The prevalence of binge eating disorder in a sample of college students in the north of Portugal

Prevalence and predictors of binge eating disorder symptoms among a sample of university students in Bangladesh: A cross-sectional survey

Background and Aims

There is a dearth of information about binge eating disorder (BED) among Bangladeshi university students, who may be more susceptible to BED due to the rise in unhealthy lifestyles and food habits. Therefore, the purpose of this study was to assess the prevalence and associated factors of BED symptoms among Bangladeshi university students.

Methods

Students (N = 525) from three public universities in Bangladesh participated in this cross-sectional study between November 2022 and March 2023. Face-to-face interviews were conducted using a structured paper-based questionnaire that included two validated survey tools; the binge eating disorder screener and the patient health questionnaire-9. To identify the factors associated with BED symptoms, multiple logistic regression analysis was conducted, with sociodemographic and behavioral information (e.g., age, sex, smoking status, etc.) considered as covariates.

Results

The prevalence of BED symptoms among participants (mean age 21.28 years, 50.3% male and 49.7% female) was 20.6%. Male students had a 2.28 times higher likelihood of having BED symptoms compared to female counterparts (adjusted odds ratio [AOR] = 2.28; 95% CI: 1.33-3.89). Older students (AOR = 3.56, 95% CI: 1.80-7.05), students who were overweight or obese (AOR = 3.32, 95% CI: 1.87-5.89), and students reporting higher depressive symptoms (AOR = 2.69, 95% CI: 1.66-4.35) were at greater risk for developing BED compared to their respective counterparts.

Conclusions

This study provides new insights into the prevalence of BED symptoms and its contributing factors among Bangladeshi students. Approximately 1-in-5 university students reported having BED symptoms. University students who are older, overweight, or obese, and who report depressive symptoms may be at greatest risk. Future longitudinal studies are needed to determine the causal factors underlying BED. Findings from this study can assist policymakers and public health professionals in developing effective and targeted strategies to mitigate the risks associated with BED among Bangladeshi university students.

Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia-a rapid review

BACKGROUND

Understanding of the epidemiology and health burden of eating disorders has progressed significantly in the last 2 decades. It was considered one of seven key areas to inform the Australian Government commissioned National Eating Disorder Research and Translation Strategy 2021-2031, as emerging research had highlighted a rise in eating disorder prevalence and worsening burden-of-illness. The aim of this review was to better understand the global epidemiology and impact of eating disorders to inform policy decision-making.

METHODS

Using a systematic Rapid Review methodology, ScienceDirect, PubMed and Medline (Ovid) were searched for peer-reviewed studies published between 2009 and 2021. Clear inclusion criteria were developed in consultation with experts in the field. Purposive sampling of literature was conducted, which predominately focused on higher-level evidence (meta-analyses, systematic reviews, and large epidemiological studies), synthesised, and narratively analysed.

RESULTS

135 studies were deemed eligible for inclusion in this review (N = 1324). Prevalence estimates varied. Global Lifetime prevalence of any eating disorder ranged from 0.74 to 2.2% in males, and 2.58-8.4% in females. Australian 3-month point-prevalence of broadly defined disorders was around 16% in females. Eating disorders appeared more prevalent in young people and adolescents, particularly females (in Australia: eating disorders ~ 22.2%; disordered eating ~ 25.7%). Limited evidence was found on sex, sexuality and gender diverse (LGBTQI +) individuals, particularly males, who had a six-fold increase in prevalence compared to the general male population, with increased illness impact. Similarly, limited evidence on First Australian's (Aboriginal and Torres Strait Islander) suggests prevalence rates similar to non-Indigenous Australians. No prevalence studies were identified specifically assessing culturally and linguistically diverse populations. Global disease burden of any eating disorder was 43.4 age-standardised disability-adjusted-life-years per 100,000; increasing by 9.4% between 2007 and 2017. Australian's total economic cost was estimated at $84 billion from years-of-life lost due to disability and death, and annual lost earnings ~ $1.646 billion."

CONCLUSIONS

There is no doubt that eating disorder prevalence and impact are on the rise, particularly in at-risk and understudied populations. Much of the evidence came from female-only samples, and Western, high-income countries which more readily have access to specialised services. Future research should examine more representative samples. There is an urgent need for more refined epidemiological methods to better understand these complex illnesses over time, to guide health policy and development-of-care.

Binge-eating disorder in university students: high prevalence and strong link to impulsive and compulsive traits

BACKGROUND

Binge eating disorder (BED) is the most common eating disorder, and is associated with significant comorbidity, with university students being particularly vulnerable. We aimed to assess associations of BED with a wide range of comorbidities and measures of impulsivity and compulsivity in university students, to gain better understanding of its prevalence, correlates and pathophysiology.

METHODS

We carried out an internet-based survey, assessing presence of BED using a validated structured self-report diagnostic tool, demographics, substance use, impulsive behaviors, psychiatric history, and measures of impulsivity and compulsivity. Approximately 10 000 students were invited to take part. Group differences between students with current BED and students without BED were investigated.

RESULTS

A total of 3415 students completed the survey, with 83 (2.4%) screening positive for BED. BED was associated with female gender, hazardous/harmful alcohol use, depression and anxiety symptoms, low self-esteem, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, treatment for psychological/emotional problems (including prescribed medication) and trait impulsivity and compulsivity. However, the largest effect sizes were evident for associations with trait impulsivity and compulsivity.

CONCLUSIONS

The associations of BED with trait impulsivity and compulsivity implicate these latent phenotypes in its pathophysiology. The identified links between BED and a wide range of mental disorders highlight the need to screen for disordered eating in student populations, including when students present with other mental health conditions.

Bipolar disorder: An evolutionary psychoneuroimmunological approach

Bipolar disorder is a mental health disorder characterized by extreme shifts in mood, high suicide rate, sleep problems, and dysfunction of psychological traits like self-esteem (feeling inferior when depressed and superior when manic). Bipolar disorder is rare among populations that have not adopted contemporary Western lifestyles, which supports the hypothesis that bipolar disorder results from a mismatch between Homo sapiens's evolutionary and current environments. Recent studies have connected bipolar disorder with low-grade inflammation, the malfunctioning of the internal clock, and the resulting sleep disturbances. Stress is often a triggering factor for mania and sleep problems, but stress also causes low-grade inflammation. Since inflammation desynchronizes the internal clock, chronic stress and inflammation are the primary biological mechanisms behind bipolar disorder. Chronic stress and inflammation are driven by contemporary Western lifestyles, including stressful social environments, unhealthy dietary patterns, limited physical activity, and obesity. The treatment of bipolar disorder should focus on reducing stress, stress sensitivity, and inflammation by lifestyle changes rather than just temporarily alleviating symptoms with psychopharmacological interventions.

The link between external and internal shame and binge eating: the mediating role of body image-related shame and cognitive fusion

PURPOSE

Despite the growing interest in binge eating, research on this public health problem in male samples is limited. Indeed, the examination of underlying emotional mechanisms and potential gender differences in binge eating are still needed. This study explored differences between men and women in binge eating severity and related emotional mechanisms. Also, this study explored the impact of external and internal shame on binge eating severity, when mediated by body image-related shame and cognitive fusion, in men and women.

METHODS

The sample consists of 787 participants from the general population (144 men and 643 women), aged from 18 to 40 years.

RESULTS

Women presented higher levels of binge eating symptomatology and also of body image-related difficulties, than men. Path analysis results showed that external and internal shame had a significant impact on binge eating severity, and that these relationships were mediated by body image-related shame and cognitive fusion. Multi-group analysis revealed the invariance of this model in both sexes.

CONCLUSION

Although men and women revealed significant differences in the severity of binge eating and related emotional mechanisms, underlying mechanisms in binge eating seem to be invariant for gender. Indeed, this study suggested that both external and internal shame experiences play an important role in binge eating symptomatology, when associated with body image-related shame and cognitive fusion, both in men and women. These findings seem to support that binge eating may emerge as a maladaptive attempt to cope with shame experiences in both sexes.

LEVEL OF EVIDENCE

Level III: case control analytic study.

Borderline personality disorder and its association with bipolar spectrum and binge eating disorder in college students from South India

BACKGROUND

Borderline personality disorder (BPD) usually emerges during adolescence and is associated with severe morbidity. Individuals with BPD are also vulnerable to develop eating disorders as well as mood disorders.

OBJECTIVE

To study the prevalence of borderline personality and its association with binge-eating and bipolar spectrum disorder in college students.

METHODS

A questionnaire based survey was conducted on a convenience sample of 500 college students (>18 years of age) in medical and engineering campus. Participants were screened on self-report measures including McLean Screening Instrument for BPD (MSI-BPD), Mood Disorder Questionnaire (MDQ) and Binge-Eating Disorder Screener (BEDS-7) for BPD, bipolar spectrum disorder (BSD) and binge-eating disorder (BED), respectively.

RESULTS

The prevalence of BPD was 76 (15.2%, 95% CI 12.3-18.6), BSD was 43 (8.6%, 95% CI 6.4-11.5) and BED was 48 (9.6%, 95% CI 7.2-12.6). There was a significantly higher proportion of BSD (OR 23.6, 95% CI 11.3-49.3) and BED (OR 3.4, 95% CI 1.8-6.5) among those with BPD than those without.

CONCLUSIONS

BPD was found in 15% of adolescents and they have higher proportion of BED and BSD. Early identification may help in planning early intervention strategies to reduce associated morbidity.

The Binge Eating Scale: Structural Equation Competitive Models, Invariance Measurement Between Sexes, and Relationships With Food Addiction, Impulsivity, Binge Drinking, and Body Mass Index

Introduction: The Binge Eating Scale (BES) is a widely used self-report questionnaire to identify compulsive eaters. However, research on the dimensions and psychometric properties of the BES is limited.

Objective: The aim of this study was to examine the properties of the Spanish version of the BES.

Methods: Confirmatory Factor Analyses (CFAs) were carried out to verify the BES factor structure in a sample of Spanish college students (N = 428, 75.7% women; age range = 18–30). An invariance measurement routine was carried out across sexes, the latent means were compared, and estimates of reliability and convergent and discriminant validity were presented.

Results: A one-factor model fit the data best and was also equivalent between sexes. The scalar invariance model showed statistically significant differences across sexes, with a higher prevalence in women. Regarding reliability, the results were excellent. Finally, high statistically significant correlations were obtained with other measures of binge eating (BE), food addiction, impulsivity, binge drinking, and body mass index (BMI).

Conclusion: The Spanish 16-item BES is a valid and reliable scale to evaluate BE in the youth population.

Prevalence of eating disorders and picking/nibbling in elderly women

OBJECTIVE

The aim of this study was to examine the point prevalence of eating disorders and picking/nibbling in elderly women.

METHODS

This was a two-stage epidemiological study that assessed 342 women aged 65-94 years old. In Stage 1, the following screening measures were used to identify possible cases: the Mini-Mental State Examination, to screen and exclude patients with cognitive impairment; Weight Concerns Scale; SCOFF (Sick, Control, One, Fat, Food) Questionnaire; Eating Disorder Examination Questionnaire-dietary restraint subscale; and three questions to screen for picking/nibbling and night eating syndrome. Women selected for Stage 2 (n = 118) were interviewed using the diagnostic items of the Eating Disorder Examination.

RESULTS

According to the DSM-5, the prevalence of all eating disorders was 3.25% (1.83-5.7, 95% C.I.). Prevalence of binge-eating disorder was 1.68% (0.82-3.82, 95% C.I.), of other specified feeding or eating disorders was 1.48% (0.63-3.42, 95% C.I.), and of bulimia nervosa 0.3% (.05-1.7, 95% C.I.)]. Binge-eating episodes were reported by 5.62% of women. No cases of anorexia nervosa or night eating syndrome were identified. The prevalence of picking/nibbling was 18.9%. Picking/nibbling was associated with increased body mass index (t(322) = -3.28, p < .001) and binge-eating episodes (χ² (1) = 5.65, p < .017).

DISCUSSION

Prevalence rates of eating disorders on elderly Portuguese women were comparable to those found on young women. Our data support the literature that suggests that binge-eating disorder is particularly prevalent in older adults. Picking/nibbling was the most prevalent eating behavior and we provide further evidence for its association with weight and disordered eating.

Body image flexibility mediates the effect of body image-related victimization experiences and shame on binge eating and weight

OBJECTIVES

The current study examined a path model testing the indirect effect of negative body-image related memories of being teased and bullied in childhood and adolescence on binge eating severity symptoms, via its effect on current body image shame and body image flexibility.

METHODS

Participants were 853 Portuguese women from the general community who completed a set of self-report measures of body image-related bullying and teasing experiences in childhood and adolescence, current body image shame, body image flexibility, binge eating symptoms, body mass index (BMI) and depressive symptoms.

RESULTS

The path model accounted for 40% of the variance of binge eating symptoms and 14% of the variance of BMI, and revealed a very good fit. Findings corroborated the plausibility of the hypothesized associations suggesting that negative body image-related memories and emotional experiences are significantly associated with binge eating symptoms and BMI, and that body image flexibility is a significant mediator of these associations. The examined relationships were preserved after controlling for the effect of depressive symptoms.

CONCLUSIONS

The current study's findings contribute to clarify the role that body image-related memories and emotional experiences may play on individuals' difficulties in regulating eating behaviour and weight, and provides preliminary support for the potential effect of body image flexibility as a self-regulatory process that operates in these associations.

Incidence and weight trajectories of binge eating disorder among young women in the community

OBJECTIVE

To assess the population prevalence and incidence of binge eating disorder (BED) among young women.

METHOD

In a nationwide longitudinal study of Finnish twins born 1975-1979, the women participated in five surveys from age 16 until their mid-thirties. At Wave 4 (mean age 24 years), the women (N = 2,825) underwent a 2-stage screening for eating disorders. We assessed the lifetime prevalence, incidence, and clinical characteristics of DSM-5 BED.

RESULTS

We detected 16 women who met DSM-5 criteria for BED, yielding a lifetime prevalence of 0.7% (95% confidence interval [CI] 0.4-1.2%). The incidence of BED among women between 10 and 24 years of age was 35 (95% CI 20-60) per 100,000 person-years. The mean age of onset of BED was 19 years (range 13-27 years). Of the cases, 13/16 (81%) were currently ill. Duration of illness at the time of assessment ranged from less than a year to 13 years (median 6 years). Of women with BED, only two had a history of other eating disorders, but six had lifetime major depressive disorder. Two-thirds of the women with BED belonged to the highest weight quartile at age 16, and their mean BMI at age 22-27 year was 26.2 kg/m(2) (range 22.1-32.5 kg/m(2)).

DISCUSSION

Incident BED as defined by DSM-5 was relatively rare among younger women and was often preceded by relative overweight. BED often occurred without a history of other eating disorders, but comorbidity with major depressive disorder was common.

Returning to emotional eating: the emotional eating scale psychometric properties and associations with body image flexibility and binge eating

PURPOSE

This study tests the Emotional Eating Scale (EES) psychometric properties and correlates, and the moderator effect of body image flexibility on the association between emotional eating and binge eating.

METHODS

The EES factorial structure was examined in female college students and women from the general population, through a principal component analysis and a confirmatory factor analysis. EES psychometric properties and moderation analyses were further conducted.

RESULTS

The EES presented a three-factor structure-Depression, Anxiety and Anger-a good model fit, internal consistency, construct validity and temporal stability. EES was positively associated with general and eating psychopathology, binge eating, and negatively associated with mindfulness and body image flexibility. Body image flexibility moderated the association between emotional eating and binge eating.

CONCLUSIONS

Findings showed that EES is a valid measure of emotional eating, and clarified the association between emotional eating and binge eating moderated by body image flexibility.

The epidemiology and genetics of binge eating disorder (BED)

This narrative review provides an overview of the epidemiology of binge eating disorder (BED), highlighting the medical history of this disorder and its entry as an independent condition in the Feeding and Eating Disorders section of the recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Estimates of prevalence are provided, as well as recognition that the female to male ratio is lower in BED than in other eating disorders. Evidence is also provided of the most common comorbidities of BED, including mood and anxiety disorders and a range of addiction disorders. In addition, discussion of the viewpoint that BED itself may be an addiction - at least in severe cases - is presented. Although the genetic study of BED is still in its infancy, current research is reviewed with a focus on certain neurotransmitter genes that regulate brain reward mechanisms. To date, a focal point of this research has been on the dopamine and the μ-opioid receptor genes. Preliminary evidence suggests that a predisposing risk factor for BED may be a heightened sensitivity to reward, which could manifest as a strong dopamine signal in the brain's striatal region. Caution is encouraged, however, in the interpretation of current findings, since samples are relatively small in much of the research. To date, no genome-wide association studies have focused exclusively on BED.

Expanding binge eating assessment: Validity and screening value of the Binge Eating Scale in women from the general population

There is growing recognition that binge eating is a prevalent problem with serious implications for both clinical and nonclinical samples. The current study aimed at examining the factor structure, psychometric properties and the screening usefulness of the Binge Eating Scale (BES) in a large sample of female college students and women from the Portuguese general population. A sample of 1008 participants was collected to conduct a confirmatory factor analysis and test the BES psychometric properties; 150 participants were further evaluated through the Eating Disorder Examination 16.0D to assess the discriminant validity of the BES. Results confirmed that the BES presents a sound one-dimensional factorial structure, with very good construct reliability and convergent validity. Also, the scale presented very good retest-reliability. Findings also offered evidence that the BES is positively associated with measures of eating and general psychopathology, and BMI. Furthermore, the BES revealed an excellent performance (96.7%) on discriminating clinically significant cases of binge eating, showing a sensitivity of 81.8% and a specificity of 97.8%. Results support the validity and usefulness of the BES as an assessment and screening tool for binge eating in women from the general population.