The prevalence of binge eating disorder and its relationship to work and classroom productivity and activity impairment

"If You Don't Eat, You Can Get Drunk Faster": A Qualitative Investigation of Food and Alcohol Disturbance (FAD) Expectancies

Background: Food and alcohol disturbance (FAD; i.e., use of any compensatory behavior within the context of a drinking episode to offset alcohol-related calories and/or enhance the effects of alcohol) is prevalent among U.S. college students and associated with negative consequences. Expectancies for anticipated outcomes of alcohol use and thinness/restriction behaviors, which comprise FAD, serve as promising targets of intervention for these behaviors individually; however, no study to date has identified or examined FAD expectancies, specifically. Objectives: The purpose of this study was to qualitatively examine the positive and negative FAD expectancies described by students experienced with FAD. Methods: Semi-structured open-ended interviews were conducted with 22 undergraduates with a lifetime history of FAD behavior (72.7% female, 77.3% white non-Hispanic, Mage=20.14). Results: Positive FAD expectancy themes included: Mood Improvement, Appearance/Weight-related Benefits, Alcohol Enhancement, and Social Approval and Connectedness. Negative FAD expectancy themes included: Reputational and Social Concerns, Negative Physical Consequences, Negative Psychological Consequences, and Cognitive and Behavioral Impairment. Conclusions: Results suggest that while there are many similarities, FAD expectancies are distinct from existing alcohol and thinness/restriction expectancies. Specifically, the Mood Improvement theme conceptualizes mood-related improvement within the context of both positive and negative reinforcement and both the Social Approval and Connectedness and Social and Reputational Consequences themes focus on the ways in which one's peers may view and interact with others. Findings lay the groundwork for identifying expectancies that underlie FAD behaviors and provide directions for future research and intervention efforts.

A systematic review with meta-analyses of the relationship between recurrent binge eating and sleep parameters

BACKGROUND

Sleep problems are known to compound the negative effects of other health issues, such as eating disorders and the associated behavior of binge eating. Previous studies suggested associations between binge eating and sleep problems, but the strength of the relationship is unknown.

METHODS

We conducted a systematic review with meta-analyses examining the relationship between binge eating and sleep parameters. We searched for studies in Scopus, PubMed, and PsycInfo. The quality of evidence, including risk of bias, was assessed with adaptations of the Newcastle-Ottawa Scale and the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies, depending on study design. Data was synthesized as the difference in sleep between people who did or did not have binge eating.

RESULTS

Thirty-one reports of studies met our eligibility criteria. Results are presented in 12 meta-analyses. In the 7 reports of studies (with 4448 participants) that assessed poor overall sleep quality, we found poorer overall sleep quality in people with binge eating compared to people without binge eating, with a standardized mean difference of 0.77 (95% confidence interval [CI] 0.61-0.92; P < 0.001), which is a large effect size. In addition, we found evidence that people with binge eating had significantly greater hypersomnia/daytime sleepiness (7 reports of studies with 4370 participants), insomnia (5 reports of studies with 12,733 participants), and difficulty falling asleep (3 reports of studies with 4089 participants) compared to people without binge eating, with moderate effect sizes (standardized mean differences of 0.57-0.66).

CONCLUSIONS

People with binge eating exhibit poorer overall sleep quality compared to people without binge eating, and may also exhibit greater hypersomnia/daytime sleepiness, insomnia, and difficulty falling asleep. It is recommended that healthcare professionals routinely screen for poor overall sleep quality when treating people with binge eating-and address sleep difficulties when present.

Development and validation of a measure of curvy ideals internalization

Several sociocultural female body ideals exist - thin, muscular/athletic, and, more recently, curvier ideals, which research specifically suggests are more prevalent among Black women. Two validated measures assess women's desire for curvier bodies, but neither assess certain facets of curvy ideals (e.g., thick vs. slim-thick) separately. We developed and validated the Curvy Ideals Internalization (CII) Scale, to be used alone or alongside existing measures of appearance ideal internalization. Focus groups among racially/ethnically diverse women informed initial items. A sample of 897 White (37.1%), Black (34.2%), and biracial Black and White (28.7%) U.S. women completed the initial 37-item CII to determine factor structure, narrow the item pool, and examine validity and reliability. A separate sample (N = 366) of U.S. Black, White, and biracial women completed the CII to confirm the factor structure. The final CII has eleven items, with factors assessing thick/curvy ideal internalization and facets of slim-thick ideal internalization: thin waist and large breast size. The CII has adequate internal consistency, test-retest reliability, construct validity, and factorial validity. The CII is appropriate for use among Black, White, and biracial women to assess internalization of curvier body ideals and needs to be validated in more diverse samples.

Relationship between college lifestyle variables, eating disorder education, and eating disorder risk

Objective: This study examined relationships between eating disorder risk (EDR), lifestyle variables (e.g., exposure to healthy eating media), and differences among male and female college students. Participants: College students (N = 323) completed survey questionnaires (Fall, 2016). Fifty-three participants retook the survey at a later time. Methods: Participants completed a survey measuring EDR using EDI-3 subscales and 10 college lifestyle variables. Female and male EDR and Time 1 and Time 2 EDR were compared. Relationships between EDR and college life-style variables were examined. Results: Exercise, fewer daily meals, less face-to-face interactions, more digital interactions, less exposure to healthy eating media, and having conversations about body image were associated with EDR risk. Male college students showed an increase in EDR over time. Conclusions: Several lifestyle factors predicted EDR in college females and males. These lifestyle factors are modifiable and may be addressed by colleges during orientation and within the campus environment.

Cost-of-illness for non-underweight binge-eating disorders

PURPOSE

This study examined economic costs associated with untreated eating disorders (EDs) characterised by regular binge eating in the absence of low weight. Both direct and indirect costs were assessed, reporting a limited societal perspective of economic impact as some costs were not included.

METHODS

One hundred and twenty six adults seeking treatment for recurrent binge eating were asked to report impairment associated with an ED. Costs were calculated using 2017 prices, including an examination of variables associated with costs.

RESULTS

Estimated societal costs for the year preceding assessment were £3268.47 (€3758.54) per person. In multivariate analyses, no reliable baseline associates of cost were identified.

CONCLUSION

The economic burden of EDs characterised by regular binge eating is significant, and underscores the need for efficacious and cost-effective treatments. Individuals with binge-eating disorders report work impairment and healthcare use that may cost the United Kingdom economy upwards of £3.5 billion (€4bn) per annum. Further studies should consider academic impairment and the economic impact of EDs on families.

LEVEL OF EVIDENCE

III: evidence obtained from well-designed cohort or case-control analytic studies.

Relationships between patterns of technology-based weight-related self-monitoring and eating disorder behaviors among first year university students

OBJECTIVE

To identify patterns of technology-based weight-related self-monitoring (WRSM) and assess associations between identified patterns and eating disorder behaviors among first year university students.

METHODS

First year university students (n = 647) completed a web-based survey to assess their use of technology-based WRSM and eating disorder behaviors. The cross-sectional data were analyzed using gender-stratified latent class analysis to identify patterns of WRSM, followed by logistic regression to calculate the predicted probability of eating disorder behaviors for each pattern of WRSM.

RESULTS

Technology-based WRSM is common among first year university students, with patterns of WRSM differing by student gender. Further, unique patterns of WRSM were associated with differing probability of engaging in eating disorder behaviors. For example, compared to the 67.0% of females who did not use technology-based WRSM, females engaging in high amounts of technology-based WRSM (33.0%) were more likely to report fasting, skipping meals, excessively exercising, and using supplements. Among males, those who reported all forms of WRSM (9.5%) were more likely to report fasting, skipping meals, purging, and using supplements but those who only used exercise self-monitoring (11.9%) did not have increased likelihood of eating disorder behaviors.

CONCLUSIONS

Using multiple forms of technology-based WRSM is associated with increased likelihood of engaging in eating disorder behaviors among both female and male, first year university students. Assessing technology-based WRSM may be a simple method to screen for elevated eating disorder risk among first year students.

Attention-deficit hyperactivity disorder symptomatology, binge eating disorder symptomatology, and body mass index among college students

Objective: To explore the relationship between symptoms of attention-deficit hyperactivity disorder (ADHD), symptoms of binge eating disorder, and body mass index (BMI) among students at a southern university. Participants: Two hundred seventy-seven college students. Methods: Between January 31, 2013 and March 27, 2013, participants completed the Adult ADHD Self-Report Scale (ASRS) Screener and the Binge Eating Scale (BES) in addition to permitting researchers to measure their height and weight. Results: Higher ASRS scores, higher BMIs, and lower BES scores were observed among men. Among both men and women, BES scores were positively correlated with BMI and ASRS scores; however, the correlation between ASRS and BMI was not significant. Conclusion: Binge eating disorder symptomatology was associated with increased ADHD symptomatology and a higher BMI among both men and women. Among students presenting with obesity or ADHD, screening for binge eating may assist with the identification of problematic eating behaviors.

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

OBJECTIVES

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

RESULTS

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

CONCLUSIONS

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

A study on the interplay between emerging adulthood and eating disorder symptomatology in young adults

PURPOSE

The primary aim of this study was to investigate the interplay between Arnett's five features of emerging adulthood and ED symptomatology. The secondary aim of the study was to investigate possible gender differences concerning the relation between emerging adulthood and ED symptomatology.

METHODS

337 university students (252 females and 85 males) participated in this study. Each participant was asked to anonymously complete the following questionnaires: Inventory of the Dimensions of Emerging Adulthood (IDEA), Eating Attitudes Test (EAT-26), and Social Physique Anxiety Scale (SPAS).

RESULTS

The female group scored higher in the EAT-26 diet, SPAS, IDEA self-focus and IDEA total score measurements. Additionally, in the female group, identity exploration was correlated with EAT-26 total and bulimia, experimentation/possibilities with EAT-26 total and diet, and negativity/instability with EAT-26 total, diet and bulimia as well as SPAS score. In the male groups, the only significant correlation was between SPAS and instability/negativity. Finally, identity exploration could predict a higher probability of developing ED (EAT ≥ 20) for both the female and male groups.

CONCLUSIONS

Emerging adulthood and ED were found to have a close relationship, especially for females. Identity exploration was the emerging adulthood factor that showed the highest relation to ED symptomatology in both the male and female groups. More research is necessary to investigate the specifics of this relationship.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Determinants of binge eating disorder among normal weight and overweight female college students in Korea

PURPOSE

The aim of the present study was to describe the clinical features of binge eating disorder (BED) in normal weight and overweight undergraduate Korean women.

METHODS

117 overweight (BMI ≥ 25 kg/m²) and 346 normal weight (18 kg/m² ≤ BMI < 25 kg/m²) undergraduate Korean women completed questionnaires to assess for BED. Their emotional eating behaviors, binge eating-related behaviors, a spectrum of compulsive behaviors such as substance abuse and obsessive-compulsive disorder, and psychological profiles were evaluated through personal interviews and questionnaires. The features of those with BED were compared to those without BED in the overweight and normal weight groups.

RESULTS

Both normal weight and overweight BED women had higher levels of functional impairment, eating disorder psychopathology including emotional and external eating behaviors, and neuroticism than their non-BED counterparts. In the normal weight group, BED women had more frequent alcohol consumption and obsessive-compulsive symptoms than non-BED women. In the overweight group, BED women had higher levels of depression and lower extraversion than non-BED women.

CONCLUSIONS

BED is associated with global functional impairment and mental health problems. Thus, the association with high functional impairments and psychiatric comorbidities suggest that people with BED may benefit from treatment.

LEVEL III

Evidence obtained from well-designed case-control analytic studies, from more than one center.

Universal prevention efforts should address eating disorder pathology across the weight spectrum: Implications for screening and intervention on college campuses

PURPOSE

Given shared risk and maintaining factors between eating disorders and obesity, it may be important to include both eating disorder intervention and healthy weight management within a universal eating disorder care delivery program. This study evaluated differential eating disorder screening responses by initial weight status among university students, to assess eating disorder risk and pathology among individuals with overweight/obesity versus normal weight or underweight.

METHODS

1529 individuals were screened and analyzed. Screening was conducted via pilot implementation of the Internet-based Healthy Body Image program on two university campuses.

RESULTS

Fifteen percent of the sample had overweight/obesity. Over half (58%) of individuals with overweight/obesity screened as high risk for an eating disorder or warranting clinical referral, and 58% of individuals with overweight/obesity endorsed a ≥10-pound weight change over the past year. Compared to individuals with normal weight or underweight, individuals with overweight/obesity were more likely to identify as Black, endorse objective binge eating and fasting, endorse that eating disorder-related concerns impaired their relationships/social life and made them feel badly, and endorse higher weight/shape concerns.

CONCLUSIONS

Results suggest rates of eating disorder pathology and clinical impairment are highest among students with overweight/obesity, and targeted intervention across weight categories and diverse races/ethnicities is warranted within universal eating disorder intervention efforts. Integrating eating disorder intervention and healthy weight management into universal prevention programs could reduce the incidence and prevalence of eating disorders, unhealthy weight control practices, and obesity among university students.

Binge Eating Disorder and Bipolar Spectrum disorders in obesity: Psychopathological and eating behaviors differences according to comorbidities

BACKGROUND

Obesity is not a mental disorder, yet DSM-5 recognizes a strong association between obesity and psychiatric syndromes. Disorders within the Bipolar Spectrum (BSD) and Binge Eating Disorder (BED) are the most frequent psychiatric disorders among obese patients. The aim of this research is to investigate the psychopathological differences and the distinctive eating behaviors that accompany these comorbidities in obese patients.

METHODS

One hundred and nineteen obese patients (40 males; 79 females) underwent psychological evaluation and psychiatric interview, and a dietitian evaluated their eating habits. Patients were divided into four groups according to comorbidities, and comparisons were run accordingly.

RESULTS

Forty-one percent of participants presented BED+BSD comorbidity (Group 1), 21% BED (Group 2) and 8% BSD (Group 3); only 29% obese participants had no comorbidity (Group 4). Female gender was overrepresented among Groups 1 and 2. BSD diagnosis varied according to comorbidities: Type II Bipolar Disorder and Other Specified and Related Bipolar Disorder (OSR BD) were more frequent in Group 1 and Type I Bipolar Disorder in Group 3. A trend of decreasing severity in eating behaviors and psychopathology was evident according to comorbidities (Group 1=Group2>Group3>Group 4).

LIMITATIONS

Limitations include the small sample size and the cross-sectional design of the study.

CONCLUSIONS

BED and BSD are frequent comorbidities in obesity. Type II Bipolar Disorder and OSR BD are more frequent in the group with double comorbidity. The double comorbidity seems associated to more severe eating behaviors and psychopathology. Distinctive pathological eating behaviors could be considered as warning signals, symptomatic of psychiatric comorbidities in Obesity.

Sleep and Eating Disorders

Insomnia is related to an increased risk of eating disorders, while eating disorders are related to more disrupted sleep. Insomnia is also linked to poorer treatment outcomes for eating disorders. However, over the last decade, studies examining sleep and eating disorders have relied on surveys, with no objective measures of sleep for anorexia nervosa or bulimia nervosa, and only actigraphy data for binge eating disorder. Sleep disturbance is better defined for night eating syndrome, where sleep efficiency is reduced and melatonin release is delayed. Studies that include objectively measured sleep and metabolic parameters combined with psychiatric comorbidity data would help identify under what circumstances eating disorders and sleep disturbance produce an additive effect for symptom severity and for whom poor sleep would increase risk for an eating disorder. Cognitive behavior therapy for insomnia may be a helpful addition to treatment of those with both eating disorder and insomnia.