Binge-eating Episodes Research Articles

Body Composition Assessment in Adult Females with Anorexia Nervosa and Bulimia Nervosa—A Cross-Sectional Study Comparing Dual-Energy X-Ray Absorptiometry Scan and Isotopic Dilution of Deuterium

BackgroundEating disorders (EDs) compromise individuals’ nutritional status, affecting, among other organs and systems, bone health. ObjectivesThis study aimed to assess and compare bone mineral density (BMD) from DXA scan and deuterium (D2O) dilution of adult females with anorexia nervosa (AN) and bulimia nervosa (BN). MethodsThis was a cross-sectional study with 53 female participants (18–49 y) with a diagnosis of AN (n = 25) or BN (n = 28). DXA scan was performed to assess BMD, FM, and FFM, and D2O dilution was used to assess total body water (TBW), FM, and FFM. Interviews/questionnaires were used to assess symptoms, illness trajectory, and physical activity. t-test, chi-square test, Pearson’s linear correlation, linear regressions, and Bland-Altman analyses were performed, with a significance level of 5%. ResultsTBW below the recommended level for adult females (≥ 45%) was more frequent in BN (60%) compared with AN (21%; P = 0.013). FM index (FMI) (soft tissue only) (t-test P = 0.06), and FFM index (FFMI) (t-test P = 0.08) agreed between DXA scan and D2O dilution. Only FFMI did not show systematic bias of proportion (β: −0.2, P = 0.177). The diagnosis of BN, binge-eating episodes, and physical activity in AN were associated with the differences in the methods’ results. FMI was positively associated with BMD in AN, and both FMI and FFMI were positively associated with BMD in BN. ConclusionsIn adult females with EDs, DXA scan and D2O dilution achieved agreement for FMI and FFMI. Changes in FM and FFM are important in understanding the mechanisms behind bone loss in EDs. Protocols for body composition assessment in EDs can help to minimize the effect of the ED diagnosis, ED behaviors (that is, excessive exercise and purging behaviors), and weight on the accuracy of measurements.

Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis.

This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = -0.27; 95% CI -0.36, -0.17; I2 67.1%) and binge eating (49 intervention arms; -0.66; 95% CI -0.76, -0.56; I2 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%-6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.

Exploring the impact of the COVID-19 pandemic on perceptual disturbances and dysfunctional eating attitudes and behaviors: A review of the literature.

From the outbreak of the novel coronavirus 2019 (COVID-19) a new physical and social distancing environment has changed our lives and, more particularly, the way of perceiving oneself, as well as eating attitudes and behaviors. An increasing number of studies have highlighted a risky scenario in terms of negative perceptions of one's body as well as disordered eating and eating disorder patterns in both clinical and general population. With regard to this postulate, this literature review posits two main concepts-perceptual disturbances and dysfunctional eating attitudes and behaviors-in the general and (sub-)clinical populations, to provide an understanding of these phenomena during the COVID-19 pandemic. The main objective of this article is to provide a comprehensive and critical review of published scientific literature about perceptual disturbances (i.e., negative body image, body image disturbances, low body esteem) and dysfunctional eating attitudes and behaviors, including disordered eating (e.g., restrictive eating, binge-eating episodes, overeating, emotional eating) and eating disorders features in community (i.e., general population) and clinical and sub-clinical samples worldwide during the COVID-19 pandemic. The PubMed, ScienceDirect, Ebsco, and Google Scholar databases were searched. The initial search produced 42 references. Scientific publications from March 2020 to April 2022 were included, and among the works compiled, only published research articles have been retained. Purely theoretical papers were also excluded. The final selection consisted of 21 studies, covering both community, clinical (i.e., eating disorder population), and sub-clinical samples. The details of the results are discussed taking into consideration the potential impact of changes in the way we perceive ourselves and interact with others (e.g., the popularity of videoconferencing and the over-use of social network sites due to social isolation) as well as changes in eating attitudes and behaviors, physical activity and exercise (e.g., as an emotional response to the insecurity generated by the pandemic context), in community and (sub-)clinical samples. The discussion sheds light on two outcomes: (1) a summary of findings with methodological considerations; (2) an intervention continuum to deal with the consequences of the COVID-19 pandemic; (3) and a final conclusion.

Loss of control in binge-eating disorder: Fear and resignation.

Binge-eating disorder involves overeating while feeling a loss of control (LOC). Emotions around LOC appear to vary; some patients fear LOC whereas others feel powerless or "resigned" to LOC. This study examined differences in psychopathology among treatment-seeking patients with binge-eating disorder categorized with fear of LOC, resignation to LOC, and no fear/resignation of LOC. Doctoral research clinicians administered diagnostic and semistructured interviews to characterize psychopathology and establish a diagnosis of binge-eating disorder in participants (N=382). The interview assessed fear of LOC in the past month. Further queries assessed whether, in the absence of fear of LOC, patients were resigned to LOC or had no fear/resignation. Patients with fear of LOC and resigned to LOC endorsed significantly greater global eating-disorder psychopathology than patients with no fear/resignation. Patients with fear of LOC reported greater distress about binge eating and greater depression than those with no fear/resignation. Patients resigned to LOC reported significantly more frequent binge-eating episodes than those with fear of LOC and no fear/resignation. Black individuals and men were more likely to report no fear/resignation than other demographic groups. This study describes a novel clinical aspect of binge-eating disorder: resignation to LOC. Findings highlight the importance of including anticipatory cognitive-affective experiences in treatment formulations and planning. Future research should examine co-occurrence of these experiences and their association with impairment. Future research should also examine how fear of LOC and resignation to LOC change during treatment and whether they predict or moderate treatment outcomes. Adults with binge-eating disorder have anticipatory cognitive-affective experiences about loss of control (LOC) over eating (i.e., fear of LOC, resigned to LOC, no fear nor resignation of LOC). Individuals who experience fear of LOC and those who are resigned to LOC had more severe psychopathology than those without fear/resignation. Binge-eating disorder has the highest prevalence of the eating disorders; thus, findings have high public significance in guiding clinicians' treatment planning.

Inhibitory Control Training Enhanced by Transcranial Direct Current Stimulation to Reduce Binge Eating Episodes: Findings from the Randomized Phase II ACCElect Trial

Introduction: Binge eating disorder (BED) is characterized by recurrent binge eating (BE) episodes with loss of control. Inhibitory control impairments, including alterations in dorsolateral prefrontal cortex (dlPFC) functioning, have been described for BED. A targeted modulation of inhibitory control circuits by the combination of inhibitory control training and transcranial brain stimulation could be promising. Objective: The aim of the study was to demonstrate feasibility and clinical effects of a transcranial direct current stimulation (tDCS)-enhanced inhibitory control training to reduce BE episodes and to generate an empirical basis for a confirmatory trial. Methods: We performed a monocentric clinical phase II double-blind randomized trial with two parallel arms. Forty-one adult outpatients with full-syndrome BED according to DSM-5 received six sessions of food-related inhibitory control training, randomly combined with 2 mA verum or sham tDCS of the right dlPFC. The main outcome was BE frequency within a 4-week interval after treatment termination (T8; primary) and at 12-week follow-up (T9; secondary) as compared to baseline. Results: BE frequency was reduced in the sham group from 15.5 to 5.9 (T8) and to 6.8 (T9); in the verum group, the reduction was 18.6 to 4.4 (T8) resp. 3.8 (T9). Poisson regression with the study arm as the factor and baseline BE frequency as the covariate revealed a p value of 0.34 for T8 and 0.026 for T9. Sham and real tDCS differed at T9 in BE frequency. Conclusions: Inhibitory control training enhanced by tDCS is safe in patients with BED and results in a substantial and sustainable reduction in BE frequency which unfolds over several weeks post-treatment. These results constitute the empirical basis for a confirmatory trial.

Characterizing naturalistic meal timing, energy intake, and macronutrient intake among individuals with loss of control eating

Binge eating demonstrates an evening diurnal shift among individuals with eating disorders. Disruptions to diurnal appetitive rhythms may be somewhat chronic and set the stage for additional disruptions to prompt binge eating. Despite known diurnal shifts in binge eating and related constructs (e.g., mood) and detailed characterizations of binge-eating episodes, no findings to date describe the naturalistic diurnal timing and composition of energy and nutrient intake on days with and without loss of control eating. We aimed to characterize eating behaviors (i.e., meal timing, energy intake, and macronutrient composition) across seven days in individuals with binge-spectrum eating disorders, assessing differences between eating episodes and days with and without loss of control eating. Undergraduate students (N = 51; 76.5% female) who endorsed past 28-day loss of control eating completed a 7-day naturalistic ecological momentary assessment protocol. Participants completed daily food diaries and reported instances of loss of control eating across the 7-day period. Results indicated that episodes of loss of control were more likely to occur later in the day, but overall meal timing did not differ across days with and without loss of control. Similarly, greater caloric consumption was more likely for episodes with loss of control, but overall caloric consumption did not differ between days with and without loss of control. Analysis of nutritional content demonstrated differences between both episodes and days with and without loss of control for carbohydrates and total fats, but not for protein. Findings provide support for the hypothesized role disruptions in diurnal appetitive rhythms play in maintaining binge eating via consistent irregularities, underscoring the importance of examining treatment adjuncts that intervene on the regulation of meal timing to enhance eating disorder treatment outcomes.

Taking Placebos as Needed to Reduce Appetite: A Randomized Controlled Trial with Ecological Momentary Assessment.

Placebos can reduce appetite. However, when placebos are prescribed over a longer period of time, compliance and response rates are not always satisfactory. A new administration approach 'as needed' was tested to improve adherence to placebo treatment and its effectiveness. Participants could decide on the time of placebo intake (when their appetite had increased substantially). A randomized controlled trial was conducted over seven days. The participants were allocated to one of two groups: a placebo group (PG; n = 41) or a control group with no placebo treatment (CG; n = 34). During the intervention, participants used a mobile phone application to rate their daily appetite, mood, and the occurrence of binge-eating episodes in their normal environment. The placebo effect was short-lived; the placebo reduced self-reported appetite only on days 1 and 2 of the trial. The placebo neither influenced mood nor binge-eating frequency. This study found an app-assisted approach with continuous monitoring to be helpful for identifying the temporal course of the placebo response. Future placebo trials should implement this method.

Toward Individualized Prediction of Binge-Eating Episodes Based on Ecological Momentary Assessment Data: Item Development and Pilot Study in Patients With Bulimia Nervosa and Binge-Eating Disorder.

Prevention of binge eating through just-in-time mobile interventions requires the prediction of respective high-risk times, for example, through preceding affective states or associated contexts. However, these factors and states are highly idiographic; thus, prediction models based on averages across individuals often fail. We developed an idiographic, within-individual binge-eating prediction approach based on ecological momentary assessment (EMA) data. We first derived a novel EMA-item set that covers a broad set of potential idiographic binge-eating antecedents from literature and an eating disorder focus group (n=11). The final EMA-item set (6 prompts per day for 14 days) was assessed in female patients with bulimia nervosa or binge-eating disorder. We used a correlation-based machine learning approach (Best Items Scale that is Cross-validated, Unit-weighted, Informative, and Transparent) to select parsimonious, idiographic item subsets and predict binge-eating occurrence from EMA data (32 items assessing antecedent contextual and affective states and 12 time-derived predictors). On average 67.3 (SD 13.4; range 43-84) EMA observations were analyzed within participants (n=13). The derived item subsets predicted binge-eating episodes with high accuracy on average (mean area under the curve 0.80, SD 0.15; mean 95% CI 0.63-0.95; mean specificity 0.87, SD 0.08; mean sensitivity 0.79, SD 0.19; mean maximum reliability of rD 0.40, SD 0.13; and mean rCV 0.13, SD 0.31). Across patients, highly heterogeneous predictor sets of varying sizes (mean 7.31, SD 1.49; range 5-9 predictors) were chosen for the respective best prediction models. Predicting binge-eating episodes from psychological and contextual states seems feasible and accurate, but the predictor sets are highly idiographic. This has practical implications for mobile health and just-in-time adaptive interventions. Furthermore, current theories around binge eating need to account for this high between-person variability and broaden the scope of potential antecedent factors. Ultimately, a radical shift from purely nomothetic models to idiographic prediction models and theories is required.

Is history of abuse predictive of eating disorders with binge-eating episodes through an effect mediated by impulsivity? A French longitudinal study.

In recent years, many studies have explored the associations among impulsivity, history of abuse, the emergence of eating disorders with episodes of binge eating (EDBE) and their severity. Nevertheless, factors associated with successful clinical outcomes of EDBE are still unknown. Our study aimed to test the hypothesis that a history of abuse is associated with unsuccessful clinical outcomes of EDBE through an effect mediated by impulsivity. We assessed patients older than 15 years, 3 months with EDBE at inclusion and at 1 year. Recovery was defined as the absence of eating disorders at 1 year. A mediation analysis was performed by means of structural equation modelling. We included 186 patients in our analyses (54% bulimia nervosa, 29% anorexia nervosa binge eating/purging type and 17% binge-eating disorder); 179 (96%) were female. One-third (n = 63) of patients reported a history of abuse, and recovery was observed for 20% of the sample (n = 38). Contrary to our assumption, a history of abuse was not associated with the absence of recovery of EDBE at 1 year. Factors unfavourable for achieving recovery were anxiety disorders (odds ratio [OR] 0.41), vomiting (OR 0.39), physical hyperactivity (OR 0.29), negative urgency and a lack of perseverance (OR 0.85 for both). Only positive urgency was positively associated with recovery (OR 1.25). We excluded 219 patients lost to the 1-year follow-up. Our findings may help to deconstruct the empirical belief that traumatic events may interfere with the successful course of treatment for eating disorders. A high level of positive urgency may be associated with more receptivity to care.

Relationship between psychopathology and binge size in binge eating spectrum disorders.

Food intake during binge eating episodes has been found to be associated with symptoms of depression and anxiety in individuals with eating disorders. To evaluate the association between caloric intake during binge eating episodes (BEE) and psychopathology in individuals with binge eating spectrum disorders (BSD). One-hundred and fourteen outpatients diagnosed with bulimia nervosa (BN) and binge eating disorder were sequentially assessed. MINI PLUS was used to assess psychiatric diagnoses. Validated self-report instruments were used to assess general and eating-related psychopathology. The assessment of caloric consumption during BEE was performed through Dietpro Clinical Program. Data analysis was performed with independent Student's t test, effect size (Cohen's d) and Pearson's correlation. Participants with BSD comorbid with a depressive disorder consumed significantly more calories during BEE than those without depression. Furthermore, participants with BSD and higher levels of impulsivity had a greater caloric intake during the episode. Specifically, regarding BN, participants with greater disease severity consumed more calories during the episode than those with less severity. Overall, depression and high impulsivity were associated with a higher caloric intake during BEE in individuals with BSD. For those with BN, the disease severity was associated with greater caloric consumption during the episode. Our results support the relevance of early identification of psychiatric comorbidities and the implementation of strategies to control mood and impulsivity aiming at a better prognosis in the treatment of BSD.

Does cognitive behavioral therapy without pharmacotherapy improve eating disorder remission rates?

Does cognitive behavioral therapy without pharmacotherapy improve eating disorder remission rates?

Role of objective binge-eating episodes and depressive/anxiety symptoms in influencing the severity of eating disorders: a cross-sectional study

Role of objective binge-eating episodes and depressive/anxiety symptoms in influencing the severity of eating disorders: a cross-sectional study

Endocannabinoid System Regulation in Female Rats with Recurrent Episodes of Binge Eating

Recurrent Binge Eating (BE) episodes characterize several eating disorders. Here, we attempted to reassemble a condition closer to BE disorder, and we analyzed whether recurrent episodes might evoke molecular alterations in the hypothalamus of rats. The hypothalamus is a brain region which is sensitive to stress and relevant in motivated behaviors, such as food intake. A well-characterized animal model of BE, in which a history of intermittent food restriction and stress induce binge-like palatable food consumption, was used to analyze the transcriptional regulation of the endocannabinoid system (ECS). We detected, in rats showing the BE behavior, an up-regulated gene expression of cannabinoid type-1 receptor (CB1), sn-1-specific diacylglycerol lipase, as well as fatty acid amide hydrolase (Faah) and monoacylglycerol lipase. A selective reduction in DNA methylation was also observed at the promoter of Faah, which is consistent with the changes in the gene expression. Moreover, BE behavior in rats was associated with an increase in anandamide (AEA) levels. Our findings support the relevant role of the ECS in the regulation of food intake in rats subjected to repeated BE episodes, and, in particular, on AEA signaling, acting via CB1 and FAAH modulation. Notably, the epigenetic regulation of the Faah gene might suggest this enzyme as a possible target for developing new therapeutical approaches.

AN INVESTIGATION OF THE IMPACT OF SOCIAL MEDIA ON THE PROCESS OF IDENTITY EXPLORATION AND THE EMERGENCE OF EATING DISORDERS IN STUDENT LIFE

As the physical and psychological well-being has become a cultural and public health focus in Western countries, the impact of social networking sites has been highlighted, especially for the young who are in the process of identity formation. For them, the rapidly evolving social media world is increasing in importance as the main arena for socializing, experimentation, exploration and communication. Studies connect the exposure of adolescents and young adults to social media with body image dissatisfaction and eating disorders (ED), mainly bulimia, anorexia and binge eating. Especially the media cultivating beauty ideals are predictors of the development of eating pathology. The aim of this study is to investigate the relationship between social media platforms and eating disorders in students and whether their use influences the process of identity formation. With a sample of 158 students from the University of Patras, the measuring instruments used in the study were a structured questionnaire to investigate the effect of social media on eating disorders and the process of identity exploration and the Bulimic Investigatory Test, Edinburgh (BITE) questionnaire to investigate the episodes of binge eating, predisposition to bulimia nervosa and the cognitive and behavioral manifestations of bulimia.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0888/a.php" alt="Hit counter" /></p>

Process Analyses of Impulsive Behavior in Binge-Eating Disorder During the Randomized Controlled IMPULS Trial

Impulsivity represents a risk factor for patients with binge-eating disorder, and we therefore investigated the treatment process of impulsive behaviors including binge-eating episodes in the randomized controlled IMPULS trial. Using 8 weekly online questionnaires throughout the assessment period, we compared 41 patients participating in the IMPULS program, which emphasized impulsive eating behavior (IG), with 39 control patients who received no intervention (CG). We assessed the frequency of binge eating, other impulsive behaviors, situations in which such behaviors could be inhibited, and the execution of alternative behaviors. Results indicate a stronger binge-eating reduction in the IG compared to the CG at the fifth, seventh, and eighth treatment weeks. Overall, both groups reduced other impulsive behaviors. They did not differ in the amount of inhibited impulsive behaviors and showed similar alternative behaviors, “distraction” most frequently used. IG patients evaluated the IMPULS program as very helpful. The stronger reduction of binge eating in the IG and positive evaluation of the treatment indicate a specific treatment effect regarding impulsive eating behavior. The reduction of other impulsive behaviors across both groups, and the initial reduction of binge eating within the CG, could be explained by an increased degree of self-observation.

The impact of COVID-19 on Black women who binge-eat: a qualitative study.

BackgroundAlthough studies have traced the impact of COVID-19 on those with eating disorders, little is known about the specific impact of the pandemic on Black American women who report disordered eating behaviors and are at risk for eating disorders. Thus, the purpose of this study is to investigate the impact of COVID-19 on Black women who binge-eat.MethodsWe recruited a purposive sample during the first wave of COVID-19 from the southeastern United States. Participants identified as Black women, reported binge-eating episodes in the last 28 days, and agreed to participate in a semi-structured interview. Prior to the interview, participants were administered a socio-demographic survey and the Eating Disorder Examination-Questionnaire. Interviews were transcribed verbatim and analyzed independently using qualitative content analysis and open coding to identify relevant codes and themes.ResultsOn average, participants (N = 20) were 43.05 ± 16.2 years of age and reported 5.6 ± 5.7 binge-eating episodes in the last 28 days. We identified six themes to describe participants' experiences managing their eating behavior during COVID-19: (1) food as a coping strategy; (2) lack of control around food; (3) increased time in a triggering environment (e.g., being at home with an easy availability of food); (4) lack of structure and routine; (5) challenges with limited food availability; and (6) positive impact of the pandemic.ConclusionIn this study, Black women reported challenges managing their eating behavior during COVID-19. Results could inform the development and tailoring of treatments for Black women reporting disordered eating behaviors.Level of EvidenceLevel V, qualitative interviews.

Adults with Recent Binge Eating Episodes Have Higher BMI, Eating Disorder Symptom Scores, And Odds of An Eating Disorder Than Non-Bingers

Upon completion, participant will be able to describe binge eating and binge-eating disorder frequency in a non-clinical sample of adults and compare eating disorder symptoms and features to non-binge eaters.

Mitigating the Severity of Binge Eating Episodes in Obese Individuals

Aim: The study aimed to analyze the change in the severity of binge eating disorder in obese individuals registered to the Adana City Training and Research Hospital Obesity Center training program. Methods: The study was a single-arm, prospective, quasi-experimental study with an interrupted time-series design. Inclusion criteria were having registered to the center for training, age between 18 to 65 years, a body mass index (BMI) equal to or over 30 and having binge eating disorder. Binge eating disorder evaluation (BEDE) was a structured form exclusively using DSM-5 binge eating disorder (BED) diagnosis and the severity criteria. The progress record included a weekly curriculum that a physician, dietitian, psychologist administered, and the physiotherapist and the monthly individual meetings data. Results: The BEDE reports showed a significant improvement, with 65 of the patients scoring below the BED diagnosis at the final evaluation. There was no difference between the genders regarding improvement in episodes. The current study showed that after twenty weeks of training that lasted for approximately 80 hours, the patients reported fewer episodes. Conclusions The training could be considered efficacious for reducing the severity of binge eating episodes in obese patients seeking treatment.

Characterizing cheat meals among a national sample of Canadian adolescents and young adults

Background“Cheat meals”, described as brief eating episodes that depart from established dietary practices to consume prohibited foods, represent a novel and increasingly common eating behavior with particular salience in adolescence and young adulthood. However, knowledge gaps remain regarding the frequency and characterization of foods and calories consumed during cheat meals, and their associations with eating disorder behaviors and psychopathology. Thus, the aims of this study were to delineate engagement in cheat meals among a large, national sample of Canadian adolescents and young adults.MethodsParticipants (N = 2,717) were from the Canadian Study of Adolescent Health Behaviors. Frequencies of engagement in cheat meals, and associated foods and calories consumed, in the past 12 months and 30 days were determined. The associations between engagement in cheat meals and eating disorder behaviors and psychopathology were determined using modified Poisson regression analyses.ResultsEngagement in cheat meals in the past 12 months was highest among men (60.9%) compared to women (53.7%) and transgender/gender non-conforming (TGNC; 52.5%) participants. Cheat meals consisting between 1,000 and 1,499 cal were those most frequently reported among all participants. Mean number of cheat meals in the past 12 months was equivalent to > 1 per week, which was similar to engagement in the past 30 days. Finally, engagement in cheat meals in the past 12 months and 30 days was associated with patterns of eating disorder behaviors and psychopathology among all participants, including binge-eating-related behaviors.ConclusionsThis study further characterized and extended knowledge of cheat meal engagement across genders, aligning with prior research by demonstrating that engagement is associated with greater eating disorder psychopathology.Plain english summaryFindings from this study add to the growing characterization of the novel behavioral phenomenon of cheat meals. Specifically, over half of adolescents and young adults across all 13 provinces and territories in Canada reported engaging in > 1 cal dense cheat meal per week, over the past 12 months. Despite the normalization and promotion of cheat meal engagement among the general public and unique fitness communities, engagement in this behavior is linked to greater eating disorder behaviors and psychopathology, including binge-eating episodes. Our findings emphasize the need for further research, public awareness, and clinical interventions aimed at addressing this potentially harmful eating behavior.

Interrater reliability and internal consistency of the eating disorder examination in the longitudinal assessment of bariatric surgery study.

Psychometric studies of eating disorder measures within bariatric surgery populations are limited. To examine the interrater reliability and internal consistency of the Eating Disorder Examination (EDE) among patients before and after bariatric surgery. Three clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium. The EDE-Bariatric Surgery Version was administered and audio-recorded by trained interviewers before and at annual assessments after bariatric surgery. Approximately 20% of interviews were randomly selected for rating by a second interviewer. Reliability of the original and brief EDE subscales was examined. Interrater reliability of the EDE subscales ranged from .86-.97 for the original subscales and .83-.95 for brief subscales before surgery, and .90-.98 for the original subscales and .92-.97 for brief subscales after bariatric surgery. Interrater agreement (based on kappa) was almost perfect for overeating and binge-eating behaviors and substantial for loss-of-control eating before surgery. Similar interrater agreements (based on kappa) were observed after surgery for subjective overeating and binge-eating episodes. Internal consistency of the subscale and global scores was variable, ranging from .41-.97. Findings provide support of the interrater reliability of the EDE, albeit with variable internal consistency, before and after bariatric surgery. Despite support for trained raters to reliably assess EDE constructs, variability in internal consistency suggests that further psychometric testing and rigorous scale development of disordered eating may be needed for the bariatric surgery population.