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Binge eating disorder in extreme obesity

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.

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References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 4th edn (DSM-IV) APA: Washington, DC 1994.

  2. 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.

    Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  CAS  Google Scholar 

  5. 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.

    CAS  PubMed  Google Scholar 

  6. Telch CF, Agras WS, Rossiter EM . Binge eating increases with increasing adiposity Int J Eat Disord 1988 7: 115–119.

    Article  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  CAS  Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. 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.

    Article  CAS  Google Scholar 

  11. 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.

    Article  CAS  Google Scholar 

  12. 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.

    Article  CAS  Google Scholar 

  13. Wilson GT, Nonas CA, Rosenblum GD . Assessment of binge eating obese patients Int J Eat Disord 1993 13: 25–33.

    Article  CAS  Google Scholar 

  14. Goldfein JA, Walsh BT, LaChaussee JL, Kissileff HR, Devlin MJ . Eating behavior in binge eating disorder Int J Eat Disord 1993 14: 427–431.

    Article  CAS  Google Scholar 

  15. 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.

    Article  CAS  Google Scholar 

  16. 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.

    Article  CAS  Google Scholar 

  17. Kalarchian MA, Wilson GT, Brolin RE, Bradley L . Binge eating in bariatric surgery patients Int J Eat Disord 1998 23: 89–92.

    Article  CAS  Google Scholar 

  18. 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.

    Google Scholar 

  19. Stunkard AJ, Messick S . The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger J Psychosom Res 1985 29: 71–83.

    Article  CAS  Google Scholar 

  20. 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.

  21. 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.

    Article  Google Scholar 

  22. 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.

    CAS  Google Scholar 

  23. Halmi KA, Sunday SR . Temporal patterns of hunger and fullness ratings and related cognitions in anorexia and bulimia Appetite 1991 16: 219–237.

    Article  CAS  Google Scholar 

  24. Das SK, Saltzman E, McCrory MA, Wang J, Hsu LKG, Shikora SA, Donikowski G, Kehayias JJ, Roberts SB . Energy expenditure in extreme obesity. (submitted)

  25. 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.

    Article  Google Scholar 

  26. 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.

    Article  CAS  Google Scholar 

  27. 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.

    Article  CAS  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. Halmi KA, Long M, Stunkard AJ et al. Psychiatric diagnosis of morbidly obese gastric bypass patients Am J Psychiat 1980 137: 470–472.

    Article  CAS  Google Scholar 

  30. Stunkard AJ . Eating patterns and obesity Psychiatr Q 1959 33: 284–295.

    Article  CAS  Google Scholar 

  31. 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.

    Article  CAS  Google Scholar 

  32. 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.

    Article  CAS  Google Scholar 

  33. 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.

    Article  CAS  Google Scholar 

  34. 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.

    Article  CAS  Google Scholar 

  35. 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.

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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.

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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

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