The significance of overvaluation of shape and weight in binge eating disorder

As publication of DSM-V draws near, research is needed to validate the diagnostic scheme for binge eating disorder (BED). Shape and weight overvaluation has stimulated considerable debate in this regard, given associations with psychosocial impairment and poor treatment outcome in BED. This study sought to further explore the convergent validity and diagnostic specificity of shape and weight overvaluation in BED. A total of 160 women with BED, and 108 women with non-eating disordered psychiatric disorders were recruited from the community. Women with BED were classified as more or less severe based on a global measure of eating-related psychopathology; subsequent receiver operating characteristics analysis determined that a threshold of at least “moderate” overvaluation best predicted membership into a more severe group. BED participants with threshold overvaluation exhibited poorer psychosocial functioning than those with subthreshold overvaluation, as well as participants with other psychiatric disorders. Discriminant function analysis revealed that threshold overvaluation predicted a diagnosis of BED versus other psychiatric disorder with 67.7% accuracy. Results suggest that shape and weight overvaluation is a useful diagnostic specifier in BED. Continued research is warranted to examine its predictive validity in natural course and treatment outcome studies.     

An examination of the interpersonal model of loss of control eating in children and adolescents

The interpersonal model of binge eating disorder proposes that social problems lead to negative affect which, in turn, precipitates binge eating episodes. However, no study to date has examined this model among youth who report loss of control (LOC) eating. Participants were 219 non-treatment-seeking children and adolescent volunteers, age 8-17 years (13.1 ± 2.8y; 50% female). Children's social problems were assessed by parent report. Youth completed self-report questionnaires of negative affect that assessed depressive symptoms and anxiety. Participants were interviewed to determine the presence or absence of LOC eating in the month prior to assessment. Structural equation modeling analyses found that social problems were positively related to LOC eating presence (p = .02). Negative affect mediated the relationship between social problems and LOC eating (95% CI Product = .00247, .01336). These preliminary results suggest that the interpersonal model of binge eating may describe one possible pathway for the development of LOC eating among non-treatment-seeking youth.     

Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa

Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.     

Subtyping children and adolescents with loss of control eating by negative affect and dietary restraint

OBJECTIVE: Research suggests that subtyping adults with binge eating disorders by dietary restraint and negative affect predicts comorbid psychopathology, binge eating severity, and treatment outcome. Little research has explored the validity and clinical utility of subtyping youth along these dimensions. METHOD: Children (aged 8-18 years) reporting loss of control eating (n=159) were characterized based upon measures of dietary restraint and negative affect using cluster analysis, and then compared regarding disordered eating attitudes and behaviors, and parent-reported behavior problems. RESULTS: Robust subtypes characterized by dietary restraint (n=114; 71.7%) and dietary restraint/high negative affect (n=45; 28.3%) emerged. Compared to the former group, the dietary restraint/high negative affect subtype evidenced increased shape and weight concerns, more frequent binge eating episodes, and higher rates of parent-reported problems (all ps<0.05). CONCLUSION: Similar to findings from the adult literature, the presence of negative affect may mark a more severe variant of loss of control eating in youth. Future research should explore the impact of dietary restraint/negative affect subtypes on psychiatric functioning, body weight, and treatment outcome.     

Self-criticism, low self-esteem, depressive symptoms, and over-evaluation of shape and weight in binge eating disorder patients

Despite the fact that negative self-evaluations are widely considered to be prominent in eating disorders, the role of self-criticism has received little empirical attention. The vast majority of research on the construct of self-criticism has focused on its role as a specific personality vulnerability factor in depression-related phenomena. In this study of 236 patients with binge eating disorder, confirmatory factor analysis supported self-criticism, self-esteem, depressive symptoms, and over-evaluation of shape and weight as distinct, albeit related, constructs. Structural equation modeling demonstrated that the relation between self-criticism and over-evaluation of shape and weight was partly mediated or explained by low self-esteem and depressive symptoms. Continued efforts to understand the role of self-criticism in eating disorders appear warranted.     

Loss of control over eating reflects eating disturbances and general psychopathology

This study examined the clinical significance of the loss of control over eating as a key component of eating disorders. It investigated the association of eating-related psychopathology and general psychopathology with objective bulimic episodes (OBEs; experiencing a loss of control while consuming large amounts of food) and subjective bulimic episodes (SBEs; experiencing a loss of control while consuming small/moderate amounts). A community sample of 81 women with a range of disordered eating was recruited: binge-eating disorder, bulimia nervosa, subclinical eating disturbances, or no eating disorders. They were interviewed using the Eating Disorder Examination and completed measures of eating-related and general psychopathology. Both OBE and SBE frequencies correlated significantly with measures of eating-related and general psychopathology, and no significant differences were found between the magnitudes of the correlations with either binge episode type. SBE frequency significantly and independently predicted global eating disorder psychopathology. The loss of control over eating, without consuming large amounts of food, was as closely associated with specific eating disorder psychopathology and general mental health as were traditionally defined OBEs. SBEs may be an important target of treatment and should be considered for future diagnostic classifications of eating disorders.     

Recurrent binge eating with and without the "undue influence of weight or shape on self-evaluation": implications for the diagnosis of binge eating disorder

Levels of eating disorder psychopathology, impairment in psycho-social functioning and use of health services were compared among probable cases of binge eating disorder (BED) with and without extreme weight or shape concerns ("undue influence of weight or shape on self-evaluation") recruited from a large community sample of women. Data for obese non-binge eaters (n=457), also recruited from the community sample, and for a clinical sample of eating disorder patients (n=128), recruited separately, were included for comparative purposes. BED cases who reported extreme weight or shape concerns (n=51, 46.4%) had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not report such concerns (n=59), after controlling for between-group differences in age and body weight. In addition, BED cases who reported extreme weight or shape concerns were more likely to have sought treatment for an eating or weight problem than those who did not. Whereas levels of eating disorder psychopathology and functional impairment were markedly elevated among BED cases with extreme weight or shape concerns, BED cases who did not report extreme weight or shape concerns resembled obese non-binge eaters in most respects. The findings support the inclusion of an undue influence of weight or shape on self-evaluation as a diagnostic criterion for BED. In the absence of this influence, eating disorders that otherwise resemble BED do not appear to be "clinically significant".     

Overconcern with weight and shape is not the same as body dissatisfaction: evidence from a prospective study of pre-adolescent boys and girls

Overconcern with weight and shape and body dissatisfaction have both emerged as significant predictors of disordered eating. However, it is unclear how these constructs relate to each other, and if each has different antecedents and consequences. This study aimed to identify prospective predictors of each construct and to determine their relative importance in predicting dietary restraint and binge eating. Eight- to 13-year-old boys and girls (N = 259) were assessed at baseline and one-year follow-up, using a range of measures that included the Child Eating Disorder Examination. Psychosocial variables predicted overconcern with weight and shape whilst objective weight predicted body dissatisfaction. Body dissatisfaction and weight and shape concern predicted restraint, and weight and shape concern and restraint predicted binge eating. Findings provide support for the theoretical differences between body dissatisfaction and overconcern with weight and shape, and highlight the importance of focusing on specific body image variables.     

A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge eating disorder

We performed a randomized controlled study to test the relative efficacy of guided self-help (gsh) cognitive-behavioral therapy (CBTgsh) and behavioral weight loss treatment (BWLgsh) treatments for binge eating disorder (BED). To provide an additional partial control for non-specific influences of attention, a third control (CON) treatment condition was included. We tested the treatments using a guided self-help approach given the promising results from initial studies using minimal therapist guidance. Ninety consecutive overweight patients (19 males, 71 females) with BED were randomly assigned (5:5:2 ratio) to one of three treatments: CBTgsh (N=37), BWLgsh (N=38), or CON (N=15). The three 12-week treatment conditions were administered individually following guided self-help protocols. Overall, 70 (78%) completed treatments; CBTgsh (87%) and CON (87%) had significantly higher completion rates than BWLgsh (67%). Intent-to-treat analyses revealed that CBTgsh had significantly higher remission rates (46%) than either BWLgsh (18%) or CON (13%). Weight loss was minimal and differed little across treatments. The findings suggest that CBT, administered via guided self-help, demonstrates efficacy for BED, but not for obesity. The findings support CBT administered via guided self-help as a first step in the treatment of BED and provide evidence for its specific effects.     

Overvaluation of shape and weight in binge eating disorder and overweight controls: refinement of a diagnostic construct

Debate continues regarding the nosological status of binge eating disorder (BED) as a diagnosis as opposed to simply reflecting a useful marker for psychopathology. Contention also exists regarding the specific criteria for the BED diagnosis, including whether, like anorexia nervosa and bulimia nervosa, it should be characterized by overvaluation of shape/weight. The authors compared features of eating disorders, psychological distress, and weight among overweight BED participants who overvalue their shape/weight (n=92), BED participants with subclinical levels of overvaluation (n=73), and participants in an overweight comparison group without BED (n=45). BED participants categorized with clinical overvaluation reported greater eating-related psychopathology and depression levels than those with subclinical overvaluation. Both BED groups reported greater overall eating pathology and depression levels than the overweight comparison group. Group differences existed despite similar levels of overweight across the 3 groups, as well as when controlling for group differences in depression levels. These findings provide further support for the research diagnostic construct and make a case for the importance of shape/weight overvaluation as a diagnostic specifier.     

Night-time eating in men and women with binge eating disorder

This study examined the frequency of night-time eating (NE) and its correlates in men and women with binge eating disorder (BED). Two-hundred and seven consecutively evaluated adults (45 men and 162 women) with BED were assessed with semi-structured interviews and a battery of behavioral and psychological measures. Overall, 28% (N = 58) of the participants reported NE. A significantly higher proportion of men (42%) than women (24%) reported NE. Overall, participants who reported NE had a significantly higher body mass index, but otherwise differed little from those who did not report NE. Men and women without NE differed little on behavioral and psychological measures, whereas women with NE had significantly higher levels of eating-, weight-, and shape-concerns than men with NE.     

Emotional, external, restrained eating and overweight in Dutch adolescents

The purpose of this study was to determine how emotional, external and restrained eating behavior and other health-related lifestyle factors were associated with being overweight in adolescents. Moreover, demographic and ethnic differences in eating behavior have been examined. The respondents were 10,087 Dutch adolescents aged 11-16 years (M= 13.0, SD= 0.8). Self-reported eating behavior was measured with the DEBQ. Health-related lifestyle was determined by physical activity, breakfasting, fruit consumption and snacking. High restrained, and low external eating were positively associated with being overweight, whereas no significant association between emotional eating and being overweight was found for girls, and a negative association for boys. Adolescents who ate breakfast on a daily basis were less likely to be overweight than those who ate breakfast irregularly or never. Being overweight was positively associated with fruit consumption for girls and negatively with physical activity for boys.     

Prognostic significance of two sub-categorization methods for the treatment of binge eating disorder: negative affect and overvaluation predict, but do not moderate, specific outcomes

Given the absence of known predictors and moderators for binge eating disorder (BED) treatment outcome and recent findings regarding meaningful sub-categorizations of BED patients, we tested the predictive validity of two subtyping methods. Seventy-five overweight patients with BED who participated in a randomized clinical trial of guided self-help treatments (cognitive-behavioral therapy (CBTgsh) and behavioral weight loss (BWLgsh)) were categorized in two ways. First, a cluster analytic approach yielded dietary-negative affect (29%) and pure dietary (71%) subtypes. Second, research conventions for categorizing patients based upon shape or weight self-evaluation yielded clinical overvaluation (51%) and subclinical overvaluation (49%) subtypes. At the end of treatment, participants subtyped as dietary-negative affect reported more frequent binge episodes compared to the pure dietary subtype, and those with clinical overvaluation reported greater eating disorder psychopathology compared to the subclinical overvaluation group. Neither method predicted binge remission, depressive symptoms, or weight loss. Neither sub-categorization moderated the effects of guided self-help CBT and BWL treatments on any BED outcomes, suggesting that these two specific treatments perform comparably across BED subtypes. In conclusion, dietary-negative affect subtyping and overvaluation subtyping each predicted, but did not moderate, specific and important dimensions of BED treatment outcome.     

Assessment of eating disorder psychopathology in obese children and adolescents: interview versus self-report questionnaire

The present study compared two methods for assessing binge eating and related eating disorder psychopathology in obese children and adolescents. A comparison was made between the child version of the Eating Disorder Examination (ChEDE) and the self-report version of the interview (ChEDE-Q). A total of 139 children and adolescents (aged 10-16 years) seeking inpatient treatment for obesity completed the ChEDE questionnaire and were administered the ChEDE interview afterwards. The ChEDE and ChEDE-Q were significantly correlated for the four subscales: restraint, eating concern, weight concern and shape concern. The ChEDE-Q generated consistently higher levels of eating disorder psychopathology. There was a significant discrepancy for the assessment of a more complex feature such as binge eating. Overall, the current study found lower levels of agreement between the EDE and EDE-Q than previously reported in adult samples. It appears that children and adolescents have difficulties in identifying binge-eating episodes when they receive no detailed instruction. It is concluded that a clinical interview is necessary to identify eating disorders in obese children and that a self-report questionnaire can only be used as a screening tool. Even then, thorough clarification of the definition of the eating disorder features is needed when using a self-report questionnaire.     

Loss of control over eating in obese youngsters

OBJECTIVE: To investigate loss of control over eating in a sample of obese youngsters seeking treatment. METHOD: Obese youngsters (aged 10-16) were categorized into those having experienced loss of control (LC) and those who had not (NoLC) using the child version of the Eating Disorder Examination. Furthermore, the LC group was subdivided into an objective binge eating (OBE) and a subjective binge eating (SBE) group. The groups were compared on psychological measures. RESULTS: LC subjects (17.9%) showed more concern about eating, weight and shape. They also reported more emotional and external eating behaviors and more depression. Youngsters who report SBE show resemblances to both NoLC and OBE subjects. DISCUSSION: LC subjects are characterized by more eating-related psychopathology and higher levels of depression. Especially obese youngsters with OBE turned out to be a pathological group.     

Rapid response predicts binge eating and weight loss in binge eating disorder: findings from a controlled trial of orlistat with guided self-help cognitive behavioral therapy

OBJECTIVE: It is important to find ways to predict response to treatments as this may inform treatment planning. We examined rapid response in obese patients with binge eating disorder (BED) who participated in a randomized placebo-controlled study of orlistat administered with cognitive behavioral therapy delivered by guided self-help (CBTgsh) format. METHODS: Fifty patients were randomly assigned to 12-week treatments of either orlistat+CBTgsh or placebo+CBTgsh, and were followed in double-blind fashion for 3 months after treatment discontinuation. Rapid response, defined as 70% or greater reduction in binge eating by the fourth treatment week, was determined by receiver operating characteristic curves, and was then used to predict outcomes. RESULTS: Rapid response characterized 42% of participants, was unrelated to participants' demographic features and most baseline characteristics, and was unrelated to attrition from treatment. Participants with rapid response were more likely to achieve binge eating remission and 5% weight loss. If rapid response occurred, the level of improvement was sustained during the remaining course of treatment and the 3-month period after treatment. Participants without rapid response showed a subsequent pattern of continued improvement. CONCLUSION: Rapid response demonstrated the same prognostic significance and time course for CBTgsh as previously documented for individual CBT. Among rapid responders, improvements were well sustained, and among non-rapid responders, continuing with CBTgsh (regardless of medication) led to subsequent improvements.     

Predictors of disinhibited eating in children with and without overweight

OBJECTIVE: This study examined how 7-13-year-old children with and without overweight respond to free access to snack food in the absence of hunger and whether this eating behaviour could be predicted by parental feeding strategies and child's characteristics. METHODS: A total of 52 children (26 normal weight and 26 overweight children) were exposed to snack food after consuming a typical meal. Parental feeding practices and child's variables were assessed via self-report. RESULTS: Two-third of the sample ate of the presented snacks and consumed an average of 68 g. Overweight boys consumed twice as much than the normal weight boys. Parental feeding strategies did not contribute to the prediction of this eating behaviour. Regardless of the children's weight status, the child's eating style strongly predicted snack intake. CONCLUSIONS: This study provides evidence that overweight boys show difficulties in regulating their eating behaviour. Inconsistent with previous work, no evidence for parental contribution of snack intake was found. The present findings suggest that in older children especially children's own eating style account for the variance in snack eating behaviour.     

Differential effects of approach bias and eating style on unhealthy food consumption in overweight and normal weight women

Objective: The current study aimed to examine the effects of approach bias for unhealthy food and trait eating style on consumption of unhealthy food in overweight and normal weight individuals.

Method: Participants were 245 undergraduate women aged 17 – 26 years. They completed an Approach–Avoidance Task, the Dutch Eating Behaviour Questionnaire (to assess restrained, emotional, and external eating), and a taste test to measure consumption of unhealthy food.

Results: An external eating style predicted increased consumption of unhealthy food. Among overweight participants, external and emotional eating style individually moderated the relationship between approach bias for unhealthy food and subsequent consumption. Specifically, approach bias was positively related to consumption in high external and emotional eaters, but negatively related to consumption in low emotional eaters. These interactions were not observed among normal weight participants.

Conclusion: Practically, the results suggest that overweight individuals who are external or emotional eaters may benefit from interventions that aim to modify approach bias towards unhealthy food cues to reduce problematic eating behaviour.     

Relationship Between Rate of Eating and Degree of Satiation

ABSTRACT

Behavioral psychologists have developed effective methods of treatment for overeating and weight control, including mealtime regulation, avoidance of taboo foods, and removal of identified precursors to the bingeing behavior. The current study sought to examine the relationship between speed of eating and levels of satiation in weight conscious individuals. Ten participants were instructed to eat at a fast and a slow rate in a within-subjects reversal design. Consuming food at a slow rate helped participants achieve satiation quicker with comparable amounts of food intake. Slow eaters were also less likely to overeat. These results suggest that slow eating may prevent excessive food consumption in weight conscious individuals, constituting an effective means of weight management.     

Loss of control eating and psychological maintenance in children: An ecological momentary assessment study

Objective

Recent research suggests that binge eating is a common experience in youth. However, it remains largely unknown how children's binge eating presents in everyday life and which psychological factors serve to maintain this binge eating.

Methods

Children aged 8-13 years with binge eating (n = 59), defined as at least one episode of loss of control (LOC) over eating within the past three months, and 59 matched children without LOC history were recruited from the community. Following a combined random- and event-sampling protocol, children were interviewed about their day-to-day eating behavior, mood, and eating disorder-specific cognitions using child-specific cell phones during a 4-day assessment period in their natural environment.

Results

LOC episodes led to a significantly greater intake of energy, particularly from carbohydrates, than regular meals of children with and without LOC eating. While LOC episodes were preceded and followed by cognitions about food/eating and body image, there was minimal evidence that negative mood states were antecedents of LOC eating.

Conclusions

The results provide support for the construct validity of LOC eating in children. Maintenance theories of binge eating for adults apply to children regarding eating disorder-specific cognitions, but the association with affect regulation difficulties requires further investigation.