Binge eating disorder (BED) is characterized by the consumption of an objectively large amount of food, in a brief period (i.e., < 2 hours), during which an individual experiences a subjective sense of loss of control, as well as later distress about the eating episode. Binge episodes must occur on average twice per week for 6 months to meet criteria for BED (1
). Unlike bulimia nervosa, BED is not accompanied by inappropriate compensatory behaviors. In the general population, approximately 2% to 3% of adults suffer from BED (2
). However, studies have shown that between 20 to 30% of obese treatment-seeking adults suffer from this disorder (3
). In adults, BED is associated with increased body mass index, medical problems, and psychopathology, including depression, anxiety, and substance abuse (2
Binge eating also occurs in overweight youth (9
). However, children and adolescents are less likely to meet full criteria for BED (12
). Instead, they more commonly experience sub-threshold binge eating (BE), in which they do not fulfill criteria of bingeing at least twice a week for the last 6 months or meet other secondary characteristics (9
). Like overweight adults with BED, overweight youth with BE are heavier, report more eating-related psychopathological features, greater weight and shape concerns, and depressive symptoms (9
It is unclear whether BE negatively affects weight loss efforts in adults or adolescents. Several early studies, with small sample sizes, found that patients with BE lost significantly less weight than did those without this condition (9
). However in the Look AHEAD study, researchers found that adult diabetic participants who reported BE at baseline, but remission of this behavior at one year, were just as successful in losing weight as those who did not endorse BE at either time point, as measured by self-report questionnaire (22
). However, those whose BE did not remit or who developed BE over the year did not lose as much weight as those who were free of this problem at 1 year. Other investigators have also reported successful weight loss in obese adults with BE (23
Few studies have examined whether BE is associated with suboptimal weight loss in obese adolescents. Wildes et al. found that children who reported BE had an increase in weight during weight loss treatment, compared to the non bingers who lost weight (25
). However, this study was limited by a one item self-report measure of binge eating. Similarly, Braet found that binge symptoms were related to less favorable outcomes after a 2 year follow up of inpatient treatment for obese children (26
). Other studies have found no relation between broadly defined BE and weight loss. Jones and colleagues examined overweight teens who reported overeating and some binge eating and who received an Internet-based intervention. These participants achieved a greater reduction, in overeating and binge eating as well as BMI, compared to a wait-list control group. However, these results were limited by self-reported height and weight at post test (27
). The authors did not examine the relationship between the severity of overeating and BE at baseline and subsequent weight loss.
The primary goal of the present study was to examine the relationship between BE status and weight loss in 82 obese adolescents who participated in a comprehensive weight-loss program. In addition to examining whether BE would be associated with suboptimal weight loss at the end of both 6 and 12 months of treatment, we also sought to confirm the relationship between BE and baseline psychopathology. Specifically, we predicted that obese adolescents with BE would report significantly greater symptoms of depression and lower self-esteem than would their counterparts without this disorder. We also wished to confirm that BE would be associated with greater levels of dietary disinhibition and hunger, as well as lower levels of cognitive restraint. Finally, we examined whether BE and measures of eating and appetite (i.e., hunger, disinhibition, and cognitive restraint) changed with weight loss treatment.