Weight Loss Treatment
The pediatric literature examining binge eating in relation to weight loss treatment outcome is limited. Epstein and colleagues found no significant changes in binge eating behaviors following family-based behavioral weight loss treatment for 8- to 12-year-olds (Epstein, Paluch, Saelens, Ernst, & Wilfley, 2001).
By contrast, in a sample of obese youths (7-17 years) taking part in an inpatient non-diet healthy lifestyle program focusing on healthy eating, moderate exercise, and cognitive-behavioral treatment, the mean frequency of binge eating episodes was significantly lower at both post-treatment and 14-month follow-up (Braet, Tanghe, Decaluwe, Moens, & Rosseel, 2004). One recent study examined the impact of LOC eating on weight loss achieved during a family-based behavioral program for 8- to 13-year-olds (Levine, Ringham, Kalarchian, Wisniewski, & Marcus, 2006).
Following treatment, children reporting LOC experienced similar weight loss to those not reporting LOC. These preliminary data suggest that weight loss treatment may not have an adverse impact on young binge eaters and that LOC eating may not affect weight loss outcome.
Perhaps of greatest concern is the finding that children and adolescents who self-report binge eating episodes tend to experience increased weight and fat gain over time compared with youths who do not report binge eating.
In a large study of boys and girls (9-14 years), Field et al. (2003) found that binge eating, as assessed by survey reports, was an independent predictor of weight gain among boys. As assessed by an adapted version of the EDE, binge eating was a predictor of elevated weight gain (Stice, Cameron, Killen, Hayward, & Taylor, 1999) and obesity onset (Stice, Presnell, & Spangler, 2002) among adolescent girls followed over a four-year period.
However, this finding was not replicated in a third study (Stice, Presnell, Shaw, & Rohde, 2005). Finally, in a study of 146 children aged 6-12 at baseline, all of whom were overweight or at risk for overweight because of a family history of obesity (Whitaker, Wright, Pepe, Seidel, & Dietz, 1997), binge eating at baseline was a predictor of additional increases in body fat mass four years later (Tanofsky-Kraff et al., 2006).
Taken together, these data point to the role that binge eating during youth may play in the development or maintenance of obesity. Additional research is required to determine whether early binge eating increases the risk for other adverse conditions such as full-syndrome eating disorders, other psychiatric disturbance, or additional health consequences above and beyond those associated with obesity.
A number of researchers have examined potential predictive factors for the development of binge eating with the aim of identifying targets for early prevention. To date, a limited number of studies have been published.
In a five-year prospective study of 216 mothers and their children, Stice and colleagues annually assessed the development of overeating in children at ages 2 through 5 years by asking mothers to respond to the question “Does your child enjoy eating certain foods so much that it appears that he/she has difficulty stopping?” (Stice, Agras, & Hammer, 1999). The researchers found that 33.8% of the children began overeating at some point during the study and that overeating increased annually, with the highest percentage of the emergence of overeating in any one-year period being 17.6%.
Furthermore, a number of factors predicted an increased hazard for the emergence of overeating, including: factors related to maternal eating behaviors such as “heightened restraint” and “drive for thinness,” mothers’ BMI, parental overweight history, and infant (first month of life) BMI and sucking duration.
Studies among older youths have examined child and adolescent atti-tudes and behaviors in the prediction of binge eating. In a prospective investigation of adolescent boys and girls (10-15 years), Field et al. (2002) examined the emergence of unhealthy behaviors including smoking, alcohol intoxication, and binge eating and purging.
While the three behaviors were associated with one another prospectively, the construct “weight concerns” was predictive of the emergence of binge eating as well as smoking and drinking alcohol to a state of inebriation. Furthermore, among a sample of ninth-grade girls, dieting was found to be predictive of binge eating onset over a four-year interval (Stice, Killen, Hayward, & Taylor, 1998).
Including a number of weight- and shape-related variables in addition to measures of depressive and anxiety symptoms, anger, self-esteem, and social support, Stice et al. (2002) prospectively studied 13- to 17-year-old girls over a two-year period.
Binge eating onset was predicted by increased dieting, pressure to be thin, modeling of eating disturbances, appearance overvaluation, body dissatisfaction, depressive symptoms, emotional eating, BMI, low self-esteem, and social support with 92% accuracy. In summary, weight- and body-related attitudes and behaviors of parents of young children and teens may be important factors in targeting the prevention of binge eating onset.
Future Research and Challenges
Because of inconsistent findings regarding factors that predict binge eating in children and adolescents as well as methods to qualitatively define the construct of binge eating in pediatric samples, continued research within these areas is required. A number of topics in need of further exploration are broadly described below.
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.