Different Methods for Assessing the Features of Eating Disorders in Patients with Binge Eating Disorder: A Replication

Objective: To compare different methods for assessing the features of eating disorders in patients with binge eating disorder (BED). Research Methods and Procedures: A total of 47 participants with BED were administered the Eating Disorder Examination (EDE) Interview and completed the EDE‐Questionnaire (EDE‐Q) at baseline. A total of 37 participants prospectively self‐monitored their eating behaviors daily for 4 weeks and then completed another EDE‐Q. Results: At baseline, the EDE and the EDE‐Q were significantly correlated on frequencies of objective bulimic episodes (binge eating), overeating episodes, and on the dietary restraint, eating concern, weight concern, and shape concern subscales. Mean differences in the EDE and EDE‐Q frequencies of objective bulimic episodes and overeating were not significant but scores on the four subscales differed significantly, with the EDE‐Q yielding higher scores. At the 4‐week point, the EDE‐Q retrospective 28‐day assessment was significantly correlated with the prospective daily self‐monitoring records for frequency of objective bulimic episodes and the mean difference between the methods was not significant. The EDE‐Q and self‐monitoring findings for subjective bulimic episodes and objective overeating differed significantly. Discussion: In patients with BED, the three assessment methods showed some areas of acceptable convergence.     

On the Relation of Attempting to Lose Weight,Restraint, and Binge Eating in Outpatients with Binge Eating Disorder

Objective: To examine the relationship among attempts to lose weight, restraint, and eating behavior in outpatients with binge eating disorder (BED). Research Methods and Procedures: Participants were 93 consecutive outpatients evaluated for a clinical trial who met Diagnostic and Statistical Manual, Fourth edition criteria for BED. The Eating Disorder Examination Interview was administered to assess attempts at weight loss, restraint, different forms of overeating, and the attitudinal psychopathology of eating disorders (i.e., concerns regarding eating, shape, and weight). In addition, the Three‐Factor Eating Questionnaire was used to assess cognitive restraint, hunger, and disinhibition. Psychometrically established measures were given to assess body dissatisfaction, depression, and self‐esteem. Results: The majority of participants (75.3%; N = 70) reported attempting to lose weight, but only 37.6% (N = 35) reported dietary restraint on at least half the days of the month. Dietary restraint and cognitive restraint were not associated with any form of binge eating or overeating. Dietary restraint and cognitive restraint were positively correlated with weight concern, shape concern, and body dissatisfaction, and negatively correlated with body mass index. To further examine the interplay between attempting to lose weight and restraint, three study groups were created: unrestrained nonattempters (21.5%, N = 20), unrestrained attempters (40.9%; N = 38), and restrained attempters (34.4%; N = 32). The three groups did not differ significantly on binge eating or other eating behaviors; however, significant differences were observed for weight concern, shape concern, and body dissatisfaction. Discussion: Attempts to lose weight and restraint are not synonymous for patients with BED. Although 75.3% of BED patients reported that they were attempting to lose weight, only 37.6% reported dietary restraint on at least half the days of the previous month. While restraint was negatively associated with body mass index, it was not related to binge eating or overeating. Our findings raise questions about prevailing models that posit restraint as a predominant factor in the maintenance of binge eating in BED.     

Prevalence and familial patterns of night eating in the Québec adipose and lifestyle investigation in youth (QUALITY) study

The prevalence and familial patterns of night eating syndrome (NES) in families enrolled in the Québec Adipose and Lifestyle InvesTigation in Youth (QUALITY) study was examined. Families (n = 395; one child, mother, and father for whom at least one parent was obese or had abdominal obesity) completed the Night Eating Questionnaire (NEQ) as part of a longitudinal study on the development of metabolic disease in children at risk for obesity. Responses on the NEQ were used to establish a diagnosis of NES and to determine the correlation and heritability of NES symptoms in families. Using comprehensive research diagnostic criteria, full threshold NES was rare: 0% of children, 0.5% of mothers, and 0.3% of fathers met criteria. When controlling for age, sex, and BMI, NEQ scores of spouses were not significantly correlated, but mothers' NEQ scores were significantly correlated with the scores of both sons (r = 0.19, P < 0.001) and daughters (r = 0.15, P = 0.05). The heritability of NEQ scores was 0.24 when controlling for age, sex, and BMI. These findings replicate previous research suggesting a low prevalence of night eating behavior in children and the aggregation of NES in families.     

Factor Structure of the Eating Disorder Examination Interview in Patients With Binge‐eating Disorder

Despite the widespread use of the Eating Disorder Examination (EDE) as a primary assessment instrument in studies of eating and weight disorders, little is known about the psychometric aspects of this interview measure. The primary purpose of this study was to evaluate the factor structure of the EDE interview in a large series of patients with binge‐eating disorder (BED). Participants were 688 treatment‐seeking patients with BED who were reliably administered the EDE interview by trained research clinicians at three research centers. Exploratory factor analysis (EFA) performed on EDE interview data from a random split‐half of the study group suggested a brief 7‐item 3‐factor structure. Confirmatory factor analysis (CFA) performed on the second randomly selected half of the study group supported this brief 3‐factor structure of the EDE interview. The three factors were interpreted as Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction. In this series of patients with BED, factor analysis of the EDE interview did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE interview in this and other eating‐disordered groups. The implications of these factor analytic findings for understanding and assessing the specific psychopathology of patients with BED are discussed.     

Prevalence and Correlates of Night Eating in the German General Population

Recently, night eating syndrome (NES) was included into the DSM-5 as an example of “Other Specified Feeding and Eating Disorders.” The study provides insight into the population prevalence of NES using a large representative German population sample (n = 2,460) with a wide age range (14–85 years). The prevalence of NES was 1.1% using a cut-off on the Night Eating Questionnaire (NEQ) of 25. A positive screening for NES was positively associated with depression and anxiety, eating disorder psychopathology, and body weight.     

Loss of control is central to psychological disturbance associated with binge eating disorder

Objective: Binge eating disorder (BED) is positively associated with obesity and psychological distress, yet the behavioral features of BED that drive these associations are largely unexplored. The primary aim of this study was to investigate which core behavioral features of binge eating are most strongly related to psychological disturbance. Methods and Procedures: A cross‐sectional study involved 180 bariatric surgery candidates, 93 members of a non‐surgical weight loss support group, and 158 general community respondents (81 men/350 women, mean age 45.8 ± 13.3, mean BMI 34.8 ± 10.8, BMI range 17.7–66.7). Validated questionnaires assessed BED and binge eating, symptoms of depression, appearance dissatisfaction (AD), quality of life (QoL) and eating‐related behaviors. Features of binge eating were confirmed by interview. BMI was determined by clinical assessment and self‐report. Results: The loss of control (LOC) over eating, that is, being unable to stop eating or control what or how much was consumed was most closely related to psychological markers of distress common in BED. In particular, those who experienced severe emotional disturbance due to feelings of LOC reported higher symptoms of depression (P < 0.001), AD (P = 0.009), and poorer mental health–related QoL (P = 0.027). Discussion: Persons who report subjective binge episodes or do not meet BED frequency criteria for objective binge episodes may still be at elevated risk of psychological disturbance and benefit from clinical intervention. Feelings of LOC could drive binge eaters to seek bariatric surgery in an attempt to gain control over body weight and psychologically disturbing eating behavior.     

Grazing and loss of control related to eating: two high-risk factors following bariatric surgery

Background: Gastric restrictive surgery induces a marked change in eating behavior. However, the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention. Objective: This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric banding (LAGB) and explored the nature and extent of change in eating patterns, their clinical associates, and impact on weight loss. Methods and Procedures: A 12‐month observational study assessed presurgical and postsurgical binge eating disorder (BED), uncontrolled eating, night eating syndrome (NES), grazing, nutrient intake and eating‐related behaviors, and markers of psychological distress. A total of 129 subjects (26 male and 103 female, mean age 45.2 ± 11.5 and BMI 44.3 ± 6.8) participated in this study. Results: Presurgical BED, uncontrolled eating, and NES occurred in 14%, 31%, and 17.1% of subjects, which reduced after surgery to 3.1%, 22.5%, and 7.8%, respectively (P = 0.05 for all). Grazing was prevalent before (26.3%) and after surgery (38.0%). Preoperative BED most frequently became grazers (P = 0.029). The average percentage weight loss (%WL) was 20.8 ± 8.5%; range ?0.67 to 50.0% and percentage of excess weight loss (%EWL) 50.0 ± 20.7%; range ?1.44 to 106.9% (P < 0.001). Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer %WL (P = 0.008 and P < 0.001, respectively) and elevated psychological distress. Discussion: Consistent with recent studies, uncontrolled eating and grazing were identified as two high‐risk eating patterns after surgery. Clearer characterization of favorable and unfavorable postsurgical eating behaviors, reliable methods to assess their presence, and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well‐being in at‐risk groups.     

Treatment outcome in people with subthreshold compared with full-syndrome binge eating disorder

Objective: There is a controversial discussion in the literature as to whether individuals with subthreshold binge eating disorder (subBED) differ clinically significantly from individuals with full‐syndrome binge eating disorder (BED). This study was designed to compare eating‐related and general psychopathology at baseline and in response to a multimodal treatment program in obese people with subBED compared with BED. Research Methods and Procedures: A total of 96 obese participants (BMI ≥ 30 kg/m²) were assessed for eating‐related and general psychopathology at baseline. Thirty‐nine participants meeting criteria for BED and 19 participants meeting criteria for subBED attended a 15‐session outpatient group therapy including cognitive behavioral therapy extended by interpersonal therapy, nutritional counseling, and a supervised walking exercise. Participants with eating disorders were reassessed at the end of treatment and at 3‐month follow‐up. The obese control group without an eating disorder (n = 38) was assessed once. This was not a randomized controlled trial. Results: Intent‐to‐treat analyses revealed no differences between subBED and full‐syndrome BED participants with regard to eating‐related and general psychopathology at baseline and with regard to treatment outcome. All participants experienced substantial improvements, and the results remained stable during follow‐up (except for dietary restraint). At follow‐up, participants with subBED and BED remained different from non‐eating disorder controls in eating‐related but not general psychopathology. Discussion: The findings indicate that our multimodal treatment program is equally effective in obese subBED and BED participants, suggesting that a differentiation currently seems not to be of clinical significance.     

Self-Efficacy in Overweight Individuals with Binge Eating Disorder

MILLER, PETER M., JULIA A. WATKINS, ROGER G. SARGENT, AND EDWARD J. RICKERT. Self-efficacy in overweight individuals with binge eating disorder. Obes Res. Objective: To evaluate the relationship between self-efficacy judgments in obese individuals with binge eating disorder, “borderline” binge eating disorder, and no binge eating problems. Research Methods and Procedures: Before participation in a residential weight management program, 79 male and female subjects were administered the Weight Efficacy Lifestyle Questionnaire (WEL) and the Binge Eating Scale (BES). Based on DSM-IV diagnostic questions, subjects were categorized as BED, Borderline BED, or non-BED. Results: Krusal-Wallace Rank-Order analysis of variance revealed significant negative associations between binge eating and total WEL scores as well as the subscales of Negative Emotions, Social Pressure, Physical Discomfort, and Positive Activities. Differences were significant between the BED and the Borderline BED groups with the exception of the Social Pressure scale and the Total WEL scores. BED diagnosis as well as severity of binge eating were strongly associated with low self-efficacy ratings. Discussion: These results indicate that obese individuals with binge eating disorder demonstrate lower self-efficacy than those without this condition and that self-efficacy is related to the severity of binge eating.     

Teasing History,Onset of Obesity,Current Eating Disorder Psychopathology,Body Dissatisfaction,and Psychological Functioning in Binge Eating Disorder

Objective: The primary goal of this study was to examine associations among teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in women with Binge Eating Disorder (BED). Research Methods and Procedures: Subjects were 115 female adults who met DSM‐IV criteria for BED. Measurements assessing teasing history (general appearance [GAT] and weight and size [WST] teasing), current eating disorder psychopathology (binge frequency, eating restraint, and concerns regarding eating, shape, and weight), body dissatisfaction, and psychological functioning (depression and self‐esteem) were obtained. Results: History of GAT, but not WST, was associated with current weight concerns and body dissatisfaction, whereas both GAT and WST were significantly associated with current psychological functioning. Patients with earlier onset of obesity reported more WST than patients with later onset of obesity, but the groups did not differ significantly in GAT, current eating disorder psychopathology, body dissatisfaction, or psychological functioning. Obese women reported more WST than non‐obese women, but no differences in GAT or the other outcome variables were observed. Higher frequency of GAT was associated with greater binge frequency in obese women, and with greater eating restraint in non‐obese women. Discussion: Although physical appearance teasing history is not associated with variability in most eating disorder psychopathology, it is associated with related functioning, most notably body dissatisfaction, depression, and self‐esteem. Our findings also suggest that the age of onset of obesity and current body mass index status in isolation are not associated with eating psychopathology or associated psychological functioning in adult patients with BED.     

Association of major depression and binge eating disorder with weight loss in a clinical setting

Objective: Obesity has been linked to both major depressive disorder (MDD) and binge eating disorder (BED) in clinical and epidemiological studies. The present study compared weight loss among patients with and without MDD and BED who participated in a hospital‐based weight loss program modeled after the Diabetes Prevention Program. Research Methods and Procedures: Of 131 obese patients who enrolled in treatment, 17% were diagnosed with MDD only, 13% were diagnosed with BED only, 17% were diagnosed with both MDD and BED, and 53% lacked either diagnosis in a pretreatment clinical interview. Results: After treatment, patients with MDD only attained 63% of the weight loss that non‐depressed patients attained. Patients with BED only attained 55% of the weight loss that non‐binge eaters attained. The effect of MDD on weight loss was not accounted for by the presence of BED or vice versa. Only 27% of patients with both MDD and BED achieved clinically significant weight loss compared with 67% of patients who had neither disorder. Results were not significantly altered when gender, age, and diabetes status were adjusted. Conclusion: Both MDD and BED were prevalent among this obese clinical population, and each disorder was independently associated with worse outcomes. Research is needed to investigate how to increase the efficacy of behavioral weight loss programs for individuals with MDD and/or BED.     

Accuracy of Self‐reported Weight and Height in Binge Eating Disorder: Misreport Is Not Related to Psychological Factors

This study examined the degree of misreport in weight, height, and BMI among overweight adults (n = 392) with binge eating disorder (BED) and tested whether the degree of misreport was associated with eating disorder psychopathology and psychological variables. Male (n = 97) and female (n = 295) participants self‐reported height and weight, and were subsequently measured by clinic staff. Participants also completed a series of diagnostic interviews and self‐report assessments. Discrepancies between self‐reported and measured values were modest. The degree of misreport for weight, height, and BMI was not related to eating disorder features, depression, and self‐esteem. Overall, the errors in self‐reported weight and height by overweight patients with BED were very slight. The degree of discrepancy between self‐reported and measured values was not related to eating disorder or psychological features, suggesting that such data are not biased or systematically related to individual differences in overweight patients with BED.     

Dopamine for “Wanting” and Opioids for “Liking”: A Comparison of Obese Adults With and Without Binge Eating

Obesity research suffers from an overinclusion paradigm whereby all participants with a BMI beyond a certain cutoff value (e.g., 30) are typically combined in a single group and compared to those of normal weight. There has been little attempt to identify meaningful subgroups defined by their salient biobehavioral differences. In order to address this limitation, we examined genetic and psychological indicators of hedonic eating in obese adults with (n = 66) and without (n = 70) binge eating disorder (BED). Our analyses focused on dopamine (DA) and opioid genetic markers because of their conjoint association with the functioning of brain reward mechanisms. We targeted three functional polymorphisms related to the D2 receptor (DRD2) gene, as well as the functional A118G polymorphism of the mu‐opioid receptor (OPRM1) gene. We found that significantly more obese controls had the “loss‐of‐function” A1 allele of Taq1A compared to their BED counterparts, whereas the “gain‐of‐function” G allele of A118G occurred with greater frequency in the BED group. A significant gene–gene combination χ² analysis also indicated that of those participants with the gain‐gain genotype (G⁺ and A1), 80% were in the BED group whereas only 35% with the loss‐loss genotype (G^? and A1⁺) were in this group. Finally, BED subjects had significantly higher scores on a self‐report measure of hedonic eating. Our findings suggest that BED is a biologically based subtype of obesity and that the proneness to binge eating may be influenced by a hyper‐reactivity to the hedonic properties of food—a predisposition that is easily exploited in our current environment with its highly visible and easily accessible surfeit of sweet and fatty foods.     

Binge eating disorder and the outcome of bariatric surgery at one year: a prospective, observational study

Previous studies have suggested that binge eating disorder (BED) impairs weight loss following bariatric surgery, leading some investigators to recommend that patients receive behavioral treatment for this condition before surgery. However, many of these investigations had significant methodological limitations. The present observational study used a modified intention-to-treat (ITT) population to compare 1-year changes in weight in 59 surgically treated participants, determined preoperatively to be free of a current eating disorder, with changes in 36 individuals judged to have BED. Changes in weight and binge eating in the latter group were compared with those in 49 obese individuals with BED who sought lifestyle modification for weight loss. BED was assessed using criteria proposed for the Diagnostic and Statistical Manual (DSM) 5. At 1 year, surgically treated participants without BED lost 24.2% of initial weight, compared with 22.1% for those with BED (P > 0.309). Both groups achieved clinically significant improvements in several cardiovascular disease (CVD) risk factors. Participants with BED who received lifestyle modification lost 10.3% at 1 year, significantly (P < 0.001) less than surgically treated BED participants. The mean number of binge eating days (in the prior 28 days) fell sharply in both BED groups at 1 year. These two groups did not differ significantly in BED remission rates or in improvements in CVD risk factors. The present results, obtained in carefully studied participants, indicate that the preoperative presence of BED does not attenuate weight loss or improvements in CVD risk factors at 1 year in surgically treated patients. Longer follow-up of participants is required.     

Binge Status and Quality of Life after Gastric Bypass Surgery: A One‐Year Study

Objective: This study evaluated gastric bypass surgery outcomes according to presurgical binge eating severity. Research Methods and Procedures: Adult patients completed assessment questionnaires including the Short Form‐36, Gormally Binge Eating Scale (BES), and Beck Depression Inventory (BDI) before and 12 months after surgery. Results: One hundred nine patients (18 men, 91 women) were recruited. Based on their baseline BES scores, patients were non‐ [n = 52 (48%)], moderate [n = 31 (28%)], or severe [n = 26 (24%)] binge eaters. Although the percentage of excess weight loss was greatest after 12 months in the severe binge eaters, the difference among groups was not significant. Severe binge eaters had higher baseline BDI scores than either non‐ or moderate binge eaters (p = 0.001). After surgery, BDI scores declined significantly in all groups from the baseline scores but remained higher postoperatively in the severe binge eaters (p = 0.018). BES scores declined significantly (p = 0.000) after surgery within all groups. There was no difference in the Short Form‐36 physical component summary scores at baseline among groups. Mental component summary scores were significantly lower in the severe binge eaters (p = 0.001). After surgery, there was no difference among groups in either physical or mental component summary scores. Discussion: In conclusion, data from the present study suggest that patients have similar outcomes in terms of improved depression scores, binge eating behavior, and health‐related quality of life regardless of their binge eating severity before surgery. Patients with the most severe binge eating behavior before surgery showed the most improvement when assessed 12 months after surgery.     

Night Eating Syndrome Is Associated with Depression,Low Self‐Esteem,Reduced Daytime Hunger,and Less Weight Loss in Obese Outpatients

Objective: The objective of this study was to assess the relationship between the night eating syndrome (NES), measures of depression and self‐esteem, test meal intake, and weight loss in obese participants. Research Methods and Procedures: The study included 76 overweight (body mass index = 36.7 ± 6.5 SD) outpatients (53 women and 23 men; aged 43.5 ± 9.5 years) entering a weight loss program. They completed a Night Eating Questionnaire, the Zung Depression Inventory, and the Rosenberg Self‐Esteem Scale. Based on criteria by Stunkard et al. (Stunkard A, Berkowitz R, Wadden T, Tanrikut C, Reiss E, Young L. Binge eating disorder and the night eating syndrome. Int J Obes Relat Metab Disord. 1996;20:1–6), participants had NES if they reported: (1) skipping breakfast ≥4 d/wk, interpreted as morning anorexia; (2) consuming more than 50% of total daily calories after 7 pm ; and (3) difficulty falling asleep or staying asleep ≥4 d/wk. Eleven (14%) participants met the criteria for NES. After an 8‐hour fast, all participants ingested a nutritionally complete liquid meal through a straw from a large opaque cooler until extremely full. They also completed ratings of hunger and fullness before and after this meal. Results: Night eaters had higher depression (p = 0.04), lower self‐esteem (p = 0.003), and less hunger (p = 0.005), and a trend for more fullness (p = 0.06) before the daytime test meal than the others. However, there were no significant differences in test‐meal intake between groups. Nevertheless, test‐meal intake was greater later in the day only for the night eaters (p = 0.01). Over a 1‐month period, the night eaters lost less weight (4.4 ± 3.2 kg) than the others (7.3 ± 3.2 kg; p = 0.04), after controlling for body mass index. Discussion: NES is a syndrome with distinct psychopathology and increased food intake later in the day, both of which may contribute to poorer weight loss outcome. NES criteria need to be better quantified and NES deserves consideration as a diagnostic eating disorder.     

Binge-Eating Disorder in Brazilian Women on a Weight-Loss Program

Objective: To examine binge-eating disorder (BED) and its association with obesity, weight patterns, and psychopathology in a Brazilian sample of female participants of a weight-loss program in São Paulo, Brazil. Research Methods and Procedures: Two hundred and seventeen overweight (body mass index ≥ 25 kg/m²) women, ages 15 to 59 years, enrolled in the Weight Watchers Program were recruited for the study at a program branch meeting after completing the Questionnaire on Eating and Weight Patterns–Revised, Beck Depression Inventory, and the Toronto Alexithymia Scale-20. Participants were categorized into four groups: those who met questionnaire criteria for BED, those who met questionnaire criteria for bulimia nervosa (BN), those that reported binge eating but did not meet all the criteria for any eating disorder (BE), and those with no eating disorder symptoms (No ED). Groups were compared on measures of weight, depressive symptoms, and alexithymia. Results: Binge eating was frequently reported by women in this study (BED, 16.1%; BN, 4.6%; BE, 22.6%). BED women had significantly higher body mass index, greater highest weight ever, and more frequent weight cycling than the No ED group. BED women also reported more depressive symptoms than BE and No ED women, and were more alexithymic than the No ED group. BE women presented more frequent weigh cycling and were also more depressed and alexithymic than the No ED group. Discussion: BED is not uncommon in overweight Brazilian women, and similar to North American and European samples, it is associated with overweight and higher levels of psychopathology in this population.     

Effect of orlistat on eating behavior among participants in a 3-year weight maintenance trial

Objective: To examine the effect of orlistat on dietary restraint, disinhibition, hunger, and binge eating and to understand the relation between changes in eating behavior and weight maintenance. Methods and Procedures: Subjects were 306 women and men (age: 19–45 years; BMI: 37.5 ± 4.1 kg/m²) included in the Scandinavian Multicenter study of Obese subjects with the Metabolic Syndrome, a 3‐year clinical trial of orlistat or placebo following an 8‐week very low energy diet (VLED). Outcomes were changes in weight and in the Three Factor Eating Questionnaire (TFEQ) and Binge Eating Scale (BES) between screening and 17 and 33 months after randomization. As reported previously, weight gain following VLED was lower in subjects treated with orlistat than with placebo. Results: Compared to screening results, dietary restraint was increased and disinhibition, hunger, and binge eating were decreased in both groups. These changes were similar in both groups with the exception of the hunger score at month 33 that was reduced more in the placebo than in the orlistat group (difference between groups ?1.1 (95% CI (?2.0, ?0.2)) P = 0.014). In multivariate analyses, scores for restraint, disinhibition and binge eating were associated with weight loss after adjustment for BMI, gender, age, and treatment (all P ≤ 0.002, model R ² = 0.12–0.17). Discussion: Orlistat did not affect eating behavior differently in any substantial way than the placebo did in this long‐term weight maintenance trial. The results indicate that increased restraint and decreased disinhibition and binge eating are important for sustained weight maintenance in obese subjects with the metabolic syndrome.     

Cognitive behavioral therapy and fluoxetine for binge eating disorder: two-year follow-up

Objective: This study assessed the long‐term effects of group behavioral treatment plus individual cognitive behavioral therapy (CBT) and/or fluoxetine in binge eating disorder (BED) patients. Research Methods and Procedures: A total of 116 individuals were randomized to an initial five‐month trial and were followed up over two years. Assessments, including binge frequency, weight, and self‐report measures, were administered at pre‐treatment, post‐treatment, and ～6, 12, 18, and 24 months after initial treatment. Results: Across treatment groups, there was overall improvement over 29 months in binge frequency and in binge abstinence. The odds of binge abstinence 2 years post‐treatment were 1.373 times the odds of binge abstinence immediately post‐treatment. There was no significant change in weight over the two‐year period. Subjects who received individual CBT evidenced lower binge frequency over the two‐year follow‐up period than patients who had not received individual CBT. Similarly, CBT was associated with increased rates of binge abstinence. There were no main effects of treatment assignment on weight over the two‐year follow‐up period. There was a significant advantage for fluoxetine assignment over the two‐year follow‐up period on depressive symptoms. Discussion: The major significance of the study rests in its examination of the long‐term effects of standardized interventions for BED. Our findings provide support for the ideas that short‐term treatment may confer long‐term benefit and that not all treatments are equivalent in the benefits they confer.     

Eating disorder symptomatology in normal-weight vs. obese individuals with binge eating disorder

Although normal-weight individuals comprise a substantial minority of the binge eating disorder (BED) population, little is known about their clinical presentation. This study sought to investigate the nature and severity of eating disturbances in normal-weight adults with BED. We compared 281 normal-weight (n = 86) and obese (n = 195) treatment-seeking adults with BED (mean age = 31.0; s.d. = 10.8) on a range of current and past eating disorder symptoms using ANOVA and χ(2) analyses. After controlling for age and sex, normal-weight participants reported more frequent use of a range of healthy and unhealthy weight control behaviors compared to their obese peers, including eating fewer meals and snacks per day; exercising and skipping meals more frequently in the past month; and avoiding certain foods for weight control. They also endorsed more frequent attempts at dieting in the past year, and feeling more frequently distressed about their binge eating, at a trend level. There were no group differences in binge eating frequency in the past month, age at onset of binge eating, overvaluation of shape/weight, or likelihood of having used certain weight control behaviors (e.g., vomiting, laxative use) or having sought treatment for an eating disorder in the past. Based on our findings, normal-weight individuals appear to be a behaviorally distinct subset of the BED population with significantly greater usage of both healthy and unhealthy weight control behaviors compared to their obese peers. These results refute the notion that distress and impairment in BED are simply a result of comorbid obesity.