Abstract
OBJECTIVE: To determine whether extremely obese binge eating disorder (BED) subjects (BED defined by the Eating Disorder Examination) differ from their extremely obese non-BED counterparts in terms of their eating disturbances, psychiatric morbidity and health status.
DESIGN: Prospective clinical comparison of BED and non-BED subjects undergoing gastric bypass surgery (GBP).
SUBJECTS: Thirty seven extremely obese (defined as BMI ≥40 kg/m2) subjects (31 women, six men), aged 22–58 y.
MEASUREMENTS: Eating Disorder Examination 12th Edition (EDE), Three Factor Eating Questionnaire (TFEQ), Structured Clinical Interview for the Diagnostic and Statistical Manual-IV (SCID-IV), Short-Form Health Status Survey (SF-36), and 24 h Feeding Paradigm.
RESULTS: Twenty-five percent of subjects were classified as BED (11% met full and 14% partial BED criteria) and 75% of subjects were classified as non-BED. BED (full and partial) subjects had higher eating disturbance in terms of eating concern and shape concern (as found by the EDE), higher disinhibition (as found by the TFEQ), and they consumed more liquid meal during the 24 h feeding paradigm. No difference was found in psychiatric morbidity between BED and non-BED in terms of DSM-IV Axis I diagnosis. The health status scores of both BED and non-BED subjects were significantly lower than US norms on all subscales of the SF-36, particularly the BED group.
CONCLUSION: Our findings support the validity of the category of BED within a population of extremely obese individuals before undergoing GBP. BED subjects differed from their non-BED counterparts in that they had a greater disturbance in eating attitudes and behavior, a poorer physical and mental health status, and a suggestion of impaired hunger/satiety control. However, in this population of extremely obese subjects, the stability of BED warrants further study.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 4th edn (DSM-IV) APA: Washington, DC 1994.
Fairburn CG, Hay PJ, Welch SL . Binge eating and bulimia nervosa: distribution and determinants In: Fairburn CG, Wilson GT (eds) Binge eating: nature, assessment, and treatment The Guilford Press: London 1993 pp 317–360.
Spitzer RL, Devlin M, Walsh BT, Hasin D, Wing RR, Marsh MD, Stunkard A, Wadden T, Yanovski SZ, Agras S, Mitchell J, Nonas C . Binge eating disorder: a multisite field trial of the diagnostic criteria Int J Eat Disord 1992 11: 191–203.
Yanovski SZ, Nelson JE, Dubbert BK, Spitzer RL . Association of binge eating disorder and psychiatric comorbidity in obese subjects Am J Psychiatry 1993 150: 1472–1479.
Stunkard AJ, 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.
Telch CF, Agras WS, Rossiter EM . Binge eating increases with increasing adiposity Int J Eat Disord 1988 7: 115–119.
De Zwann M, Mitchell JE, Seim HC, Specker SM, Pyle RL, Raymond NC, Crosby RB . Eating related and general psychopathology in obese females with binge eating disorder Int J Eat Disord 1994 15: 43–52.
Marcus MD, Wing RR, Ewing L, Kern E, McDermott M, Gooding W . A double-blind placebo-controlled trial of fluoxetine plus behavior modification in the treatment of obese binge-eaters and non-binge eaters Am J Psychiat 1990 147: 876–881.
Striegel-Moore RH, Wilson GT, Wilfley DE, Elder KA, Brownell KD . Binge eating in an obese community sample Int J Eat Disord 1998 23: 27–37.
Wilfley DE, Friedman MA, Dounchis JZ, Stein RI, Welch RR, Ball SA . Comorbid psychopathology in binge eating disorder: relation to eating disorder severity at baseline following treatment J Consult Clin Psychol 2000 68: 641–649.
Shisslak CM, Pazda SL, Crago M . Body weight and bulimia as discriminators of psychological characteristics among anorexic, bulimic and obese women J Abnorm Psychol 1990 99: 380–384.
Wadden TA, Foster GD, Leitzia KA, Wilk JE . Metabolic, anthropomorphic, and psychological characteristics of obese binge eaters Int J Eat Disord 1993 14: 17–25.
Wilson GT, Nonas CA, Rosenblum GD . Assessment of binge eating obese patients Int J Eat Disord 1993 13: 25–33.
Goldfein JA, Walsh BT, LaChaussee JL, Kissileff HR, Devlin MJ . Eating behavior in binge eating disorder Int J Eat Disord 1993 14: 427–431.
Yanovski SZ, Leet M, Yanovski JA, Flood M, Gold PW, Kissileff HR, Walsh BT . Food selection and intake of obese women with binge-eating disorder Am J Clin Nutr 1992 56: 975–980.
Flegal KM, Carroll RJ, Kuczmarski RJ, Johnson CL . Overweight and obesity in the United States: prevalence and trends, 1960–1994 Int J Obess Relat Metab Disord 1998 22: 39–47.
Kalarchian MA, Wilson GT, Brolin RE, Bradley L . Binge eating in bariatric surgery patients Int J Eat Disord 1998 23: 89–92.
Fairburn CG, Cooper Z . The eating disorder examination (12 Edition) In: Fairburn CG, Wilson GT (eds) Binge eating: nature, assessment, and treatment The Guilford Press: London 1993 pp 317–360.
Stunkard AJ, Messick S . The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger J Psychosom Res 1985 29: 71–83.
First MB, Gibbon M, Spitzer RL, Williams JBW . Structured Clinical Interview for DSM-IV Axis I Disorders —Patient Edition (SCID I/P, Version 2.0 Biometrics Research Department 1997.
Ware JE, Sherbourne CD . The MOS 36-Item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection Med Care 1992 30: 473–483.
Kissileff HR, Klingsber G, van Itallie TB . Universal eating monitor for continuous recording of solid or liquid consumption in man Amer J Physio 1980 238: R14–22.
Halmi KA, Sunday SR . Temporal patterns of hunger and fullness ratings and related cognitions in anorexia and bulimia Appetite 1991 16: 219–237.
Das SK, Saltzman E, McCrory MA, Wang J, Hsu LKG, Shikora SA, Donikowski G, Kehayias JJ, Roberts SB . Energy expenditure in extreme obesity. (submitted)
Marcus MD, Wing RR, Guare J, Blair EH, Jawad A . Lifetime prevalence of major depression and its effects on treatment outcomes in obese type II diabetic patients Diabetes Care 1992 15: 553–555.
Mussell MP, Peterson CB, Weller CL, Crosby RD, de Zwaan M, Mitchell JE . Differences in body image and depression among obese women with and without binge eating disorder Obes Res 4: 431–439.
Berman WH, Berman ER, Heymsfield S et al. The effect of psychiatric disorders on weight loss in obesity clinic patients Behav Med 1993 18: 167–172.
Goldsmith SJ, Anger-Friedfeld K, Beren S et al. Psychiatric illness in patients presenting for obesity treatment Int J Eat Disord 1992 12: 63–71.
Halmi KA, Long M, Stunkard AJ et al. Psychiatric diagnosis of morbidly obese gastric bypass patients Am J Psychiat 1980 137: 470–472.
Stunkard AJ . Eating patterns and obesity Psychiatr Q 1959 33: 284–295.
Birketvedt GS, Florholmen J, Sundsfjord J, Osterud B, Dinges D, Bilker W, Stunkard AJ . Behavioral and neuroendocrine characteristics of the night-eating syndrome JAMA 1999 282: 657–663.
Striegel-Moore RH, Dohm FA, Soloman EE, Fairburn CG, Pike KM, Wilfley DE . Subthreshold binge eating disorder Int J Eat Disord 2000 27: 270–278.
Fairburn CG, Cooper Z, Doll HA, Norman P, O'Connor M . The natural course of bulimia nervosa and binge eating disorder in young women Arch Gen Psychiatr 2000 57: 659–665.
Cachelin FM, Striegel-Moore RH, Elder KA, Pike KM, Wilfley DE, Fairburn CG . Natural course of a community sample of women with binge eating disorder Int J Eat Disord 1999 25: 45–54.
Russel GFM . Anorexia nervosa: its identity as an illness and its treatment In: Price JH (ed.) Modern trends in psychological medicine Vol 2 pp: 131–164.
Acknowledgements
This work was supported by National Institute of Health grant 5 R01 MH/DK 54092. Support was also provided through the General Clinical Research Center at New England Medical Center, funded by the National Center for Research Resources of the NIH under grant number M01RR00054. The authors thank Susan Roberts, Ph.D., Elizabeth Lydon, R.N., Barbara Tanenbaum, R.D., Catherine Brown, R.N. and the CSU staff, David Liu, Elizabeth Cohen and Hui-Qi Tong.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hsu, L., Mulliken, B., McDonagh, B. et al. Binge eating disorder in extreme obesity. Int J Obes 26, 1398–1403 (2002). https://doi.org/10.1038/sj.ijo.0802081
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ijo.0802081
Keywords
This article is cited by
-
Comparison of eating disorders and eating behaviors in adults with and without type 2 diabetes prior to bariatric surgery
Journal of Eating Disorders (2022)
-
Behavioral and psychological factors associated with suboptimal weight loss in post-bariatric surgery patients
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity (2021)
-
Genetic variation affects binge feeding behavior in female inbred mouse strains
Scientific Reports (2019)
-
Association between hedonic hunger and body-mass index versus obesity status
Scientific Reports (2018)
-
Predictors of Binge Eating among Bariatric Surgery Candidates: Disinhibition as a Mediator of the Relationship Between Depressive Symptoms and Binge Eating
Obesity Surgery (2018)