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Yan WS, Liu SJ, Liu MM. Validation and Psychometric Properties of the Chinese Version of the Binge Eating Scale in Young Adults. Psychol Res Behav Manag 2024; 17:1611-1624. [PMID: 38628983 PMCID: PMC11020360 DOI: 10.2147/prbm.s456275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024] Open
Abstract
Background Although structured clinical interviews are considered the gold standard for assessing binge eating disorder (BED), the self-administered Binge Eating Scale (BES) has been widely used as a screening tool for BED in clinical research. However, the psychometric properties of the BES among Chinese young adults remain unclear. This study aimed to examine the validity of a Chinese version of the BES with a large sample. Methods A total of 2182 young adult college students were tested using the Simplified Chinese version of BES (SCBES), the 7-Item Binge-Eating Disorder Screener (BEDS-7), the Zung Self-Rating Depression Scale (SDS), the Generalized Anxiety Disorder Scale (GAD-7), and the Dual-Modes of Self-Control Scale (DMSC). The frequency of objective binge-eating episodes was used as a measure of severity. Validity and reliability of the SCBES were assessed through multiple analyses, along with the item analysis. Results The data revealed that the SCBES demonstrated reasonable reliability and validity. The Cronbach's α value was 0.813, with a one-month test-retest reliability of 0.835. The exploratory factor analysis (EFA) extracted three first-order factors, which explained a total of 53.82% of the variance. The confirmatory factor analysis (CFA) confirmed the three-factor model (ie, Binge-eating behaviors, Lack of control, Negative affects related to overeating), with a good model fit. The SCBES also demonstrated excellent concurrent and criterion validity, significantly correlating with the BEDS-7 and frequency of objective binge-eating episodes (r=0.760-0.782, p<0.001). Gender, body mass index, depression, anxiety, impulsivity, and self-control were significantly associated with the total score of SCBES. Conclusion The SCBES demonstrated sound psychometric properties and exhibited good cross-cultural adaptability in Chinese young adults, with a novel three-factor model fitting the data best. This scale could serve as a useful screening tool for identifying the severity of binge eating behaviors among Chinese youths.
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Affiliation(s)
- Wan-Sen Yan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, People’s Republic of China
- Guizhou Research Institute for Health Development, Guizhou Medical University, Guiyang, People’s Republic of China
| | - Su-Jiao Liu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, People’s Republic of China
| | - Meng-Meng Liu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, People’s Republic of China
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Yan HY, Lin FG, Tseng MCM, Fang YL, Lin HR. The psychometric properties of Binge Eating Scale among overweight college students in Taiwan. J Eat Disord 2023; 11:47. [PMID: 36964612 PMCID: PMC10039566 DOI: 10.1186/s40337-023-00774-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The Binge Eating Scale (BES) is a widely used measuring tool to assess binge eating problems in Western countries. However, the psychometric properties of such scales among cross-cultural youth groups are insufficient, and the factor structure continues to be debated; therefore, further research is needed. The aim of this study was to examine the properties of BES among overweight college students in Taiwan. METHODS A cross-sectional design and convenience sampling were adopted to recruit 300 overweight students from five universities. A translated Traditional Chinese version of BES was used for the survey, and the validity of the scale was tested using the Confirmatory Factor Analysis (CFA) and Bulimic Investigatory Test, Edinburgh (BITE). The reliability was evaluated using internal consistency and test-retest reliability. RESULTS The CFA results showed a reasonable model fit. The first-order two-factor model was consistent with that of the original BES and significantly correlated with the criterion of BITE score. Cronbach's α value, representing internal consistency reliability, and the intraclass correlation coefficient of repeated measures made one month apart were both 0.83, indicating good reliability and stability. Significant correlations were observed between the BES score and sex and BMI; however, no correlation was observed between BES scores and age. CONCLUSION The BES presents sound psychometric properties, has good cross-cultural applicability, and can be used as a first-line screening tool by mental health professionals to identify the severity of binge eating behavior among overweight college students in Taiwan. It is recommended that participant diversity and obesity indicators be incorporated into the scale in the future to establish a universal psychometric tool.
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Affiliation(s)
- Huey-Yeu Yan
- PhD Program, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, 112303, Taiwan
- Department of Nursing, University of Kang Ning, Taipei City, 114311, Taiwan
| | - Fu-Gong Lin
- Department of Optometry, Asia University, Taichung, 413305, Taiwan
| | - Mei-Chih Meg Tseng
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110301, Taiwan
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235041, Taiwan
- Department of Psychiatry, National Taiwan University College of Medicine, Taipei City, 100233, Taiwan
| | - Yue-Lin Fang
- Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No.95, Wenchang Rd., Shilin Dist., Taipei City, 111045, Taiwan.
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Rd., Beitou Dist., Taipei City, 112303, Taiwan.
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Yan HY, Liu CY, Tseng MCM, Lee TY, Mu PF, Lin HR. Severity of Binge Eating Behavior among Overweight College Students in Taiwan and Associated Factors. Healthcare (Basel) 2023; 11:338. [PMID: 36766913 PMCID: PMC9914246 DOI: 10.3390/healthcare11030338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Binge eating (BE) is considered a marker of obesity and overweight and a significant characteristic of feeding and eating disorders. Despite the high prevalence of obesity on college campuses, the issue of BE among college students in Taiwan has received little attention. The aim of this study was to investigate BE behavior among overweight college students in Taiwan and associated factors. METHODS This study utilized a cross-sectional survey. A total of 300 overweight college students were recruited through convenience sampling. Data were collected using a self-administered Binge Eating Scale (BES) and a body weight composition monitor (Model No. OMRON, HBF-126) and analyzed using descriptive statistics, correlation analysis, and regression analysis. RESULTS The average BES score was 10.67 (SD = 6.66, 0-34). With a BES score of 17 as the cut-off point, 17.3% (n = 52) of the participants were found to have moderate or severe BE behavior. Analysis of the demographic and psychosocial data using Spearman's rho rank correlation coefficient revealed that sex, body mass index (BMI), uncontrolled eating, weight loss diets, academic stress, peer competition, interpersonal distress, and unpleasant or major life events were significantly correlated with BE behavior and its probability (rs = -0.14-0.15, p < 0.05). Furthermore, logistic regression analysis indicated that the odds ratio of the BES scores of female participants and those who stated to have experienced uncontrolled eating, weight loss diets, peer competition, and interpersonal distress was 1.05-6.04 times those of male participants and those without such experiences (p < 0.05). CONCLUSION The study found that nearly one-fifth of participants presented moderate to severe levels of BE behaviors, and these were significantly correlated with sex and external environmental stress. This study suggests early intervention from campus psychological health personnel to provide proper therapy.
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Affiliation(s)
- Huey-Yeu Yan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
- Department of Nursing, University of Kang Ning, Taipei City 114311, Taiwan
| | - Chieh-Yu Liu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
| | - Mei-Chih Meg Tseng
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110301, Taiwan
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Tzu-Ying Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
| | - Pei-Fan Mu
- School of Nursing, National Yang Ming Chiao Tung University, Taipei City 112304, Taiwan
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
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Mina A, Hallit S, Rogoza R, Obeid S, Soufia M. Binge eating behavior in a sample of Lebanese Adolescents: Correlates and Binge Eating Scale validation. J Eat Disord 2021; 9:134. [PMID: 34670627 PMCID: PMC8527281 DOI: 10.1186/s40337-021-00493-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Anthony Mina
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Radoslaw Rogoza
- Institute of Psychology, Cardinal Stefan Wyszyński University, Wóycickiego 1/3, 01-938, Warsaw, Poland
| | - Sahar Obeid
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Michel Soufia
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
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Simoes E, Correia-Lima J, Calfat ELDB, Otani TZDS, Vasques DAC, Otani VHO, Bertolazzi P, Kochi C, Seelaender M, Uchida RR. Sex-Dependent Dyslipidemia and Neuro-Humoral Alterations Leading to Further Cardiovascular Risk in Juvenile Obesity. Front Nutr 2021; 7:613301. [PMID: 33644105 PMCID: PMC7906975 DOI: 10.3389/fnut.2020.613301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/21/2020] [Indexed: 01/21/2023] Open
Abstract
Objective: Childhood obesity is a growing concern as the World Health Organization (WHO) states that ~10% of adolescents worldwide are overweight or obese. This condition is the reflex of energy imbalance between the calories consumed and those expended. Sex-related responses associated with dyslipidemia, hormonal alterations, and neuro-humoral disruptions in childhood obesity are the focus of the present investigation. Methods: Ninety-two Brazilian adolescents were enrolled and divided between obese and eutrophic groups. Obesity was assessed using body mass index Z-score according to age and weight. Anthropometrical analyses, blood pressure, blood lipids, metabolism-regulating hormones, and neuropeptides were carried out. Results: Systolic blood pressure was higher in female and male patients with obesity. Obese females presented alterations in lipid profile and an augment of cardiovascular disease prediction ratios TC/HDL, TG/HDL, LDL/HDL, and VLDL/HDL. The levels of leptin, GIP, and neuropeptide showed sex-dimorphism in obesity. The obese adolescents presented increased levels of circulating insulin, c-peptide, amylin, glucagon, and GLP-1. Correlation analysis showed significant linearity between body mass index, blood pressure, lipids, lipoproteins, hormones, and neuropeptides content. Conclusions: Our data support an existing link associating hypertension, dyslipidemia, and neuro-hormonal imbalance in childhood obesity. We also described a sex-dependent pattern in childhood obesity-associated dyslipidemia and blood pressure in female patients with obesity solely.
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Affiliation(s)
- Estefania Simoes
- Cancer Metabolism Research Group, University of São Paulo, São Paulo, Brazil
| | - Joanna Correia-Lima
- Cancer Metabolism Research Group, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Pamela Bertolazzi
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Cristiane Kochi
- Physiology Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Marilia Seelaender
- Cancer Metabolism Research Group, University of São Paulo, São Paulo, Brazil.,Faculdade de Medicina, University of São Paulo, São Paulo, Brazil.,Laboratórios de Inventigação Médica 26, Hospital das Clínicas of the University of São Paulo, São Paulo, Brazil
| | - Ricardo Riyoiti Uchida
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Norberg MM, Handford CM, Magson NR, Basten C. Reevaluating Cue Exposure and Response Prevention in a Pilot Study: An Updated Treatment for Binge Eating Disorder. Behav Ther 2021; 52:195-207. [PMID: 33483117 DOI: 10.1016/j.beth.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022]
Abstract
Approximately half of individuals with binge eating disorder (BED) fail to improve when treated with cognitive behavioral therapy; thus, better treatments are needed. Cue exposure and response prevention (CERP) may be one option, but its full potential for reducing binge eating remains unknown because prior applications for binge eating have not utilized the broad range of strategies believed to optimize exposure therapy. The current single-subject AB design investigated the acceptability and effectiveness of a comprehensive CERP treatment among 8 women who met DSM-5 criteria for binge eating disorder. Changes in the number of binges were measured from baseline to the end of treatment, and desire to eat, salivation, and idiographic expectancies of aversive outcomes to food-cue exposure (idiographic CS-US expectancies), including expectancies about ability to tolerate distress when exposed to food cues were measured across the course of treatment. Statistical analysis revealed a significant reduction in the number of binges from baseline to the end of treatment. Across the course of treatment, desire to eat and idiographic CS-US expectancies reduced, and distress tolerance expectancies increased. No participants dropped out and all reported being maximally satisfied with the treatment. Based on these findings, future randomized-control trials with larger samples should examine the efficacy of CERP and mechanisms underlying change with the aim of establishing a more effective treatment for binge eating disorder.
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Swarna Nantha Y, Kalasivan A, Ponnusamy Pillai M, Suppiah P, Md Sharif S, Krishnan SG, Samy Pullay S, Osman NA. The validation of the Malay Yale Food Addiction Scale 2.0: factor structure, item analysis and model fit. Public Health Nutr 2020; 23:402-409. [PMID: 31538554 PMCID: PMC10200618 DOI: 10.1017/s1368980019002684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/27/2019] [Accepted: 06/14/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The development of a second version of the Yale Food Addiction Scale (YFAS) coincides with the latest updates in the diagnosis of addiction as documented in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The objective of the present study was to translate the YFAS 2.0 into the Malay language and test its psychometric properties in a primary-care population. DESIGN Patients were assessed for food addiction utilizing the Malay YFAS 2.0. The participants were also assessed for eating disorder using the validated Malay Binge Eating Scale. The psychometric properties of the YFAS 2.0 were determined by analysing factor structure, overall item statistics, internal consistency and construct validity. SETTING Between 2017 and 2018, participants were chosen from a regional primary-care clinic in the district of Seremban, Malaysia. PARTICIPANTS Patients (n 382) from a regional primary-care clinic. RESULTS The prevalence of food addiction was 5·0%. A two-factor structure of the YFAS was confirmed as the most optimal solution for the scale via confirmatory factor analysis. In both its diagnostic and symptom count version, the YFAS 2.0 had good internal consistency (Kuder-Richardson α > 0·80 and McDonald's ω > 0·9). CONCLUSIONS We validated a psychometrically sound Malay version of the YFAS 2.0 in a primary-care population. Both diagnostic and symptom count versions of the scale had robust psychometric properties. The questionnaire can be used to develop health promotion strategies to detect food addiction tendencies in a general population.
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Affiliation(s)
- Yogarabindranath Swarna Nantha
- Primary Care Research Initiative and Methods Education Department (PRIMED), Seremban Primary Health Care Clinic, Jalan Rasah, 70300 Seremban, Malaysia
- Non-Communicable Disease Department, Seremban Primary Health Care Clinic, Jalan Rasah, 70300 Seremban, Malaysia
- Monash University Malaysia, Sunway City, 47500 Subang Jaya, Malaysia
| | - Ahalya Kalasivan
- Primary Care Research Initiative and Methods Education Department (PRIMED), Seremban Primary Health Care Clinic, Jalan Rasah, 70300 Seremban, Malaysia
| | - Mahalakshmi Ponnusamy Pillai
- Primary Care Research Initiative and Methods Education Department (PRIMED), Seremban Primary Health Care Clinic, Jalan Rasah, 70300 Seremban, Malaysia
| | - Poopathy Suppiah
- Non-Communicable Disease Department, Seremban Primary Health Care Clinic, Jalan Rasah, 70300 Seremban, Malaysia
| | - Salmiah Md Sharif
- Non-Communicable Disease Department, Seremban Primary Health Care Clinic, Jalan Rasah, 70300 Seremban, Malaysia
| | - Shamini Gayathri Krishnan
- Non-Communicable Disease Department, Seremban Primary Health Care Clinic, Jalan Rasah, 70300 Seremban, Malaysia
| | - Subasni Samy Pullay
- Non-Communicable Disease Department, Seremban Primary Health Care Clinic, Jalan Rasah, 70300 Seremban, Malaysia
| | - Noor Ashikin Osman
- Non-Communicable Disease Department, Seremban Primary Health Care Clinic, Jalan Rasah, 70300 Seremban, Malaysia
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Chevinsky JD, Wadden TA, Chao AM. Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges. Diabetes Metab Syndr Obes 2020; 13:1117-1131. [PMID: 32341661 PMCID: PMC7166070 DOI: 10.2147/dmso.s213379] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/26/2020] [Indexed: 12/21/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.
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Affiliation(s)
| | - Thomas A Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Ariana M Chao
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
- Correspondence: Ariana M Chao University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA19104, USATel +1215-746-7183Fax +1215-898-2878 Email
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Escrivá-Martínez T, Galiana L, Rodríguez-Arias M, Baños RM. The Binge Eating Scale: Structural Equation Competitive Models, Invariance Measurement Between Sexes, and Relationships With Food Addiction, Impulsivity, Binge Drinking, and Body Mass Index. Front Psychol 2019; 10:530. [PMID: 30967808 PMCID: PMC6440315 DOI: 10.3389/fpsyg.2019.00530] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/22/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: The Binge Eating Scale (BES) is a widely used self-report questionnaire to identify compulsive eaters. However, research on the dimensions and psychometric properties of the BES is limited. Objective: The aim of this study was to examine the properties of the Spanish version of the BES. Methods: Confirmatory Factor Analyses (CFAs) were carried out to verify the BES factor structure in a sample of Spanish college students (N = 428, 75.7% women; age range = 18–30). An invariance measurement routine was carried out across sexes, the latent means were compared, and estimates of reliability and convergent and discriminant validity were presented. Results: A one-factor model fit the data best and was also equivalent between sexes. The scalar invariance model showed statistically significant differences across sexes, with a higher prevalence in women. Regarding reliability, the results were excellent. Finally, high statistically significant correlations were obtained with other measures of binge eating (BE), food addiction, impulsivity, binge drinking, and body mass index (BMI). Conclusion: The Spanish 16-item BES is a valid and reliable scale to evaluate BE in the youth population.
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Affiliation(s)
- Tamara Escrivá-Martínez
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain.,Polibienestar Institute, University of Valencia, Valencia, Spain
| | - Laura Galiana
- Department of Methodology for the Behavioral Sciences, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Marta Rodríguez-Arias
- Department of Psychobiology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Rosa M Baños
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain.,Polibienestar Institute, University of Valencia, Valencia, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto Carlos III, Madrid, Spain
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10
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Psychometric properties of the modified Yale Food Addiction Scale Version 2.0 in an Italian non-clinical sample. Eat Weight Disord 2019; 24:37-45. [PMID: 30414076 DOI: 10.1007/s40519-018-0607-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/24/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To assess the dimensionality and psychometric properties of the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) in an Italian non-clinical sample. METHODS 262 adults (184 women) were administered the Italian versions of the mYFAS 2.0, and questionnaires measuring binge eating severity, anxiety and depression symptoms, and emotional dysregulation. RESULTS 15 individuals (5.7%) met the criteria for a diagnosis of food addiction according to the mYFAS 2.0. Bayesian confirmatory factor analysis supported a single-factor solution for the mYFAS 2.0. The mYFAS 2.0 had good internal consistency (Ordinal α = 0.91), and convergent validity with binge eating severity (r = 0.67, p < 0.001), both anxiety (r = 0.31, p < 0.001) and depressive (r = 0.35, p < 0.001) symptoms, and difficulties in emotion regulation (r = 0.35, p < 0.001). Finally, both discriminant validity with dietary restraint (Gamma = 0.11; p = 0.52) and incremental validity in predicting binge eating severity over emotion dysregulation and psychopathology (b = 0.52; t = 11.11; p < 0.001) were confirmed. CONCLUSIONS The Italian mYFAS 2.0 has satisfactory psychometric properties and can be used as a brief instrument for the assessment of addictive eating behaviors when time constraints prevent the use of the original version. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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11
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Validation of the Arabic version of the binge eating scale and correlates of binge eating disorder among a sample of the Lebanese population. J Eat Disord 2019; 7:40. [PMID: 31798879 PMCID: PMC6885321 DOI: 10.1186/s40337-019-0270-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/23/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To test the psychometric properties of the Arabic version of the Binge Eating Scale (BES), a self-questionnaire assessing binge eating, in a sample of the Lebanese population. The secondary objective was to evaluate factors associated with binge eating. METHODS This cross-sectional study, conducted between January and May 2018, enrolled 811 adult participants from all districts of Lebanon. The BES was administered to study its psychometric properties. The sample was divided into two separate samples (405 for sample 1 and 406 for sample 2). An exploratory factor analysis was executed on Sample 1, followed by a confirmatory factor analysis on Sample 2 using the structure obtained in Sample 1. Three hierarchical stepwise linear regressions were conducted to assess factors associated with binge eating. RESULTS The factor analysis suggested a two-factor structure for the BES explaining a total of 41.4% of the variance. All items could be extracted from the list. The internal consistency of the measurement was adequate (Cronbach's alpha = 0.86). The confirmatory factor analysis revealed an adequate fit to the model with satisfactory Maximum Likelihood Chi-Square/Degrees of Freedom (χ2/df), Steiger-Lind RMSEA, Joreskog GFI, and AGFI. Higher BMI, depression, anxiety, emotional eating, greater body dissatisfaction, and more pressure from media to lose weight were associated with higher binge eating. Higher expressive suppression facet score was associated with lower binge eating. CONCLUSION The Arabic version of BES could be a useful tool for screening and assessing the binge eating behaviors in clinical practice and research. Also, being dissatisfied with one's body size, having a history of sexual abuse, family history of binge eating, increased depressive/anxiety symptoms, and lower self-esteem seem to be associated with higher BES scores.
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Abstract
PURPOSE This study was aimed to examine the structural and construct validity of the Italian version of the Yale Food Addiction Scale in a multisite sample of postgraduate students. METHODS Two hundred and fifty-six subjects (78.1% females) aged from 18 to 53 years (mean = 23.93, SD = 4.96) and attending different postgraduate university programs at multiple Italian universities completed the Italian YFAS, the Italian Binge Eating Scale (BES), the Italian Eating Attitudes Test-26 and the Italian Dutch Eating Behavior Questionnaire (DEBQ) online through Qualtrics. RESULTS Confirmatory Factor Analysis showed that the single-factor model of the Italian YFAS including all original items had adequate fit indexes (χ2252 = 454.183; p < 0.001; normed χ2 = 1.802; RMSEA = 0.056; 90% CI 0.048-0.076; CFI = 0.761; WRMR = 1.592). However, item analysis revealed that item#25 had zero variance (all subjects were assigned the same score after item dichotomization) and item#24 had a low factor loading, and were thus removed. Furthermore, item#10 and item#11 showed to be almost perfectly correlated (r = 0.998) and were thus parceled. The resulting 19-item single-factor model revealed a better fit to the data (χ2152 = 235.69; p < 0.001; normed χ2 = 1.556; RMSEA = 0.046; 90% CI 0.034-0.058; CFI = 0.858; WRMR = 1.236) and its internal consistency was acceptable (KR-20 = 0.72). Also, a single-factor model including the seven diagnostic symptoms was tested and showed adequate fit values (χ220 = 41.911; p < 0.003; normed χ2 = 2.09; RMSEA = 0.065; 90% CI 0.037-0.093; CFI = 0.946; WRMR = 1.132). Statistically significant and small-to-high correlations were found with all convergent measures, in particular with the BES. CONCLUSION The Italian 19-item YFAS resulted to be a valid and reliable tool for the assessment of food addiction in postgraduate students. LEVEL OF EVIDENCE Level V, descriptive study.
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Factors Associated with Binge Eating Behavior among Malaysian Adolescents. Nutrients 2018; 10:nu10010066. [PMID: 29320461 PMCID: PMC5793294 DOI: 10.3390/nu10010066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 02/06/2023] Open
Abstract
Although there are numerous studies on binge eating behavior in the Western countries, studies on this behavior in Malaysia are still limited. Therefore, this cross-sectional study aimed to determine the risk factors associated with binge eating behavior among adolescents in Malaysia. The study included 356 adolescents (42.7% males and 57.3% females), aged 13 to 16 years. They completed a self-administered questionnaire on demographic and socioeconomic backgrounds, frequency of family meals, family meal environments, family cohesion, perception of body size, self-esteem, depressive symptoms, perfectionistic self-presentation, and binge eating behavior. Furthermore, their weight, height, and waist circumference were measured. It was found that 14.0% of the participants engaged in binge eating behavior (15.2% in females and 12.5% in males). Additionally, it was identified that high levels of depressive symptoms, high levels of body dissatisfaction, poor family cohesion, and low self-esteem were significantly contributed to binge eating behavior after controlling for sex (adjusted R2 = 0.165, F = 15.056, p < 0.001). The findings may suggest that improving the relationships between family members, along with eliminating adolescents’ negative emotions could help in the prevention of binge eating behavior among adolescents. The identified modifiable risk factors should be incorporated into binge eating preventive programs to increase the effectiveness of the programs.
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Zhang J, Abbasi O, Malevanchik L, Mohan N, Denicola R, Tarangelo N, Marzio DHD. Pilot study of the prevalence of binge eating disorder in non-alcoholic fatty liver disease patients. Ann Gastroenterol 2017; 30:664-669. [PMID: 29118561 PMCID: PMC5670286 DOI: 10.20524/aog.2017.0200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/30/2017] [Indexed: 01/01/2023] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States. Binge eating disorder (BED) is the most common form of eating disorder. NAFLD and BED have similar risk factors, including obesity, insulin resistance, and metabolic syndrome. The aim of our study was to examine prevalence of BED in NAFLD patients. Methods We administered the Binge Eating Scale (BES), a questionnaire validated to screen for BED, to NAFLD patients at our Fatty Liver Center. Demographics were retrieved retrospectively from our electronic medical record. Results Of the total 95 NAFLD patients screened, 22 (23.1%) had binge eating tendencies; 6 of the 22 (6.3%) scored 27 or more points, suggestive of severe binge eating. Patient demographics included 59 females and 36 males (14 females and 8 males positive for BED). Liver disease severity and of metabolic syndrome presence were similar in both groups: 45 patients had steatosis, 25 steatohepatitis, and 24 cirrhosis, of which 10 steatosis, 5 steatohepatitis, and 7 cirrhosis patients screened positive for BED. Of the NAFLD patients with BED, 50.0% had insulin resistance, 68.2% hypertension, and 50.0% hyperlipidemia, whereas among non-BED NAFLD patients 58.9% had insulin resistance, 63.0% hypertension, and 67.1% hyperlipidemia. Conclusions This pilot study suggests that BED may have a higher prevalence among NAFLD patients than in the general population. Based on these preliminary results, further study into the prevalence of BED is recommended. More data is need to identify effects of BED on the progression of NAFLD and role of BED treatment.
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Affiliation(s)
- Jinyu Zhang
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia (Jinyu Zhang, Neena Mohan, Richard Denicola, Nicholas Tarangelo), USA
| | - Omair Abbasi
- Department of Psychiatry, Thomas Jefferson University (Omair Abbasi), USA
| | - Lev Malevanchik
- Department of Internal Medicine, University of California at San Francisco (Lev Malevanchik), USA
| | - Neena Mohan
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia (Jinyu Zhang, Neena Mohan, Richard Denicola, Nicholas Tarangelo), USA
| | - Richard Denicola
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia (Jinyu Zhang, Neena Mohan, Richard Denicola, Nicholas Tarangelo), USA
| | - Nicholas Tarangelo
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia (Jinyu Zhang, Neena Mohan, Richard Denicola, Nicholas Tarangelo), USA
| | - Dina Halegoua-De Marzio
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia (Dina Halegoua-DeMarzio), USA
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Imperatori C, Innamorati M, Lamis DA, Farina B, Pompili M, Contardi A, Fabbricatore M. Childhood trauma in obese and overweight women with food addiction and clinical-level of binge eating. CHILD ABUSE & NEGLECT 2016; 58:180-190. [PMID: 27442689 DOI: 10.1016/j.chiabu.2016.06.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 06/19/2016] [Accepted: 06/24/2016] [Indexed: 06/06/2023]
Abstract
Childhood trauma (CT) is considered a major risk factor for several disorders as well as for the development of eating psychopathology and adult obesity. The main aims of the present study were to assess in overweight and obese women: (i) the independent association between CT and food addiction (FA), and (ii) CT in patients with both FA and clinical-level of binge eating (BE), versus patients who only engage in FA or BE. Participants were 301 overweight and obese women seeking low-energy-diet therapy. All of the patients were administered self-report measures investigating FA, BE, CT, anxiety and depressive symptoms. CT severity was moderately and positively associated with both FA (r=0.37; p<0.001) and BE (r=0.36; p<0.001) severity. The association between FA and CT remained significant after controlling for potential confounding variables. Furthermore, compared to patients without dysfunctional eating patterns, the co-occurrence of FA and BE was associated with more severe CT as well as with more severe psychopathology (i.e., anxiety and depressive symptoms) and higher BMI. Our results suggest that clinicians should carefully assess the presence of CT in individuals who report dysfunctional eating patterns in order to develop treatment approaches specifically for obese and overweight patients with a history of CT.
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Affiliation(s)
| | | | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
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Manaf NA, Saravanan C, Zuhrah B. The Prevalence and Inter-Relationship of Negative Body Image Perception, Depression and Susceptibility to Eating Disorders among Female Medical Undergraduate Students. J Clin Diagn Res 2016; 10:VC01-VC04. [PMID: 27134977 DOI: 10.7860/jcdr/2016/16678.7341] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/09/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Female students are thought to be more negatively impacted by body image ideals and often more susceptible to various eating related disorders compared to men. A previous study using a sample of female students in Malaysia did not identify whether the increase in susceptibility to eating disorders can be explained by the level of body image acceptance. AIM To identify the prevalence of depression and susceptibility to eating disorders among a sample of 206 female students in one of the private universities in Malaysia and explore the relationship between depression, body image and susceptibility to eating disorders. In addition, this study aimed to determine whether depression is a mediator between body image and susceptibility to eating disorders among female college students. MATERIALS AND METHODS The Body Image Acceptance and Action Questionnaire were used to assess body image acceptance, the Patient Health Questionnaire to measure depression and the Eating Attitude Test- 26 was used to assess susceptibility to eating disorders. RESULTS The results showed that 65.5% (n=135) of the students were depressed and 6.3% (n=13) were susceptible to eating disorders. There was a significant positive relationship between depression and eating disorders and a negative relationship between body image and depression as well as between body image and eating disorder. Further, the regression model showed that depression was partially mediating the effect of body image on eating disorders. CONCLUSION Body image and depression contribute to eating disorders and treating depression could reduce susceptibility to eating disorders.
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Affiliation(s)
- Nurajirahbt Abdul Manaf
- Student, Division of Psychology and Behavioural Sciences, International Medical University , Malaysia
| | - Coumaravelou Saravanan
- Visiting Academic in Clinical Psychology, Department of Family & Community Medicine and Behavioural Sciences, University of Sharjah , UAE
| | - Beevi Zuhrah
- Assistant Professor, School of Life Sciences, Heriot-Watt University , Malaysia
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Deal LS, Wirth RJ, Gasior M, Herman BK, McElroy SL. Validation of the yale-brown obsessive compulsive scale modified for binge eating. Int J Eat Disord 2015; 48:994-1004. [PMID: 26032442 DOI: 10.1002/eat.22407] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Establish the Yale-Brown obsessive compulsive scale modified for binge eating (YBOCS-BE) as a fit for purpose measure of treatment benefit in clinical trials of binge eating disorder (BED). METHODS YBOCS-BE psychometric properties were evaluated with data from a Phase 2 randomized controlled trial of lisdexamfetamine dimesylate in 260 adults with BED. Assessments included: Cohen's effect size estimates of item-level sensitivity and scale-level external responsiveness; item-to-total correlations; Cronbach's alpha for internal consistency reliability; Spearman correlations against reference measures for construct validity; known-groups analyses for discriminating ability; t tests of within-group differences between baseline and post baseline visits for internal responsiveness; and multiple anchor-based approaches to estimate minimum clinically important change (MCIC). RESULTS No significant distribution anomalies were seen. Items appear sensitive to treatment group differences. Item-to-total correlations were positive. Internal consistency is 0.81. Large correlations (>0.50) were seen between YBOCS-BE score change and the Clinical Global Impression-Improvement (CGI-I; 0.58) and score changes for the following; number of binge days (0.38), Clinical Global Impression-Severity (CGI-S; 0.57), the disinhibition (0.57) and hunger (0.52) subscales of the Three-Factor Eating Questionnaire (TFEQ), and the Barratt Impulsiveness Scale (BIS-11; 0.58). MCIC estimates range from -4 to -17. DISCUSSION The YBOCS-BE was found to be a reliable and valid measure of an important and unique concept in BED-related clinical studies. Study limitations include using protocol-defined BED severity level and the exclusion of psychiatric comorbidities.
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Affiliation(s)
| | - R J Wirth
- Vector Psychometric Group, LLC, Managing Partner
| | - Maria Gasior
- Global Development Team Lead, Neuroscience, Shire Development, Inc
| | - Barry K Herman
- Global Medical Lead, Neuroscience, Shire Development, Inc
| | - Susan L McElroy
- Chief Research Officer, Lindner Center of HOPE, Professor of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine
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Barclay KS, Rushton PW, Forwell SJ. Measurement properties of eating behavior self-assessment tools in adult bariatric surgery populations: a systematic review. Obes Surg 2015; 25:720-37. [PMID: 25691348 DOI: 10.1007/s11695-015-1593-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The present study aims to identify the range of eating behavior self-assessment tools reported in the adult bariatric surgery literature and evaluate the measurement properties of these tools using pre-established criteria. This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This review revealed the use of 20 distinct tools; however, evidence for measurement properties specific to bariatric surgery populations was limited to only ten of these tools, as reported in 14 papers. Validity varied extensively and there was a widespread lack of information regarding measurement of change over time and patient burden. According to the evaluation criteria, there was adequate support for two tools. Several other tools show potential but would benefit from additional investigation of their measurement properties prior to continued use with bariatric surgery patients.
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Affiliation(s)
- Karen S Barclay
- Mental Health and Addictions, Vancouver Coastal Health, Vancouver, British Columbia, Canada,
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Expanding binge eating assessment: Validity and screening value of the Binge Eating Scale in women from the general population. Eat Behav 2015; 18:41-7. [PMID: 25880043 DOI: 10.1016/j.eatbeh.2015.03.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 01/14/2015] [Accepted: 03/19/2015] [Indexed: 01/18/2023]
Abstract
There is growing recognition that binge eating is a prevalent problem with serious implications for both clinical and nonclinical samples. The current study aimed at examining the factor structure, psychometric properties and the screening usefulness of the Binge Eating Scale (BES) in a large sample of female college students and women from the Portuguese general population. A sample of 1008 participants was collected to conduct a confirmatory factor analysis and test the BES psychometric properties; 150 participants were further evaluated through the Eating Disorder Examination 16.0D to assess the discriminant validity of the BES. Results confirmed that the BES presents a sound one-dimensional factorial structure, with very good construct reliability and convergent validity. Also, the scale presented very good retest-reliability. Findings also offered evidence that the BES is positively associated with measures of eating and general psychopathology, and BMI. Furthermore, the BES revealed an excellent performance (96.7%) on discriminating clinically significant cases of binge eating, showing a sensitivity of 81.8% and a specificity of 97.8%. Results support the validity and usefulness of the BES as an assessment and screening tool for binge eating in women from the general population.
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Imperatori C, Innamorati M, Lamis DA, Contardi A, Continisio M, Castelnuovo G, Manzoni GM, Fabbricatore M. Factor Structure of the Binge Eating Scale in a Large Sample of Obese and Overweight Patients Attending Low Energy Diet Therapy. EUROPEAN EATING DISORDERS REVIEW 2015; 24:174-8. [PMID: 26147590 DOI: 10.1002/erv.2384] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In the present study, we evaluated the dimensionality and psychometric properties of the Italian version of the Binge Eating Scale (BES) in a 669 (127 men and 542 women) obese and overweight patients seeking weight loss treatment. All participants were administered the Italian version of the BES. Fit statistics for the alternative SEM models demonstrated that both the one-factor and competing two-factor models had a comparable fit to the data. Thus, we selected the one-factor model as the most parsimonious. The BES had good internal consistency reliability (α = 0.89) with a moderate mean inter-item correlation (rii = 0.34). Given that we were not able to clearly determine the best model among the competing two-factor models and a comparable fit of these models with the one-factor model, we have suggested that the one-factor model is the best fitting model describing the dimensionality of the BES.
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Affiliation(s)
| | - Marco Innamorati
- Università Europea di Roma, Rome, Italy.,Istituto Skinner, Rome, Italy
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna Contardi
- Università Europea di Roma, Rome, Italy.,Istituto Skinner, Rome, Italy
| | | | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano IRCCS, Piancavallo (Oggebbio), Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milano, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano IRCCS, Piancavallo (Oggebbio), Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milano, Italy
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Improvement in binge eating in non-diabetic obese individuals after 3 months of treatment with liraglutide – A pilot study. Obes Res Clin Pract 2015; 9:301-4. [DOI: 10.1016/j.orcp.2015.03.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 03/22/2015] [Indexed: 11/18/2022]
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