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Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. DISCLOSURE
  8. Acknowledgments
  9. References

Objective: Binge eating disorder (BED) is positively associated with obesity and psychological distress, yet the behavioral features of BED that drive these associations are largely unexplored. The primary aim of this study was to investigate which core behavioral features of binge eating are most strongly related to psychological disturbance.

Methods and Procedures: A cross-sectional study involved 180 bariatric surgery candidates, 93 members of a non-surgical weight loss support group, and 158 general community respondents (81 men/350 women, mean age 45.8 ± 13.3, mean BMI 34.8 ± 10.8, BMI range 17.7–66.7). Validated questionnaires assessed BED and binge eating, symptoms of depression, appearance dissatisfaction (AD), quality of life (QoL) and eating-related behaviors. Features of binge eating were confirmed by interview. BMI was determined by clinical assessment and self-report.

Results: The loss of control (LOC) over eating, that is, being unable to stop eating or control what or how much was consumed was most closely related to psychological markers of distress common in BED. In particular, those who experienced severe emotional disturbance due to feelings of LOC reported higher symptoms of depression (P < 0.001), AD (P = 0.009), and poorer mental health–related QoL (P = 0.027).

Discussion: Persons who report subjective binge episodes or do not meet BED frequency criteria for objective binge episodes may still be at elevated risk of psychological disturbance and benefit from clinical intervention. Feelings of LOC could drive binge eaters to seek bariatric surgery in an attempt to gain control over body weight and psychologically disturbing eating behavior.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. DISCLOSURE
  8. Acknowledgments
  9. References

An “eating binge” is characterized by the uncontrolled consumption of an objectively large amount of food (1). Binge eating disorder (BED) is a recognized eating disorder where bingeing occurs at an average frequency of 2 days per week over the previous 6 months. A strong relationship with psychological markers of distress and self-condemnation characterizes BED (1,2,3). Higher general psychopathology (4), elevated symptoms of depression (4,5), and higher ratings of body image distress and weight and shape concern (6,7,8) are common associates. Prevalence estimates are typically high among bariatric surgery candidates, and the association with severe emotional disturbance occurs beyond that produced by the obese state (9). Quality of life (QoL) may also be reduced (10), but not all reports agree (11).

The increased risk of obesity and psychological distress in BED is established. What is not established is the association between the specific diagnostic features of BED and markers of psychological disturbance. The binge frequency, binge size, and experience of loss of control (LOC) over eating are all potential causes of distress. Striegel-Moore et al. (12,13) considered binge frequency but found few distinctions in measures of psychological disturbance between obese subjects bingeing ≥1 to <2 vs. ≥2 binges per week. Niego et al. (14) compared persons with BED differing in binge size (objectively large vs. subjectively large volumes) but also reported similar levels of depression and psychological disturbance. The relationship between the LOC over eating and psychological distress has also received little attention in those with BED. However, women with BED have identified a binge episode by feelings of LOC and less so by the amount of food consumed (15). Work comparing full and partial syndrome bulimic nervosa suggests that the experience of LOC is more strongly associated with psychological distress than binge volume (16,17,18). A number of researchers have proposed LOC to be the most important and consistent feature of a binge (15,19,20).

Improved understanding of the link between BED and psychological distress will inform intervention strategies and patient management. This study investigated interrelationships between the central behavioral features of BED and three markers of psychological distress—symptoms of depression, appearance dissatisfaction (AD), and mental health–related QoL. Subjects included three community groups varying in BMI and current weight control endeavors. Additional data were collected on usual dietary intake and other aspects of eating behavior. The association between features of binge eating and BMI was also considered. We hypothesized that psychological distress related to BED and binge eating would be most closely associated with the LOC related to eating.

Methods and procedures

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. DISCLOSURE
  8. Acknowledgments
  9. References

Subjects

Participants were recruited between August 2004 and January 2006 in a cross-sectional design. Data were obtained from three separate groups: (i) Members of the general community who were not trying to lose weight. These participants responded to flyers placed on notice boards in two large metropolitan hospitals and a large Australian university. (ii) Persons attending a weight loss support group (“Take Off Weight Naturally,” a company consisting of over 130 support groups within Victoria). These participants responded to flyers posted at group meetings. And (iii) bariatric surgery candidates who were accepted into the surgical program at The Centre for Bariatric Surgery, The Avenue Hospital, Melbourne, Australia. One stipulation for program inclusion was a BMI ≥ 40 kg/m2, or BMI ≥ 35kg/m2 with significant comorbid disease (21). These participants were invited to join the study at the time of acceptance into the program.

Subjects were men or women aged between 18 and 70 years and were excluded if they had undergone previous bariatric surgery. Six hundred and forty-eight survey packs were distributed. A total of 431 eligible surveys were returned representing an overall response rate of 66.5%. The study was approved by the Monash University Standing Committee on Ethics in Research involving Humans and conducted in accordance with the Helsinki Declaration of 1975 as revised in 1983. All subjects were informed regarding the nature of the questionnaires and consented to study involvement.

Anthropometry

Heights and weights reported by the surgery candidates were verified against recent clinic measurements. Demographic data from the community respondents and support group were based on self-report. Within these two groups, 87% stated they had weighed themselves within the previous month.

Bed

The Questionnaire on Eating and Weight Patterns—Revised (22,23) was used to screen for binge eating behaviors. Subjects who reported any characteristics of a binge underwent a semistructured clinical (70%) or phone interview (30%). This interview aimed to accurately determine (i) the amount consumed during self-reported binge episodes, (ii) the experience of LOC, (iii) the extent of associated distress, and (iv) the frequency of binge eating. A single experienced clinician conducted all interviews according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria (1). Subjects were provided with fuller descriptions of difficult concepts such as the experience of LOC, that is, feelings that they could not stop eating or control what or how much they were eating. To assess the extent of the distress associated with feelings of LOC over eating, subjects self-rated their emotional disturbance between a score of 1 (no disturbance) to 5 (extreme disturbance). The interviewer was not blinded to recruitment group.

Subjects were subsequently divided into three groups:

  • 1
    ) “Full BED”: persons reporting a frequency of ≥2 objective binge episodes/week in association with significant psychological distress related to overeating and/or feelings of LOC, as indicated by a response of 4 or 5 to criterion C1 or C2 (Table 1). An objective bulimic (binge) episode was defined as an LOC during the consumption of an amount of food considered abnormally large for the circumstances by both the subject and the interviewer (24).
  • 2
    ) “Subjective LOC”: persons experiencing feelings of LOC during subjective bulimic (binge) episodes. A subjective bulimic episode was defined as an LOC during the consumption of an amount of food considered abnormally large for the circumstances by the subject but not the interviewer (24). No minimum criterion for subjective binge frequency was set. This group did not include persons reporting objective bulimic episodes.
  • 3
    ) Non-binge eaters (NBEs): persons reporting no sense of LOC associated with consumption of either subjectively or objectively large amounts of food.
Table 1. . BED criteria and the distribution of central behavioral features of BED within the “Full BED” and “Subjective LOC” groups
inline image

It should be noted that 40 subjects reported an LOC related to eating but did not meet any subgroup criteria. For example, some subjects reported less than two objective binge episodes/week. Others reported objective or subjective bulimic episodes that were not accompanied by significant psychological distress. These 40 subjects were excluded from the binge eating subgroups and were not considered NBEs but have been included in some subsequent analyses where indicated in the text.

Other eating behavior

The Three-Factor Eating Questionnaire (25) collected information on three dimensions of human eating behavior: (i) cognitive restraint (the amount of intentional restriction of food intake; the intent to diet), (ii) disinhibition of eating (the inability to resist social, emotional, or external eating cues), and (iii) subjective feelings of hunger.

The Cancer Council Victoria Food Frequency Questionnaire (26,27) was used to assess subject's usual dietary intake. This optically scannable, semiquantitative questionnaire contains 74 foods with 10 frequency options and four diagrams of different foods with seven options to define average portion sizes of each. Validity of the Cancer Council Victoria Food Frequency Questionnaire relative to 7-day food records has proven acceptable (26).

Psychological health and QoL

The Beck Depression Inventory (BDI) (28) assessed for the presence of symptoms of depressive illness. A score of 0–9 was considered “Normal”; 10–16 “Mild depression”; 17–29 “Moderate depression”; and 30–63 “Severe depression” (29).

The Multidimensional Body Self-Relations Questionnaire (30) provided a measure of AD or body image distress. The difference between the appearance orientation subscale (how one values physical appearance in general) and the appearance evaluation subscales (how one rates their own physical appearance) was used to indicate the degree of AD (31).

The Medical Outcomes Trust Short Form-36 (SF-36) was used to assess health-related QoL (32,33). This survey measures eight health-related domains, which can be divided into physical and mental components to calculate the SF-36 physical component summary (PCS) and mental component summary (MCS) scales (33). These two health summary scales were adjusted to achieve a community mean value of 50 with an s.d. of 10. The MCS score was considered a measure of mental health–related QoL and used as a measure of psychological distress.

Data analyses

Descriptive statistics were used to express the mean ± s.d. for all continuous variables. Recruitment groups were considered in an ordinal manner at analysis: community = 1, support group = 2, and those seeking surgery = 3. One-way ANOVA with Tukey post-hoc analyses were conducted to assess differences between the recruitment groups and between the three eating subgroups. χ2 analyses assessed for differences between categorical values, and the Kruskal–Wallis test for ordinal data. The “Full BED” and “Subjective LOC” subgroups were compared to groups matched for gender, BMI, age, and “recruitment origin” from NBE using independent t-tests, χ2 analysis, and the Mann–Whitney test as appropriate.

Binary logistic regression explored to what extent recruitment origin predicted membership of the binge eating subgroups. Factors entered into the model included “recruitment origin,” gender, BMI, and age. Within the total cohort, linear regression identified which BED diagnostic criteria were independently predictive of higher BDI and AD scores, a lower SF-36 MCS score, and increasing BMI. Factors entered stepwise into the models included age, gender, “recruitment origin,” BMI, BDI score and AD score as appropriate, and all BED diagnostic criteria as binary, ordinal, or continuous variables. Diagnostic criteria that did not contribute to the predictive model were systematically removed. All variables were normally distributed except BDI score, which required log transformation. SPSS version 12.0.1 was used for statistical analysis. A P value of <0.05 was considered statistically significant. A P value of >0.05 and <0.10 was considered a statistical trend.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. DISCLOSURE
  8. Acknowledgments
  9. References

Participant description

The three recruitment groups differed according to intent to lose weight: (i) community respondents not actively seeking weight loss (BMI range 17.7–45.5 kg/m2), (ii) weight loss support group members (BMI range 21.3–60.2 kg/m2), and (iii) bariatric surgery candidates (BMI range 31.9–66.7 kg/m2). As anticipated, demographic, clinical, and psychological features varied between groups (Table 2).

Table 2. . Descriptive characteristics and comparison of the three original recruitment groups*
inline image

The distribution of binge eating subgroups within the original recruitment groups is also shown in Table 2. Rates of “Full BED” were significantly higher among bariatric surgery candidates compared to the two other recruitment groups. The distribution of those reporting a “Subjective LOC” did not differ. A binary logistic regression model which included “recruitment origin,” gender, BMI, and age showed that membership of the surgical group explained 8% (P < 0.001) of the variance in the “Full BED” subgroup.

Characteristics of the binge eating subgroups

The mean demographic, clinical, behavioral and psychological characteristics of the three binge eating subgroups are listed in Table 3. The BMI range for “Full BED” was 22.2–62.1 kg/m2; 20.1–66.6 kg/m2 among “Subjective LOC,” and 17.7–66.7 kg/m2 in NBE. Mean BMI differed between all subgroups. BMI was highest in “Full BED”; the “Subjective LOC” subgroup had a higher BMI than NBE. There was no difference in gender distribution or age between the three subgroups (columns 2, 4, and 6 in Table 3). AD and the emotional upset associated with feelings of LOC were highest among “Full BED” and differed between all groups. Mental health–related QoL was also highest in “Full BED” but did not differ between “Subjective LOC” and NBE. The BDI score did not differ significantly between “Full BED” and “Subjective LOC,” although the median score for “Full BED” was in the range for “moderate” depressive symptoms, compared to “mild” in “Subjective LOC.”

Table 3. . Comparison between the three eating subgroups; “Full BED,” “LOC,” and “Non-binge eaters” (columns 2, 4, and 6)
 Full BEDBED comparison groupSubjective LOCLOC comparison groupNon-binge eaters
  • In general the “Full BED” scored highest on psychological and eating-related measures, and “Non-binge eaters” scored lowest. Comparison between “Full BED” and “BED Comparison Group” again showed numerous psychological and behavioral differences, while comparison between “LOC” and “LOC Comparison Group” showed no distinctions in markers of psychological distress. Data presented as mean ± s.d. except where indicated.

  • AD, appearance dissatisfaction; BDI, Beck Depression Inventory; BED, binge eating disorder; CHO, carbohydrate; LOC, loss of control; MCS, mental component score; PCS, physical component score; SF-36, Short Form-36.

  • Comparison groups are “Non-binge eaters” matched for age, gender, BMI and recruitment origin.

  • Data log transformed for analysis and presented as median (interquartile range (IQR)).

  • Ordinal data analyzed using Mann–Whitney test and presented as median (IQR) for paired groups and Kruskal–Wallis test for the three eating subgroups. Statistical analysis between the three eating subgroups using AVOVA with Tukey post-hoc analysis

  • a,b,c

    Means with different superscript letters differ significantly at or >P < 0.05. Statistical analysis between eating subgroups and their matched controls using Independent t -tests for continuous variables, and 2for categorical variables

  • *

    P < 0.05

  • **

    P < 0.01

  • ***

    P < 0.001 indicate significant differences between eating subgroups and matched controls.

n38384646307
Men/women7/317/317/397/3958/249
Mean age42.7 ± 8.243.9 ± 8.546.8 ± 14.047.6 ± 13.846.1 ± 14.0
Mean BMI42.8 ± 8.1a42.6 ± 7.637.0 ± 10.4b37.4 ± 10.332.5 ± 10.6c
Current weight118.6 ± 24.3a117.8 ± 20.5101 ± 27.1b103 ± 27.890.3 ± 29.7c
BDI score20 (15–31)a12 (6–16)***12 (6–18)a7.5 (3–15)*7 (3–13)b
AD score2.1 ± 0.84a1.4 ± 1.2**1.5 ± 1.1b0.84 ± 1.3*0.75 ± 1.2c
Emotional upset re: LOC5 (4–5)a3 (2–4)***3.5 (3–4)b2 (2–3)***2 (1–3)c
SF-36 PCS37.5 ± 9.7a42.0 ± 11.142.9 ± 11.545.4 ± 10.547.0 ± 11.5b
SF-36 MCS41.9 ± 7.4a47.3 ± 6.1**47.5 ± 8.1b48.8 ± 7.449.3 ± 6.6b
Restraint8.2 ± 3.99.0 ± 4.69.4 ± 4.88.9 ± 4.69.5 ± 4.8
Disinhibition14.3 ± 1.5a9.6 ± 3.7***12.0 ± 3.0b8.1 ± 3.7***7.4 ± 4.1c
Hunger11.2 ± 2.6a7.2 ± 3.8***8.4 ± 3.4b5.6 ± 4.1**5.5 ± 3.6c
Energy (Kj)11,693 ± 4,634a7,710 ± 2,413***8,794 ± 3,013b7,834 ± 3,4637,672 ± 2,861c
CHO (gm)282 ± 124a187 ± 70.0***221 ± 73.4b177 ± 67.5**189 ± 72.5c
Fat (gm)124 ± 56.3a73.5 ± 27.7***82.9 ± 34.6b77.3 ± 39.871.2 ± 31.7b
Protein (gm)129 ± 47.3a92.2 ± 28.3***100 ± 33.1b99 ± 63.191.3 ± 38.7b

The “Full BED” and “Subjective LOC” subgroups were carefully matched for recruitment origin, BMI, age, and gender to comparison groups derived from NBE (Table 3). Compared to matched controls “Full BED” reported significantly higher symptoms of depression, greater AD, and poorer mental health–related QoL. The median BDI depression score for the “Full BED” group was 20.0, representing moderate depressive symptoms. The median score for the control group was 12.0 (“mild depression”). “Full BED” reported higher emotional distress related to feelings of LOC. Dietary disinhibition, hunger, and usual dietary intake were also increased.

Higher levels of psychological distress were also apparent when the “Subjective LOC” group was compared to matched controls (Table 3). The “Subjective LOC” group showed higher symptoms of depression, more appearance-related distress, far greater emotional upset related to their perceived LOC over eating, and higher dietary disinhibition and hunger.

In order to further explore the emotional upset related to LOC, the “Subjective LOC” subgroup was divided into those with “great” or “extreme” emotional disturbance due to feelings of LOC (score 4 or 5 for criterion C2) and those reporting “no” to “moderate” disturbance (score 1, 2, or 3 for criterion C2). The group with more severe emotional disturbance related to feelings of LOC (n = 23) scored higher on the BDI (median (interquartile range); 15 (12–21) vs. 7 (6–12), P < 0.001) and AD scales (1.9 ± 0.8 vs. 1.1 ± 1.2, P = 0.009). Mental health–related QoL assessed by the SF-36 MCS was significantly poorer (44.9 ± 8.6 vs. 50.2 ± 6.8, P = 0.027).

Psychological distress and binge eating

Linear regression was used to explore which central behavioral features of binge eating (listed in Table 1) best predicted an elevated BDI and AD score, and lower SF-36 MCS score (Table 4). The total cohort of 431 was used in the analysis. This included all subjects in the three binge eating subgroups, plus the 40 subjects with characteristics of binge eating who did not meet any subgroup criteria. Without controlling for demographic or psychological factors, higher ratings of emotional distress related to feelings of LOC (criterion C2) predicted BDI, AD, and SF-36 MCS scores. Higher ratings of emotional distress for criterion C1—“eating more than you think is best for you”—also contributed to BDI and AD scores. The SF-36 MCS was associated with the frequency of objective bulimic episodes. With gender, age, BMI, and recruitment origin in the regression equation, higher ratings of emotional distress related to feelings of LOC continued to predict a proportion of variance in all three markers of psychological distress. The frequency of objective bulimic episodes continued to predict a degree of variance in the SF-36 MCS.

Table 4. . Central behavioral features of binge eating predicting an elevated BDI or AD score, or low SF-36 MCS score in the total cohort of 431
 BDI score (n = 417)AD score (n = 418)SF-36 MCS
  1. Demographic and weight-related factors influenced all three measures of psychological distress; however, scores were further predicted by higher ratings of emotional distress related to the experience of being unable to “stop eating or control what or how much” was consumed, and to a lesser extent by the frequency of objective binges. Statistical analysis using linear regression. Bold face has been used to highlight the total and subtotal variance from the β and P values. AD, appearance dissatisfaction; BDI, beck depression inventory; LOC, loss of control; MCS, mental component score; NS, not significant; SF-36, Short Form-36.

Analysis with no controlling variables   
    C2 Upset by feelings of LOCβ = 0.32, P < 0.001β = 0.34, P < 0.001β = 0.29, P < 0.001
    C1 Upset by overeatingβ = 0.18, P = 0.034β = 0.26, P = 0.001NS
    Frequency of objective bingesNSNSβ = −0.11, P = 0.023
    Total variance (r 2)22.7%33.6%12.1%
Analysis controlling for gender, age, BMI, and recruitment origin   
    Ageβ = 0.15, P < 0.001NSβ = 0.15, P = 0.001
    Women gender (F = 1, M = 2)β = −0.08, P = 0.05β = −0.18, P < 0.001β = 0.11, P = 0.015
    Higher BMIβ = 0.14, P = 0.049β = 0.13, P = 0.040NS
    Recruitment originβ = 0.22, P = 0.003β = 0.33, P < 0.001β = −0.22, P < 0.001
    Sub total of variance (r 2)27.6%41.0%7.1%
    C2 Upset by feelings of LOCβ = 0.27, P < 0.001β = 0.29, P < 0.001β = −0.26, P < 0.001
    Frequency of objective bingesNSNSβ = −0.10, P = 0.041
    Additional variance4.7%5.5%6.5%
    Total variance (r 2)32.3%46.5%13.6%

BMI and binge eating

In a similar way, linear regression was used to explore the association between the central behavioral features of binge eating and increasing BMI. Without controlling for demographic and psychological factors, higher ratings of emotional distress related to feeling of LOC predicted most variance in BMI (β = 0.23, P = 0.006). Higher ratings of emotional distress related to criterion C1, “eating more than you think is best for you” (β = 0.17, P = 0.030), and criterion C3, “eating when not physically hungry” (β = 0.15, P = 0.002), also predicted a proportion of variance in BMI (total variance (r2) = 22.5%). Owing to the significant co-linearity between BMI and membership of the bariatric surgical group, the subsequent linear regression analysis controlled for gender, age, BDI score, and AD score but not recruitment group. The central behavioral features of binge eating that contributed to the association with BMI were higher ratings of emotional distress for criterion C2 (β = 0.19, P < 0.001) and criterion A1, “consumption of a truly large amount of food” (β = 0.16, P < 0.001).

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. DISCLOSURE
  8. Acknowledgments
  9. References

The primary aim of this study was to explore the relationship between the central behavioral features of binge eating and markers of psychological distress in BED. In support of our hypothesis, the feeling of LOC related to eating was the factor most closely associated with psychological disturbance. Persons who experienced “great” or “extreme” emotional disturbance due to feelings of LOC reported significantly higher symptoms of depression, greater dissatisfaction with appearance, and poorer mental health–related QoL. The association between feelings of LOC and psychological disturbance was highest among those meeting full BED diagnostic criteria but was also elevated in persons reporting subjective bulimic episodes.

Although binge frequency and binge size (objectively or subjectively large) were less strongly associated with psychological distress, after controlling for covariables, a higher objective binge frequency was associated with poorer mental health–related QoL. Poorer mental health–related QoL also occurred among those with BED when compared to matched controls and was positively associated with emotional disturbance related to LOC. This supports the notion that frequent objective bulimic episodes inherent in BED have the potential to negatively influence QoL, independent of the burden of obesity. This relationship may also occur in reverse, where persons with lower psychological well-being are more susceptible to binge eating.

In research and clinical practice, the diagnostic features of BED and the robust association with psychological disturbance are increasingly recognized. Yet, this is the first empirical evidence to support the greater potential significance of feelings of LOC as an associate of psychological distress in BED. Those who report subjective bulimic episodes or who do not meet the frequency criteria for objective bulimic episodes may still be at elevated risk of psychological disturbance.

As a single group, those experiencing a “Subjective LOC” reported higher symptoms of depression, more dissatisfaction with appearance, and greater emotional distress related to feelings of LOC than NBE. In particular, those who were emotionally disturbed by their experience were a subgroup with distinctly higher psychological impairment. Persons who engage in subjective bulimic episodes also appear vulnerable to weight gain and obesity. However, in this study, the risk of significant psychological dysfunction and extreme obesity was lower in those reporting a “Subjective LOC” than persons meeting full BED criteria. Nevertheless, individuals who experience repeated feelings of LOC may still benefit from clinical assessment and intervention. Furthermore, the assessment of eating behavior and perceived control over eating may benefit the clinical investigation of psychological disturbance.

In this cross-sectional study, those with BED constituted a distinctive group. They were more prevalent among obese bariatric surgery candidates than members of a weight loss support group and community controls not seeking weight loss. Compared to matched controls binge eaters were severely distressed about their recurrent LOC over eating, had more symptoms of depression, higher AD, and poorer mental health–related QoL. Their hunger drive was elevated, and they reported a reduced ability to resist social, emotional, or external eating cues. The BED group also reported a higher usual energy and macronutrient intake. All these characteristics would tend to generate weight gain and have a negative impact on efforts to control or lose weight. Those with BED may, therefore, be more inclined to undergo bariatric surgery in an attempt to gain control over their body weight and control over adverse, psychologically disturbing eating behaviors.

Debate persists over the suitability of bariatric surgery in persons with BED (34,35,36). Based on the findings of this study, it could be hypothesized that surgically augmented eating control may contribute to the reliable improvement in psychological state that occurs following surgery (37,38). However, feelings of LOC can continue after surgical intervention (39,40,41,42), even though the ability to eat objectively large amounts of food is altered substantially. The relationship between perceived control over food intake and psychological status after surgery is not known.

In this study, a number of robust associations emerged; however, the cross-sectional design of the study does not allow the determination of causality. Binge eating and feelings of LOC were carefully assessed using the Questionnaire on Eating and Weight Patterns as a screening tool, as previously suggested (43). The extent of disordered eating was then determined in a semistructured clinical or phone interview. Although the three original recruitment groups differed, this diversity highlighted the setting in which binge eating is more likely to occur, and the disparity between recruitment groups was statistically controlled.

In conclusion, the feature of binge eating most strongly associated with psychological disturbance was the emotional upset driven by feelings of LOC over eating. Persons who engage in subjective bulimic episodes were also at elevated risk for psychological distress, particularly if their experience of perceived LOC was accompanied by strong feelings of upset and remorse. Clinicians and researchers should be aware of the potential relationship between feelings of LOC related to eating and psychological disturbance. It is also possible that the uncontrolled eating patterns inherent in BED, along with the burden of obesity, may drive individuals with BED toward surgical weight loss intervention.

Future studies could investigate variations in the experience of LOC and the association with psychological impairment. For example, whether long-term binge eaters who accept their inevitable binges are less distressed than persons who attempt failed restraint. Prospective research should also assess the association between presurgical BED and feelings of LOC and postsurgical control over eating behavior, weight outcomes, and psychological state.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. DISCLOSURE
  8. Acknowledgments
  9. References

We thank the study participants for their time and involvement, and the staff at the Centre for Obesity Research and Education (CORE) and the Centre for Bariatric Surgery in Windsor, Victoria for their ongoing support and assistance.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. DISCLOSURE
  8. Acknowledgments
  9. References