Regardless of demographic variables, adolescents who report binge eating are more likely to manifest disordered eating cognitions, depressive symptoms, poor family and social functioning, and emotional stress than those who do not (French et al., 1997; Johnson et al., 2002; Ledoux, Choquet, & Manfredi, 1993; Neumark-Sztainer, & Hannan, 2000; Steiger, Puentes-Neuman, & Leung, 1991). Furthermore, cross-sectional data suggest that binge eating is associated with overweight in adolescents.
A school-based study of 7th- through 12th-graders found that overweight participants self-report binge eating more frequently than do their normal-weight peers (Neumark-Sztainer et al., 1997).
Similar findings have been reported in a number of studies; older and heavier teens report a higher prevalence of binge eating than their younger and leaner counterparts (Ackard, Neumark-Sztainer, Story, & Perry, 2003; Field et al., 1997a). The association between binge eating, overweight and sex remains unclear. In a study by Field et al. (1997b), overweight was associated with binge eating in girls but not boys, while Ackard et al. reported a relationship between binge eating and obesity among boys but not girls.
Treatment-Seeking Overweight Adolescents
Although few non-treatment-seeking adolescents meet full criteria for BED, the prevalence of BED among treatment-seeking obese teens has been reported by three studies. Among a sample of 51 girls aged 14-16 years, 30% manifested “unequivocal binge-eating” by interview assessing the BED criteria (Berkowitz, Stunkard, & Stallings, 1993).
Decaluwe and Braet (2003) reported that only 1% of 196 boys and girls (10-16 years) seeking either inpatient or outpatient weight loss treatment met full BED criteria based upon their responses to the Eating Disorder Examination (EDE) (Fairburn & Cooper, 1993) adapted for children (Bryant-Waugh et al., 1996).
In a more recent study of 12- to 17-year-old severely obese teens, not only did 6.3% meet criteria for BED according to their EDE interviews, but participants with BED suffered from eating-related and psychological distress at levels similar to those of adults with the disorder (Glasofer et al., 2007).
Findings from studies that did not assess for full BED criteria suggest that subthreshold binge eating (fewer than two binge episodes per week over six months) among overweight adolescents appears to be substantial, with estimates ranging from 20% (Isnard et al., 2003) to approximately 35% (Decaluwe, Braet, & Fairburn, 2001) in weight loss treatment-seeking samples.
Studies of adolescents seeking weight loss treatment have found that those who report subthreshold binge eating have greater eating-related distress, anxiety, and depressive symptomatology and poorer self-esteem than those who do not report any binge eating (Berkowitz et al., 1993; Decaluwe, & Braet, 2003; Decaluwe et al.; Glasofer et al., 2007; Goossens, Braet and Decaluwe, 2007; Isnard et al.). In contrast to nontreatment samples, BMI differences between binge eaters and non-binge eaters have generally not been found (Berkowitz et al.; Decaluwe, Braet, & Fairburn, 2003; Glasofer et al., 2007; Goossens et al., 2007; Isnard et al. 2003), with the exception of the Decaluwe and Braet study (2003). Of the studies examining both sexes, again only Decaluwe and Braet reported a significant difference, with binge eating more common among girls than boys.
Uniformed Services University of the Health Sciences and National Institute of Child Health and Human Development, Bethesda, MD 20892.
This research was supported by the Intramural Research Program of the NIH, grant ZO1-HD-00641 (NICHD, NIH) to Dr. J. Yanovski.