Rachel D. Barnes

Comparison of Methods for Identifying and Assessing Obese Patients with Binge Eating Disorder in Primary Care Settings

OBJECTIVE Given the prevalence and health significance of binge eating disorder (BED) it is important to determine if time-efficient self-reports can adequately assess BED and its features in primary care settings. We compared the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire for Eating and Weight Patterns-Revised (QEWP-R), administered to obese patients with BED in primary care setting to the Eating Disorder Examination (EDE) interview. METHOD Sixty-six participants completed the questionnaires and were interviewed. RESULTS The EDE interview was significantly correlated with the EDE-Q (binge eating, four subscales, and global score) and the QEWP-R (binge eating, distress, and body image). The EDE-Q yielded significantly lower estimates of binge eating and significantly higher scores on the EDE subscales. The QEWP-R yielded significantly higher scores on the behavioral indicators and distress about binge eating and body image variables. DISCUSSION These findings suggest that these two self-report measures have potential utility for identifying BED in obese patients in primary care.

The relation between parental influence, body image, and eating behaviors in a nonclinical female sample

The purpose of the current study is to create a comprehensive composite measure of parental influence based on previously developed measures to clarify the underlying dimensions of parental influence and to determine the degree to which parental influence relates to body image and dysfunctional weight concerns. Previously published literature was reviewed for measures of parental influence, and items from 22 measures were condensed and combined into a single questionnaire, which was completed by 367 female undergraduate psychology students. Two dimensions emerged from a principle components analysis: Direct Influence, which includes weight and eating related comments, and Modeling, which includes parental modeling of dieting and related behavior. Direct Influence and Modeling were significantly related to eating disturbance, such as drive for thinness and bulimic symptomatology. Overall, the results integrate the previous literature and clarify the underlying dimensions of parental influence. Further, this study provides directions for future research related to the development and maintenance of body image and eating disturbance.

Validation of the food thought suppression inventory.

The Food Thought Suppression Inventory (FTSI) was designed as a domain-specific measure of food-related thought suppression, and the FTSI has been found to be associated with eating pathology, including binge eating. Although initial research in this area is promising, as it may provide understanding of the cognitive processes related to the development of eating pathology and obesity, little is known about the psychometric properties of the FTSI. In the current study, the validity of the FTSI was examined, and the FTSI was found to be a valid, reliable, single factor measure of food thought suppression.

Development and Validation of the Eating Loss of Control Scale

Recurrent objective bulimic episodes (OBE) are a defining diagnostic characteristic of binge eating disorder (BED) and bulimia nervosa (BN). OBEs are characterized by experiencing loss of control (LOC) while eating an unusually large quantity of food. Despite nosological importance and complex heterogeneity across patients, measurement of LOC has been assessed dichotomously (present/absent). This study describes the development and initial validation of the Eating Loss of Control Scale (ELOCS), a self-report questionnaire that examines the complexity of the LOC construct. Participants were 168 obese treatment-seeking individuals with BED who completed the Eating Disorder Examination interview and self-report measures. Participants rated their LOC-related feelings or behaviors on continuous Likert-type scales and reported the number of LOC episodes in the past 28 days. Principal component analysis identified a single-factor, 18-item scale, which demonstrated good internal reliability (α = .90). Frequency of LOC episodes was significantly correlated with frequency of OBEs and subjective bulimic episodes. The ELOCS demonstrated good convergent validity and was significantly correlated with greater eating pathology, greater emotion dysregulation, greater depression, and lower self-control but not with body mass index. The findings suggest that the ELOCS is a valid self-report questionnaire that may provide important clinical information regarding experiences of LOC in obese persons with BED. Future research should examine the ELOCS in other eating disorders and nonclinical samples.

Test–retest reliability of the proposed DSM-5 eating disorder diagnostic criteria

The proposed DSM-5 classification scheme for eating disorders includes both major and minor changes to the existing DSM-IV diagnostic criteria. It is not known what effect these modifications will have on the ability to make reliable diagnoses. Two studies were conducted to evaluate the short-term test-retest reliability of the proposed DSM-5 eating disorder diagnoses: anorexia nervosa, bulimia nervosa, binge eating disorder, and feeding and eating conditions not elsewhere classified. Participants completed two independent telephone interviews with research assessors (n=70 Study 1; n=55 Study 2). Fair to substantial agreements (κ=0.80 and 0.54) were observed across eating disorder diagnoses in Study 1 and Study 2, respectively. Acceptable rates of agreement were identified for the individual eating disorder diagnoses, including DSM-5 anorexia nervosa (κs of 0.81 to 0.97), bulimia nervosa (κ=0.84), binge eating disorder (κs of 0.75 and 0.61), and feeding and eating disorders not elsewhere classified (κs of 0.70 and 0.46). Further, improved short-term test-retest reliability was noted when using the DSM-5, in comparison to DSM-IV, criteria for binge eating disorder. Thus, these studies found that trained interviewers can reliably diagnose eating disorders using the proposed DSM-5 criteria; however, additional data from general practice settings and community samples are needed.

Exploring Weight Gain in Year Before Treatment for Binge Eating Disorder: A Different Context for Interpreting Limited Weight Losses in Treatment Studies

OBJECTIVE To examine weight changes in obese patients with binge-eating disorder (BED) during the year before seeking treatment and to explore correlates of weight changes. METHOD Seventy-eight consecutive, treatment-seeking, obese BED patients were assessed with structured interviews and self-report questionnaires. RESULTS Overall, participants reported a mean weight gain of 15.1 pounds during the 12 months before treatment. This overall weight gain comprised remarkable heterogeneity, ranging from a 30-pound loss to a 53-pound gain. The subgroup of participants who reported gaining weight (76% of sample) reported gaining an average of 22.2 pounds during the 12 months before treatment. Weight change was associated with significantly more frequent binge eating and overeating during breakfasts. DISCUSSION Treatment-seeking obese patients with BED reported having gained substantial amounts of weight during the previous year. These findings provide an important context for interpreting the modest weight losses typically reported by treatment studies of BED.

A Randomized Controlled Trial Comparing Scalable Weight Loss Treatments in Primary Care

Primary‐care (PC) settings may be an opportune place to deliver obesity interventions. Scalable interventions utilizing motivational interviewing (MI), supported by Internet resources, may overcome obstacles to effective obesity treatment dissemination. This study was a randomized controlled trial testing two Web‐supported interventions, motivational interviewing (MIC) and nutrition psychoeducation (NPC), an attention‐control intervention, in comparison with usual care (UC).

Sex differences in biopsychosocial correlates of binge eating disorder: a study of treatment-seeking obese adults in primary care setting

OBJECTIVE Although community-based studies suggest equivalent levels of physical and psychological impairment by binge eating disorder (BED) in men and women, men with BED are still underrepresented in clinical studies. This study aimed to provide a comprehensive analysis of sex differences in biopsychosocial correlates of treatment-seeking obese patients with BED in primary care. METHOD One hundred-ninety obese adults (26% men) were recruited in primary care settings for a treatment study for obesity and BED. RESULTS Very few significant sex differences were found in the developmental history and in current levels of eating disorder features, as well as psychosocial factors. Women reported significantly earlier age at onset of overweight and dieting and greater frequency of dieting. Men reported more frequent strenuous exercise. Men were more likely than women to meet criteria for metabolic syndrome; men were more likely to show clinically elevated levels of triglycerides, blood pressure, and fasting glucose levels. CONCLUSION Despite few sex differences in behavioral and psychosocial factors, metabolic problems associated with obesity were more common among treatment-seeking obese men with BED than women. The findings highlight the importance of including men in clinical studies of BED and active screening of BED in obese men at primary care settings.

Social anxiety and self-consciousness in binge eating disorder: associations with eating disorder psychopathology

OBJECTIVE Research has consistently shown that anxiety disorders are common among individuals with eating disorders. Although social phobia has been found to be highly associated with eating disorders, less is known about social anxiety in individuals with binge eating disorder (BED). The present study examined associations between social anxiety and self-consciousness with body mass index (BMI) and eating disorder psychopathology in BED. METHODS Participants were 113 overweight or obese treatment-seeking men and women with BED. Participants were administered semistructural diagnostic clinical interviews and completed a battery of self-report measures. RESULTS Social anxiety was positively and significantly correlated with shape and weight concerns and binge eating frequency. After accounting for depressive levels, social anxiety and self-consciousness accounted for significant variance in eating, shape, and weight concerns and overall eating disorder global severity scores (Eating Disorder Examination). Social anxiety also accounted for significant variance in binge eating frequency after covarying for depressive levels. Social anxiety and self-consciousness were not significantly associated with BMI or dietary restraint. DISCUSSION Our findings suggest that greater social anxiety and heightened self-consciousness are associated with greater eating disorder psychopathology, most notably with greater shape and weight concerns and binge eating frequency in patients with BED. Social anxiety and self-consciousness do not appear to be merely functions of excess weight, and future research should examine whether they contribute to the maintenance of binge eating and associated eating disorder psychopathology.

Psychometric properties of the food thought suppression inventory in men

The Food Thought Suppression Inventory (FTSI) recently was validated with an undergraduate female sample. The measure proved to be a highly reliable and valid one-factor measure of food thought suppression. The current study examined the psychometric properties of the FTSI within 289 men. Results suggest that removing one item resulted in a reliable and valid one-factor measure of food thought suppression for men. Similar to the published results with women, the FTSI was related to pathological eating behaviors (e.g. binge eating, compensatory behaviors), and heavier individuals endorsed higher levels of food thought suppression.