The Questionnaire on Eating and Weight Patterns-5: an updated screening instrument for binge eating disorder.

Abstract

Binge eating disorder (BED) recently has been included as a feeding and eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),1 and consequently, there is a need for assessment measures that reflect the DSM-5 criteria. Therefore, we have revised and updated the widely used Questionnaire on Eating and Weight Patterns (QEWP), which was developed for use in the original field trials of the proposed criteria for BED. These criteria were included in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV)2 and DSM-IV TR in an appendix for further study. In the sections that follow, we provide a background for the development and use of this instrument and describe modifications made to accommodate the DSM-5 criteria, with the hope that provision of the QEWP-5 will stimulate research to document its utility in clinical and research settings. Behaviors consistent with BED, primarily in persons with obesity, were first described by Stunkard in 1959.3 Beginning in the 1980s, an increasing number of studies confirmed that recurrent binge eating characterized a distinct phenotype among obese individuals. The great majority of these individuals did not purge (or use other compensatory behaviors) after binge eating, thus differentiating their behavior from that of individuals with bulimia nervosa (BN). In 1992, Spitzer and colleagues, in consultation with the American Psychiatric Association’s Workgroup on Eating Disorders for the DSM-IV, proposed preliminary criteria for a new eating disorder, BED, as a distinct diagnosis.4 The collaborative group developed the Questionnaire on Eating and Weight Patterns (QEWP), which screened respondents for BED and also assessed demographic and behavioral characteristics, weight history, and other eating-disordered behaviors. The QEWP was administered by self-report or telephone in multisite field trials in a variety of settings, including university-based and commercial weight loss clinics, self-help groups, and community settings.4,5 The initial multisite field trial established that BED was common in those attending specialized obesity treatment programs (30.1 percent), but far less prevalent in community samples (2.0 percent).4 BED also was more common in women than men, although the gender discrepancy was not as marked as that seen in anorexia nervosa or BN. Finally, providing evidence of face validity, BED was strongly associated with obesity, as well as a history of weight fluctuation, in both the treatment-seeking and community samples. A second large multisite study that included weight-control, community, and college-student samples, as well as patients with bulimia nervosa, confirmed the prevalence of BED observed in the first trial, as well as the disorder’s association with obesity, weight fluctuation, functional impairment, and numerous demographic characteristics (as assessed by an expanded version of the original QEWP). BED also was found to be distinct from BN.5 In 1993, the QEWP was revised (QEWP-R) to focus primarily on assessing diagnostic criteria for BED, with continued inclusion of questions for research purposes (such as temporality of binge eating and dieting).6 This version also included revised decision tools for making a tentative diagnosis of BED based on responses to the questionnaire. The QEWP and QEWP-R have been further revised by others to include Adolescent and Parent Report versions and translated into multiple languages, including Spanish and Portuguese. In addition, some investigators have adapted the QEWP to capture episodes of loss of control (LOC) eating that do not involve the consumption of an objectively large amount of food (i.e., subjective bulimic episodes). This inclusion is potentially important because evidence suggests that the experience of LOC eating may be a fundamental characteristic of BED, independent of the amount of food consumed.7 The QEWP has been shown to have reasonable agreement with interview-based measures such as the SCID and the EDE. However, the QEWP generally is more sensitive and less specific, suggesting that the QEWP should only be used to screen for BED, with its confirmation by interview.