Recent studies suggest that binge eating disorder (BED) is as prevalent among African American and Hispanic Americans as among Caucasian Americans; however, data regarding the characteristics of treatment-seeking individuals from racial and ethnic minority groups are scarce. The purpose of this study was to investigate racial/ethnic differences in demographic characteristics and eating disorder symptoms in participants enrolled in treatment trials for BED.
Data from 11 completed randomized, controlled trials were aggregated in a single database, the Clinical Trials of Binge Eating Disorder (CT-BED) database, which included 1,204 Caucasian, 120 African American, and 64 Hispanic participants assessed at baseline. Age, gender, race/ethnicity, education, body mass index (BMI), binge eating frequency, and Eating Disorder Examination (EDE) Restraint, Shape, Weight, and Eating Concern subscale scores were examined.
Mixed model analyses indicated that African American participants in BED treatment trials had higher mean BMI than Caucasian participants, and Hispanic participants had significantly greater EDE shape, weight, and eating concerns than Caucasian participants. No racial or ethnic group differences were found on the frequency of binge eating episodes. Observed racial/ethnic differences in BED symptoms were not substantially reduced after adjusting for BMI and education. Comparisons between the CT-BED database and epidemiological data suggest limitations to the generalizability of data from treatment-seeking samples to the BED community population, particularly regarding the population with lower levels of education.
Further research is needed to assess alternative demographic, psychological, and culturally specific variables to better understand the diversity of treatment-seeking individuals with BED.
binge eating; eating disorders; treatment; health disparities; ethnicity
The purpose of this study was to systematically review the reliability of scores on the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q) and to examine the validity of their use as measures of eating disorder symptoms.
Articles describing the psychometric properties of the EDE and EDE-Q were identified in a systematic search of major computer databases and a review of reference lists. Articles were selected based on a priori inclusion and exclusion criteria.
Fifteen studies were identified that examined the psychometrics of the EDE, whereas 10 studies were found that examined the psychometrics of the EDE-Q.
Both instruments demonstrated reliability of scores. There is evidence that scores on the EDE and EDE-Q correlate with scores on measures of similar constructs and support for using the instruments to distinguish between cases and non-cases. Additional research is needed to broaden the generalizability of the findings.
eating disorder examination; eating disorder examination-questionnaire; reliability; validity; psychometrics
We studied the relation between intrusive and repetitive hair-pulling, the defining feature of trichotillomania, and compulsive and impulsive features in 1453 individuals with anorexia nervosa and bulimia nervosa. We conducted a series of regression models examining the relative influence of compulsive features associated with obsessive compulsive disorder; compulsive features associated with eating disorders; trait features related to harm avoidance, perfectionism and novelty seeking; and self harm. A final model with a reduced sample (n=928) examined the additional contribution of impulsive attributes. One out of 20 individuals endorsed hair-pulling. Evidence of a positive association with endorsement of compulsive behavior of the obsessive compulsive spectrum emerged. Hair-pulling may be more consonant with ritualistic compulsions than impulsive urges in those with eating disorders.
eating disorders; trichotillomania; hair-pulling; anorexia nervosa; bulimia nervosa; impulsivity; compulsivity
Despite the widespread use of the Eating Disorder Examination (EDE) as a primary assessment instrument in studies of eating and weight disorders, little is known about the psychometric aspects of this interview measure. The primary purpose of this study was to evaluate the factor structure of the EDE interview in a large series of patients with binge-eating disorder (BED). Participants were 688 treatment-seeking patients with BED who were reliably administered the EDE interview by trained research clinicians at three research centers. Exploratory factor analysis (EFA) performed on EDE interview data from a random split-half of the study group suggested a brief 7-item 3-factor structure. Confirmatory factor analysis (CFA) performed on the second randomly selected half of the study group supported this brief 3-factor structure of the EDE interview. The three factors were interpreted as Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction. In this series of patients with BED, factor analysis of the EDE interview did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE interview in this and other eating-disordered groups. The implications of these factor analytic findings for understanding and assessing the specific psychopathology of patients with BED are discussed.
To examine the caloric intake in women with anorexia nervosa (AN) and how it varies by day as a function of the presence or absence of binge eating and/or purging behaviors.
Female participants with AN (n = 84, mean age = 24.4, range 18–51) were recruited from three different sites. Data on food intake were obtained through the use of 24-h dietary recall using the Nutritional Data Systems for Research, and data on binge eating and purging behaviors were collected on palmtop computers using an ecological momentary assessment paradigm. Daily macronutrient intake was compared on days during which binge eating and/or purging behaviors did or did not occur.
On days during which binge eating and purging behaviors both occurred, participants reported significantly greater kilocalorie intake when compared with days when neither behavior occurred, or when only binge eating or purging occurred. Binge eating episodes were only modest in size on days when purging did not occur. Energy intake overall was higher than expected.
Intake on days where binge eating occurred varied dramatically based on whether or not purging occurred. Whether markedly increased binge eating intake was causally related to purging is unclear. Nonetheless eating episodes were at times quite large and equivalent to those reported by participants with bulimia nervosa in other research.
AN; binge eating; compensatory behaviors; caloric intake
Follow-up studies of eating disorders (EDs) suggest outcomes ranging from recovery to chronic illness or death, but predictors of outcome have not been consistently identified. We tested 5151 single-nucleotide polymorphisms (SNPs) in approximately 350 candidate genes for association with recovery from ED in 1878 women. Initial analyses focused on a strictly defined discovery cohort of women who were over age 25 years, carried a lifetime diagnosis of an ED, and for whom data were available regarding the presence (n=361 ongoing symptoms in the past year, ie, ‘ill') or absence (n=115 no symptoms in the past year, ie, ‘recovered') of ED symptoms. An intronic SNP (rs17536211) in GABRG1 showed the strongest statistical evidence of association (p=4.63 × 10−6, false discovery rate (FDR)=0.021, odds ratio (OR)=0.46). We replicated these findings in a more liberally defined cohort of women age 25 years or younger (n=464 ill, n=107 recovered; p=0.0336, OR=0.68; combined sample p=4.57 × 10−6, FDR=0.0049, OR=0.55). Enrichment analyses revealed that GABA (γ-aminobutyric acid) SNPs were over-represented among SNPs associated at p<0.05 in both the discovery (Z=3.64, p=0.0003) and combined cohorts (Z=2.07, p=0.0388). In follow-up phenomic association analyses with a third independent cohort (n=154 ED cases, n=677 controls), rs17536211 was associated with trait anxiety (p=0.049), suggesting a possible mechanism through which this variant may influence ED outcome. These findings could provide new insights into the development of more effective interventions for the most treatment-resistant patients.
GABA; anorexia nervosa; recovery from eating disorders; genetic association; single nucleotide polymorphisms; eating/metabolic disorders; GABA; eating/metabolic disorders; neurogenetics; biological psychiatry; genetic association; anorexia nervosa; recovery from eating disorders; single-nucleotide polymorphisms; phenomic association
Significant discrepancies have been found between interview- and questionnaire-based assessments of psychopathology; however, these studies have typically compared instruments with unmatched item content. The Eating Disorder Examination (EDE), a structured interview, and the questionnaire version of the EDE (EDE-Q) are considered the preeminent assessments of eating disorder symptoms and provide a unique opportunity to examine the concordance of interview- and questionnaire-based instruments with matched item content. The convergence of EDE and EDE-Q scores has been examined previously; however, past studies have been limited by small sample sizes and have not compared the convergence of scores across diagnostic groups. A meta-analysis of 16 studies was conducted to compare the convergence of EDE and EDE-Q scores across studies and diagnostic groups. With regard to the EDE and EDE-Q subscale scores, the overall correlation coefficient effect sizes ranged from .64 to .75. The overall Cohen's d effect sizes ranged from .31 to .59 with participants consistently scoring higher on the questionnaire. With regard to the items measuring behavior frequency, the overall correlation coefficient effect sizes ranged from .49 to .64 for binge eating and .84 to .89 for compensatory behaviors. The overall Cohen's d effect sizes ranged from -.14 to -.23, with participants reporting more binge eating on the interview in 70% of the studies. These results suggest that the interview and questionnaire assess similar constructs, but that the two instruments should not be used interchangeably. Additional research is needed to examine the inconsistencies between binge frequency scores on the two instruments.
Eating Disorder Examination; Eating Disorder Examination-Questionnaire; Convergent validity; Meta-analysis
This analysis is a follow-up to an earlier investigation of 182 genes selected as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN). As those initial case-control results revealed no statistically significant differences in single nucleotide polymorphisms, herein we investigate alternative phenotypes associated with AN. In 1762 females using regression analyses we examined: (1) lowest illness-related attained body mass index; (2) age at menarche; (3) drive for thinness; (4) body dissatisfaction; (5) trait anxiety; (6) concern over mistakes; and (7) the anticipatory worry and pessimism vs. uninhibited optimism subscale of the harm avoidance scale. After controlling for multiple comparisons, no statistically significant results emerged. Although results must be viewed in the context of limitations of statistical power, the approach illustrates a means of potentially identifying genetic variants conferring susceptibility to AN because less complex phenotypes associated with AN are more proximal to the genotype and may be influenced by fewer genes.
covariates; eating disorders; association studies; personality; genetic
To investigate mothers' changes in prevalence of postpartum depression (PPD) symptoms over 0–9 months postpartum and determine which symptoms best distinguish depressed from nondepressed women.
This was a prospective study of English-literate mothers of newborns, recruited from four family medicine clinics and three pediatric clinics. Mothers completed surveys at 0–1, 2, 4, 6, and 9 months postpartum, and surveys included demographic characteristics, a two-question depression screen, the 9-Item Patient Health Questionnaire (PHQ-9), and other health and work characteristics.
There were 506 participants (33% response rate), and 112 (22.1%) had a positive PHQ-9 (score ≥10) at some time within the first 9 months after delivery. The proportion of women with a positive PHQ-9 was greatest at 0–1 month (12.5%), then fell to between 5.0% and 7.1% at 2–6 months, and rose again to 10.2% at 9 months postpartum. Most of the PHQ-9 symptoms differentiated well between depressed and nondepressed women; items that were less discriminating were abnormal sleep, abnormal appetite/eating, and fatigue. Assessment of possible predictors of a change from negative to positive PHQ-9 between 6 and 9 months postpartum revealed only one significant predictor: prior history of depression.
Depressive symptoms in this sample were most frequent at 0–1 month and 9 months postpartum. Most PHQ-9 items differentiated well between depressed and nondepressed mothers; these findings support the use of the PHQ-9 for PPD screening. Future research is needed to confirm our observed secondary peak in depressive symptoms at 9 months postpartum and to investigate possible causes.
Extensive population-based genome-wide association studies have identified an association between the FTO gene and BMI; however, the mechanism of action is still unknown. To determine whether FTO may influence weight regulation through psychological and behavioral factors, seven single nucleotide polymorphisms (SNPs) of the FTO gene were genotyped in 1085 individuals with anorexia nervosa (AN) and 677 healthy weight controls from the international Price Foundation Genetic Studies of Eating Disorders. Each SNP was tested in association with eating disorder phenotypes and measures that have previously been associated with eating behavior pathology: trait anxiety, harm-avoidance, novelty seeking, impulsivity, obsessionality, compulsivity, and concern over mistakes. After appropriate correction for multiple comparisons, no significant associations between individual FTO gene SNPs and eating disorder phenotypes or related eating behavior pathology were identified in cases or controls. Thus, this study found no evidence that FTO gene variants associated with weight regulation in the general population are associated with eating disorder phenotypes in AN participants or matched controls.
We investigated sociodemographic characteristics in women with and without lifetime eating disorders.
Participants were from a multi-site international study of eating disorders (N = 2096). Education level, relationship status, and reproductive status were examined across eating disorder subtypes and compared with a healthy control group.
Overall, women with eating disorders were less educated than controls, and duration of illness and age of onset were associated with educational attainment. Menstrual status was associated with both relationship and reproductive status, but eating disorder subtypes did not differ significantly from each other or from healthy controls on these dimensions.
Differences in educational attainment, relationships, and reproduction do exist in individuals with eating disorders and are differentially associated with various eating disorder symptoms and characteristics. These data could assist with educating patients and family members about long-term consequences of eating disorders.
Children; relationship; education; anorexia nervosa; bulimia nervosa; amenorrhea
Both obesity and depression are prominent during adolescence, and it is possible that obesity is a trigger for adolescent depression. The purpose of this paper is to evaluate whether overweight or obese status contributes to the development of depression in adolescent females.
Participants were 496 adolescent girls who completed interview based measures of depression and had their height and weight measured at 4 yearly assessments. Repeated measures logistic regressions with generalized estimating equations were used to evaluate whether overweight or obese status were associated with Major depression or an increase in depressive symptoms the following year.
Main Outcome Measures
Major depression and depressive symptoms were evaluating using a modified version of the K-SADS interview. Overweight and obese status was determined using standardized protocols to measure height and weight.
Results showed that obese status, not overweight status, was associated with future depressive symptoms, but not Major depression. This study demonstrated that obesity is a risk factor for depressive symptoms, but not for clinical depression.
As depressive symptoms are considered along the spectrum of depression with clinical depression at the high end, these results suggest that weight status could be considered a factor along the pathway of development of depression in some adolescent females.
Adolescence; obesity; depression; longitudinal
This study compared the best available treatment for bulimia nervosa,
cognitive–behavioural therapy (CBT) augmented by fluoxetine if
indicated, with a stepped-care treatment approach in order to enhance
To establish the relative effectiveness of these two approaches.
This was a randomised trial conducted at four clinical centres
registration number: NCT00733525). A total of 293 participants with bulimia
nervosa were randomised to one of two treatment conditions: manual-based CBT
delivered in an individual therapy format involving 20 sessions over 18 weeks
and participants who were predicted to be non-responders after 6 sessions of
CBT had fluoxetine added to treatment; or a stepped-care approach that began
with supervised self-help, with the addition of fluoxetine in participants who
were predicted to be non-responders after six sessions, followed by CBT for
those who failed to achieve abstinence with self-help and medication
Both in the intent-to-treat and completer samples, there were no
differences between the two treatment conditions in inducing recovery (no
binge eating or purging behaviours for 28 days) or remission (no longer
meeting DSM–IV criteria). At the end of 1-year follow-up, the
stepped-care condition was significantly superior to CBT.
Therapist-assisted self-help was an effective first-level treatment in the
stepped-care sequence, and the full sequence was more effective than CBT
suggesting that treatment is enhanced with a more individualised approach.
The purpose of this investigation was to compare three types of treatment for binge eating disorder to determine the relative efficacy of self-help group treatment compared to therapist-led and therapist-assisted group cognitive-behavioral therapy.
A total of 259 adults diagnosed with binge eating disorder were randomized to wait-list or 20 week group treatment that was therapist-led, therapist-assisted, or self-help. Binge eating as measured by the Eating Disorder Examination was assessed at baseline, post-treatment, 6- and 12 month follow-up and outcome was determined using logistic regression and analysis of covariance (intention-to-treat).
At end of treatment, the therapist-led (51.7%) and the therapist-assisted (33.3%) conditions had higher binge eating abstinence rates than the self-help (17.9%) and wait-list (10.1%) conditions. No differences in abstinence rates were observed at either follow-up assessment. The therapist-led condition also showed more reductions in binge eating at post-treatment and follow-up compared to the self-help condition, and treatment completion rates were higher in the therapist-led (88.3%) and wait-list (81.2%) conditions than the therapist-assisted (68.3%) and the self-help (59.7%) conditions.
Therapist-led group cognitive-behavioral treatment for binge eating disorder led to higher binge eating abstinence rates, greater reductions in binge eating frequency, and lower attrition at the end of treatment compared to group self-help treatment. Although these findings indicate that therapist delivery of group treatment is associated with better short-term outcome and less attrition than self-help treatment, the lack of group differences at follow-up suggests that self-help group treatment may be a viable alternative to therapist-led interventions. (Clinical Trials Registration: Treatment of Binge Eating Disorder, #NCT00041743; http://www.clinicaltrials.gov/ct2/show/NCT00041743?term=00041743&rank=1)
The current paper provides an analysis of the use of artificial sweeteners, caffeine, and excess fluids in patients diagnosed with anorexia nervosa.
Seventy subjects with anorexia nervosa (AN) were recruited to participate in an ecologic momentary assessment study which included nutritional analysis using the Nutrition Data Systems for Research (NDS-R), a computer based dietary recall system.
When subtypes were compared, AN-restricting subtype (AN-R) subjects and AN-Binge-Purge (AN-B/P) subjects did not differ in quantity of aspartame, caffeine, or water consumed. Daily water consumption was related to daily vomiting frequency in AN-B/P but not to daily exercise frequency in either AN-R or AN-B/P subjects.
Caffeine, water, and aspartame consumption can be variable in AN patients and the consumption of these substances appears to be only modestly related to purging behavior.
The purpose of this investigation was to examine differences in personality dimensions among individuals with bulimia nervosa, binge eating disorder, non-binge eating obesity and a normal weight comparison group as well as to determine the extent to which these differences were independent of self-reported depressive symptoms.
Personality dimensions were assessed using the Multidimensional Personality Questionnaire in 36 patients with bulimia nervosa, 54 patients with binge eating disorder, 30 obese individuals who did not binge eat, and 77 normal weight comparison participants.
Participants with bulimia nervosa reported higher scores on measures of stress reaction and negative emotionality compared to the other three groups, and lower well-being scores compared to the normal weight comparison and the obese samples. Patients with binge eating disorder scored lower on well-being and higher on harm avoidance than the normal weight comparison group. In addition, the bulimia nervosa and binge eating disorder groups scored lower than the normal weight group on positive emotionality. When personality dimensions were re-analyzed using depression as a covariate, only stress reaction remained higher in the bulimia nervosa group compared to the other three groups and harm avoidance remained higher in the binge eating disorder than the normal weight comparison group.
The higher levels of stress reaction in the bulimia nervosa sample and harm avoidance in the binge eating disorder sample after controlling for depression indicate that these personality dimensions are potentially important in the etiology, maintenance, and treatment of these eating disorders. Although the extent to which observed group differences in well-being, positive emotionality and negative emotionality reflect personality traits, mood disorders, or both is unclear, these features clearly warrant further examination in understanding and treating bulimia nervosa and binge eating disorder.
We performed association studies with 5,151 SNPs that were judged as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN) based on location under reported linkage peaks, previous results in the literature (182 candidate genes), brain expression, biological plausibility, and estrogen responsivity. We employed a case–control design that tested each SNP individually as well as haplotypes derived from these SNPs in 1,085 case individuals with AN diagnoses and 677 control individuals. We also performed separate association analyses using three increasingly restrictive case definitions for AN: all individuals with any subtype of AN (All AN: n = 1,085); individuals with AN with no binge eating behavior (AN with No Binge Eating: n = 687); and individuals with the restricting subtype of AN (Restricting AN: n = 421). After accounting for multiple comparisons, there were no statistically significant associations for any individual SNP or haplotype block with any definition of illness. These results underscore the importance of large samples to yield appropriate power to detect genotypic differences in individuals with AN and also motivate complementary approaches involving Genome-Wide Association (GWA) studies, Copy Number Variation (CNV) analyses, sequencing-based rare variant discovery assays, and pathway-based analysis in order to make up for deficiencies in traditional candidate gene approaches to AN.
single nucleotide polymorphisms; probands; anorexia nervosa; bulimia nervosa
To investigate changes in mothers’ body dissatisfaction from delivery to 9 months postpartum, and the relationship of postpartum body dissatisfaction to weight, other health, and social characteristics.
In this prospective longitudinal study, 506 mothers completed surveys at 0-1 and 9 months postpartum. Postpartum changes in body dissatisfaction and weight were evaluated by paired t-tests, and predictors of postpartum body dissatisfaction were identified by stepwise multiple regression analysis.
Mothers’ body dissatisfaction increased significantly from 0-1 to 9 months postpartum (mean scores of 15.2 and 18.2, respectively, p < .001). Although women lost an average of 10.1 pounds (sd = 16.3) or 4.6 kg. (sd = 7.4) between 0-1 and 9 months postpartum (p < .001), their weight at 9 months postpartum remained an average of 5.4 pounds (sd = 15.6) or 2.5 kg (sd = 7.1) above their pre-pregnancy weights (p < .001). Body dissatisfaction at 9 months postpartum was associated with overeating or poor appetite, higher current weight, worse mental health (SF-36 Mental Health scale), race other than black, bottle-feeding (vs. breastfeeding), being single (vs. married), and having fewer children,.
Mothers’ body satisfaction worsened from 1 to 9 months postpartum, and 9-month body dissatisfaction was associated with eating/appetite abnormalities, greater weight, worse mental health, non-black race, non-breastfeeding status, and fewer immediate family relationships. Given these relationships, it is important to educate women about expected postpartum weight and body changes, and to find ways to enhance mothers’ postpartum self-esteem and body satisfaction.
postpartum; body image; mental health; weight gain
To examine the course of Eating Disorder NOS (EDNOS) compared with anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED).
Prospective study of 385 participants meeting DSM-IV criteria for AN, BN, BED and EDNOS at 3 sites. Recruitment was from the community and specialty clinics. Participants were followed at 6-month intervals over a 4-year period using the Eating Disorder Examination as the primary assessment.
EDNOS remitted significantly more quickly that AN or BN but not BED. There were no differences between EDNOS and full ED syndromes, or the sub-types of EDNOS, in time to relapse following first remission. Only 18% of the EDNOS group had never had or did not develop another ED diagnosis during the study, however this group did not differ from the remaining EDNOS group.
EDNOS appears to be a way station between full ED syndromes and recovery, and to a lesser extent from recovery or EDNOS status to a full ED. Implications for DSM-V are examined.
Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.
shape and weight concerns; binge eating disorder; bulimia nervosa; obesity; body image
To pilot a stepped collaborative care intervention for postpartum depression (PPD) and evaluate health differences between self-diagnosed depressed and non-depressed women.
Participants – 506 mothers of infants from 7 clinics – completed surveys at 0–1, 2, 4, 6, and 9 months postpartum and a Structured Clinical Interview for DSM-IV (SCID). SCID-positive depressed women were randomized to stepped collaborative care or usual care. Nine-month treatment, health, and work outcomes were evaluated for stepped care vs. control depressed women (n = 19, 20), and self-diagnosed depressed vs. non-depressed women (n = 122, 344).
Forty-five women had SCID-positive depression, while 122 had self-diagnosed depression. For SCID-positive depressed women, the stepped care intervention increased mothers’ awareness of their depression diagnosis (100% vs. 61%, p = .008) and their receipt of treatment (94% vs. 56%, p = .019). Self-diagnosed depressed women (vs. non-depressed) had more depressive symptoms and acute care visits, worse general and mental health, and greater impact of health problems on regular activities.
The stepped care intervention improved women’s knowledge of their PPD diagnosis and their receipt of treatment. However, our formal diagnostic procedures missed many women whose depressed mood interfered with their health and function.
postpartum depression; treatment outcome; mental health services
Disordered eating, body dissatisfaction, and obesity have been associated cross-sectionally with suicidal behavior in adolescents. This study examined these relationships in a longitudinal design, in order to determine the extent to which these variables predicted suicidal ideation and attempts. The study population included 2,516 older adolescents and young adults who completed surveys for Project EAT- II (Time 2), a five year follow-up study of adolescents who took part in Project EAT (Time 1). Multiple logistic regression was used to estimate odds ratios for suicidal behaviors at Time 2. Predictor variables included Time 1 extreme and unhealthy weight control behaviors (EWCB and UWCB), body dissatisfaction, and BMI percentile. Suicidal ideation was reported by 15.2% of males and 21.6% of females and suicide attempts were reported by 3.5% males and 8.7% females. For females, suicidal ideation at Time 2 was predicted by Time 1 EWCB. The odds ratio (OR) for suicide attempts was similarly elevated in females reporting EWCB at Time 1. These OR for both suicidal ideation and suicide attempts remained elevated even after controlling for Time 2 depressive symptoms. In males, EWCB was not associated with suicidal ideation or suicide attempts five years later. BMI and body dissatisfaction did not predict suicidal ideation or suicide attempts in males or females. These results emphasize the importance of extreme weight control behaviors.
suicide; obesity; body dissatisfaction; eating disorders
To determine the prevalence of binge eating disorder (BED) and night eating syndrome (NES) among applicants to the Look AHEAD (Action for Health in Diabetes) study.
Research Methods and Procedures
The Eating Disorders Examination-Questionnaire (EDE-Q) and the Night Eating Questionnaire (NEQ) were used to screen patients. Phone interviews were conducted using the EDE for those who reported at least eight episodes of objective binge eating in the past month and using the Night Eating Syndrome History and Interview for those who scored ≥25 on the NEQ. Recruitment at four sites (Birmingham, n = 200; Houston, n = 259; Minneapolis, n = 182; and Philadelphia, n = 204) yielded 845 participants (58% women; mean age = 60.1 ± 6.7 years; mean BMI = 36.2 ± 6.3 kg/m2).
Screening scores were met by 47 (5.6%) applicants on the EDE-Q and 71 (8.4%) on the NEQ. Of the 85% (40/47) who completed the EDE interview, 12 were diagnosed with BED, representing 1.4% of the total sample. Of the 72% (51/71) who completed the Night Eating Syndrome History and Interview, 32 were diagnosed with NES, equal to 3.8% of the total sample. Three participants had both BED and NES. Participants with eating disorders were younger, heavier, and reported more eating pathology than those without eating disorders.
Among obese adults with type 2 diabetes, NES was reported more frequently than BED, which, in turn, was less common than expected.
hyperphagia; hemoglobin; prevalence; eating disorders; psychopathology
Snapping of the biceps femoris tendon over the fibular head is an uncommon condition. Reported causes include an anomalous insertion of the tendon, trauma at the insertion site of the tendon, and an abnormality of the fibular head. This article reports a case of a painful snapping biceps femoris tendon in a patient without an anomalous tendon insertion or an abnormality of the fibular head. Partial release of the superior aspect of the tendon resulted in resolution of symptoms.
biceps femoris tendon; snapping knee