In this study of binge eating in overweight, treatment-seeking adolescents, 45% of teens reported they had engaged in binge or LOC eating at some time in their lives. Individuals diagnosed with full-syndrome BED were distinguishable from those reporting subthreshold levels of binge eating or no binge eating in that they experienced higher emotional distress and disturbed eating cognitions, equivalent to that experienced by adults with BED (Wilfley, Schwartz et al., 2000
). However, individuals who endorsed recent subthreshold binge eating in the last 3 months were also distinguishable from those who reported no LOC eating whatsoever, with the former group reporting higher levels of disturbed eating cognitions and anxiety and their parents reporting more child behavior problems. In general, the number of binge episodes endorsed by adolescents was positively associated with measures of psychopathology.
In contrast to adult studies (Crow et al., 2002
; Striegel-Moore et al., 1998
), but consistent with one prior adolescent study (Johnson et al., 1999
), participants with BED experienced significantly higher levels of eating-disordered attitudes, more negative mood, and anxiety compared to those with recent subthreshold binge eating in the last 3 months. This finding may be due to differences in the subthreshold criteria employed in adult studies. To be categorized in the RECENT-BINGE group, participants in our sample needed only to endorse engaging in a single binge eating episode in the past 3 months. In adult studies, the requirement for sub-threshold BED ranges from once per week (Striegel-Moore et al., 1998
) to once per month (Crow et al., 2002
). A threshold less than once per month, but greater than one episode in 3 months, may warrant study to determine at what limit binge episodes become indicative of greater psychopathology in adolescents.
Despite lower scores on the EDE scales compared with the BED group, those with infrequent but recent binge eating episodes had significantly higher scores on the eating, shape and weight concern subscales, the global EDE scale, and trait anxiety than their overweight counterparts who did not report binge or LOC eating in the past. These findings support prior research that children and adolescents who engage in binge eating at any frequency in a recent period preceding assessment suffer from more disturbed eating cognitions and anxiety than those without a history of binge or LOC eating (Decaluwe et al., 2003
; Johnson et al., 1999
; Morgan et al., 2002
; Tanofsky-Kraff et al., 2004
). This study found a log-linear relationship between binge frequency and scores from the EDE, STAIC, and CDI, suggesting a continuous relationship between binge or LOC eating and psychopathology among teens in our sample.
The higher weight concern scores of adolescents in the RECENT-BINGE group are particularly troubling because weight concern is believed to be a risk factor for the development of an eating disorder in healthy weight samples (Killen et al., 1994
; Stice et al., 1998
; Stice, Presnell, & Spangler, 2002
). Although the Killen studies did not use the EDE subscale to measure concern, the two measures broadly capture worries and preoccupation with one’s body weight. In addition to weight concern, thin body preoccupation is a prospective predictor of eating disorders (McKnight Investigators, 2003
), suggesting that a broader construct of disturbed eating cognitions may predict future eating disorders. Although it is unclear whether increases in eating and shape concern may also serve as risk factors for full-syndrome eating disorders among overweight teens, it is notable that in the current study, teens in the RECENT-BINGE group reported more shape concern than those in both lower threshold groups.
In addition to the potential risk of eating disorder development, participants who binge eat may be at risk for excessive weight gain. Binge eating has been associated with additional weight gain in three longitudinal studies of primarily healthy weight adolescents (Field et al., 2003
; Stice, Cameron, Killen, Hayward, & Taylor, 1999
; Stice et al., 2002
). In a three-year longitudinal study of younger children at risk for adult obesity, binge eating has also been shown to predict weight and fat gain (Tanofsky-Kraff et al., 2006
). Therefore, participants with BED or recent but infrequent binge eating may be at risk for excessive weight gain compared with teens endorsing past LOC or never experiencing LOC eating. Future research is needed to determine whether binge eating is a risk factor for further weight gain in severely overweight treatment-seeking adolescents.
Our finding that almost half of the participants experienced binge or LOC eating, either presently or at some point in their lifetime, supports prior studies of overweight treatment-seeking adolescents (Decaluwe et al., 2003
; Isnard et al., 2003
) and suggests a higher frequency of binge eating among this population than those found in overweight and normal weight nontreatment-seeking youth. Among nontreatment-seeking overweight youth, prevalence estimates for LOC/binge eating are lower, from 14.6% (Tanofsky-Kraff et al., 2004
) to 33.1% (Morgan et al., 2002
) in children and ~18.5% in adolescents (Johnson et al., 2002
). Binge eating estimates among normal weight non-treatment-seeking youth are lower than those reported by their overweight counterparts (Tanofsky-Kraff et al., 2004
). Our results suggest that binge or LOC eating is an experience shared by a substantial proportion of overweight treatment-seeking adolescents, and future research is required to investigate the potential impact of binge or LOC eating on the outcome of both medication and behavioral weight-loss interventions in this population.
Strengths of this study include the use of interview methodology for the investigation of eating-disordered pathology and the racially diverse sample. However, because many adolescents in this study were extremely overweight, our findings are limited in that they may not generalize to samples of less overweight teens or to healthy weight teens. The relatively small size of the BED group may also have provided potentially unstable estimates of the characteristics of overweight, treatment-seeking adolescents with BED. In summary, our findings suggest that a sizeable number of overweight teens seeking weight loss struggle with LOC and/or binge eating. Furthermore, although adolescents endorsing recent, subthreshold binge eating do not experience distress to the same degree as those with DSM-IV-TR BED, they do report greater distress than those who have not experienced LOC eating. Given this higher level of distress, overweight adolescents who report binge eating, even at subthreshold levels, may benefit from interventions focused on their LOC eating experiences in addition to traditional behavioral modification techniques for weight loss. Finally, frequent or recent binge eating may serve as an intervention target for the prevention of full-syndrome eating disorders and excessive weight gain.