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Eating behavior in obese BED, obese non-BED, and non-obese control participants: A naturalistic study

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Abstract

Laboratory studies have shown considerable differences between the eating behavior, particularly binge eating behavior, of participants with and without binge eating disorder (BED). However, these findings were not replicated in two field experiments employing ecological momentary assessment (EMA) in which obese BED and obese non-BED participants reported comparable binge eating behavior. In the current study, we examined differences in binge eating with an innovative assessment scheme employing both EMA and a standardized computer-based dietary recall program to avoid some of the limitations of past laboratory and field research. Obese BED, obese non-BED, and non-obese control participants reported significant differences in eating patterns, loss of control, overeating, and binge eating behavior. Of particular importance was the finding that BED participants engaged in more overeating and more binge eating episodes than non-BED participants. These findings suggest that the use of EMA in combination with dietary recall may be a relatively objective and useful approach to assessing binge eating behavior. The findings further suggest that individuals with BED are observably different from those without the disorder, which may have implications for eating disorder diagnoses in DSM-V.

Introduction

Binge eating disorder (BED) is characterized in the DSM-IV by the consumption of an objectively large amount of food coupled with a sense of loss of control and not accompanied by compensatory behaviors. BED patients are commonly obese and also experience more impaired emotional functioning, lower quality of life, and poorer physical health compared to non-BED obese individuals (de Zwaan et al., 2002). This population also may have higher rates of impairment and distress due to the increased presence of comorbid psychopathology (Wilfley et al., 2000). Further, the behavior of binge eating has been shown to be associated with weight gain and subsequent obesity (Fairburn et al., 2001, de Zwaan, 2001).

Objective evidence that the eating behavior of BED patients differs from other obese individuals without BED would add support to the validity of the diagnosis (Walsh & Boudreau, 2003). However, data from two different assessment methodologies are contradictory. Several laboratory studies have shown that obese BED individuals eat significantly more than comparable obese non-BED (NBED) participants during a simulation of a binge eating episode. When asked to “binge eat” or “let themselves go when eating”, BED participants eat markedly more than NBED participants. This finding appears in the laboratory consistently, regardless of whether participants are given an array of food (e.g., Yanovski et al., 1992) or a single-item test meal (e.g., Sysko, Devlin, Walsh, Zimmerli, & Kissileff, 2007).

Field studies have attempted to examine binge eating patients in their natural settings (e.g., Wegner et al., 2002) employing a methodology called Ecological Momentary Assessment (EMA) and two EMA-based field studies are particularly relevant to the current investigation. Contrary to the laboratory findings, Greeno, Wing, and Shiffman (2000) that both BED and NBED groups reported binge eating frequencies that well exceeded the minimum of two binge eating episodes per week required for diagnosis and that the caloric content of the participant-identified binge eating episodes did not differ between the BED and NBED groups (800 vs. 792 calorie, respectively). A second EMA study (le Grange, Gorin, Catley, & Stone, 2001) found that binge eating frequency did not significantly differ between the BED and NBED groups.

The two EMA studies described above used a combination of self-identified behaviors (i.e., after a participant engaged in an eating episode, he/she labeled the eating episode as a “binge” or as something else) and food logs. Both of these techniques have proven useful in clinical settings as well as in several recent empirical studies, however they have several limitations, not the least of which are the subjectivity of the participant-labeled behaviors and the validity of the food logs due to poor compliance and retrospective recall biases (Engel, Wonderlich, & Crosby, 2005). Further, the use of traditional food logs likely limits the validity of comparisons of caloric intake across groups. Regardless of the specific reasons for the contradictory findings in the literature, reconciling this discrepancy will provide extremely useful information about the BED diagnosis.

In the current study, we attempt to circumvent the above mentioned limitations by employing a novel adaptation of EMA assessment. Described in more detail below, we couple EMA techniques with a standardized computer dietary recall system that minimizes reliance on retrospective recall, avoids relying on participant definitions of behaviors, and enables us to place EMA and eating information in correct temporal space. Due to this more comprehensive assessment method, we hypothesized that both groups of obese samples (with BED and without BED) would have greater rates of binge eating and overeating than non-obese controls (NOC) while in their natural environment. Also, we hypothesized that the BED group would have greater rates of binge eating compared to the NBED obese group.

Section snippets

Participants

Participants included 40 individuals recruited through community and university flyers and by referral from an eating disorders treatment facility. Flyers posted in the community and local universities sought individuals who were “normal weight or overweight and over the age of 18“. Because we were primarily looking to recruit BED patients from the eating disorders treatment facility, clinicians were told that we were seeking individuals who were obese, binge ate, and did not engage in

Loss of control

When examining loss of control immediately before any eating episode, a significant effect for group was identified, F(2,928) = 28.03, p < .001. See Table 1 for more details.

Eating behavior

Table 1 shows the number of eating episodes per day, the number of kilocalories per day, and the number of kilocalories per eating episode (all age-corrected) for each of the three groups. Analyses showed a significant group difference in the number of eating episodes per day, F(2,280) = 9.25, p = .001. The total number of

Discussion

In the current study, we found a number of important differences between the obese participants (BED and NBED) and the NOC group. Further, we found several differences between BED and NBED participants and, importantly, showed that the BED group reported more overeating and binge eating than the NBED group.

We believe that the findings of the current study help clarify the contradictory conclusions of laboratory studies (e.g., Yanovski et al., 1992) and field studies (le Grange et al., 2001,

Acknowledgements

We thank the National Eating Disorders Association for providing funding for the current project.

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