Assessment of binge eating disorder in morbidly obese patients evaluated for gastric bypass: SCID versus QEWP-R

The need for future research into the assessment and monitoring of eating disorder risk in the context of obesity treatment

In adolescents and adults, the co-occurrence of eating disorders and overweight or obesity is continuing to increase, and the prevalence of eating disorders is higher in people with higher weight compared to those with lower weight. People with an eating disorder with higher weight are more likely to present for weight loss than for eating disorder treatment. However, there are no clinical practice guidelines on how to screen, assess, and monitor eating disorder risk in the context of obesity treatment. In this article, we first summarize current challenges and knowledge gaps related to the identification and assessment of eating disorder risk and symptoms in people with higher weight seeking obesity treatment. Specifically, we discuss considerations relating to the validation of current self-report measures, dietary restraint, body dissatisfaction, binge eating, and how change in eating disorder risk can be measured in this setting. Second, we propose avenues for further research to guide the development and implementation of clinical and research protocols for the identification and assessment of eating disorders in people with higher weight in the context of obesity treatment. PUBLIC SIGNIFICANCE: The number of people with both eating disorders and higher weight is increasing. Currently, there is little guidance for clinicians and researchers about how to identify and monitor risk of eating disorders in people with higher weight. We present limitations of current research and suggest future avenues for research to enhance care for people living with higher weight with eating disorders.

Identifying eating disorders in adolescents and adults with overweight or obesity: A systematic review of screening questionnaires

OBJECTIVE

This review aimed to examine the validity of self-report screening questionnaires for identifying eating disorder (ED) risk in adults and adolescents with overweight/obesity.

METHOD

Five databases were searched from inception to September 2020 for studies assessing validation of self-report ED screening questionnaires against diagnostic interviews in adolescents and adults with overweight/obesity. The review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013).

RESULTS

Twenty-seven papers examining 15 questionnaires were included. Most studies validated questionnaires for adults (22 of 27 studies), and most questionnaires (12 of 15) screened for binge eating or binge-eating disorder (BED). The Eating Disorder Examination Questionnaire (sensitivity = .16-.88, specificity = .62-1.0) and Questionnaire on Eating and Weight Patterns (sensitivity = .07-1.0, specificity = .0-1.0) were most frequently validated (six studies each). Five studies of three questionnaires were in adolescents, with the Adolescent Binge-Eating Disorder Questionnaire having highest sensitivity (1.0) but lower specificity (.27). Questionnaires designed to screen for BED generally had higher diagnostic accuracy than those screening for EDs in general.

DISCUSSION

Questionnaires have been well validated to identify BED in adults with overweight/obesity. Validated screening tools to identify other EDs in adults and any ED in adolescents with overweight/obesity are lacking. Thus, clinical assessment should inform the identification of patients with co-morbid EDs and overweight/obesity.

PUBLIC SIGNIFICANCE

Individuals with overweight/obesity are at increased risk of EDs. This review highlights literature gaps regarding screening for ED risk in this vulnerable group. This work presents possibilities for improving care of individuals with overweight/obesity by reinventing ED screening tools to be better suited to diverse populations.

Concurrent validity of the Brazilian Portuguese version of the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) in the general population

The Questionnaire on Eating and Weight Patterns-5 is a self-report instrument developed for the screening of Binge Eating Disorder (BED) and Bulimia Nervosa (BN) according to DSM-5. The present study aimed to examine the concurrent validity of the Brazilian version of QEWP-5 to assess BED and BN in the general population. The Brazilian version of QEWP-5 was administered to 2297 subjects, aged from 18 to 60 years. All screen-positive and a subset of screen-negative participants were also interviewed by telephone using the eating disorders (ED) module of Structured Clinical Interview for DSM-IV - Patients Version (SCID-I-P) for the assessment of BED, BN, and their subthreshold forms. For the assessment of BED, the sensitivity of QEWP-5 was 0.41 and its specificity was 0.90. The positive and negative predictive values were 0.48 and 0.87, respectively. Regarding the assessment of BN, QEWP-5 showed a sensitivity of 0.56, a specificity of 0.90, a positive predictive value of 0.35, and a negative predictive value of 0.95. For the global screening of ED (BED, BN, and subthreshold forms), QEWP-5 showed a sensitivity of 0.71, a specificity of 0.83, a positive predictive value of 0.64 and a negative predictive value of 0.87. QEWP-5 can be a useful instrument for the initial screening of diagnostic threshold ED psychopathology in general population samples. However, it has less utility in identifying cases of BED and BN independently.

Reliability of the Brazilian version of the questionnaire on eating and weight patterns-5 (QEWP-5)

PURPOSE

The Questionnaire on Eating and Weight Patterns-5 (QEWP-5) is a self-report instrument developed to screen individuals for binge eating disorder (BED) and bulimia nervosa (BN) as diagnosed by the DSM-5. This instrument was cross-culturally adapted for the Brazilian Portuguese and well understood by the target sample. The present study aimed to assess the test-retest reliability of the Brazilian version of QEWP-5 in a sample of undergraduate students from Dietitian and Psychology courses.

METHODS

The Brazilian version of QEWP-5 was administered to a sample of 345 male and female undergraduate students, from dietitian (n = 179) and psychology (n = 166) courses. The instrument was applied twice with a time interval of 2 weeks between the applications. The kappa coefficient was used to assess the temporal stability of the questionnaire in the screening of BED and BN.

RESULTS

Overall, the kappa coefficient for the screening of BED was .48, and for the screening of BN was .71. In the dietitian course, the temporal stability was .60 (for the assessment of BED) and .80 (for BN). In the psychology course, the kappa values for the assessment of BED and BN were .27 and .60, respectively. All values were statistically significant (p < .001).

CONCLUSION

In general, the stability of the Brazilian version of QEWP-5 was considered moderate to assess BED and substantial for the screening of BN in undergraduate students. Stratifying by course, the questionnaire had higher stability for the assessment of BED and BN in dietitian students.

LEVEL OF EVIDENCE

Level V, descriptive study.

Psychometric proprieties of the Italian version of the questionnaire on eating and weight patterns (QEWP-5) and its accuracy in screening for binge-eating disorder in patients seeking treatment for obesity

PURPOSE

The aim of the current study was to assess the psychometric proprieties of the Italian version of the latest edition of the Questionnaire of Eating and Weight Patterns (QEWP-5), evaluating its accuracy in screening patients with binge-eating disorder (BED).

METHODS

The Italian translation of the tool was administered to 604 Italian-speaking adults seeking treatment for obesity. The clinical sample was given the Eating Disorder Examination interview to assess for BED. Participants also completed the Symptom Checklist 90, the Obesity-Related Well-Being and the Binge-Eating Scale.

RESULTS

The sensitivity of the QEWP-5 was 0.49, and its specificity 0.93. The positive and negative predictive values were 0.34 and 0.96, respectively. Agreement between QEWP-5 and EDE using Cohen's kappa was 0.35. Nevertheless, among patients with an EDE diagnosis of no BED, those 'QEWP-5-positive' for BED displayed higher eating-disorder and general psychopathology scores, poorer weight-related quality of life, and greater severity of binge-eating behaviours than those 'QEWP-5-negative' for BED.

CONCLUSION

Despite the low concordance with the EDE interview in terms of detecting the presence of BED, the QEWP-5 may be a useful initial screening tool for the clinical assessment of adults seeking treatment for obesity.

LEVEL OF EVIDENCE

Level V, Descriptive study.

Evaluation of eating disorders and their association with glycemic control and metabolic parameters in adult patients with type 2 diabetes mellitus

BACKGROUND

There is little data on the prevalence and effects of eating disorders in patients with T2DM.

AIMS

To evaluate the presence of eating disorders (ED) and their association with glycemic control and metabolic parameters in adult patients with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study was conducted in the endocrinology outpatient unit of our tertiary care centre between January 2017 to December 2018. Eating Attitudes Test (EAT-26) and Binge Eating Scale (BES) questionnaires were used to screen for ED in adults with T2DM (group 1) and controls without T2DM (group 2). Cut off scores ≥18 on BES was considered as a positive screen for Binge eating disorder in participants with and without T2DM. A score of ≥30 on EAT-26 was defined as abnormal for participants with T2DM and ≥20 for those without T2DM. Formal psychiatric assessment was done to diagnose ED in those who screened positive on the basis of scores on BES or EAT-26 or both. Demographic, anthropometric and relevant medical details like duration of treatment, glycemic control, complications were recorded.

RESULTS

A total of 512 individuals (256 in each group) participated in this study. Out of these, 10.9% of individuals with T2DM and 14.1% of those without T2DM screened positive for ED, with no significant difference in the two groups. After a detailed psychiatric assessment, two patients (0.8%) in each group were confirmed to have ED. Participants with T2DM who were on thiazolidinediones had higher odds (2.2) of screening positive for an ED.(p = 0.03).

CONCLUSIONS

Our study reveals that eating disorders are not very common in our clinical population of T2DM, and the prevalence is comparable to BMI matched individuals without T2DM. The prevalence rates of eating disorders are lower (in both controls and patients with T2DM) than those reported from developed western countries.

Food consumption and glycemic testing of adults and elderly diabetic patients from Public Health: A systematic review of assessment methods

AIMS

To map and discuss the different methods used to assess food consumption and glycemic testing of adults and elderly diabetic patients from Public Health.

MATERIALS AND METHODS

A total of 710 records were identified by searching databases integrated by the Virtual Health Library website, between September and October 2017. The Newcastle Ottawa scale was used for study quality assessment. A total of 8 studies met inclusion criteria for analysis. Study characteristics were extracted and synthesized to generate comparisons.

RESULTS

Food consumption was evaluated by Food Frequency Questionnaire, 24-hour Dietary Recall, Eating Attitudes Test (EAT-26), Questionnaire On Eating and Weight Patterns (QEWP-R), and questioning the salt intake. Glucose testing methods included Postprandial Glucose, Glycated Hemoglobin (HbA1C), fasting glucose, and self-reported diabetes.

CONCLUSIONS

Most methods that access food consumption use single questionnaires, which are easy to administer and yield easily interpreted results. For glycemic testing, the majority used are conventional methods.

The role of central dopamine and serotonin in human obesity: lessons learned from molecular neuroimaging studies

Obesity results from an imbalance between energy intake and expenditure, and many studies have aimed to determine why obese individuals continue to (over)consume food under conditions of caloric excess. The two major "neurotransmitter hypotheses" of obesity state that increased food intake is partially driven by decreased dopamine-mediated reward and decreased serotonin-mediated homeostatic feedback in response to food intake. Using molecular neuroimaging studies to visualize and quantify aspects of the central dopamine and serotonin systems in vivo, recent PET and SPECT studies have also implicated alterations in these systems in human obesity. The interpretation of these data, however, is more complex than it may appear. Here, we discuss important characteristics and limitations of current radiotracer methods and use this framework to comprehensively review the available human data on central dopamine and serotonin in obesity. On the basis of the available evidence, we conclude that obesity is associated with decreased central dopaminergic and serotonergic signaling and that future research, especially in long-term follow-up and interventional settings, is needed to advance our understanding of the neuronal pathophysiology of obesity in humans.

Binge eating disorder and night eating syndrome in adults with type 2 diabetes: a systematic review

BACKGROUND

Type 2 diabetes (T2DM) is increasing in prevalence worldwide, and is closely linked to obesity. Binge Eating Disorder (BED) and Night Eating Syndrome (NES) are eating disorders that are common in obesity, and may affect the management as well as long term outcomes of T2DM. Therefore, the aim of this review was to assess the prevalence and associations of BED or NES in adults with T2DM.

METHODS

We conducted a systematic review. The databases MEDLINE, CINAHL and AMED were searched for articles which met the inclusion criteria; including patients > 18 years old, with T2DM, and BED and/or NES. The reference lists of included studies were also searched. Meta-analysis was not attempted due to the limited number of studies that measured the outcomes of interest.

RESULTS

A total of 10 studies (2 included NES) were included in this systematic review. The number screened for BED and NES were 6527 and 1039 participants, respectively. Point prevalence was 1.2-8.0% for BED and 3.8-8.4% for NES. Patients with T2DM and BED had higher BMI than patients with T2DM without BED in the two studies that reported BMI. There was no statistically significant difference in HbA1c between patients with and without BED in the two studies that measured HbA1c.

CONCLUSIONS

BED and NES are common in adults with T2DM, and BED is associated with higher BMI in patients with T2DM. However, only two studies reported important outcomes measures such as BMI and HbA1c in patients with T2DM. Hence, further well-designed studies are needed to assess the impact of BED and NES in patients with T2DM. Health Care Professionals should consider the diagnosis of BED and NES in patients with T2DM.

An Open Trial Targeting Food Cue Reactivity and Satiety Sensitivity in Overweight and Obese Binge Eaters

Data suggests that individuals who binge eat are more responsive to food cues in the environment and less sensitive to satiety cues. The aim of this open trial was to evaluate the feasibility, acceptability, and initial effectiveness of a novel treatment grounded in Schachter's externality theory targeting food cue reactivity and satiety responsiveness with obese adults who binge eat. Treatment was provided in groups, and utilized appetite monitoring, cue-exposure treatment, in vivo exercises, self-monitoring, and coping skills. Twenty-eight overweight and obese adults who binge eat (82% female; mean age = 47.5 years [SD = 12.8]; BMI = 38.9 [SD = 10.3]; 79% White non-Hispanic) participated in a 4-month group-based treatment program. Assessments were conducted at baseline, posttreatment, and 3-month follow-up time points. Results indicated that this treatment was well accepted and had high retention at posttreatment. Initial effectiveness showed significant decreases in BMI, and improvements in loss of control and overeating episodes, food responsiveness, and power of food. The majority of results were maintained at the 3-month follow-up time point. This open trial provides preliminary evidence for the feasibility, acceptability, and initial effectiveness of this treatment on both eating disorder symptoms and weight in obese adults who binge eat. Because these data are preliminary, further treatment development and randomized controlled studies are needed.

Psychometric Evaluation of Disordered Eating Measures in Bariatric Surgery Candidates

INTRODUCTION

Assessment of disordered eating is common in bariatric surgery candidates, yet psychometric properties of disordered eating measures in this population are largely unknown.

METHODS

Measures were completed by 405 adult bariatric surgery candidates at pre-surgical consultation. Fit of the original scale structures was tested using confirmatory factor analysis (CFA) and alternative factor solutions were generated using exploratory factor analysis (EFA). Reliability (internal consistency), construct validity (convergent and divergent) and criterion validity (with the EDE as criterion) were assessed.

MATERIALS

The measures prioritised for evaluation are the following: Eating Disorder Examination Questionnaire (EDE-Q; n = 405), Three-Factor Eating Questionnaire (TFEQ; n = 405), Questionnaire of Eating and Weight Patterns Revised (QEWP-R; n = 204), Clinical Impairment Assessment (CIA; n = 204) and the Eating Disorder Examination clinical interview (EDE; n = 131).

RESULTS

CFA revealed adequate fit for only the CIA in its current form (CFI = 0.925, RMSEA = 0.096). EFA produced revised scales with improved reliability for the EDE, EDE-Q and TFEQ. Reliability of revised subscales was improved (original scales α = 0.43-0.82; revised scales α = 0.67-0.93). Correlational analyses of the CIA and revised versions of remaining scales with measures of psychological wellbeing and impairment revealed adequate convergent validity. All measures differentiated an EDE-classified disordered eating group from a non-disordered eating group (criterion validity). Diagnostic concordance between the EDE, EDE-Q and QEWP-R was low, and identification of disordered eating behaviours was inconsistent across measures.

CONCLUSIONS

Findings highlight the limitations of existing disordered eating questionnaires in bariatric surgery candidates. Results suggest revised assessments are required to overcome these limitations and ensure that measures informing clinical recommendations regarding patient care are reliable and valid.

An open trial evaluating an attention bias modification program for overweight adults who binge eat

BACKGROUND AND OBJECTIVES

Binge eating is prevalent and is associated with significant psychiatric and medical comorbidities. To date, the most effective psychological treatments for individuals who binge eat are not effective for all patients and they do not result in significant weight loss. Dual process theories suggest that implicit factors, such as attention bias, may influence behavior, even when the behavior is in opposition to long-term goals. Attention bias modification programs have been tested in other areas of psychopathology, and could be utilized to improve outcomes for people who binge eat. Thus, the aim of this open trial was to conduct a preliminary evaluation of an attention bias modification program (ABM-Food) designed to train attention away from food cues.

METHODS

Adults who binge eat and were overweight or obese enrolled in an 8-week ABM-Food program, which consisted of one session in the lab each week and two training sessions at home. Nine participants completed the ABM-Food training program and the post-treatment assessment, and 8 completed the 3-month post-treatment assessment.

RESULTS

Results showed that the ABM-Food program is a feasible and acceptable treatment for adults who binge eat. Initial effectiveness data showed decreases in weight, eating disorder symptoms, binge eating, loss of control and responsivity to food in the environment, as well as changes in attention bias. The majority of these effects remained at the 3-month follow-up time point.

LIMITATIONS

This study is limited by the single-group open label trial, and the small sample size.

CONCLUSIONS

This open trial provides initial evidence for the feasibility, acceptability and effectiveness of ABM-Food for individuals who binge eat and are overweight or obese.

Cirurgia bariátrica e transtornos alimentares: uma revisão integrativa

RESUMO Objetivo Realizar revisão sobre transtornos alimentares e comportamentos alimentares transtornados relacionados à cirurgia bariátrica. Métodos Revisão integrativa da literatura nas bases de dados PubMed, Lilacs, Bireme, portal SciELO com descritores indexados com critérios de inclusão: oferecer dado sobre a presença ou frequência de transtorno alimentar e/ou comportamentos alimentares disfuncionais previamente e/ou após a cirurgia. Resultados Foram selecionados 150 estudos (14 nacionais e 136 internacionais): 80,6% eram com avaliação de pacientes pré-/pós-cirúrgicos; 12% eram estudos de caso e 7,3% eram estudos de revisão. Diferentes instrumentos foram usados para avaliação, principalmente o Questionnaire on Eating and Weight Patterns, a Binge Eating Scale e Eating Disorders Examination Questionnaire. A compulsão alimentar foi o comportamento mais avaliado, com frequências/prevalências variando de 2% a 94%; no caso do transtorno da compulsão alimentar as frequências/prevalências variaram de 3% a 61%. Houve também a descrição de anorexia e bulimia nervosa, síndrome da alimentação noturna e comportamento beliscador. Alguns estudos apontam melhora dos sintomas no pós-cirúrgico e/ou seguimento enquanto outros apontam surgimento ou piora dos problemas. Conclusão Apesar da variabilidade entre métodos e achados, comportamentos alimentares disfuncionais são muito frequentes em candidatos à cirurgia bariátrica e podem ainda surgir ou piorar após a intervenção cirúrgica. Profissionais de saúde devem considerar de maneira mais cuidadosa tais problemas neste público, dadas às consequências para o resultado cirúrgico e qualidade de vida.

Psychometric evaluation of self-report measures of binge-eating symptoms and related psychopathology: A systematic review of the literature

OBJECTIVE

Binge eating is a symptom common to bulimia nervosa, anorexia nervosa (binge/purge subtype), and binge eating disorder. There are many self-report measures available to aid the assessment of eating disorders symptoms, but there has not yet been a systematic review of the literature to identify the most valid and reliable measures for use in assessment and treatment of binge eating.

METHOD

A systematic review of the psychometric properties of self-report measures that assess binge eating symptoms and psychopathology was conducted. Two independent raters assessed the psychometric properties of each measure using a standardized quality analysis tool.

RESULTS

Of the 2,927 studies identified, 72 studies met the inclusion criteria and described the psychometric properties of 29 different self-report measures, and nine specific subscales within these. Results from the quality analysis tool utilized in this study indicated that none of the included measures currently meet all nine criteria of adequate psychometric properties.

DISCUSSION

Most of the included measures had evidence for some adequate psychometric properties. Two measures received six out of nine positive ratings for the assessed psychometric properties, the BITE and the BULIT-R, and thus appear to be the measures with the most evidence of their validity and reliability. Overall, our findings implicate a need for further investigation of the psychometric properties of the available self-report questionnaires in this field.

Psychometric evaluation of disordered eating measures in bariatric surgery patients

INTRODUCTION

Bariatric surgery is considered the most effective weight loss intervention for obese persons. However, accurate assessment is essential to identify disordered eating that may impair achievement of optimal post-surgical outcomes. Measures of disordered eating are yet to be thoroughly psychometrically evaluated in bariatric surgery patients, therefore their utility is unknown.

METHODS

Participants were 108 adults who completed psychological measures approximately 12 months after bariatric surgery. The fit of the original scale structures was tested using Confirmatory Factor Analysis (CFA) and alternative factor solutions were generated using Exploratory Factor Analysis (EFA). Reliability (internal consistency) and construct validity (convergent and divergent) were also assessed.

MATERIALS

Eating Disorder Examination Questionnaire (EDE-Q), Questionnaire of Eating and Weight Patterns Revised (QEWP-R), Three Factor Eating Questionnaire (TFEQ) and Clinical Impairment Assessment (CIA).

RESULTS

CFA revealed none of the original disordered eating measures met adequate fit statistics. EFA produced revised scales with improved reliability (original scales α=0.47-0.94; revised scales α=0.76-0.98) and correlational analyses with measures of psychological wellbeing and impairment demonstrated adequate convergent validity. Reported prevalence of disordered eating behaviours differed between the EDE-Q and QEWP-R.

CONCLUSIONS

Psychometric evaluation did not support the use of the commonly used disordered eating measures in bariatric patients in their original form. The revised version of the EDE-Q replicates findings from recent research in bariatric surgery candidates. The alternate structures of the CIA and TFEQ suggest differences in the manifestation of disordered eating following surgery. Results suggest that revised measures are required to overcome the limitations of existing measures.

Measurement properties of eating behavior self-assessment tools in adult bariatric surgery populations: a systematic review

The present study aims to identify the range of eating behavior self-assessment tools reported in the adult bariatric surgery literature and evaluate the measurement properties of these tools using pre-established criteria. This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This review revealed the use of 20 distinct tools; however, evidence for measurement properties specific to bariatric surgery populations was limited to only ten of these tools, as reported in 14 papers. Validity varied extensively and there was a widespread lack of information regarding measurement of change over time and patient burden. According to the evaluation criteria, there was adequate support for two tools. Several other tools show potential but would benefit from additional investigation of their measurement properties prior to continued use with bariatric surgery patients.

The eating-related behaviours, disorders and expectations of candidates for bariatric surgery

It is important that clinicians and researchers understand the possible eating-related difficulties experienced by pre-bariatric surgery candidates, as well as their expectations of how their eating and hunger will change after surgery. This review examines English-language publications related to the eating-related behaviours, disorders and expectations of bariatric candidates. Seventy-five articles related to binge eating disorder, grazing, night eating syndrome, emotional eating, food cravings and addiction, and pre-surgical expectations of post-surgical eating in this population were critically reviewed. A variety of often problematic eating behaviours appear more common in bariatric candidates than in non-obese populations. The literature suggests that 4-45% of candidates may have binge eating disorder, 20-60% may graze, 2-42% may have night eating syndrome, 38-59% may engage in emotional eating and 17-54% may fit criteria for food addiction. Binge eating may also be more prevalent in bariatric candidates than in similarly obese non-surgical individuals. Expectations of surgery are high, with pre-surgical candidates believing their bariatric procedure will virtually guarantee significantly improved eating behaviours. Study replications are needed, and further investigation into prevalence, impacts and candidate characteristics related to disordered eating behaviours, as well as candidates' expectations of eating after surgery, will be important. Further comparisons of bariatric candidates to similarly obese non-bariatric populations will be important to understand eating-related characteristics of candidates beyond those related to their weight. Future research may be improved by the use of validated measures, replicable methodologies, minimization of data collected in circumstances where respondents may been motivated to 'fake good', use of prospective data and consistent definitions of key terminology.

The patient experience with DSM-5-defined binge eating disorder: characteristics, barriers to treatment, and implications for primary care physicians

BACKGROUND

Binge eating disorder (BED) is now a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). However, post-DSM-5 patient profiles and viewpoints on BED diagnosis and treatment remain unclear. This study used a focus group methodology to examine demographic and clinical characteristics, as well as perceptions of diagnosis and treatment from patients with BED symptoms who were either formally diagnosed with BED or undiagnosed.

METHODS

Binge eating disorder-diagnosed individuals (n = 11) or those meeting the DSM-5 BED diagnostic criteria but were undiagnosed (n = 14) participated in 6 semistructured focus groups conducted by trained staff at 3 geographic locations in the United States. Patients completed a series of demographic and clinical measures and then engaged in a moderated discussion focused on identifying factors associated with their experiences with BED.

RESULTS

Sixty percent of the patients were female, 48% were white and 40% were black, and 76% were employed. The diagnosed group had a slightly higher socioeconomic status; undiagnosed patients had a higher average body mass index. In the overall sample, comorbid anxiety (40%) and depression (40%) were the most common psychiatric comorbidities. Even in the diagnosed group, only half of the patients (54.5%) became aware of BED through their health care provider (HCP; n = 6). Patients perceived that HCPs were focused more on physical ailments, were judgmental about weight, and were unable to distinguish BED from obesity. They also expressed a desire for safe, nonjudgmental interactions with HCPs.

CONCLUSIONS

Education and income may be factors affecting access to care and BED diagnosis. Both patient groups reported considerable psychopathology and medical comorbidities. Moreover, the patient groups perceived HCPs as both having inadequate understanding of BED and providing insensitive and ineffective communication regarding eating behaviors. The study findings in diagnosed and undiagnosed patient groups underscore the need for greater BED disease state awareness and patient sensitivity among HCPs.

Screening for DSM-5 Other Specified Feeding or Eating Disorder in a Weight-Loss Treatment-Seeking Obese Sample

OBJECTIVE

To evaluate the effectiveness of specific self-report questionnaires in detecting DSM-5 eating disorders identified via structured clinical interview in a weight-loss treatment-seeking obese sample, to improve eating disorder recognition in general clinical settings.

METHOD

Individuals were recruited over a 3-month period (November 2, 2011, to January 10, 2012) when initially presenting to a hospital-based weight-management center in the northeastern United States, which offers evaluation and treatment for outpatients who are overweight or obese. Participants (N = 100) completed the Structured Clinical Interview for DSM-IV eating disorder module, a DSM-5 feeding and eating disorders interview, and a battery of self-report questionnaires.

RESULTS

Self-reports and interviews agreed substantially in the identification of bulimia nervosa (DSM-IV and DSM-5: tau-b = 0.71, P < .001) and binge-eating disorder (DSM-IV and DSM-5: tau-b = 0.60, P < .001), modestly for subthreshold binge-eating disorder (tau-b = 0.44, P < .001), and poorly for other subthreshold conditions (night-eating syndrome: tau-b = -0.04, P = .72, r = 0.06 [DSM-5]).

DISCUSSION

Current self-report assessments are likely to identify full syndrome DSM-5 eating disorders in treatment-seeking obese samples, but unlikely to detect DSM-5 other specified feeding or eating disorders. We propose specific content changes that might enhance clinical utility as suggestions for future evaluation.

Measurement of disordered eating in bariatric surgery candidates: a systematic review of the literature

Symptoms of disordered eating are common among patients seeking bariatric surgery, and assessment of eating pathology is typical in pre-surgical evaluations. A systematic review was conducted to evaluate the definitions, diagnostic criteria and measures used to assess disordered eating in adults seeking bariatric surgery. The review identified 147 articles featuring 34 questionnaires and 45 interviews used in pre-surgical assessments. The Questionnaire on Eating and Weight Patterns Revised and the Structured Clinical Interview for DSM were the most frequently used questionnaire and interview respectively. Variations to pre-surgical diagnostic criteria included changes to the frequency and duration criteria for binge eating, and inconsistent use of disordered eating definitions (e.g., grazing). Results demonstrate a paucity of measures designed specifically for an obese sample, and only 24% of questionnaires and 4% of interviews used had any reported psychometric evaluation in bariatric surgery candidates. The psychometric data available suggest that interview assessments are critical for accurately identifying binge episodes and other diagnostic information, while self-report questionnaires may be valuable for providing additional information of clinical utility (e.g., severity of eating, shape and weight-related concerns). Findings highlight the need for consensus on disordered eating diagnostic criteria and psychometric evaluation of measures to determine whether existing measures provide a valid assessment of disordered eating in this population. Consistent diagnosis and the use of validated measures will facilitate accurate identification of disordered eating in the pre-surgical population to enable assessment of suitability for surgery and appropriate targeting of treatment for disordered eating to optimise treatment success.

Prevalence of psychiatric disorders before and 1 year after bariatric surgery: the role of shame in maintenance of psychiatric disorders in patients undergoing bariatric surgery

OBJECTIVE

The present study examined prevalence of psychiatric disorders before and 1 year after weight loss surgery. Furthermore, we studied if level of pre-operative shame could be a maintaining factor for psychiatric disorders at 1-year follow-up.

METHOD

One-hundred and twenty-seven patients (F/M: 94/33) with mean body mass index (BMI) ± standard deviation (s) =45.3±5.2 kg/m(2) and mean age 41.3±10.3 years participated in the study. Eighty-seven patients met for follow-up 1 year after surgery. Psychiatric disorders were assessed by the Mini International Neuropsychiatric Interview (M.I.N.I.) and the Structured Clinical Interview (SCID-II). Levels of depression, anxiety and shame were assessed by the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the Internalized Shame Scale (ISS).

RESULTS

Sixty-one patients (48%) at pre-operative assessment and 16 patients (18%) at 1-year follow-up had a comorbid psychiatric disorder. The strongest predictor of post-operative psychiatric disorder was pre-operative psychiatric disorder, odds ratio of 27.7 (95% CI for EXP (B) 3.2-239.8, P =0.003). Pre-operative level of shame (higher than 50-point ISS score) was also a significant predictor for post-operative psychiatric disorders, odds ratio of 9.1 (95% CI for EXP (B) 1.8-44.4, P =0.007).

CONCLUSION

There was a significant reduction in prevalence of psychiatric disorders from pre-operative assessment to follow-up 1 year after surgery. Level of shame at pre-operative assessment was associated with maintenance of psychiatric problems. This finding is of clinical importance, since psychiatric disorders persisting after bariatric surgery have strong impact on the course of weight loss and quality of life.

Readability and comprehension of self-report binge eating measures

The validity of self-report binge eating instruments among individuals with limited literacy is uncertain. This study aims to evaluate reading grade level and multiple domains of comprehension of 13 commonly used self-report assessments of binge eating for use in low-literacy populations. We evaluated self-report binge eating measures with respect to reading grade levels, measure length, formatting and linguistic problems.

RESULTS

All measures were written at a reading grade level higher than is recommended for patient materials (above the 5th to 6th grade level), and contained several challenging elements related to comprehension. Correlational analyses suggested that readability and comprehension elements were distinct contributors to measure difficulty. Individuals with binge eating who have low levels of educational attainment or limited literacy are often underrepresented in measure validation studies. Validity of measures and accurate assessment of symptoms depend on an individual's ability to read and comprehend instructions and items, and these may be compromised in populations with lower levels of literacy.

The EDE-Q, BULIT-R, and BEDT as self-report measures of binge eating disorder

Binge eating disorder, currently classified as an eating disorder not otherwise specified, is a valid and clinically useful psychiatric diagnosis. Given its probable inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), identification of self-report measures with high levels of diagnostic utility should improve the likelihood and accuracy of screening. The aim of the current study was to assess the diagnostic utility of two widely used measures of eating disorder symptoms, namely the Eating Disorder Examination-Questionnaire (EDEQ) and the Bulimia Test-Revised (BULIT-R), as well as a factor of the BULIT-R (coined the Binge Eating Disorder Test or BEDT), newly created specifically for the assessment of BED. Participants included 15 individuals with BED and 26 non-BED controls, as determined via the diagnostic section of the Eating Disorder Examination, who met criteria for being overweight or obese. Results showed that the BEDT achieved 100% sensitivity, specificity, positive and negative predictive values. The BULIT-R and Eating Concern subscale of the EDE-Q evidenced strong sensitivity (100 vs 87), specificity (96 vs 100), positive predictive values (94 vs 100), and negative predictive values (100 vs 93), respectively. Results suggest that the BEDT is an excellent overall measure of BED in obese populations. The BULIT-R affords the advantage of ruling out compensatory behaviors, particularly of the non-purging variety (e.g., severe restriction outside of binges), while the brevity of the Eating Concern subscale of the EDE-Q makes it optimal for use in brief screening situations.

Enhanced striatal dopamine release during food stimulation in binge eating disorder

Subjects with binge eating disorder (BED) regularly consume large amounts of food in short time periods. The neurobiology of BED is poorly understood. Brain dopamine, which regulates motivation for food intake, is likely to be involved. We assessed the involvement of brain dopamine in the motivation for food consumption in binge eaters. Positron emission tomography (PET) scans with [(11)C]raclopride were done in 10 obese BED and 8 obese subjects without BED. Changes in extracellular dopamine in the striatum in response to food stimulation in food-deprived subjects were evaluated after placebo and after oral methylphenidate (MPH), a drug that blocks the dopamine reuptake transporter and thus amplifies dopamine signals. Neither the neutral stimuli (with or without MPH) nor the food stimuli when given with placebo increased extracellular dopamine. The food stimuli when given with MPH significantly increased dopamine in the caudate and putamen in the binge eaters but not in the nonbinge eaters. Dopamine increases in the caudate were significantly correlated with the binge eating scores but not with BMI. These results identify dopamine neurotransmission in the caudate as being of relevance to the neurobiology of BED. The lack of correlation between BMI and dopamine changes suggests that dopamine release per se does not predict BMI within a group of obese individuals but that it predicts binge eating.

Binge eating disorder and the outcome of bariatric surgery at one year: a prospective, observational study

Previous studies have suggested that binge eating disorder (BED) impairs weight loss following bariatric surgery, leading some investigators to recommend that patients receive behavioral treatment for this condition before surgery. However, many of these investigations had significant methodological limitations. The present observational study used a modified intention-to-treat (ITT) population to compare 1-year changes in weight in 59 surgically treated participants, determined preoperatively to be free of a current eating disorder, with changes in 36 individuals judged to have BED. Changes in weight and binge eating in the latter group were compared with those in 49 obese individuals with BED who sought lifestyle modification for weight loss. BED was assessed using criteria proposed for the Diagnostic and Statistical Manual (DSM) 5. At 1 year, surgically treated participants without BED lost 24.2% of initial weight, compared with 22.1% for those with BED (P > 0.309). Both groups achieved clinically significant improvements in several cardiovascular disease (CVD) risk factors. Participants with BED who received lifestyle modification lost 10.3% at 1 year, significantly (P < 0.001) less than surgically treated BED participants. The mean number of binge eating days (in the prior 28 days) fell sharply in both BED groups at 1 year. These two groups did not differ significantly in BED remission rates or in improvements in CVD risk factors. The present results, obtained in carefully studied participants, indicate that the preoperative presence of BED does not attenuate weight loss or improvements in CVD risk factors at 1 year in surgically treated patients. Longer follow-up of participants is required.

Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study

BACKGROUND

The psychological symptoms associated with binge eating disorder (BED) have been well documented. However, the physical symptoms associated with BED have not been explored. Gastrointestinal (GI) symptoms such as heartburn and diarrhea are more prevalent in obese adults, but the associations remain unexplained. Patients with bulimia have increased gastric capacity. The objective of the study was to examine if the severity of binge eating episodes would be associated with upper and lower GI symptoms.

METHODS

Population-based survey of community residents through a mailed questionnaire measuring GI symptoms, frequency of binge eating episodes and physical activity level. The association of GI symptoms with frequency of binge eating episodes was assessed using logistic regression models adjusting for age, gender, body mass index (BMI) and physical activity level.

RESULTS

In 4096 subjects, BED was present in 6.1%. After adjusting for BMI, age, gender, race, diabetes mellitus, socioeconomic status and physical activity level, BED was independently associated with the following upper GI symptoms: acid regurgitation (P<0.001), heartburn (P<0.001), dysphagia (P<0.001), bloating (P<0.001) and upper abdominal pain (P<0.001). BED was also associated with the following lower GI symptoms: diarrhea (P<0.001), urgency (P<0.001), constipation (P<0.01) and feeling of anal blockage (P=0.001).

CONCLUSION

BED appears to be associated with the experience of both upper and lower GI symptoms in the general population, independent of the level of obesity. The relationship between increased GI symptoms and physiological responses to increased volume and calorie loads, nutritional selections and rapidity of food ingestion in individuals with BED deserves further study.

The contributions of weight problem perception, BMI, gender, mood, and smoking status to binge eating among college students

College student participants (N=1063; 77.8% response rate) completed a web-based survey assessing demographics, depression, anxiety, body image, cigarette smoking, and weight history. Among overweight participants, 42.6% of those who believed they were overweight admitted to binge eating, while only 30.1% who did not feel overweight did so (p<.05). Among non-overweight participants, 43.2% of those who believed they were overweight admitted to binge eating, while only 32.9% of those who did not feel overweight did so (p<.05). Weight Problem Perception (WPP) mediated the contribution of BMI on binge eating outcomes, and WPP contributed significantly to the prediction of binge eating, beyond the risk conferred by established correlates of binge eating (e.g., gender, mood, and cigarette smoking). Results suggest that when assessing risk for binge eating, a one-question assessment of whether or not an individual believes s/he is overweight has significant predictive power. Findings are consistent with literature on the importance of the "fat self-schema" [Stein, K.F., & Corte, C. (2007). Identity impairment and the eating disorders: Content and organization of the self-concept in women with anorexia nervosa and bulimia nervosa. European Eating Disorders Review, 15 (1), 58-69] in disordered eating and theory implicating identity in the maintenance of addictive behavior [West, R.W. (2006). Theory of Addiction. Malden, MA: Blackwell Publishing, Inc.].

Time trends in obesity and eating disorders

OBJECTIVE

Obesity is a well-known risk factor for eating disorders, and has been increasing in the normal population over the last decades. This study examines whether the increase in obesity is followed by an increase in prevalence of eating disorders in the general female population.

METHOD

We compared the prevalence of eating disorders and obesity in two nationally representative surveys in Norway in 1991 (n = 1,537) and 2004 (n = 1,467). Eating disorder diagnoses were obtained using the self-report questionnaire survey for eating disorders (SEDs) at both time points.

RESULTS

The prevalence of overweight and obesity has doubled from 1991 to 2004, whereas the prevalence of eating disorders has been stable. Obesity was strongly associated with eating disorders both in 1991 and 2004.

CONCLUSION

Despite the strong association between obesity and eating disorders, the increase in obesity is not followed by an increase in eating disorders.

The prevalence of binge eating disorder and borderline personality symptomatology among gastric surgery patients

In this study, we examined the prevalence of binge eating disorder (BED) and borderline personality disorder (BPD) in a sample of 121 candidates seeking surgery for obesity. In this predominantly female sample (85.9%), according to the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R), the prevalence of BED was 6.5%. As for the prevalence of BPD, 14.0% exceeded the clinical cut-off score on the Self-Harm Inventory (SHI), 14.0% exceeded the clinical cut-off score on the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4), and 7.4% exceeded the clinical cut-off score on the McLean Screening Inventory for Borderline Personality Disorder (MSI-BPD). Overall, 24.8% of the sample exceeded the clinical cut-off on at least one measure of BPD whereas only 3.3% exceeded the clinical cut-off on all three measures. In addition, there was a significant inverse relationship between the discrepancy between highest and lowest adult body mass index, and scores on the PDQ-4 and the MSI-BPD. The authors discuss the implications of these findings.

A comparison of eating disorders among patients receiving surgical vs non-surgical weight-loss treatments

BACKGROUND

Little is known about differences between patients in surgical and non-surgical weight-loss treatments (WLT) regarding eating disorders, level of general psychopathology, and health-related quality of life (HRQL). Such differences could indicate different clinical needs in the management of surgical compared to non-surgical WLT patients.

METHODS

Participants were a subset of 100 patients from a Swedish study investigating the long-term effects of eating disorders in WLT. Participants filled out the Eating Disorders in Obesity Questionnaire as well as self-rating questionnaires of general psychopathology and HRQL before initiating surgical (n = 54) or non-surgical (n = 46) WLT.

RESULTS

Eating disorders were found to be more common among patients accepted for surgical treatments, whereas binge eating (as a symptom) was found to be equally common in both groups. Surgical patients also indicated higher levels of psychopathology compared to those receiving non-surgical treatment.

CONCLUSION

Patients in surgical WLT are younger, more obese, and indicate higher levels of eating disorders and psychopathology than non-surgical WLT patients. Results highlight the importance of surgical WLT units having adequate knowledge, resources, and methods for detecting and addressing issues of eating disorders and psychopathology before and during the WLT. Future longitudinal studies need to ascertain to what extent eating and general psychopathology influence the outcome of WLT in terms of lapses, complications, weight gain, quality of life, etc.

High-dose escitalopram in the treatment of binge-eating disorder with obesity: a placebo-controlled monotherapy trial

OBJECTIVE

The purpose of this study was to evaluate the efficacy and safety of high-dose escitalopram in the treatment of binge-eating disorder (BED) associated with obesity.

METHOD

Forty-four outpatients with BED by DSM-IV criteria and obesity were randomized to receive either escitalopram (N = 21) or placebo (N = 23) in a 12-week, double-blind, flexible dose (10-30 mg/day) study.

RESULTS

In the primary analysis, escitalopram (mean dose 26.5 mg/day) and placebo had similar rates of reduction of binge episodes, binge days and obsessive-compulsive symptoms of BED. However, escitalopram was associated with statistically significant reductions in weight, body mass index (BMI), and global severity of illness scores. In a secondary analysis, escitalopram was associated with statistically significant reductions in frequency of binge episodes and binge days, weight, BMI and severity of illness, but not in obsessive-compulsive symptoms of BED. No changes in metabolic variables, including measures of ghrelin and leptin, were observed. High-dose escitalopram was well tolerated.

CONCLUSION

High-dose escitalopram was not efficacious in reducing obsessive-compulsive symptoms of BED, but was efficacious in reducing weight and global severity of illness. No definitive conclusions about its efficacy in reducing binge-eating frequency could be drawn due to limitations related to statistical power.

Psychometric properties of the Eating Disorders in Obesity questionnaire: validating against the Eating Disorder Examination interview

Inconclusive results of how weight-loss treatment (WLT) results are affected by participants' eating disorders and/or binge eating are partly due to the variation caused by the multitude of assessment instruments used. The objective of the present study was to evaluate the psychometric properties of a short DSM-IV-based assessment instrument designed to be used specifically in WLT settings, the Eating Disorders in Obesity (EDO) questionnaire. Participants were 97 patients seeking WLT at four surgical and one non-surgical clinics. Participants were assessed by the EDO and the Eating Disorder Examination (EDE) interview . The validity and reliability of the EDO was measured as concordance with the EDE, and test-retest agreement of the EDO, respectively. Validity as well as reliability was found to be good for both eating disorders diagnoses and binge eating as a distinct symptom. Results suggest that the EDO is a short, easily administered instrument with good psychometric properties which makes it a suitable, economical method of assessing eating disorders and binge eating in clinical WLT settings.

Intragastric balloon and binge eating

BACKGROUND

In recent years, particular attention has been paid to the effect that eating disturbances and especially binge eating can have on the outcome of surgical treatments for obesity. Endoscopic positioning of the Bioenterics intragastric balloon (BIB) is mainly used in the work-up for surgical treatment of morbid obesity. Available data show that the BIB is a valid tool for reducing weight and co-morbidity, even if only a temporary treatment in morbidly obese patients. We evaluated the results of treatment with the BIB with the patient's tendency to indulge in binge eating.

METHODS

Between April 2003 and March 2006, 89 patients with morbid obesity (BMI 39-55) were enrolled in the study. Before introducing the BIB and within 3 months after removal, patients underwent a psychiatric evaluation and the following psychodiagnostic tests: SCID (Structured Clinical Interview for DSM IV), ED-SCID (Eating Disorder Module, Structured Clinical Interview) and BSQ (Binge Scale Questionnaire). All those positive for the BED criteria according to the DSM IV, and who had at least one binge eating episode per week, were considered Binge Eaters (BE).

RESULTS

Of the 89 patients enrolled, 75 were eligible for evaluations (M:F = 12:63), and 27 were positive for binge eating (BE). There were no significant differences in age and preoperative BMI between the BE group and the 48 patients without BE (NBE group). The complication and failure rates with the BIB treatment were significantly higher in the BE group (P<0.01). After treatment with the BIB, both groups showed a significant reduction in BMI (P<0.01), but the NBE-group showed a significantly higher weight (BMI 5.7 +/- 2.5 kg/m2) than the BE-group (BMI 3.3 +/- 2.2 kg/m2) (P=0.03).

CONCLUSION

The results of treatment with the intragastric balloon appear to be affected by binge eating pattern in morbidly obese patients, even if the presence of this behavior does not prevent a successful reduction in the BMI. Binge eating does not seem to be a contraindication for the adjuvant use of the BIB before a bariatric operation. A limitation of our study is the short period of observation, related to the period of the BIB in the gastric lumen (not more than 6 months). Further studies may show whether the association of psychiatric treatment with the BIB in patients affected by binge eating may enhance the results of the treatment.

Eating behavior as a prognostic factor for weight loss after gastric bypass

BACKGROUND

Binge-eating disorder (BED) may be associated with unsatisfactory weight loss in obese patients submitted to bariatric procedures. This study aims to investigate whether the presence of binge eating before Roux-en-Y gastric bypass (RYGBP) influences weight outcomes.

METHODS

In a prospective design, 216 obese patients (37 males, 178 females, BMI=45.9 +/- 6.0 kg/m2) were assessed for the lifetime prevalence of BED and classified at structured interview into 3 subgroups: no binge eating (NBE=43), sub-threshold binge eating (SBE=129), and binge-eating disorder (BED=44). All patients were encouraged to take part in a multidisciplinary program following surgery, and weight loss at follow-up was used as the outcome variable.

RESULTS

At 1-year follow-up, NBE patients (n=41) showed percent excess BMI loss (%EBL) significantly higher than SBE patients (n=112) (P=0.027), although this effect was not significantly different between NBE and BED patients (n=44). At 2-year follow-up, NBE patients (n=33) showed %EBL higher than SBE (n=64) (P=-0.003) and BED patients (n=34) (P<0.001). Nevertheless, we found no significant weight loss differences between SBE (subclinical) and BED (full criteria) patients at any period of follow-up. Preliminary results at 3-year follow-up suggest that such an effect may be enduring.

CONCLUSION

The presence of a history of binge eating prior to treatment is associated with poorer weight loss in obese patients submitted to RYGBP. Because BED is highly prevalent in obese patients seeking bariatric surgery, its early recognition and treatment may be of important clinical value.

Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study

BACKGROUND

In a single-center, placebo-controlled study, topiramate reduced binge eating and weight in patients with binge eating disorder (BED) and obesity. The current investigation evaluated the safety and efficacy of topiramate in a multicenter, placebo-controlled trial.

METHODS

Eligible patients between 18 and 65 years with >or= 3 binge eating days/week and a body mass index (BMI) between 30 and 50 kg/m2 were randomized.

RESULTS

A total of 407 patients enrolled; 13 failed to meet inclusion criteria, resulting in 195 topiramate and 199 placebo patients. Topiramate reduced binge eating days/week (-3.5 +/- 1.9 vs. -2.5 +/- 2.1), binge episodes/week (-5.0 +/- 4.3 vs. -3.4 +/- 3.8), weight (-4.5 +/- 5.1 kg vs. .2 +/- 3.2 kg), and BMI (-1.6 +/- 1.8 kg/m2 vs. .1 +/- 1.2 kg/m2) compared with placebo (p < .001). Topiramate induced binge eating remission in 58% of patients (placebo, 29%; p < .001). Discontinuation rates were 30% in each group; adverse events (AEs) were the most common reason for topiramate discontinuation (16%; placebo, 8%). Paresthesia, upper respiratory tract infection, somnolence, and nausea were the most common AEs with topiramate.

CONCLUSIONS

This multicenter study in patients with BED associated with obesity demonstrated that topiramate was well tolerated and efficacious in improving the features of BED and in reducing obesity.

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.