no eating disorder who were seeking treatment from a specialist unit.

METHODS

Overall, 1,134 patients with obesity but no Diagnostic and Statistical Manual of Mental Disorders eating disorder diagnosis were included. The Eating Disorder Examination interview was administered by expert clinicians to assess the eating disorder psychopathology and overvaluation of shape and weight. Patients also completed the Symptom Check List-90-Revised and the 36-Item Short Form Health Survey to assess general psychopathology and quality of life, respectively.

RESULTS

Roughly 20% of the patients with obesity presented with clinical overvaluation of shape and weight, which was associated with the female gender, higher expected weight loss, more severe eating-related psychopathology, higher general psychopathology, and lower mental quality of life. Linear and logistic regression analyses indicated that the clinical variables independently correlated with overvaluation of shape and weight in these patients were female gender, Eating Disorder Examination Eating Concern subscale score, and 36-Item Short Form Health Survey mental component summary score.

CONCLUSIONS

These findings are sufficient to justify routine assessment of overvaluation of shape and weight in patients seeking treatment for obesity.

The effect of trauma and dissociation on the outcome of cognitive behavioural therapy for binge eating disorder: A 6-month prospective study

BACKGROUND

Binge eating disorder (BED) is commonly associated with a history of trauma. Yet, there is little insight into the potential effect that trauma, dissociation, and depressive symptoms may have on the outcome of treatment interventions.

METHODS

A total of 142 treatment-seeking patients admitted with a diagnosis of DSM-5 BED (88% female; mean age = 38.7; SD = 10.8) took part in a 6-month, protocolized, group cognitive behavioural therapy (CBT). Self-report questionnaires were administered to assess lifetime traumatic experiences, dissociation, and depression. Body mass index and the number of binges per week (BPW) were measured throughout treatment. The main outcomes were the percentage reduction in BPW and remission (i.e., less than one BPW; cf. DSM-5).

RESULTS

Most BED patients (91.5%) reported a history of trauma, with two in three patients reporting three or more traumatic experiences. Whereas the number of traumatic experiences was not significantly associated with a reduction in BPW or remission, a higher traumatic impact score significantly decreased the likelihood of obtaining remission at the end of treatment (OR = 0.96; 95% CI [0.92, 0.99]). Higher levels of dissociative symptoms partially mediated this prospective association.

CONCLUSIONS

The impact of traumatic experiences, as opposed to the number of traumatic experiences experienced, negatively predicts remission after 6 months of CBT. These findings highlight the importance of addressing trauma and dissociative features in the CBT treatment of BED.

Gender and help-seeking for an eating disorder: findings from a general population sample

PURPOSE

This study aimed to compare gender differences in eating disorder (ED) features and to examine the role of gender as a predictor of ED help-seeking controlling for other putative determinants, namely weight/shape overvaluation, age, BMI, and impairment in role functioning.

METHODS

Demographic, ED symptoms, and related data were collected during household interviews of individuals aged ≥ 15 years. One hundred and forty-eight participants (164 after data were weighted) with an ED syndrome were identified.

RESULTS

Compared to women, men with an ED were younger and had lower levels of purging and overvaluation. However, men and women with an ED had similar levels of functional impairment, binge eating and strict dieting. In univariate analyses, males in general, but not males with an ED, were significantly less likely than females to seek help for an ED. In multivariate analysis of people with an ED, only BMI was significantly associated with treatment-seeking.

CONCLUSION

Functional health impairment and common ED behaviours were similar for men and women with EDs. Gender may not be a primary reason to be more or less likely to seek help for an ED. Rather, other features, most notably, a higher BMI, appear to be stronger predictors of ED-specific help-seeking.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Clinical Relevance of Overvaluation of Shape and Weight Among Bariatric Surgery Candidates

Overvaluation of shape and weight (OSW), or self-evaluation based primarily on body shape and weight, is associated with cognitive and behavioral aspects of eating disorders (including dietary restraint; concerns about eating, shape, and weight; and loss of control eating (LOC-eating), as well as psychological distress. We explored associations among OSW, depressive symptoms, and various forms of eating-related psychopathology, including whether frequency of LOC-eating mediates observed associations, among 88 bariatric surgery candidates. OSW was positively correlated with LOC-eating frequency, eating-related psychopathology, and depressive symptoms. There was a direct effect of OSW on depressive symptoms and eating-related psychopathology. LOC-eating frequency partially mediated the association between OSW and eating-related psychopathology. These findings demonstrate that OSW is important to assess as a marker of psychosocial distress.

Toward an understanding of the distinctiveness of body-image constructs in persons categorized with overweight/obesity, bulimia nervosa, and binge-eating disorder

OBJECTIVE

We examined distinctiveness of different aspects of body-image disturbance in persons categorized with eating/weight disorders. We compared dissatisfaction with weight/shape, overvaluation of weight/shape, preoccupation with weight/shape, and fear of weight gain - in three study groups of persons categorized with overweight/obesity [O/O], bulimia nervosa [BN], and binge-eating disorder [BED] and examined how each body-image construct relates to clinical measures within and between the study groups.

METHOD

1017 community volunteers completed measures of body-image, eating-disorder psychopathology, and depression. Participants were categorized into three study groups: O/O (N = 511), BN-purging type (N = 167), and BED (N = 339).

RESULTS

Groups differed significantly on the four body-image constructs (medium-to-large effect sizes) with a consistent severity gradient with BN greater than BED greater than O/O. Both within and between groups, the four body-image constructs varied in strengths of association among themselves and with clinical measures. Analyses revealed considerable variability in variance accounted for in the clinical measures; distinctive significant patterns observed across the groups included: dissatisfaction with BMI, preoccupation and fear with eating concerns and restraint, and overvaluation with depression.

CONCLUSION

Clinical manifestations of body-image disturbances are complex and show important differences across study groups defined as overweight/obesity, BN, and BED. Improved understanding of distinctions between different body-image constructs and their differential salience across different eating/weight disorders is needed to improve case conceptualization and treatment formulation.

Associations between self-reported diabetes mellitus, disordered eating behaviours, weight/shape overvaluation, and health-related quality of life

BACKGROUND

Eating disorders (ED) and disordered eating behaviours (DEB) have been found to be common in people with diabetes mellitus (DM). However, findings have been inconsistent.

OBJECTIVE

This study investigated the association between self-reported diabetes (Type 1 or 2) with ED/DEB (binge eating, subjective binge eating or loss of control overeating, severe dieting and purging) weight/shape overvaluation, and health-related quality of life (HRQoL) in a household survey in South Australia.

METHOD

In 2017 2977 people aged ≥15 years, who were representative of the general population, were interviewed. Participants reported their gender, age, household income, highest educational attainment, area of residence, presence of DM, ED/DEB, level of overvaluation, current HRQoL and height and weight. For the analyses between ED/DEB, self-reported DM and HRQoL, a grouping variable was created: 1) people without ED/DEB or self-reported DM; 2) people without ED/DEB and with self-reported DM; 3) people with ED/DEB and without self-reported DM; and 4) people with ED/DEB and self-reported DM. Analyses were stratified by sex and age group.

RESULTS

Subjective binge eating prevalence was higher in people with self-reported DM (6.6% vs 2.8%, p = 0.016), and overvaluation was lower in those with DM (36% vs 43.8%, p = 0.007). In analyses stratified by sex and age group, subjective binge eating was higher in women and in people over 45 years with self-reported DM and overvaluation was lower in men and in people over 45 years with self-reported DM. However, these differences were not significant on tests of gender and age interaction. People in both DM groups scored significantly lower than people without DM groups on physical HRQoL. In contrast, people in both ED/DEB groups scored lower than people without ED/BEB on mental HRQoL.

CONCLUSION

People with self-reported DM had a higher prevalence of subjective binge eating, a lower prevalence of overvaluation and there were no significant effects of age or gender. Furthermore, participants with self-reported DM and comorbid ED or DEB had impairments of both mental and physical HRQoL. Assessing an individual's sense of control over eating along with other DEB is likely important for identification of these mental health problems.

The Significance of Overvaluation of Shape or Weight in Binge-Eating Disorder: Results from a National Sample of U.S. Adults

OBJECTIVE

This study aimed to examine the prevalence of overvaluation of shape or weight in a nationally representative sample of U.S. adults with binge-eating disorder (BED) and to compare functioning correlates using a group of adults with bulimia nervosa (BN).

METHODS

Participants included 207 respondents from the National Epidemiologic Survey on Alcohol and Related Conditions who met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnoses of BED (n = 163) or BN (n = 44). Sociodemographic characteristics and functioning were compared in BED with overvaluation (BED+OV), BED without overvaluation (BED), and BN.

RESULTS

Approximately 50% of BED respondents reported overvaluation. Mean age was lower in BN than BED. Mean BMI was lower in BED+OV than BED and higher than BN. A greater proportion of BED+OV reported functional impairment than BED. BN was more likely to report "serious problems doing daily tasks" than BED and less likely to report "impairment in normal activities" than BED+OV. BN reported significantly lower mental functioning than BED.

CONCLUSIONS

Findings based on this nationally representative sample are that overvaluation was associated with greater functional impairment within BED, and BED+OV reported greater impairment than BN in interference with normal activities but less impairment related to mental health. The increased impairment associated with BED+OV provides support for overvaluation as a diagnostic specifier for BED.

Ten-year time trends in mental and physical health correlates of weight/shape overvaluation

OBJECTIVE

To investigate the relationships between weight/shape overvaluation, health-related quality of life (HRQoL) and functional role impairment (days out of role [DOR]) in the general population over 11 years.

METHOD

Five cross-sectional surveys of men and women representative of the South Australian population were conducted in 2005, 2008, 2009, 2015, and 2016 (n_total  = 15,140). Data were collected on demographics, overvaluation, HRQoL, DOR, and eating disorder behaviours.

RESULTS

Between 2005 and 2016, the prevalence of moderate overvaluation increased from 18.1% to 40.0%, marked overvaluation from 7.5% to 23.7%, and extreme overvaluation from 3.1% to 9.2% (all p < 0.001). Overvaluation at any level was associated with more DOR in 2005 but not in 2016, and the association between HRQoL impairment and overvaluation weakened over time.

CONCLUSION

Although the population prevalence of overvaluation has increased significantly in the past decade, the impairment associated with it appears to have reduced.

Cross-sectional comparison of health-related quality of life and other features in people with and without objective and subjective binge eating using a general population sample

OBJECTIVES

Evidence suggests that while objective binge eating (OBE) and subjective binge eating (SBE) differ in the amount of food consumed, both are associated with impairment in people with eating disorders. However, only OBE is accounted for in the diagnostic criteria of eating disorders. This study compared the sociodemographic profile and burden of OBE versus SBE at a population level.

DESIGN

Population-based survey.

PARTICIPANTS

A representative sample of 3028 men and women. Participants were categorised into four groups based on their reporting of binge eating in the past 3 months: non-binge eating group (no OBE or SBE), OBE group, SBE group and OSBE group (both OBE and SBE).

OUTCOME MEASURES

Demographics (age, genderand body mass index, BMI), binge eating, distress, weight/shape overvaluation and health-related quality of life. Groups were compared on sociodemographic information, overvaluation and health-related quality of life. The OBE and SBE groups were also compared on the distress related to binge eating.

RESULTS

No differences were found between the SBE group and OBE group in age, gender, BMI, mental health-related quality of life and overvaluation (all p>0.05). However, differences were found in the OSBE participants, namely that they were younger, had a higher mean BMI, lower mental health-related quality of life and higher overvaluation of weight/shape than the non-binge-eating participants (all p<0.001). Proportions of participants who reported distress related to binge eating in the OBE and SBE groups also did not differ (p=0.678).

CONCLUSION

There is little difference in the demographic profile or burden of people who engage in OBE versus SBE, supporting the proposed inclusion of SBE in the diagnostic criteria for eating disorders in International Classification of Diseases-11. People who experience both OBE and SBE may experience a relatively higher eating disorder severity and impairment.

I weigh therefore I am: Implications of using different criteria to define overvaluation of weight and shape in binge-eating disorder

OBJECTIVE

Research suggests that overvaluation of weight and shape is a clinical feature in binge-eating disorder (BED). However, this construct has been differentially defined in the literature even when using the same measure. Here we compare two cut-offs that have previously been used to differentiate clinical and subthreshold overvaluation using the EDE-Q.

METHOD

Individuals with BED (n = 72, 93% female) and no history of an eating disorder (NED; n = 21, 91% female) completed measures of eating disorder (ED) and general psychopathology online. Individuals with BED were categorized as having clinical or subthreshold overvaluation using two different cut-offs used in previous studies. The clinical, subthreshold, and NED groups were compared on ED and general psychopathology. The association between overvaluation and psychopathology was also assessed in the BED and NED groups.

RESULTS

The two cut-offs yielded identical results, with individuals in the clinical overvaluation group reporting greater ED psychopathology than those in the subthreshold and NED groups. When considered as a continuous variable, overvaluation was a significant predictor of both ED-related and general psychopathology.

DISCUSSION

The two cut-offs yielded identical results, likely due to the high internal consistency between overvaluation items. Under such circumstances, the use of either cut-off seems appropriate. However, given the associations reported in the regression analyses, we propose that considering overvaluation as a dimensional variable, rather than a categorical one, may have greater utility.

Appearance-based rejection sensitivity as a mediator of the relationship between symptoms of social anxiety and disordered eating cognitions and behaviors

Previous research has established a robust relationship between symptoms of social anxiety and disordered eating. However, the mechanisms that may underpin this relationship are unclear. Appearance-based rejection sensitivity (ABRS)-the tendency to anxiously expect and overreact to signs of appearance-based rejection-may be a crucial explanatory mechanism, as ABRS has been shown to maintain social anxiety symptoms and predict disordered eating. We therefore tested whether ABRS mediated the relationship between social anxiety symptoms and various indices of disordered eating (over-evaluation of weight/shape, restraint, binge eating, compulsive exercise, and vomiting). Data from community-based females (n=299) and males (n=87) were analyzed. ABRS was shown to mediate the relationship between social anxiety and the over-evaluation, restraint, binge eating, and compulsive exercise frequency, but not vomiting. These effects also occurred for both females and males separately. Findings demonstrated that ABRS may be an important mechanism explaining why socially anxious individuals report elevated symptoms of disordered eating. Future research testing all proposed mediating variables of the social anxiety-disordered eating link in a single, integrative model is required to identify the most influential mechanisms driving this relationship.

Correlates of weight-related quality of life among individuals with binge eating disorder before and after cognitive behavioral therapy

Individuals with obesity and binge eating disorder (BED) report poorer weight-related quality of life (WRQOL) compared to individuals with obesity alone. Cognitive behavioral therapy (CBT), the best available treatment for BED, does not consistently produce weight loss or improvements in weight QOL. The purpose of the current study was to examine baseline and longitudinal associations between eating-related and psychosocial variables and dimensions of weight QOL. We examined associations between predictor variables, including body mass index (BMI), eating disorder (ED) psychopathology, and psychosocial factors, in relation to three dimensions of WRQOL among 171 patients whom received CBT for BED. Participants completed interviews and self-report measures at baseline prior to CBT and at end of treatment. At baseline the following associations were significant: BMI, ED psychopathology, and self-esteem were associated with weight-related self-esteem; gender, BMI, and self-esteem were associated with weight-related public distress (i.e., stigma and worry in public because of one's weight); and age, BMI, and ED psychopathology were associated with weight-related physical function. At end of treatment, the following associations were significant: changes in ED psychopathology and coping predicted weight-related self-esteem; changes in coping and self-esteem predicted weight-related public distress; and changes in BMI and subjective binge eating predicted weight-related physical function. Overall, changes in a number of ED and associated symptoms were associated with improvements in WRQOL.

Correlates of the over-evaluation of weight and shape in binge eating disorder and mixed eating disorder samples: A meta-analytic review

This meta-analysis assessed the strength of the association between correlates of shape and weight over-evaluation across binge eating disorder and mixed eating disorder samples. Across 32 studies, over-evaluation correlates were divided into demographic, eating pathology, or psychosocial. Shape and weight over-evaluation was associated with higher eating pathology and psychosocial impairment. The method of assessment (interview versus self-report questionnaire) moderated some of the relationships. Over-evaluation was unrelated to demographics and treatment outcome. These findings highlight the importance of addressing shape and weight over-evaluation during treatment, and support the idea of using shape and weight over-evaluation as a severity specifier for binge eating disorder.

Disentangling body image: The relative associations of overvaluation, dissatisfaction, and preoccupation with psychological distress and eating disorder behaviors in male and female adolescents

OBJECTIVE

The distinctiveness and relative clinical significance of overvaluation, dissatisfaction, and preoccupation with body weight/shape remains inconclusive. This study sought to add to the evidence by testing associations between these three body image constructs and indicators of clinical significance.

METHOD

Male and female secondary students (N = 1,666) aged 12-18 years completed a survey that included measures of dissatisfaction with, overvaluation of, and preoccupation with weight/shape, psychological distress, eating disorder behaviors, and basic demographic information. Conditional process analysis was employed to test the independent and mediating effects of overvaluation, dissatisfaction, and preoccupation on distress, dietary restraint, and objective binge eating.

RESULTS

Overvaluation, dissatisfaction, and preoccupation were highly correlated (r = 0.47-0.84). In girls, preoccupation demonstrated the strongest independent and mediating effects on distress, dietary restraint, and binge eating; whereas neither the direct or indirect effects of dissatisfaction on distress and overvaluation on binge eating were significant. Among boys however, the direct and indirect effects of overvaluation, dissatisfaction, and preoccupation on distress and eating disorder behaviors were relatively equal.

DISCUSSION

Preoccupation with weight/shape may be particularly clinically significant in girls, whereas all constructs of body image disturbance may be equally clinically significant in boys. The findings are consistent with the view that these constructs, while closely related, are distinct. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:118-126).

Effects of a cognitive-behavioral exposure-based body image therapy for overweight females with binge eating disorder: a pilot study

BACKGROUND

Although not part of the diagnostic criteria of the DSM-5, body image disturbance seems to be a relevant feature of Binge Eating Disorder (BED) as well as of other eating disorders such as Anorexia Nervosa (AN) or Bulimia Nervosa (BN). Hence, the aim of the present pilot study was to assess the changeability of body image disturbance in a sample of overweight females with BED by a cognitive-behavioral treatment, directly addressing body image disturbance.

METHOD

Overweight females (N = 34) with BED were randomized to a manualized body image therapy or a waiting-list control group. The final sample consisted of n = 15 participants in the intervention group and n = 19 in the control group due to two drop-outs in the control condition. Before and after the intervention or the waiting period, respectively, participants filled out a questionnaire battery assessing several body image and eating disorder related features. To quantify the perceptual component of body image disturbance, a digital photo distortion technique based on a picture of each participant taken in a standardized suit was applied.

RESULTS

In a two-way ANOVA, significant Time × Group interactions were found for eating and shape concerns, drive for thinness, body dissatisfaction, depressiveness and low self-esteem. Follow-up t-tests indicated a significant symptom reduction of a generally high magnitude in the intervention group. No significant changes concerning body checking and the estimations of one's own "real", "felt" and "ideal" body dimensions were found.

CONCLUSION

The strong symptom reduction in the cognitive-affective component of body image disturbance indicates that an exposure-based cognitive-behavioral body image intervention is a promising treatment module for overweight females with BED, but future research with a larger sample size is needed to quantify possible changes in all components of body image.

Testing for interactive and non-linear effects of risk factors for binge eating and purging eating disorders

Almost no research has tested whether risk factors interact in the prediction of future eating disorder onset, which might suggest qualitatively distinct etiologic pathways. Accordingly, this prospective study tested for possible interactions between risk factors in the prediction of binge eating and purging eating disorders in adolescents. It also examined sex differences in pathways to risk. Two analytical approaches were used: (1) classification tree analysis (CTA), which is ideally suited to identifying non-linear interactions and the optimal cut-points for defining risk, with follow-up random forest analyses; and (2) two-way interaction terms in a series of logistic regression models. Data were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a population-based study that followed participants from pre-birth to young adulthood. This study involved 1297 adolescents (49% male), 146 (11%) of whom developed bulimia nervosa, binge eating disorder or purging disorder in late adolescence. In CTA, sex was the first and most potent predictor of eating disorder risk with females showing a 5-fold increase in risk relative to males. For males and females, weight and eating concerns were the next most potent predictor of risk and three risk groups emerged, reflecting non-linear risk. For females with intermediate weight and eating concerns, externalizing problems emerged as an additional predictor. Interaction terms in logistic regression models did not produce significant results after correcting for multiple testing. Findings advance knowledge on risk pathways to eating disorder onset, highlight non-linear risk processes, and provide cut-points for prospectively identifying high-risk youth for prevention programs.

A preliminary evaluation of the validity of binge-eating disorder defining features in a community-based sample

OBJECTIVE

Little empirical attention has been paid to the DSM-5 definition of binge-eating disorder (BED), particularly to the associated features of binge episodes. The present study sought to determine how the associated features and undue influence of weight/shape on self-evaluation contribute to evidence of a clinically significant eating disorder.

METHOD

Secondary analyses were conducted on data (N = 80; 76.3% women, 76.3% Caucasian, ages 18-43) collected through an epidemiological study of eating patterns. Descriptive statistics were used to report the sample prevalence of the features, independently and in combination. Correlations and alpha reliability were employed to examine relationships among associated features, distress regarding bingeing, and clinical diagnosis. Regression models and receiver-operating characteristic (ROC) curves were used to determine the utility of the features for explaining variance in distress.

RESULTS

Internal consistency reliability for indicators was low, and several features demonstrated low or nonsignificant associations with distress and diagnosis. Feeling disgusted/depressed/guilty was the only unique predictor of distress (p = 0.001). For the ROC curves, three features was the best threshold for predicting distress.

DISCUSSION

Results support the need to refine the features to ensure better detection of clinically significant eating pathology for research inclusion and treatment of the illness. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:524-528).

Food cravings, binge eating, and eating disorder psychopathology: Exploring the moderating roles of gender and race

OBJECTIVE

To examine the moderating effects of gender and race on the relationships among food cravings, binge eating, and eating disorder psychopathology in a community sample.

METHODS

Data were collected from a convenience sample of 320 adults (53% male; mean age 28.5±8.2years; mean BMI 27.1±5.2kg/m(2); mean education 15.1±2.2years; 64% white, 24% black, and 13% other race) participating in a cross-sectional study examining the interactions between stress, self-control and addiction. Participants completed a comprehensive assessment panel including a demographic questionnaire, the Food Craving Inventory, and Eating Disorder Examination Questionnaire. Data were analyzed using multiple logistic regression for binge eating behavior and multiple linear regression for eating disorder psychopathology.

RESULTS

Overall, food cravings demonstrated significant main effects for binge eating behavior (adjusted OR=2.65, p<.001) and global eating disorder psychopathology (B=.47±.09, p<.001). Females had a stronger relationship between food cravings and eating disorder psychopathology than males; there were no statistically significant differences by race.

CONCLUSION

These findings, based on a diverse sample recruited from the community, suggest that food cravings are associated with binge eating and eating disorder psychopathology and may represent an important target for interventions.

Shared and unique mechanisms underlying binge eating disorder and addictive disorders

Scientific interest in "food addiction" is growing, but the topic remains controversial. One critique of "food addiction" is its high degree of phenotypic overlap with binge eating disorder (BED). In order to examine associations between problematic eating behaviors, such as binge eating and "food addiction," we propose the need to move past examining similarities and differences in symptomology. Instead, focusing on relevant mechanisms may more effectively determine whether "food addiction" contributes to disordered eating behavior for some individuals. This paper reviews the evidence for mechanisms that are shared (i.e., reward dysfunction, impulsivity) and unique for addiction (i.e., withdrawal, tolerance) and eating disorder (i.e., dietary restraint, shape/weight concern) frameworks. This review will provide a guiding framework to outline future areas of research needed to evaluate the validity of the "food addiction" model and to understand its potential contribution to disordered eating.

Characteristics of binge eating disorder in relation to diagnostic criteria

The objective of this review was to examine the evidentiary basis for binge eating disorder (BED) with reference to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) diagnostic criteria for BED. A PubMed search restricted to titles and abstracts of English-language reviews, meta-analyses, clinical trials, randomized controlled trials, journal articles, and letters using human participants was conducted on August 7, 2015, using keywords that included "binge eating disorder," DSM-5, DSM-IV, guilt, shame, embarrassment, quantity, psychological, behavior, and "shape and weight concerns." Of the 257 retrieved publications, 60 publications were considered relevant to discussions related to DSM-5 diagnostic criteria and were included in the current review, and 20 additional references were also included on the basis of the authors' knowledge and/or on a review of the reference lists from relevant articles obtained through the literature search. Evidence supports the duration/frequency criterion for BED and the primary importance of loss of control and marked distress in identifying individuals with BED. Although overvaluation of shape/weight is not a diagnostic criterion, its relationship to the severity of BED psychopathology may identify a unique subset of individuals with BED. Additionally, individuals with BED often exhibit a clinical profile consisting of psychiatric (eg, mood, obsessive-compulsive, and impulsive disorders) and medical (eg, gastrointestinal symptoms, metabolic syndrome, and type 2 diabetes) comorbidities and behavioral profiles (eg, overconsumption of calories outside of a binge eating episode and emotional eating). Future revisions of the BED diagnostic criteria should consider the inclusion of BED subtypes, perhaps based on the overvaluation of shape/weight, and an evidence-based reassessment of severity criteria.

Evaluation of the DSM-5 severity indicator for binge eating disorder in a clinical sample

OBJECTIVE

This study tested the new DSM-5 severity criterion for binge eating disorder (BED) based on frequency of binge-eating in a clinical sample. This study also tested overvaluation of shape/weight as an alternative severity specifier.

METHOD

Participants were 834 treatment-seeking adults diagnosed with DSM-5 BED using semi-structured diagnostic and eating-disorder interviews. Participants sub-grouped based on DSM-5 severity levels and on overvaluation of shape/weight were compared on demographic and clinical variables.

RESULTS

Based on DSM-5 severity definitions, 331 (39.7%) participants were categorized as mild, 395 (47.5%) as moderate, 83 (10.0%) as severe, and 25 (3.0%) as extreme. Analyses comparing three (mild, moderate, and severe/extreme) severity groups revealed no significant differences in demographic variables or body mass index (BMI). Analyses revealed significantly higher eating-disorder psychopathology in the severe/extreme than moderate and mild groups and higher depression in moderate and severe/extreme groups than the mild group; effect sizes were small. Participants characterized with overvaluation (N = 449; 54%) versus without overvaluation (N = 384; 46%) did not differ significantly in age, sex, BMI, or binge-eating frequency, but had significantly greater eating-disorder psychopathology and depression. The robustly greater eating-disorder psychopathology and depression levels (medium-to-large effect sizes) in the overvaluation group was observed without attenuation of effect sizes after adjusting for ethnicity/race and binge-eating severity/frequency.

CONCLUSIONS

Our findings provide support for overvaluation of shape/weight as a severity specifier for BED as it provides stronger information about the severity of homogeneous groupings of patients than the DSM-5 rating based on binge-eating.

Genetics and Epigenetics of Eating Disorders

Eating disorders (EDs) are serious psychiatric conditions influenced by biological, psychological, and sociocultural factors. A better understanding of the genetics of these complex traits and the development of more sophisticated molecular biology tools have advanced our understanding of the etiology of EDs. The aim of this review is to critically evaluate the literature on the genetic research conducted on three major EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). We will first review the diagnostic criteria, clinical features, prevalence, and prognosis of AN, BN, and BED, followed by a review of family, twin, and adoption studies. We then review the history of genetic studies of EDs covering linkage analysis, candidate gene association studies, genome-wide association studies, and the study of rare variants in EDs. Our review also incorporates a translational perspective by covering animal models of ED-related phenotypes. Finally, we review the nascent field of epigenetics of EDs and a look forward to future directions for ED genetic research.

Evaluation of the DSM-5 severity indicator for binge eating disorder in a community sample

Research has examined various aspects of the diagnostic criteria for binge-eating disorder (BED) but has yet to evaluate the DSM-5 severity criterion. This study examined the DSM-5 severity criterion for BED based on binge-eating frequency and tested an alternative severity specifier based on overvaluation of shape/weight. 338 community volunteers categorized with DSM-5 BED completed a battery of self-report instruments. Participants were categorized first using DSM-5 severity levels and second by shape/weight overvaluation and were compared on clinical variables. 264 (78.1%) participants were categorized as mild, 67 (19.8%) as moderate, 6 (1.8%) as severe, and 1 (0.3%) as extreme. Analyses comparing mild and moderate severity groups revealed no significant differences in demographic variables or BMI; the moderate severity group had greater eating-disorder psychopathology (small effect-sizes) but not depression than the mild group. Participants with overvaluation (N = 196; 60.1%) versus without (N = 130; 39.9%) did not differ significantly in age, sex, BMI, or binge-eating frequency. The overvaluation group had significantly greater eating-disorder psychopathology and depression than the non-overvaluation group. The greater eating-disorder and depression levels (medium-to-large effect-sizes) persisted after adjusting for ethnicity/race and binge-eating severity/frequency, without attenuation of effect-sizes. Findings from this non-clinical community sample provide support for overvaluation of shape/weight as a specifier for BED as it provides stronger information about severity than the DSM-5 rating based on binge-eating. Future research should include treatment-seeking patients with BED to test the utility of DSM-5 severity specifiers and include broader clinical validators.

Prospective association between overvaluation of weight and binge eating among overweight adolescent girls

PURPOSE

We investigated whether overvaluation of weight, defined as having a high degree of concern with weight such that it unduly influences self-evaluation, was prospectively associated with binge eating onset among overweight adolescent girls and whether overvaluation of weight signaled greater impairment among those with weekly binge eating.

METHODS

We used generalized estimating equations to assess the prospective association between weight overvaluation at Time 1 and the onset of weekly binge eating at Time 2 among 767 overweight adolescent girls (ages 12-18 years) participating in the Growing Up Today Study. In a cross-sectional analysis of overweight girls with weekly binge eating at Time 2, we examined whether overvaluation of weight was associated with greater impairment assessed by examining their rates of more severe depressive symptoms and low subjective social status.

RESULTS

At Time 1, 24.5% of overweight/obese girls overvalued weight. Overweight girls who overvalued weight were more likely to have started binge eating weekly 2 years later (odds ratio, 2.9; 95% confidence interval [CI], 1.2-7.3). Among overweight girls who reported weekly binge eating at Time 2, those who overvalued weight were at greater risk of having more severe depressive symptoms (odds ratio, 10.4; 95% CI, 1.3-85.6). Also among girls with weekly binge eating at Time 2, we saw a significant association between continuous measures of overvaluation and subjective social status (β, .71; 95% CI, .08-1.34) but not in analyses using binary measures.

CONCLUSIONS

We found that overvaluation was associated with the development of weekly binge eating in overweight girls and with greater impairment among those with weekly binge eating.

Risk factors for binge eating and purging eating disorders: differences based on age of onset

OBJECTIVE

To (1) determine whether childhood risk factors for early onset binge eating and purging eating disorders also predict risk for later-onset binge eating and purging disorders, and (2) compare the utility of childhood and early adolescent variables in predicting later-onset disorders.

METHOD

Participants (N = 1,383) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed when participants were aged 14, 17, and 20. Risk factors for early onset eating disorders have been reported previously (Allen et al., J Am Acad Child Psychiat, 48, 800-809, 2009). This study used logistic regression to determine whether childhood risk factors for early onset disorders, as previously identified, would also predict risk for later-onset disorders (n = 145). Early adolescent predictors of later-onset disorders were also examined.

RESULTS

Consistent with early onset cases, female sex and parent-perceived child overweight at age 10 were significant multivariate predictors of binge eating and purging disorders with onset in later adolescence. Eating, weight, and shape concerns at age 14 were also significant in predicting later-onset disorders. In the final stepwise multivariate model, female sex and eating, weight, and shape concerns at age 14 were significant in predicting later-onset eating disorders, while parent-perceived child overweight at age 10 was not.

DISCUSSION

There is overlap between risk factors for binge eating and purging disorders with early and later onset. However, childhood exposures may be more important for early than later onset cases.

Health related quality of life, physical fitness and physical activity participation in treatment-seeking obese persons with and without binge eating disorder

This study compared the mental and physical health related quality of life (HRQL) of 40 obese persons with BED with 20 age, gender and body mass index (BMI) matched obese persons without BED and 40 age and gender matched non-obese volunteers. Variables contributing to the variability in HRQL were identified. Participants were asked to fill in the MOS 36-item Short Form Health Survey (SF-36), the Symptoms Checklist-90 (SCL-90), the Baecke questionnaire, the bulimia subscale of the Eating Disorder Inventory and the Body Attitude Test. All participants also performed a 6-minute walk test (6MWT). BED patients showed a significant impaired physical and mental HRQL compared with obese and non-obese control groups. In the BED-group female participants showed a significantly more impaired mental HRQL than male participants (40.0±21.2 versus 66.6±10.1). The distance achieved on the 6MWT (512.1±75.8m) explained 22.5% of the variability in physical HRQL in the obese BED-group while gender and the SCL-90 depression score (39.1±12.2) explained 47.1% of the variability in mental HRQL. The present findings suggest that the treatment of obese individuals with BED might benefit by giving more attention to HRQL, depressive symptoms and physical fitness.

Disordered eating links to body-relevant and body-irrelevant influences on self-evaluation

We investigated eating- and weight-related correlates of self-evaluation influences (SEIs) and examined the extent to which such SEIs can be both over- and undervalued and the extent to which measurement strategy affects SEIs. A female undergraduate sample (n = 549) completed 3 measures of SEI importance and questionnaires assessing disordered eating (DE), body mass index (BMI), and depression. SEI measures included Likert scale, rank ordering, and pairwise forced choice; a subset (n = 62) also completed the Shape- and Weight-Based Self-Esteem Scale (SAWBS). Only rank ordering, forced choice, and SAWBS constrain choices among SEIs, such that prioritizing one SEI necessarily deprioritizes another, which reflects real-world restrictions on individuals' allotment of time and energy (e.g., spending hours exercising daily necessarily reduces time available for other activities). By any measure, women with DE overvalue body shape and weight. The constraining measures reveal systematic undervaluation of intelligence and achievement among women with DE and an enhanced effect of DE on the overvaluation of weight and on the undervaluation of being a good person among those with higher BMI. Depressed women's self-evaluations overemphasize appearance and underemphasize interpersonal relationships. Self-evaluations of women with DE are marked by both over- and undervaluation of relevant SEIs; the overvaluation of shape and weight in DE may be associated with costs. Future use of constraining measures, such as forced choice or rank ordering, may enhance our understanding of both over- and underemphasized SEIs among women with DE.

Eating disorder examination-questionnaire factor structure and construct validity in bariatric surgery candidates

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.

Predictive significance of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up

BACKGROUND

Undue influence of body shape or weight on self-evaluation - referred to as overvaluation - is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating disorder (BED). This study examined the concurrent and predictive significance of overvaluation of shape/weight in obese patients with BED participating in a randomized clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL). Method A total of 90 participants were randomly assigned to 6-month group treatments of CBT or BWL. Assessments were performed at baseline, throughout- and post-treatment, and at 6- and 12-month follow-ups after completing treatments with reliably administered semi-structured interviews and established measures.

RESULTS

Participants categorized with overvaluation (n = 52, 58%) versus without overvaluation (n = 38, 42%) did not differ significantly in demographic features (age, gender and ethnicity), psychiatric co-morbidity, body mass index or binge eating frequency. The overvaluation group had significantly greater levels of eating disorder psychopathology and poorer psychological functioning (higher depression and lower self-esteem) than the non-overvaluation group. Overvaluation of shape/weight significantly predicted non-remission from binge eating and higher frequency of binge eating at the 12-month follow-up, even after adjusting for group differences in depression and self-esteem levels.

CONCLUSIONS

Our findings suggest that overvaluation does not simply reflect concern commensurate with being obese or more frequent binge eating, but also is strongly associated with heightened eating-related psychopathology and psychological distress, and has negative prognostic significance for longer-term treatment outcomes. Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED as it provides important information about severity and treatment outcome.