Abstract
Abstract Objective: Binge Eating Disorder (BED) is highly prevalent among individuals seeking weight loss treatment. Considering the possible trigger factors for BED, different studies focused on the role of emotional eating. The present study compared threshold, subthreshold BED, and subjects without BED in a population of overweight/obese individuals seeking weight loss treatment, considering the anamnesis, the eating disorder specific and general psychopathology, the organic and psychiatric comorbidity, the emotional eating as a trigger factor for binge eating, and the quality of life. Design: cross-sectional survey. Subjects: Four hundred thirty eight overweight subjects seeking weight loss treatment have been enrolled in the study. Measurements: Subjects have been evaluated by means of a clinical interview (SCID I) and different self-reported questionnaires (Eating Disorder Examination Questionnaire, Binge Eating Scale, Beck Depression Inventory, Spielberg's State-Trait Anxiety Inventory, Symptom Checklist 90, Emotional Eating Scale, and Obesity Related Well-Being questionnaire). Results: One hundred and five subjects (24% of the sample) fulfilled the DSM-IV criteria of lifetime BED, 146 (33.3%) fulfilled the criteria of lifetime subthreshold BED, and 187 (42.7%) subjects were diagnosed overweight non-BED. No correlations between the binges frequencies and the overweight levels were found. All the three groups showed high psychiatric comorbidities, and the three groups significantly differed in terms of emotional eating, which was positively correlated to the binge eating frequencies. Conclusions: Threshold and subthreshold BED deserve a careful psychopathological investigation and emotional eating seems to play a key role as trigger factor for binge eating. Obesity is associated with a high psychiatric comorbidity and a low quality of life, independently from the specific and general eating disorder psychopathology.
Highlights
Obesity is a heterogeneous syndrome which can be considered as the result of the interactions between genetic, social, economic, endocrine, metabolic and psychopathological factors.[1,2] Different studies considered two distinct and specific subgroups of overweight subjects: obese whose eating pattern is characterized by binges, such as to meet the diagnosis of Binge Eating Disorder (BED), and obese without BED.[3]
Patients with BED, subthreshold BED and overweight without BED were evaluated by means of a structured clinical interview and different self-reported questionnaires, in order to evaluate similarities and differences in terms of anamnesis, the eating disorder specific and general psychopathology, the emotional eating, the organic and psychiatric comorbidity, and the quality of life
We found that 24.2% of the patients met the DSM IV criteria for lifetime BED, and 33.3% fulfilled the criteria for subthreshold BED, confirming previous findings about the prevalence and the relevance of clinical significant loss of control over eating in samples of overweight and obese subjects seeking weight loss treatment.[10,16,17,42,43,44]
Summary
Obesity is a heterogeneous syndrome which can be considered as the result of the interactions between genetic, social, economic, endocrine, metabolic and psychopathological factors.[1,2] Different studies considered two distinct and specific subgroups of overweight subjects: obese whose eating pattern is characterized by binges, such as to meet the diagnosis of Binge Eating Disorder (BED), and obese without BED.[3] When comparing obese BED and obese nonBED subjects, the BED ones have been shown to have a more severe eating-related psychopathology, a higher axis I, and II comorbidity, and a worse quality of life.[4,5,6,7,8,9,10,11,12,13] Current provisional diagnostic criteria for BED require that binges occur at least twice per week for a minimum of 6 months,[14] and the differences between the individuals with high and low frequencies of binge eating have been studied with conflicting results.[15,16,17,18] Individuals diagnosed with full blown (threshold) BED reported earlier onset of binge eating, increased food cravings, increased diet pills use, greater fear of weight gain, more severe body perception disturbances, greater drive for thinness and less interoceptive awareness, when compared with those individuals with subthreshold BED (i.e., those who had recurrent binge eating but at a significantly less frequent rate than full BED).[15,18] On the other hand, Striegel-Moore et al.[16] found that BED did not differ from subthreshold BED (having a minimum of one binge episode per week) on dieting, weight history, and body image disturbance.[16] In another study, women with BED and subthreshold BED, after controlling for BMI, did not differ significantly on measures of weight and shape concern, restraint, psychiatric distress, and history of seeking treatment for an eating or weight problem.[19]
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