To date, a relatively small literature on binge eating among youths exists. This lack of research may be due, in part, to the possibility that childhood binge eating may differ from such behaviors in adults or that construct explanations in adult measures (which are often adapted for child use) do not resonate with children. Most eating-disordered behaviors are difficult to assess, particularly among younger children, who may be manifesting only the early signs of eating disorders.
Furthermore, children may be unaware of their emotional experiences, particularly with regard to the experience of loss of control over eating. Thus, an overarching challenge presented to researchers and clinicians is how to assess eating patterns given that children are not often aware of their emotional experiences during eating episodes and may find it difficult to understand and report them (Maloney, McGuire, & Daniels, 1988). Indeed, it has been suggested that the DSM-IV-TR (APA, 2000) does not adequately account for binge eating behaviors among children (Marcus & Kalarchian, 2003).
Differences in the prevalence rates, correlates and outcomes of binge eating among youths are likely affected by the methods used to assess binge eating and may have an important influence on study results, particularly among younger children. To date, most studies have used single-item surveys, self-report questionnaires, or parents’ reports of their children’s behaviors; a minority of cases have used interview methodology. Comparisons of these methods suggest that responses differ based upon the type of measure used and the particular respondent.
Among samples of non-treatment-seeking children and adolescents of all weight strata, comparisons of self-reports of binge eating to parents’ reports of their children’s binge eating (Johnson, Grieve, Adams, & Sandy, 1999; Steinberg et al., 2004) and child self-reports to child interview methodology (Field, Taylor, Celio, & Colditz, 2004; Tanofsky-Kraff et al., 2003) have found that the identification of binge eating presence is inconsistent across measures.
Furthermore, parents’ reports of their children’s binge eating have demonstrated poor concordance with interviews with children (Tanofsky-Kraff, Yanovski, & Yanovski, 2005). Similarly low levels of agreement between self-reports of binge eating and interview methods were revealed in a study of obese 10- to 16-year-olds seeking inpatient weight loss treatment (Decaluwe & Braet, 2004).
Although interview-based methodologies, as opposed to self-report questionnaires, are recommended and considered the optimal means to assess binge eating behaviors among adults (Bryant-Waugh, Cooper, Taylor, & Lask, 1996; Wilfley, Schwartz, Spurrell, & Fairburn, 1997), it remains unclear whether this recommendation holds true for children.
Until a clear phenotype of binge eating among youths is defined and an optimal mode of assessment is determined, it is suggested that pediatric clinicians consider the following guideline. If feasible, multiple assessments should be administered to both the child and the parent. Ideally, interview methods, including probes to explicate the concept of loss of control while eating, are recommended.
Furthermore, it may be useful to ask families about constructs that may be associated with binge eating, such as eating in response to both negative and positive emotions, eating in the absence of hunger or past satiation, and the individual child’s feelings about his or her eating patterns.
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.