This preliminary investigation of the associations among binge eating, sex and weight-related quality of life (QOL) in obese, treatment-seeking adolescents revealed that adolescents describing at least one recent episode of binge eating reported significantly poorer QOL in several important domains of functioning: health, mobility, and self-esteem. Across all domains, with the exception of work/school, girls reported poorer QOL than boys. However, in many domains, it was girls with binge eating who reported the poorest QOL compared to all other groups. Said differently, binge eating among girls, but generally not among boys, was related to significantly greater impairment in weight-related QOL in the important QOL domains of activities of daily living, mobility, self-esteem, and social/interpersonal functioning.
When depressive symptoms were accounted for, binge eating was no longer significantly related to QOL, suggesting that the main effect of binge eating on QOL across boys and girls may be driven primarily via depression. In contrast, girls tended to report poorer QOL than boys across most domains (activities of daily living, mobility, self-esteem, and social/interpersonal functioning) even when controlling for depression, suggesting that the impact of sex on QOL may be independent of depressive symptoms. Analyzing the interaction of binge eating and sex on QOL, girls with binge eating continued to reported worse social/interpersonal functioning and mobility than all other weight-loss treatment seeking adolescents in our sample, independent of depressive symptoms.
Findings from the current study are consistent with several lines of previous research. The present study’s finding that binge eating is associated with poorer QOL in obese adolescents is consistent with literature indicating a relationship between binge eating and QOL among adults [8
] and youth with type 2 diabetes [11
]. Notably, the present relationship between binge eating and QOL remained significant after accounting for adolescents’ extent of obesity (i.e.
, percent adiposity), suggesting that the poorer QOL reported by those with binge eating cannot be attributed solely to a greater degree of obesity. Similarly, the finding that girls in the current study reported significantly worse QOL than boys in nearly all domains of functioning is consistent with previous data that obese adolescent females endorse poorer QOL compared to obese males [37
These observations are important to consider in light of apparent interactions between binge eating and sex. The associations between binge eating and QOL were stronger among girls compared to boys in most domains, including mobility, self-esteem, social/interpersonal functioning and work/school. One possible explanation is that obese adolescent girls may experience binge eating as more distressing than boys [39
]. Although obese boys certainly are not immune from the social stigma associated with obesity, there is evidence for even greater socio-cultural pressure on adolescent girls to be ultra
]. Compared to males, adolescent [41
] and adult [42
] females tend to experience greater relevance of body weight and shape for identity and self-esteem. Indeed, adolescent girls often report that changing their eating patterns is a means to feeling better about themselves [43
]. Consistent with clinical data that females experience binge eating as guilt-inducing and embarrassing [30
], it is possible that binge eating impacts girls’ evaluation of themselves across domains (e.g., self-esteem, interpersonal relationships) to a greater extent than their male counterparts. Alternatively, it is possible that problems in weight-related QOL domains, such as difficulties in interpersonal functioning, might promote binge eating behaviors [44
Similar to several adult studies [36
], we found that depressive symptoms were strongly related to impaired QOL independent of binge eating. However, this finding should be interpreted in light of the significant collinearity between binge eating and depressive symptoms [4
]. In the present study, correlation analyses of the association between QOL and depressive symptoms confirmed the expected significant relationship between binge eating and symptoms of depression. Given that obese youth suffer from greater depressive symptoms [47
] and report lower psychosocial QOL than non-overweight youth [48
], it is possible that the association between depressive symptoms and QOL is even more potent among obese youth than among non-overweight youth. In analyses accounting for depressive symptoms, binge eating was only significantly related to adolescent girls’ weight-related QOL in social/interpersonal functioning and mobility domains. Since most effective interventions for binge eating have been developed from therapies designed to treat depression [44
], interventions targeting both mood and eating behavior may simultaneously improve QOL [49
]. Nevertheless, the unique relationship of adolescent girls’ binge eating with QOL in some domains (i.e.
, mobility and social/interpersonal functioning), even after accounting for symptoms of depression, suggests that binge eating may influence QOL by mechanisms other than depressed mood. In other words, QOL may be impacted by factors such as the inconvenience, time, or cost to other pleasurable activities rendered by binge eating.
Strengths of this study include the use of a structured interview for the assessment of binge eating in a relatively large sample of obese adolescents of varied sex and race/ethnicity. Although there were more girls than boys in the sample, significant sex differences were still detectable. Our findings may be limited in terms of their generalizability to obese, treatment-seeking youth. However, it is highly relevant to understand binge eating and QOL among such adolescents. Investigations of the psychosocial correlates of weight-related QOL are important for the identification of targets upon which to design successful weight-loss programs that can fully address the range of problems and concerns salient for obese treatment-seeking adolescents. Yet, it is important to point out that the associations observed in the current study are cross-sectional, and therefore, conclusions about directionality cannot be made. It is possible that binge eating may promote poorer QOL, or that poorer QOL in domains such as self-esteem may influence binge eating patterns.