Clarify and Conceptualize Binge Eating in Children

A better understanding of what constitutes binge eating among youths may produce more consistent findings across studies and help target children in need of intervention for overweight or more severe eating disturbance.

Researchers typically base measures that assess disturbed eating patterns upon adult versions that contain probes relevant to adults with binge eating but not necessarily to children. In particular, the construct and experience of "loss of control" requires further investigation, particularly given that some children may not understand the concept, nor may they comfortably admit to feeling "out of control" or "unable to stop" once having started eating. As such, exploratory research is required to capture the qualitative aspects of aberrant eating episodes described by children.

Analyzing a number of behavioral, physical, and emotional variables potentially surrounding aberrant eating episodes has been suggested as one method to elucidate eating patterns among overweight individuals (Tanofsky-Kraff & Yanovski, 2004). Such methods may be especially germane to studying children's eating episodes and may provide a child-specific phenotype that is reflective of adult binge eating.

Research should also focus on the importance of the criterion of a "large amount of food given the context" to describe binge episodes in children.

Some data already suggest that the experience of LOC among youths, as opposed to episode size, may be the more salient factor associated with emotional distress and body composition (Morgan et al., 2002; Tanofsky-Kraff et al., 2004, 2005).

Furthermore, because nutritional needs change in growing children, quantifying whether a given amount of food is unambiguously large given the age and sex of a child as well as the context of the eating episode is not only challenging but often disputable. In taking a conservative approach such as that required in administering the EDE (Fairburn & Cooper, 1993), if an amount of food described during an episode is not unambiguously large, researchers will often code the amount as "not large." Therefore, the quantity of food that constitutes "binge" episodes in children is often not much larger than an amount of food considered "not unambiguously large."

In a 2003 review of the literature on binge eating in children and adolescents, Marcus and Kalarchian proposed provisional BED research criteria for children 14 years and younger (Table 4.2).

Table 4.2. Provisional Research Criteria for Diagnosing Binge Eating Disorder in Children (Marcus & Kalarchian, 2003) A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Food seeking in absence of hunger (e.g., after a full meal). 2. A sense of lack of control over eating (e.g., endorse that, "When I start to eat, I just can't stop").