It has been theorized that loss of control (LOC) is a more salient marker of pediatric binge eating episodes than the reported amount of food consumed during such episodes.8
Yet, direct tests of this notion are scant. In the present study, we compared a sizeable, adequately powered sample of children and adolescents who were categorized by eating episode size and whether or not LOC was reported. Consistent with our hypotheses, youth with both types of LOC eating exhibited greater disordered eating attitudes and behaviors than youth reporting OO or NE. It is especially notable that relative to children and adolescents with NE or OO, those who reported either SBE or OBE displayed heightened levels of body shape and weight concerns, which have been shown to be prospective risk factors for the development of partial or full syndrome eating disorders.44,45
Compared to their peers with NE or OO, youth who reported either SBE or OBE reported greater emotional eating in response to depressive symptoms and feelings of anger/anxiety/frustration, more frequent eating in the absence of hunger in response to negative affect, and higher depressive and anxiety symptoms. Such associations are congruent with prior data illustrating relationships between pediatric LOC eating and emotional eating, eating in the absence of hunger, and general psychopathology.10,11,15,25
These observed patterns are consistent with affective theories of binge eating, which propose that LOC may occur as a consequence of attempts to alleviate temporary or chronic negative affect.46
Indeed, negative affect has been shown to predict increases in bulimic symptoms, including OBE, in children and adolescents.2,47–49
Although results from the present study are cross-sectional and cannot be construed to imply causation, our data suggest that future studies should examine the effects of negative affect on LOC, SBE, and/or OBE longitudinally.
The current findings clearly delineate that, in a non-treatment seeking sample of youth, the subjective experience of low-frequency LOC, regardless of the reported amount of food consumed, is consistently tied to greater negative affective experiences and reports of eating in response to such emotional distress. The presence of LOC, regardless of the reported size of food intake, may be a particularly important indicator of risk for disordered eating attitudes and behaviors and general psychopathology in youth for several reasons. Foremost, children often do not have the same kind of independent access to food as adults, which may put a ceiling on the amount of food they would otherwise consume during an episode of LOC eating.8
Another consideration is that youth, especially those who are overweight, tend to underreport their food intake.50
Since classification of SBE versus OBE often relies on children's self-reports, it is possible that youth who report consuming an amount of food that is ambiguously large may actually be eating a larger amount of food that would constitute an OBE. Indeed, this explanation is supported by our findings that youth who reported SBE or OBE had similar body composition to each other and greater BMI-z scores and adiposity than youth who reported either OO or NE. Additionally, binge eating behaviors in youth can be difficult to assess because it can be challenging to determine what constitutes an unambiguously large amount of food in developing boys and girls of different ages and pubertal stages.8
For example, reported consumption of two large hamburgers, a large order of French fries, and a large soft drink, might be considered unambiguously large for a pre-pubertal 8-year-old girl; however, the size classification of the same reported amount of food consumed would be much more ambiguous in a 15-year-old boy in the midst of a growth spurt.
Interestingly, examination of parents' reports revealed a pattern that was somewhat discrepant from youths' self-reports. On comparisons of disordered eating attitudes and behaviors, parents of children with the presence of any type of eating episode (i.e., OO, SBE, or OBE) rated their children higher on eating in the absence of hunger in response to negative affect and fatigue/boredom than parents of youth with NE. Further, OO youth were distinguished by the highest parent-perceived eating in the absence of hunger in response to external cues. In terms of symptoms of general psychopathology, OO and OBE youths' parents reported the greatest internalizing symptoms. Judging from parents' perspectives, it is plausible that children who experience overeating with or without LOC may be at elevated risk for disordered eating and general psychopathology compared to children's whose eating is comparatively normative. Such a possible explanation fits with research suggesting that overweight youth have greater overall disordered eating behaviors and attitudes and parent-reported behavioral problems than non-overweight youth.14
Alternatively, it is quite likely that parents may be better observers of objective over-consumption than of their children's internal experiences of LOC. In turn, parents may infer their child's internal experience based on these objective observations. Consistent with this notion are studies finding that parents and youth show little agreement on reports of child eating behavior51
or psychosocial problems, especially for internalizing symptoms.52
The current study findings should be considered in light of its limitations. All data were cross-sectional and correlational, thus the causal direction of any relations cannot be established. Prospective examinations of youth with NE, OO, SBE, and OBE and their disordered eating, general psychopathology, and weight outcomes are necessary for truly distinguishing whether LOC itself is the most salient marker of risk for disordered eating and obesity. Also, it is important to note that although measures of psychological symptomatology among youth with LOC were higher relative to the other eating groups in the sample, they did not reach levels that elicit clinical concern. Nonetheless, subclinical levels of disordered eating pathology have been shown to predict future clinically relevant disordered eating.45,47
Finally, the current study classified youth based on the presence or absence of ≥1 episode of OO, SBE, or OBE in the month prior to assessment. Although this classification scheme is commonly employed and may be most appropriate among non-treatment seeking youth who primarily report only one episode,16
frequency of SBE or OBE episodes appears to play an important role, at least among weight-loss treatment-seeking obese samples of youth.13,24
Regardless, it is noteworthy that the current findings were replicated when we limited analyses to youth with ≥2 recent eating episodes.
One strength of the current study was the administration of the EDE to a large sample of youth with enough participants who reported SBE or OBE episodes that the study was adequately powered to detect potential differences. A second strength was the comparison of pediatric eating episode types with multiple youth self-reports, parent reports, and objective measurements. Although binge eating behaviors in adults have been extensively studied, the investigation of children's binge eating behaviors is an emerging field.8
Results from the current study may help to guide the research on pediatric binge eating in non-treatment-seeking samples by demonstrating that the assessment of subjective LOC over eating may be one of the most salient markers of disordered eating and overweight risk in youth.