Prevalence of gastrointestinal symptoms in obese and normal weight binge eaters

OBJECTIVES: Disturbances in gastrointestinal function may result from disordered eating and may lead to increases in gastrointestinal (GI) symptoms. We compared GI symptoms in obese and non-obese binge eaters and non-binge eaters. METHODS: One hundred nineteen obese and 77 normal-weight females completed a questionnaire on bowel symptoms and binge eating behaviors for the previous 3 months. Based on binge behaviors and body mass index (> 30 kg/m2), individuals were grouped as obese binge eaters (n = 73), obese non-binge eaters (n = 43), non-obese binge eaters (n = 14), and normal-weight controls (n = 61). RESULTS: Obese binge eaters reported more upper GI symptoms than normal controls or obese non-binge eaters (p < 0.001). Compared with normal controls, nausea, vomiting, and bloating was 2-4 times more prevalent in both binge eating groups. Indigestion was more prevalent in both obese groups. Obese binge eaters reported more lower GI symptoms than normal-weight controls (p < 0.05). Binge eating in both weight groups was associated with more frequent abdominal pain and dyschezia. Obesity was associated with more frequent constipation, diarrhea, straining, and flatus, whether or not subjects reported binge eating. Chi-square showed a significant association between obesity, binge eating, and symptoms of irritable bowel syndrome, using the Manning criteria. CONCLUSIONS: Specific GI symptoms were associated with binge eating and obesity. Overall, symptoms were more prevalent and more severe in obese binge eaters. The high prevalence of GI symptoms in obese patients who indulge in binge eating should be considered in their evaluation and treatment.     

Binge eating onset in obese patients with binge eating disorder

In this study we examined whether obese women with binge eating disorder (BED) reporting earlier onset binge eating differed from those with later onset binge eating on salient clinical parameters. Subjects were 112 women who sought treatment for BED. Subjects with early (< or = age 18) and later onset (> age 18) did not differ in age, weight, body mass index, or severity of binge eating. Participants were interviewed using the Eating Disorder Examination (EDE) and the Structured Clinical Interview for DSM-III-R, and completed a weight and diet history questionnaire. Early-onset binge eaters were more likely than those with later-onset to binge-eat before dieting, to have early onset of obesity and dieting, to have longer binge-free periods, and more paternal obesity and binge eating. Early-onset binge eaters also reported more eating-disorders psychopathology, and they were more likely to report a lifetime history of bulimia nervosa and DSM-III-R mood disorder. These data suggest that there are marked differences among BED patients presenting for treatment. Further research is needed to determine whether these differences reflect a different etiology or have implications for treatment.     

Does interpersonal therapy help patients with binge eating disorder who fail to respond to cognitive-behavioral therapy?

The aim of this quasi-experimental study was to examine the effectiveness of group interpersonal therapy (IPT) in treating overweight patients with binge eating disorder who did not stop binge eating after 12 weeks of group cognitive-behavioral therapy (CBT). Participants in this study were randomly allocated to either group CBT or to an assessment-only control group. After 12 weeks of treatment with CBT, 55% of participants met criteria for improvement and began 12 weeks of weight loss therapy, whereas the nonresponders began 12 weeks of group IPT. Over the 24-week period, participants who received treatment reduced binge eating and weight significantly more than the waiting-list control group. However, IPT led to no further improvement for those who did not improve with CBT. Predictors of poor outcome were early onset of, and more severe, binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled evaluation of the distress criterion for binge eating disorder.

Objective: Research has examined various aspects of the validity of the research criteria for binge eating disorder (BED) but has yet to evaluate the utility of Criterion C, “marked distress about binge eating.” This study examined the significance of the marked distress criterion for BED using 2 complementary comparison groups. Method: A total of 1,075 community volunteers completed a battery of self-report instruments as part of an Internet study. Analyses compared body mass index (BMI), eating-disorder psychopathology, and depressive levels in 4 groups: 97 participants with BED except for the distress criterion (BED–ND), 221 participants with BED including the distress criterion (BED), 79 participants with bulimia nervosa (BN), and 489 obese participants without binge eating or purging (NBPO). Parallel analyses compared these study groups using the broadened frequency criterion (i.e., once weekly for binge/purge behaviors) proposed for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) and the 4th edition (DSM–IV) twice-weekly frequency criterion. Results: The BED group had significantly greater eating-disorder psychopathology and depressive levels than the BED–ND group. The BED group, but not the BED–ND group, had significantly greater eating-disorder psychopathology than the NBPO comparison group. The BN group had significantly greater eating-disorder psychopathology and depressive levels than all 3 other groups. The group differences in eating-disorder psychopathology existed even after controlling for depression levels, BMI, and demographic variables, although some differences between the BN and BED groups were attenuated when controlling for depression levels. Conclusions: These findings provide support for the validity of the “marked distress” criterion for the diagnosis of BED. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

One-year follow-up of cognitive-behavioral therapy for obese individuals with binge eating disorder.

The results of a 1-year posttreatment follow-up of 93 obese women diagnosed as having binge eating disorder (BED) and treated with group cognitive–behavior therapy (CBT) followed by weight loss treatment are described. The group as a whole maintained both reductions in binge eating and abstinence rates fairly well. However, they regained the weight lost during treatment. Those who stopped binge eating during CBT maintained a weight lost of 4.0 kg over the follow-up period. In contrast, those who continued to binge gained 3.6 kg. Twenty-six percent of those abstinent after CBT met criteria for BED at follow-up and had gained weight, whereas the remaining 74% had lost weight. Stopping binge eating appears critical to sustained weight loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbid psychopathology in binge eating disorder: Relation to eating disorder severity at baseline and following treatment.

Individuals with binge eating disorder (BED) have high rates of comorbid psychopathology, yet little is known about the relation of comorbidity to eating disorder features or response to treatment. These issues were examined among 162 BED patients participating in a psychotherapy trial. Axis I psychopathology was not significantly related to baseline eating disorder severity, as measured by the Structured Clinical Interview for DSM-III-R (SCID-I and SCID-II) and the Eating Disorder Examination. However, presence of Axis II psychopathology was significantly related to more severe binge eating and eating disorder psychopathology at baseline. Although overall presence of Axis II psychopathology did not predict treatment outcome, presence of Cluster B personality disorders predicted significantly higher levels of binge eating at 1 year following treatment. Results suggest the need to consider Cluster B disorders when designing treatments for BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A monoclonal inhibition enzyme immunoassay for detection of antibodies against hepatitis B core antigen: confirmation of an immunodominant epitope

We examined the situational antecedents of binge eating episodes and tested for consistency in the antecedents. We evaluated the antecedents of two successive binges via structured interviews with 50 normal-weight nonpurging females who regularly binge. Cluster analysis yielded two categories of binge-promoting situations: solitary negative affect situations and social eating situations. When this empirically derived classification of binge situations was used, the two successively occurring binges did not systematically fall into the same cluster. Consistency on other measures was also modest. Implications of these findings for conceptual models of binge eating and treatment, including the prospect of individually tailored interventions, are discussed.     

Rapid response predicts treatment outcomes in binge eating disorder: Implications for stepped care.

The authors examined rapid response in 75 overweight patients with binge eating disorder (BED) who participated in a randomized clinical trial of guided self-help treatments (cognitive-behavioral therapy [CBTgsh] and behavioral weight loss [BWLgsh]). Rapid response, defined as a 65% or greater reduction in binge eating by the 4th treatment week, occurred in 62% of CBTgsh and 47% of BWLgsh participants. Rapid response was unrelated to most patient characteristics except for eating psychopathology and depressive symptoms. Participants with rapid response were more likely to achieve binge remission and had greater improvements in overall eating pathology and depressive symptomatology than participants without rapid response. Rapid response had different prognostic significance for the 2 treatments. In terms of binge eating, participants receiving CBTgsh, but not BWLgsh, did equally well regardless of whether they experienced rapid response. In terms of increasing restraint and weight loss, participants with rapid response receiving BWLgsh had greater restraint and weight loss than participants receiving CBTgsh. Rapid response has utility for predicting outcomes, provides evidence for specificity of treatment effects, and has implications for stepped care treatment models of BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of women physically abused by their spouses and who seek treatment regarding marital conflict.

Abused women (23 physically vs 25 marital discordant nonabused) reported significantly more fear of their spouses and reported that their spouses were significantly more coercive and psychologically aggressive than women in the 2 matched nonabused groups. Abused women did not report higher rates of abuse as a child, nor did they report higher rates of past psychopathology than women in the nonabused groups. However, abused women and nonabused discordant women reported higher rates of emotional abuse in childhood than maritally satisfied nonabused women. Result suggests that childhood abuse and a history of depression may be risk factors for women in abusive and nonabusive discordant relationships. Abused women reported higher rates of posttraumatic stress disorder than women in the discordant-only and community control groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Onset of binge eating and dieting in overweight women: implications for etiology, associated features and treatment

This study investigated differences between overweight binge eating women who reported the onset of binge eating prior to or following the onset of dieting (binged first [BF], or dieted first [DF]). Of overweight binge eating subjects enrolled in a treatment study, 38.7% indicated binge eating first, and 48.1% dieting first. The mean age of onset of binge eating differed significantly between the two groups (11.8 years vs. 25.7 years). More of the BF group (82.5%) satisfied proposed binge eating disorder (BED) criteria than did the DF group (52.0%), although short of significantly. The results suggest that: (a) the leading hypothesis concerning dieting as a cause of binge eating does not apply to a substantial number of individuals who binge eat; (b) there may be an early pattern and a late pattern in the development of binge eating among overweight individuals; and (c) the early or binge first pattern may be more likely to result in BED.     

Examination of predictors and moderators for self-help treatments of binge-eating disorder.

Predictors and moderators of outcomes were examined in 75 overweight patients with binge-eating disorder (BED) who participated in a randomized clinical trial of guided self-help treatments. Age variables, psychiatric and personality disorder comorbidity, and clinical characteristics were tested as predictors and moderators of treatment outcomes. Current age and age of BED onset did not predict outcomes. Key dimensional outcomes (binge frequency, eating psychopathology, and negative affect) were predominately predicted, but not moderated, by their respective pretreatment levels. Presence of personality disorders, particularly Cluster C, predicted both posttreatment negative affect and eating disorder psychopathology. Negative affect, but not major depressive disorder, predicted attrition, posttreatment negative affect, and eating disorder psychopathology. Despite the prognostic significance of these findings for dimensional outcomes, none of the variables tested were predictive of binge remission (i.e., a categorical outcome). No moderator effects were found. The present study found poorer prognosis for patients with negative affect and personality disorders, suggesting that treatment outcomes may be enhanced by attending to the cognitive and personality styles of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivations for weight loss and behavior change strategies associated with natural recovery from obesity.

Untreated adults (n?=?21) with lengthy weight problem histories who had maintained stable weight loss for a mean of 4.5 years were interviewed and completed questionnaires about their motivations for and behavioral strategies used during weight loss. Currently obese, untreated adults (n?=?20) served as controls. Successful natural recovery was associated with behavior changes like those emphasized in behavioral weight management programs (e.g., healthier food choices, eating more slowly, regular exercise). Motivations for weight loss were largely negative and reflected appearance and psychosocial concerns. Demographic, weight history, and health variables generally did not distinguish the groups. Obesity treatment was widely available but was viewed negatively. These findings reveal natural processes involved in sustained weight loss, highlight the potential importance of separating influences on behavior change from influences on help-seeking, and suggest ways that obesity treatments could be improved to increase their appeal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral treatment of obese binge eaters: do they need different care?

This study investigated the relationship between binge eating and the outcome of weight loss treatment. Participants in a 48-week trial of a structured diet combined with exercise and behavior therapy were classified into one of four groups: no overeating; episodic overeating; subthreshold binge-eating disorder(BED); and BED. Binge eating status was not associated with either dropout or adherence to the diet, but did affect weight loss and mood. The BED group lost significantly more weight at the end of treatment than all other groups, even when adjusting for initial weight. At 1-year follow-up, there were no differences among groups in weight loss or weight regain. The BED group began treatment with significantly higher BDI scores, but improvement in mood occurred by week 5. On the basis of these findings, and a review of the recent literature, we conclude that obese binge eaters respond as favorably to standard dietary and behavioral treatments as do obese nonbingers.     

Binge eating disorder: Reliability and validity of a new diagnostic category.

Examined the reliability and validity of binge eating disorder (BED), which has been proposed for inclusion in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). The interrater reliability of the BED diagnosis compared favorably with that of most diagnoses in the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). To assess validity, the authors compared obese individuals with and without BED and bulimia nervosa patients. BED Ss differed from the non-BED obese group on variables related to dieting and weight histories but did not differ significantly on other important variables, including measures of psychopathology. When compared with bulimia nervosa patients, Ss with BED had significantly less psychopathology and reported significantly less dietary restraint. This study lends some support to the concept of BED but suggests that additional studies of the characteristics of this disorder at different degrees of obesity would be useful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of children and community members concerning the circumstances of orphans in rural Zimbabwe

This study examined two groups of people who were pursuing treatment for obesity: either medical intervention (a hospital group; N = 20) or support for dietary restriction (a community group; N = 18). This study addressed four questions: (1) Were there differences between the two groups in terms of their psychological distress (as measured by the Symptom Checklist)? (2) Does binge eating moderate psychological distress? (3) Do feelings of ineffectiveness moderate psychological distress? and (4) Which variables best accounted for group membership (i.e., type of treatment sought)? Results suggested that the hospital group was significantly more distressed than the community group. However, there were no differences between the two groups with respect to binge eating or feelings of ineffectiveness. These findings suggest that it is the effects of morbid obesity that are most likely to moderate psychological distress.     

Binge antecedents in obese women with and without binge eating disorder.

In this study, women with binge eating disorder (BED; n?=?41) and weight- and age-matched comparison women without BED (NBED; n?=?38) monitored their eating for 6 days, using handheld computers to measure mood, appetite, and setting at all eating episodes and comparison noneating episodes. Poor mood, low alertness, feelings of poor eating control, and craving sweets all preceded binge episodes for the BED group. An unanticipated finding was the frequent report of binge episodes in the comparison group; only feelings of poor eating control and craving sweets predicted binge episodes in this group. Binge eating NBED women tended to experience worse mood, less control, and more craving than other NBED women, contributing to evidence of the close relationship of binge eating and decrements in emotional and appetitive functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overvaluation of shape and weight in binge eating disorder.

The excessive influence of shape or weight on self-evaluation--referred to as overvaluation--is considered by some a central feature across eating disorders but is not a diagnostic requirement for binge eating disorder (BED). This study examined shape/weight overvaluation in 399 consecutive patients with BED. Participants completed semistructured interviews, including the Eating Disorder Examination (EDE; C. G. Fairburn & Z. Cooper, 1993) and several self-report measures. Shape/weight overvaluation was unrelated to body mass index (BMI) but was strongly associated with measures of eating-related psychopathology and psychological status (i.e., higher depression and lower self-esteem). Participants were categorized via EDE guidelines into 1 of 2 groups: clinical overvaluation (58%) or subclinical overvaluation (42%). The 2 groups did not differ significantly in BMI or binge eating frequency, but the clinical overvaluation group had significantly greater eating-related psychopathology and poorer psychological status than the subclinical overvaluation group. Findings suggest that overvaluation does not simply reflect concern commensurate with being overweight but is strongly associated with eating-related psychopathology and psychological functioning and warrants consideration as a diagnostic feature for BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: Meta-analysis and implications for DSM.

Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from AN and BED on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS. Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for AN except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or BED except for binge frequency did not differ significantly from full syndrome cases. Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others—such as purging disorder and non-fat-phobic AN—may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In situ morphology of fetal aortic isthmus following ductal constriction in rats

Obese female subjects with binge eating disorder BED; (N = 107) completed the Beck Depression Inventory, Symptom Checklist-90, Inventory of Interpersonal Problems, and Rosenberg Self-Esteem Scale. Subjects were divided into moderate or severe binger on the basis of scores on the Binge Eating Scale, and grouped into moderately or severely obese by performing a median split on their weights. Spearman correlational analyses were performed to determine the relationship between psychopathology and obesity and psychopathology and binge eating. Analyses of variance (ANOVAs) were then performed using scores on the psychological measures with subjects grouped both by severity of obesity and severity of binge eating. The results indicated that in our sample, obesity and scores on the measures of psychiatric symptomatology were unrelated. However, a significant positive relationship was found between binge eating severity and degree of psychiatric symptomatology. We suggest that binge eating may account for the observed relationship between obesity and psychopathology reported in previous studies. We discuss the importance of assessing BED when conducting research with obese individuals.     

A test of the voluntarism hypothesis among nonvolunteering opiate addicts who voluntarily return to treatment.

Research on the voluntarism hypothesis, which holds that self-reported psychopathology is greater on MMPI clinical scales among addicts who enter treatment on their own volition than among those who do not, has been plagued by differences in treatment settings, types of voluntarism, and lack of experimental designs. Experimental design deficiencies were corrected in the present study, where MMPI scores of 20 former nonvolunteering addicts who voluntarily returned for treatment were compared with 20 matched addicts who had volunteered on both 1st and 2nd admissions. The voluntarism hypothesis was supported. Former nonvolunteers evidenced significantly higher MMPI scores on 2nd admission for scales F, Mf, Pt, Sc, and Si. Volunteers did not significantly differ between 1st and 2nd admissions. Findings underscore the necessity for continuing to improve methods in addiction research. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)