William G. Johnson

Measuring binge eating in adolescents: Adolescent and parent versions of the questionnaire of eating and weight patterns

OBJECTIVE This study investigated the psychometric properties of an adolescent version of the Questionnaire of Eating and Weight Patterns (QEWP-A). METHOD Male and female adolescents between 10-18 years completed the QEWP-A and measures of depression and eating attitudes. Height and weight were also measured. Parents completed a parental version (QEWP-P) that was referenced to their children. Adolescent and parent responses to the QEWP were independently categorized into no diagnosis (ND), nonclinical binge eating (NCB), and binge eating disorder (BED) groups. RESULTS Adolescent and parental agreement over the diagnostic categories was as follows: 81.6% for ND, 15.5% for NCB, and 25% for BED with an overall kappa of. 19. Adolescents with BED had significantly higher levels of depression than the other two groups with NCB being higher than ND. For eating attitudes, BED adolescents were more deviant than the other two groups who did not differ from one another. DISCUSSION The QEWP-A displayed adequate concurrent validity. The low overall agreement between adolescents and their parents was influenced by high and low base rates in the NCB and BED categories, respectively. This lack of agreement is consistent with other behavioral problems such as depression. The data suggest that parental perceptions of eating problems approximate those of their children when no problem is present. However, parents are not as likely to be aware of eating difficulties when they actually exist.

Binge eating disorder and the proposed DSM-IV criteria: Psychometric analysis of the questionnaire of eating and weight patterns

Proposed binge eating disorder (BED) diagnostic criteria were investigated to provide necessary psychometric characteristics and explore their utility in assessment. One hundred four subjects (52 self-referred bingers, 52 comparison subjects) completed an initial administration of the Questionnaire of Eating and Weight Patterns (QEWP). The results supported the ability of the two core BED criteria (i.e., episodic overeating, loss of control) to discriminate between clinical and nonclinical binge eaters. Thirty-nine of the self-referred and 40 of the comparison subjects completed a second QEWP administration 3 weeks later. Results indicated that the BED diagnosis was moderately stable over the 3-week interval (kappa = .58, combined sample). Using self-monitoring data completed by the self-referred subjects, predictive efficiency analyses indicated that the QEWP was able to identify both high and low probability binge eaters. Implications of the findings for the definition, assessment, and utility of the BED diagnosis are discussed.

Prevalence and correlates of binge eating in white and African American adolescents

OBJECTIVE This study examined the prevalence and correlates of binge eating in a biracial sample of adolescent males and females. METHOD White and African American students in Grades 6-12 (N=822) completed measures of social economic status (SES), body mass index (BMI), depression, current-ideal body image discrepancy, eating attitudes, dieting frequency, dietary intake, and activity level. RESULTS Binge eating prevalence was highest among African American boys relative to the other demographic groups: 26% African American boys, 17% African American girls, 19% white boys, 18% white girls. Binge eating rates increased with age for white participants and decreased with age for African American participants. Depressive symptoms and consumption of high-fat foods predicted binge status among adolescents, whereas SES, BMI, eating attitudes, body image discrepancy, dieting, and low activity level failed to add predictive value. DISCUSSION The observation of developmental differences in binging between whites and African Americans corresponds to their physical maturational divergence. These findings underscore the need for population-based surveys that sample binge eating across age, gender, and ethnicity.

Energy regulation over the menstrual cycle

To investigate the influence of ovarian hormones on energy regulation, twenty-six normal weight, noneating disordered women recorded their food consumption, exercise, and eating patterns over one menstrual cycle. Serum levels of ovarian hormones were measured to determine three menstrual cycle phases, namely perimenstrual, follicular/ovulatory, and luteal. Energy intake increased 685.9 kJ/day (p < 0.05) from the follicular/ovulatory to the luteal phase. The percent of energy intake as protein and carbohydrate was relatively constant over the three menstrual cycle phases, but the intake from fat increased 2% (p < 0.05) during the luteal phase, representing a 9.2 g/day increment. Variations in energy and fat intake over the menstrual cycle were not attributable to differences in energy expenditure through exercise or dietary restraint, and appear to be related to changes in the estrogen/progesterone ratio.

A naturalistic functional analysis of binge eating

A naturalistic functional analysis of self-monitoring records was used to investigate the time of day, day of week, social context, physical context, hunger, and mood prior to eating as antecedent conditions to binge eating in binge eating disordered (BED) individuals, non-clinical binge eaters (NCB), and normal control subjects (NRM). An analysis of reported binge episodes found that BED subjects reported 36.2% of their food intakes as binges, compared to 23.2% for NCB subjects, and 12.1% for NRM subjects. Important similarities as well as differences in the overall eating and binging patterns of the three groups of subjects were identified. The frequency and pattern of meals were very similar and binging occurred primarily in the evening at supper or at later snacks. All three groups also displayed a pattern of binge eating in response to negative emotions, with NRM subjects also binging in response to positive emotions. Furthermore, the abstinence violation effect was observed in all three groups.

Psychopathology correlates of binge eating and binge eating disorder.

The present study examined the psychopathology associated with binge eating disorder (BED), a new diagnostic category proposed for DSM-IV to classify patients with significant binge eating problems in the absence of purging. Self-report measures of psychopathology (e.g., depression, anxiety) and body image disturbance were administered to 72 women who prospectively (1) met criteria for BED (DSM-IV criteria), (2) reported frequent bingeing but did not meet BED criteria, and (3) denied problems with eating. Subjects satisfying BED criteria reported higher levels of psychopathology than normals on all measures and subclinical binge eaters scored between these two groups, but they were closer to subjects without eating problems. The pattern of results was essentially unchanged when corrected for weight. BED subjects and subclinical binge eaters were less satisfied with their bodies than were normal controls. These findings suggest that BED is not only characterized by frequent bingeing, but more importantly is associated with elevated psychopathology. Overall, these results lend support to the diagnostic criteria proposed for BED.

A Comparison of Instruments for Assessing Competency to Stand Trial

The present study compared two instruments for assessing competency to stand trial, The Competency Screening Test and a revised version of The Georgia Court Competency Test. in a sample of 140 defendants admitted to the forensic unit of a state hospital for court-ordered pretrial evaluation. Scores on the tests were used to predict staff decisions about competency. Correlates of scores on the two tests also were examined. The tests were highly correlated with one another and with the decisions of forensic examiners. Although neither of these instruments should provide the sole basis for competency decisions, both may be useful components of a comprehensive program of competency evaluation.

Restrained eating: Measuring an elusive construct.

As a measure of restrained eating, Hermans Restraint Scale (1978) reliably predicts laboratory food consumption in college students regardless of their weight. However, the generality and psychometric properties of the scale have not been established. In the present study, 136 male and female adults were cross-classified as obese and normal and as dieting or non-dieting. The subjects were administered a single questionnaire containing items of the Lie, Social Desirability, and Restraint scales presented in randomized order. Unlike previous reports by Herman, the three adult groups differed significantly on the Restraint Scale in the following order: Obese dieters greater than Obese non-dieters greater than normals. Also, alpha reliability coefficients varied across groups and corrected item-total correlations also displayed considerable variability with no uniformity apparent for individual item correlations. The factor analysis identified three factors within the ten item scale, and for the obese dieters, the scale was not independent of social desirability. These results indicate that the Restraint Scale has limited usefulness beyond laboratory settings with college students.

The performance of obese and normal size children on a delay of gratification task

Abstract We sought to extend Schachters external hypothesis of obesity to children by predicting that obese children would evidence fewer delayed choices than normals on a delay of gratification task. Obese and normal size children ranging in age from 6–11 yr were presented with ten choices (5 food, 5 non-food) each of which involved an immediately available, smaller reward or two of the same available the next day. For the total group, the expected relationship between degree of obesity and delayed choices was significant for the food but not the non-food items. While significant, the former relationship was small and not characteristic of all age groups. The results are discussed within a developmental framework of externality and obesity.

Macronutrient intake, eating habits, and exercise as moderators of menstrual distress in healthy women.

The present investigation studied the relationship between symptoms of menstrual distress and macronutrient intake, eating behavior, and exercise in healthy women.Twenty-six normally menstruating women with no complaints of menstrual distress completed a disguised questionnaire on menstrual symptoms and monitored the type and amount of food consumed as well as the type and duration of exercise during a full menstrual cycle. Menstrual cycle phases were determined by the presence of menses, ovarian hormonal assays, and basal temperature monitoring. Reports of pain, water retention, negative affect, behavior change, and arousal were significantly higher (p <.05 or better) in the perimenstruum when compared to the follicular and luteal phases. During the perimenstruum, a higher energy intake of carbohydrate was associated with higher ratings of negative affect (p <.01) and impaired performance/decreased activity (p <.05). Lower energy intake of protein was associated with higher ratings of well being (p <.05). Overeating and dieting behavior were related to greater water retention (p <.01), autonomic reactions (p <.05), and appetite (p <.05). The amount of aerobic exercise in contrast to the intensity was related to lower water retention (p <.01), autonomic reactions (p <.05), and appetite (p <.01). Carbohydrate consumption, eating behavior, and regular exercise are reliably associated with menstrual distress and deserving of experimental evaluation as treatment interventions for menstrual distress.