Identifying eating disorders in adolescents and adults with overweight or obesity: A systematic review of screening questionnaires.

In the historical development of psychiatric nosology, as in the rest of medicine, more severe disorders tend to be recognized before disorders with milder symptom profiles. Thus, psychiatric classifications recognized schizophrenia and melancholia before schizotypal personality disorder and dysthymia. So, too, with the classification of eating disorders; anorexia nervosa, which may result in death, was recognized many years before bulimia nervosa. The most recent addition to the psychiatric classification of eating disorders is “binge eating disorder.” The diagnosis of binge eating disorder is given to the many obese individuals who are distressed by recurrent binge eating, yet do not regularly engage in the compensatory behavior (e.g., vomiting or use of laxatives) that is seen in individuals with bulimia nervosa. Although binge eating disorder is not an official DSM-IV diagnosis, a variety of studies support its validity (1–4). A description of the disorder and its diagnostic criteria appear in DSM-IV Appendix B, titled “Criteria Sets and Axes Provided for Further Study.” Binge eating disorder is common among study groups drawn from weight-control programs (15%–50%), which show women are approximately 1.5 times more likely to have the disorder than men. In nonpatient community samples, a prevalence rate of 1%–4% has been reported (1, 3). Typically, the disorder begins in late adolescence or in the early 20s, often after weight loss from severe dieting. Common associated features include marked fluctuations in weight over time and a history of depression, anxiety, low self-esteem, somatic concern, and interpersonal sensitivity. Along with the recognition of binge eating disorder and its clinical features, there has been increasing interest in developing effective treatments for the disorder. Several studies have examined the relative efficacy of psychotherapeutic and psychopharmacological approaches (5). This case conference illustrates some of the challenges and rewards involved in the treatment of a patient with binge eating disorder.

Adults living with obesity have a higher risk of eating disorders and disordered eating behaviours such as binge eating(1,2). However, the prevalence of disordered eating/eating disorders in adults presenting for obesity treatment is unknown and this information is needed to guide service provision. This systematic review aimed to estimate the prevalence of disordered eating/eating disorders in adults presenting for obesity treatment. Embase, MEDLINE and PsycINFO were searched to March 2024. Eligible studies (k) measured disordered eating/eating disorders in adults with overweight/obesity presenting for obesity treatment and included ≥ 325 participants to ensure a representative sample. Prevalence estimates were synthesised using random effect meta-analysis. 81 studies were included (n = 92,002, 75.9% female, median (IQR) age 44 (6) years, BMI 45 (11) kg/m2. Most studies were conducted in the United States (k = 44) and Italy (k = 15). Most prevalence data related to binge eating disorder or binge eating severity. The pooled prevalence of binge eating disorder, assessed by clinical interview, was 17% (95% CI: 12–22, 95% prediction interval (PI): 0–42, k = 19, n = 13447, τ2 = 0.01) using DSM-IV criteria and 12% (95% CI: 5–20, 95% PI: 0–40, k = 9, n = 7680, τ2 = 0.01) using DSM-V criteria. The pooled prevalence for severe binge eating (Binge Eating Scale score > 25) was 12% (95% CI: 8–16, 95% PI: 0–31, k = 18, n = 12136, τ2 = 0.01). For binge eating disorder, measured by clinical interview, the prevalence range for females and males was 14.9 to 27.0% (k = 12), and 4.0 to 24.1% (k = 3) respectively. For moderate to severe binge eating (Binge Eating Scale score ≥ 18) the prevalence for females and males ranged from 20.0 to 32.8%, and 7.1 to 77.5% (k = 2). Three studies reported prevalence by ethnicity. The prevalence of severe binge eating (Binge Eating Scale scores ≥ 27) was 9.5 to 41.7% in white populations (k = 2), 7.5 to 35.8% in black populations (k = 2), and 5.7% in Hispanic populations (k = 1). One study reported binge eating disorder, assessed by clinical interview, for white, black and Hispanic populations and reported prevalence of 15.3%, 11.3% and 11.4% respectively. Overall, there was high variability in the prevalence of binge eating and binge eating disorder in adults presenting for obesity treatment, with available data indicating prevalence can range up to 42%. It is important to identify which population level factors drive this heterogeneity to inform service provision however, the limited data highlights a significant knowledge gap in the reporting of eating disorders in underrepresented populations which needs to be addressed.

To determine the prevalence of binge eating disorder (BED) and night eating syndrome (NES) among applicants to the Look AHEAD (Action for Health in Diabetes) study. The Eating Disorders Examination-Questionnaire (EDE-Q) and the Night Eating Questionnaire (NEQ) were used to screen patients. Phone interviews were conducted using the EDE for those who reported at least eight episodes of objective binge eating in the past month and using the Night Eating Syndrome History and Interview for those who scored > or =25 on the NEQ. Recruitment at four sites (Birmingham, n = 200; Houston, n = 259; Minneapolis, n = 182; and Philadelphia, n = 204) yielded 845 participants (58% women; mean age = 60.1 +/- 6.7 years; mean BMI = 36.2 +/- 6.3 kg/m(2)). Screening scores were met by 47 (5.6%) applicants on the EDE-Q and 71 (8.4%) on the NEQ. Of the 85% (40/47) who completed the EDE interview, 12 were diagnosed with BED, representing 1.4% of the total sample. Of the 72% (51/71) who completed the Night Eating Syndrome History and Interview, 32 were diagnosed with NES, equal to 3.8% of the total sample. Three participants had both BED and NES. Participants with eating disorders were younger, heavier, and reported more eating pathology than those without eating disorders. Among obese adults with type 2 diabetes, NES was reported more frequently than BED, which, in turn, was less common than expected.

IntroductionObesity is a major public health problem and some developed countries have declared it ‘the modern day epidemic’. One of the major eating disorders that leads to obesity is BED, which involves consuming large quantities of high carbohydrate food. Studying the factors that cause and contribute to BED can help tackle this major health hazard and alleviate a huge burden on the nationalized health service.ObjectivesTo determine the frequency of Binge Eating Disorder (BED) among obese adults, and to study its relationship to depression, anxiety, life stressors, personality and self esteem.MethodsThe sample was a randomised sample of clinically obese individuals, body mass index (BMI) of 30 and above. The sample was collected from two sites; Nutrition Clinic in Student’s Hospital, Cairo University and a Private Nutrition Centre. 250 cases were recruited over one year. All patients were subjected to a clinical interview derived from Kasr El Aini sheet , and measurement of Waist- Hip Ratio. Assessment of depression and anxiety was through Beck Depression Inventory , Hamilton Depression Rating Scale and Taylor Manifest Anxiety Scale(TMAS). Other tools used were the Eysenck’s Personality Inventory, Eating Disorder Inventory -2.ResultsBED among obese adults was 48%; 83 % of them had drive for thinness, 25% were bulimics, 45 % had ineffectiveness feeling. Also 83 % had body dissatisfaction, 8% were perfectionism seeking, 43 % showed interpersonal distrust and 25% presented maturity fears. Impulsivity was scored high in 25% , 66.6%had social insecurity and 77% had severe Extraversion. All were statistically significant. On the other hand there were no statistical significant difference between obese adults with BED and those without on TMAS. Half percent of participants with BED and 34.6 percent of participant without BED had moderate level of anxiety. In addition , there were no significant difference between obese participants with BED and those without BED according to BDI. However, 83.3% of obese cases with BED while 60 % for those without BED had manifest depression ranging from mild to severe depression.ConclusionsObese adults with BED have more drive for thinness, body dissatisfaction, feeling of ineffectiveness, perfectionism seeking, interpersonal distrust, maturity fears and social insecurity than non BED. Extraversion and Neuroticism are also more among BED. There were no significance different between both group in relation to Anxiety and Depression.Disclosure of InterestNone Declared

Excessive energy intake likely favors metabolic dysfunction in patients with schizophrenia and may be, in part, the consequence of antipsychotic treatments. However, previous studies on the prevalence of bulimia and binge eating symptoms in antipsychotic-treated patients are contradictory and not sufficiently informative. The prevalence of bulimia nervosa, binge eating disorder, and subsyndromal binge eating disorder was studied using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria in 156 patients with schizophrenia or schizoaffective disorder treated with antipsychotic monotherapy. The effects of different antipsychotics were compared. The prevalence of full syndromal binge eating disorder was 4.4% and that of subsyndromal binge eating disorder was 18.7% in patients (23.1% for binge eating spectrum disorder), and there were no cases of bulimia nervosa. Compared with the whole sample, binge eating spectrum disorders were significantly more prevalent in clozapine- and olanzapine-treated patients. Comparisons of patients having undergone treatment for 2 years or less with patients treated for more than 2 years showed that binge eating spectrum disorders decrease significantly over time, the difference being significant in clozapine- and olanzapine-treated patients. Night eating, simply assessed by a single question, showed a prevalence of 30% and was more prevalent in women treated with clozapine and olanzapine, with no significant change over time. Binge eating disorders should be considered as important factors involved in the development of weight gain and metabolic syndrome in antipsychotic-treated patients with schizophrenia. The difficulty to reliably assess binge eating spectrum disorders in patients with psychosis is highlighted.

Background and AimsAll eating disorders (EDs) lead to a significant decrease of health status, psychosocial functioning and quality of life (QoL). Individuals with untreated binge eating disorder (BED) tend to gain weight over time, which may contribute to serious health issues. In somatic hospital departments, some outpatients have reduced compliance with lifestyle changes. This may, to some extent, be due to patients with an undiagnosed ED receiving the incorrect treatment. In this cross-sectional study, we aimed to investigate the prevalence of EDs among patients referred to lifestyle courses.ResultsA total of 136 patients referred from somatic hospital departments to lifestyle changes in a specialized hospital unit were included in the study. The response rate was 69.4%. Self-reported ED or sub-clinical symptoms of ED according to the Eating Disorder Examination Questionnaire (EDE-Q) were found in 17.65%. Of these, 11.03% fulfilled the self-reported criteria for an ED (BED, 7.35%; bulimia nervosa, 3.68%). Patients with an ED or subclinical ED symptoms had elevated grazing behaviour compared to those without ED symptomatology. A statistically significant difference in QoL was also found.Discussion and ConclusionsThe prevalence of self-reported ED or subclinical ED symptoms in patients referred to a lifestyle course is substantial. This ED group had reduced QoL and larger grazing behaviour compared to patients without ED symptomatology. Thus, the prevalence of undiagnosed EDs among patients within somatic hospital departments may be substantial, underlining the importance of screening and further research within this topic.Level of EvidenceLevel III, well-designed cohort study.SignificanceWhat is already known on this subject? In a review including populations from Scandinavia, the USA and South America, the estimated BED prevalence in individuals with higher body weight seeking help to lose weight is 13–27% [22]. Dawes et al. (2016) conducted a meta-analysis investigating the prevalence of mental health conditions among bariatric surgery candidates and recipients. They included 25 studies with a total of 13,769 patients and found that the prevalence of BED was 17% (13–21%) [10]. What this study adds? We have identified a group of patients who may be receiving inappropriate treatment with weight loss intervention instead of specialized ED intervention. It appears that this issue is valid in various somatic hospital departments. Thus, this is a field that requires further attention and investigation.

Eating Disorders

To (1) determine whether childhood risk factors for early onset binge eating and purging eating disorders also predict risk for later-onset binge eating and purging disorders, and (2) compare the utility of childhood and early adolescent variables in predicting later-onset disorders. Participants (N = 1,383) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed when participants were aged 14, 17, and 20. Risk factors for early onset eating disorders have been reported previously (Allen et al., J Am Acad Child Psychiat, 48, 800-809, 2009). This study used logistic regression to determine whether childhood risk factors for early onset disorders, as previously identified, would also predict risk for later-onset disorders (n = 145). Early adolescent predictors of later-onset disorders were also examined. Consistent with early onset cases, female sex and parent-perceived child overweight at age 10 were significant multivariate predictors of binge eating and purging disorders with onset in later adolescence. Eating, weight, and shape concerns at age 14 were also significant in predicting later-onset disorders. In the final stepwise multivariate model, female sex and eating, weight, and shape concerns at age 14 were significant in predicting later-onset eating disorders, while parent-perceived child overweight at age 10 was not. There is overlap between risk factors for binge eating and purging disorders with early and later onset. However, childhood exposures may be more important for early than later onset cases.

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.

Eating disorders (EDs) are prevalent in college students, yet limited research on EDs across racial/ethnic groups in population-based samples exists. This study aimed to examine differences in prevalence and presentations of EDs by race/ethnicity in a national college sample. Students at 26 US colleges/universities (N = 29,951) completed a population-based mental health screen. Prevalence of probable anorexia nervosa (AN), clinical/subclinical bulimia nervosa (BN) or binge-eating disorder (BED) and ED risk were examined across racial/ethnic groups by gender using chi-square and Fisher's exact tests. Among those with probable EDs, ED behavior frequency, weight/shape concerns, probable psychiatric comorbidities, and psychotherapy utilization were compared across groups using chi-square, Fisher's exact tests, and one-way analyses of variance. Asian women had higher AN prevalence than Black, Hispanic, and White women; AN prevalence in Black women was lower than Asian, Hispanic, Multiracial, and White women (p < 0.05). Hispanic women had higher BN/BED prevalence than Asian, Black, and White women, and higher ED risk prevalence than Asian, Multiracial, and White women (p < 0.05). Among those with EDs (N = 3929), there were no significant differences in ED behavior frequencies between any groups. White women had higher comorbid probable alcohol use disorder prevalence than Asian, Black, Hispanic, and Multiracial women (p < 0.05). Asian men had lower psychotherapy utilization than Black, Hispanic, Multiracial, and White men (p < 0.05). Prevalence of EDs was similar across racial/ethnic groups; where differences emerged, minoritized students often had a higher prevalence. Results highlight the need for routine ED screening for all college students.

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. Sixty-six participants completed the questionnaires and were interviewed. 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. These findings suggest that these two self-report measures have potential utility for identifying BED in obese patients in primary care.

Objective: An increase in the prevalence of many psychological problems including Eating Disorders (EDs) during COVID-19 pandemic is noteworthy. Weight change experienced by many people in this period is accompanied by a deterioration in eating attitudes and behaviors. The aim of this study is to determine how eating attitudes and behaviors differ according to gender and weight change, and the prevalence of EDs during COVID-19 pandemic. Method: Firstly, Socio-demographic-Clinical Information Form, Eating Attitude Test-26 (EAT-26), and Eating Disorder Examination Questionnaire (EDE-Q) were administered to 771 participants. Then, the Eating Disorder Assessment for DSM-5 (EDA-5) was conducted as a semi-structured online clinical interview with the participants’ at-risk group. EDA-5 is a web-based diagnostic clinical interview which scans the last three-month according to the DSM-5 Eating Disorders diagnostic criteria that is administered by a clinician specialized in EDs. Results: Research findings indicated that participants' EAT-26 and EDE-Q scores differ significantly according to gender and weight change experienced during the pandemic. The prevalence of ED was 3% (N=20). According to sub types, Binge Eating Disorder was 1.3% (N=9), Bulimia Nervosa was 0.7% (N=5), Anorexia Nervosa was 0.4% (N=3), subthreshold Binge Eating Disorder was 0.4% (N=3), and subthreshold Bulimia Nervosa was 0.14% (N=1). Although not meeting the diagnostic criteria, the number of participants with disordered eating behavior was found to be 0.29% (N=2). Conclusion: A higher prevalence rate was found compared to previous studies in Turkey which is assumed to provide evidence that the prevalence of EDs increased during the COVID-19 period.

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Eating disorders (EDs) are complex medical conditions that pose a considerable health burden for individuals with type 1 diabetes mellitus (T1DM). EDs in individuals with T1DM are linked to poor metabolic control, which heightens the risk of diabetes complications. Consequently, regular screening for EDs is essential. This study investigates the prevalence of EDs in adolescents with T1DM, investigating the associations with diabetes duration, pubertal stage, glycemic control, and diabetes-related complications. In this cross-sectional study, 350 adolescents (155 males, 195 females) with T1DM, aged 12–18, were recruited from Mansoura University Children’s Hospital. Participants completed the Diabetes Eating Problem Survey-Revised (DEPS-R) questionnaire, with scores ≥ 20 prompting clinical interviews to confirm EDs. Clinical data, including HbA1c, BMI, and body composition, were analyzed. Socioeconomic status (SES) and family factors were assessed. The prevalence of EDs was 22.6%, including other specified feeding or eating disorders (OSFED) (68.4%), binge eating (11.4%), bulimia nervosa (7.6%), avoidant restrictive (7.6%), and anorexia nervosa (5.1%). Binary logistic regression analysis showed that the significant predictors of ED in the study cohort were diabetes duration (OR = 1.75 (1.66–1.84), p < 0.001), and HbA1c (OR = 5.94 (2.4–14.6), p < 0.001). Conclusions: Adolescents with EDs had higher (SES), more family conflicts, longer diabetes duration, and were more prone to diabetic nephropathy and poor glycemic control. Screening for EDs is recommended from pre-adolescence through early adulthood.What Is Known:• Adolescents with T1DM are more vulnerable to develop EDs compared to their peers without T1DMWhat Is New:• The DEPS-R and DSM-V were useful clinical tools for screening and for diagnosis of EDs respectively among adolescents with T1DM• We advise to screen for EDs in adolescents with T1DM who aged around 13.6 years, at Tanner stage 3, with duration of T1DM >5 years, and/or with HbA1c >7.5%

The purpose of this chapter is to review the literature on the relationship between attention-deficit-hyperactivity-disorder (ADHD) and binge eating as seen in bulimia nervosa (BN) and binge eating disorder (BED), including the shared phenomenology, genetics and treatment. The authors reviewed all the published peer reviewed literature in the past decade available through PubMed on the epidemiology, phenomenology, genetics and management of binge eating behavior, especially as it manifests in eating disorders (BN, BED), as well as in obesity and within the context of ADHD throughout the lifespan. It was found that there is a significant association between ADHD and binge eating in clinical populations. Inattentiveness and impulsivity noted in ADHD are thought to play a role in the preoccupations, urges and impulsive behaviors of those who experience binge-eating episodes. Molecular genetic studies have also identified common genes involved in dopamine transport, suggesting a shared genetic predisposition to binge eating, obesity and ADHD. Case reports on individuals with BN and ADHD suggest benefit from psychostimulant medication. In addition, other anti-ADHD medications such as atomoxetine have been used independently in trials to treat obesity and BED. Individuals with current symptoms or a past history of ADHD are at risk of having coexisting binge eating and obesity. Screening for ADHD in patients with binge-eating behaviors may identify individuals who could benefit from anti-ADHD medications. Further research may help to identify shared neurobiological mechanisms and particular risk factors, as well as to determine the efficacy and tolerability of certain medications in this population.