Appearance vs. Health Reasons for Seeking Treatment Among Obese Patients with Binge Eating Disorder

Objectives : This study examined reasons for seeking treatment reported by obese patients diagnosed with binge eating disorder (BED). Research Methods and Procedures : Participants were 248 adults (58 men and 190 women) who met DSM criteria for BED. Participants were recruited through advertisements for treatment studies looking for persons who wanted to “stop binge eating and lose weight.” Patients’ reasons for seeking treatment were examined with respect to demography (gender and age), obesity (BMI and age of onset), features of eating disorders, and associated psychological functioning (depression and self‐esteem). Results : Of the 248 participants, 64% reported health concerns and 36% reported appearance concerns as their primary reason for seeking treatment. Reasons for seeking treatment did not differ significantly by gender. Patients seeking treatment because of appearance‐related reasons had lower BMIs than those reporting health‐related reasons (34.8 vs. 38.5, respectively), but they reported greater body dissatisfaction, more features of eating disorders, and lower self‐esteem. Discussion : Reasons that prompt treatment seeking among obese individuals with BED reflect meaningful patient characteristics and, therefore, warrant assessment and consideration during treatment planning. Further research is needed to determine whether reasons for treatment seeking among different obese patient groups affect treatment outcomes.     

Childhood Psychological,Physical, and Sexual Maltreatment in Outpatients with Binge Eating Disorder: Frequency and Associations with Gender,Obesity, and Eating‐Related Psychopathology

Objective: To examine rates of reported childhood maltreatment in binge eating disorder (BED), and to explore associations with obesity, gender, eating disorder features, and associated functioning. Research Methods and Procedures: Subjects were 145 consecutive outpatients with BED as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition. Subjects were interviewed and they completed questionnaires to assess eating disorder features and functioning. The Childhood Trauma Questionnaire was given to assess childhood maltreatment in five domains (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). Results: A total of 83% of BED patients reported some form of childhood maltreatment. A total of 59% of BED patients reported emotional abuse, 36% reported physical abuse, 30% reported sexual abuse, 69% reported emotional neglect, and 49% reported physical neglect. There were no differences in the distribution of any form of childhood maltreatment by gender or by obesity status. The different forms of maltreatment were not associated with variability in current body mass index, binge eating, or in the attitudinal features of eating disorders. Only one of the five forms of maltreatment (physical neglect) was associated with dietary restraint in women. Emotional abuse was significantly associated with greater body dissatisfaction, higher depression, and lower self‐esteem in men and women and sexual abuse was associated with greater body dissatisfaction in men. The different forms of maltreatment were unrelated to the age at onset of overweight, dieting, or binge eating. Discussion: BED outpatients reported a wide range of childhood experiences of maltreatment that do not differ by gender or obesity status. Different forms of maltreatment were not associated with the onset of overweight, dieting, or binge eating, or with variability in current body mass index or eating disorder features (except for one association between physical neglect and dietary restraint). Reports of emotional abuse were associated with greater body dissatisfaction and depression and lower self‐esteem in men and women and sexual abuse with greater body dissatisfaction in men.     

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.     

Childhood Maltreatment in Extremely Obese Male and Female Bariatric Surgery Candidates**

Objective: To examine rates of self‐reported childhood maltreatment in extremely obese bariatric surgery candidates and to explore associations with sex, eating disorder features, and psychological functioning. Research Methods and Procedures: Three hundred forty (58 men and 282 women) extremely obese consecutive candidates for gastric bypass surgery completed a questionnaire battery. The Childhood Trauma Questionnaire was given to assess childhood maltreatment. Results: Overall, 69% of patients self‐reported childhood maltreatment: 46% reported emotional abuse, 29% reported physical abuse, 32% reported sexual abuse, 49% reported emotional neglect, and 32% reported physical neglect. Except for higher rates of emotional abuse reported by women, different forms of maltreatment did not differ significantly by sex. Different forms of maltreatment were generally not associated with binge eating, current BMI, or eating disorder features. At the Bonferonni‐corrected significance level, emotional abuse was associated with higher eating concerns and body dissatisfaction, and emotional neglect was associated with higher eating concerns. In terms of psychological functioning, at the Bonferonni‐corrected level, emotional abuse and emotional neglect were associated with higher depression and lower self‐esteem, and physical abuse was associated with higher depression. Discussion: Extremely obese bariatric surgery candidates reported rates of maltreatment comparable with those reported by clinical groups and roughly two to three times higher than normative community samples. Reported experiences of maltreatment differed little by sex and were generally not significantly associated with current BMI, binge eating, or eating disorder features. In contrast, maltreatment—notably emotional abuse and neglect—were significantly associated with higher depression and lower self‐esteem.     

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.     

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.     

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.     

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.     

Characteristics of Men with Persistent Thinness

Objective: Although Western society is increasingly obesogenic, some individuals maintain low weights. Thin women manifest fewer eating disorders and higher self‐esteem. However, little is known about persistently thin men. Research Methods and Procedures: Participants completed measures of demographics, psychiatric history, body size, eating behavior, and personality. Results: Thinness was associated with less eating pathology. Thin men were more likely to meet criteria for generalized anxiety disorder (odds ratio = 2.46). Discussion: Persistent thinness may protect men from eating disorders.     

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.     

The Metabolic Syndrome and Behavioral Correlates in Obese Patients With Binge Eating Disorder

This study examined the frequency of the metabolic syndrome (MetSyn) and explored behavioral eating‐ and weight‐related correlates in obese patients with binge eating disorder (BED). Ninety‐three treatment‐seeking obese BED patients (22 men and 71 women) with and without the MetSyn were compared on demographic features and a number of current and historical eating and weight variables. Sixty percent of the obese patients with BED met criteria for the MetSyn, with men and whites having significantly higher rates than women and African Americans, respectively. Patients with vs. without coexisting MetSyn did not differ significantly in self‐reported frequency of binge eating or severity of eating disorder psychopathology. Multivariate hierarchical logistic regression analysis revealed that, after controlling for gender, ethnicity, and BMI, fewer episodes of weight cycling and regular meal skipping were significant predictors of the MetSyn. These findings suggest that lifestyle behaviors including weight loss attempts and regular meal consumption may be potential targets for prevention and/or treatment of the MetSyn in obese patients with BED.     

Emotional Eating,Alexithymia, and Binge‐Eating Disorder in Obese Women

Objective: To investigate the relationships between alexithymia and emotional eating in obese women with or without Binge Eating Disorder (BED). Research Methods and Procedures: One hundred sixty‐nine obese women completed self‐report questionnaires, including the Beck Depression Inventory, the State Trait Anxiety Inventory, the Stress Perceived Scale, the Dutch Eating Behaviour Questionnaire, and the Toronto Alexithymia Scale. The presence of BED, screened using the Questionnaire of Eating and Weight Patterns, was confirmed by interview. Results: Forty obese women were identified as having BED. BED subjects and non‐BED subjects were comparable in age, body mass index, educational level, and socioeconomic class. According to the Dutch Eating Behaviour Questionnaire, BED subjects exhibited higher depression, anxiety, perceived stress, alexithymia scores, and emotional and external eating scores than non‐BED subjects. Emotional eating and perceived stress emerged as significant predictors of BED. The relationships between alexithymia and emotional eating in obese subjects differed between the two groups according to the presence of BED. Alexithymia was the predictor of emotional eating in BED subjects, whereas perceived stress and depression were the predictors in non‐BED subjects. Discussion: This study pointed out different relationships among mood, alexithymia, and emotional eating in obese subjects with or without BED. Alexithymia was linked to emotional eating in BED. These data suggest the involvement of alexithymia in eating disorders among obese women.     

Psychiatric and Medical Symptoms in Binge Eating in the Absence of Compensatory Behaviors

Objective: To explore the extent to which binge eating in the absence of compensatory behaviors (BE) is associated with psychiatric and medical symptoms in men and women and to control for the independent effects of BMI. Research Methods and Procedures: A series of regression models was applied to questionnaire data on 8045 twins, 18 to 31 years old, from a population‐based Norwegian registry. Results: BE was significantly associated with elevated obesity, overweight, symptoms of eating disorders, symptoms of anxiety and depression, panic attacks, depressive episodes, and reduced life satisfaction in both men and women. In women, BE was independently associated with insomnia and early menarche. In men, BE was independently associated with specific phobia, daily smoking, alcohol use, use of pain medication, impairment due to mental health, neck‐shoulder, lower back, and chronic muscular pain, and impairment due to physical health. Both men and women with BE reported higher rates of psychiatric treatment. Discussion: Our results indicate that there is substantial comorbidity between BE and psychiatric symptoms independently of BMI for both men and women. Medical symptoms co‐occur less frequently than previously reported from treatment‐seeking populations in women. Across all domains, the array of symptoms exhibited by men with BE was broader than that observed in women with BE. This observation suggests the importance of considering gender differences in future studies of psychiatric and medical morbidity, binge eating, and obesity.     

Energy Intake Patterns in Obese Women with Binge Eating Disorder

Objective: For binge eating disorder (BED) to be accepted as a distinct diagnostic category in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, it must be demonstrated that the criteria identify a diagnostic entity that is distinct from bulimia nervosa and obesity. This study examined the difference in total energy intake per day, patterns of energy intake throughout the day, and nutrient content of foods consumed in obese individuals who met the criteria for BED (on binge and non‐binge days) and those who did not. Research Methods and Procedures: Twenty women, 12 who met Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria for BED and 8 matched obese controls, participated in the study. All participants underwent six random 24‐hour dietary recall telephone interviews conducted by experienced interviewers using the Nutrition Data Software System. Results: The BED group ingested significantly more kilocalories on days when they had binge eating episodes than the obese control group on average. The BED group ate significantly more in the evening on binge days than their control group counterparts. There is some indication in the data that those with BED may be restricting caloric intake. Finally, data indicated that the BED group ate significantly more protein, carbohydrate, and fat on binge days than on non‐binge days. However, the proportion of kilocalories from each nutrient shifted on BED binge days compared with non‐binge days to favor consumption of fat over carbohydrates. Discussion: More research needs to be done to determine if these findings are reproducible. Then, the neurobiological underpinnings of these differences in nutrient intake patterns and nutrient selection can be studied to help to determine the biological basis of the disorder.     

Differences in Body Image and Depression Among Obese Women With and Without Binge Eating Disorder

Obese individuals with binge eating disorder (BED) differ from obese non-binge eating (NBE) individuals in a number of clinically relevant ways. This study examined attitudinal responses to various measures of body image in women seeking obesity treatment, by comparing NBE participants (n=80) to those with BED (n=48). It was hypothesized that women with BED would demonstrate greater attitudinal disturbance of body image compared to NBE individuals. It was further hypothesized that significant differences between groups would remain after statistically controlling for degree of depression. Consistent with the primary hypothesis, BED participants reported significantly increased attitudinal disturbance in body dissatisfaction and size perception compared to NBE participants. Although shared variance was observed between measures of depression and body image on some items, several aspects of increased body image disturbance remained after statistically controlling for depression. Treatment implications and recommendations for future research are discussed.     

Internalization of weight bias: Implications for binge eating and emotional well-being

Objective: This study examined the relationship between internalization of negative weight‐based stereotypes and indices of eating behaviors and emotional well‐being in a sample of overweight and obese women. Research Method and Procedures: The sample was comprised of 1013 women who belonged to a national, non‐profit weight loss organization. Participants completed an on‐line battery of self‐report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias and symptoms of depression and self‐esteem, attitudes about weight and obesity, and binge eating behaviors. In addition, participants were asked to list the most common weight‐based stereotypes and whether they believed them to be true or false. Results: Participants who believed that weight‐based stereotypes were true reported more frequent binge eating and refusal to diet in response to stigma experiences compared with those who reported stereotypes to be false. The degree to which participants believed stereotypes to be true or false was not related to types or amount of stigma experiences reported, self‐esteem, depression, or attitudes toward obese persons. In addition, engaging in weight loss strategies as a response to bias was not predicted by stereotype beliefs or by actual stigma experiences, regardless of the amount or types of stigma reported. Discussion: These findings suggest that obese individuals who internalize negative weight‐based stereotypes may be particularly vulnerable to the negative impact of stigma on eating behaviors and also challenge the notion that stigma may motivate obese individuals to engage in efforts to lose weight. This study highlights a new area of research that warrants attention to better understand weight stigma and its potential consequences for health.     

Binge eating disorder and night eating syndrome in adults with type 2 diabetes

Objective: To determine the prevalence of binge eating disorder (BED) and night eating syndrome (NES) among applicants to the Look AHEAD (Action for Health in Diabetes) study. Research Methods and Procedures: The Eating Disorders Examination–Questionnaire (EDE‐Q) and the Night Eating Questionnaire (NEQ) were used to screen patients. Phone interviews were conducted using the EDE for those who reported at least eight episodes of objective binge eating in the past month and using the Night Eating Syndrome History and Interview for those who scored ≥25 on the NEQ. Recruitment at four sites (Birmingham, n = 200; Houston, n = 259; Minneapolis, n = 182; and Philadelphia, n = 204) yielded 845 participants (58% women; mean age = 60.1 ± 6.7 years; mean BMI = 36.2 ± 6.3 kg/m²). Results: Screening scores were met by 47 (5.6%) applicants on the EDE‐Q and 71 (8.4%) on the NEQ. Of the 85% (40/47) who completed the EDE interview, 12 were diagnosed with BED, representing 1.4% of the total sample. Of the 72% (51/71) who completed the Night Eating Syndrome History and Interview, 32 were diagnosed with NES, equal to 3.8% of the total sample. Three participants had both BED and NES. Participants with eating disorders were younger, heavier, and reported more eating pathology than those without eating disorders. Discussion: Among obese adults with type 2 diabetes, NES was reported more frequently than BED, which, in turn, was less common than expected.     

Weight Loss Expectations in Patients with Binge‐Eating Disorder

Objective: To study weight loss expectations in patients with binge‐eating disorder and to examine whether expectations differed by sex and motivation for treatment. Research Methods and Procedures: One hundred and thirty patients (104 women and 26 men), aged 23 to 61 (mean age, 43.0 years), with BED completed a measure of desired weights that included their dream weight, happy weight, acceptable weight, and disappointed weight. In a structured interview, participants were asked their primary motivation for seeking treatment (appearance or health) and their lowest adult weight (LAW). Results: The BED participants reported weight loss expectations that far exceeded expert and governmental guidelines. In this sample, desired dream body mass index (BMI), happy BMI, and acceptable BMI averaged reductions in current weight of 36%, 29%, and 23%, respectively. Even the “disappointed” BMI was an average 14% reduction in current weight, and was 1.5 to 3 times greater than the expert recommendation (5% to 10%). Comparisons of desired weights were significantly different for women and men, whereas percent reductions from current weight were not. Although weight goal expectations were significantly lower for those motivated by appearance, compared with those motivated by health, percent reductions for current weight were not. Desired dream weight correlated with reported LAW, and the mean difference between these weights was not significant. Discussion: These findings suggest that patients with BED have weight loss expectations that far exceed expert and governmental guidelines and that these expectations do not differ by sex or motivation for seeking treatment. One possible explanation for these unrealistic desired weights may be the patients’ recollections of their LAWs.     

Dieting Frequency in Obese Patients With Binge Eating Disorder: Behavioral and Metabolic Correlates

This study examined the clinical significance of self‐reported frequency of time spent dieting in obese patients with binge eating disorder (BED). A total of 207 treatment‐seeking obese BED patients (57 men and 150 women) were dichotomized by dieting frequency and gender and compared on a number of historical, psychological, and metabolic variables. Frequent dieters reported significantly earlier age of onset for binge eating, dieting, and obesity, more episodes of weight cycling, greater weight suppression, and greater eating disorder pathology than infrequent dieters; no differences, however, emerged on current binge eating frequency or psychological distress. Among women but not among men, frequent dieters had consistently lower chances of abnormalities in total cholesterol, high‐density lipoprotein (HDL) cholesterol, and the total/HDL cholesterol ratio while infrequent dieters had greater chances of abnormalities on these variables. Dietary restraint was inversely correlated with abnormalities in triglycerides, HDL cholesterol, and the total/HDL cholesterol ratio but was unrelated to low‐density lipoprotein (LDL) cholesterol. In summary, frequent dieters of both genders had greater lifetime and current eating and weight concerns, and in women, decreased chance of metabolic abnormalities than infrequent dieters. Our findings suggest that frequent dieting attempts, particularly in women, are associated with greater eating disorder pathology but may have a beneficial effect on metabolic functioning and cardiovascular disease risk independent of actual weight status. These findings may have implications for clinical advice provided to obese BED patients.     

Toward an Understanding of Health Services Use in Women with Binge Eating Disorder

Objectives : This study examined health services use in community samples of 102 white and 60 black women with binge eating disorder (BED), 164 white and 85 black healthy comparison women, and 86 white and 21 black women with a noneating Axis I psychiatric disorder. Research Methods and Procedures : Participants were matched on age, ethnicity, and education and were asked about their use of emergency room visits, outpatient physician visits for medical care, outpatient psychotherapy visits, and days spent in the hospital over the previous 12 months. Total health services use was computed. Results : There were no between‐group differences in outpatient physician visits or inpatient hospital days. Relative to healthy comparison women, women with BED and women with other Axis I disorders had increased total health services use, psychotherapy visits, and emergency department visits. Relative to women with noneating Axis I disorders, women with BED had less use of psychotherapy visits. Although obese white women were more likely to report emergency department visits than obese black women were, nonobese white women were less likely to report emergency department visits than nonobese black women were. Discussion : That health services use by women with BED compared more with that of women with other Axis I disorders than with that of healthy women suggested that BED has clinical significance and is not benign in terms of its impact on the health care system. It appeared, however, that despite the availability of effective treatments, few women with BED received psychotherapy.