Binge Eating Identified by Adolescent Binge Eating Disorder Questionnaire

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Adolescents with clinical binge eating disorder differ from those without binge eating, in that this behavior is more frequent.
Adolescents with clinical binge eating disorder differ from those without binge eating, in that this behavior is more frequent.

Research published in the Journal of Pediatrics has found that the Adolescent Binge Eating Questionnaire is a possible screening tool to identify obese adolescents who are at high risk for binge eating disorder (BED) to guide them to a specialist who can provide diagnosis and care.

Catherine Chamay-Weber, MD, from the University of Geneva, Switzerland, and colleagues recruited 94 adolescents ages 12 to 18 years (59.6% girls) from the Pediatric Obesity Care Center of Geneva University Hospitals who had a body mass index greater than the 97th percentile.

The participants were first asked to complete the ADO-BED (adolescent binge eating disorder) questionnaire and then were interviewed by research psychologists assessing for BED who were blinded to the results of the questionnaires.

The researchers found that: 

  • 21 participants (22.3%) met criteria for the full clinical disorder;
  • 26 participants (27.6%) met criteria for a subclinical BED;
  • clinical BED was more common in girls (28.6%) than in boys (13.2%), but the difference was not significant (P =.08); and
  • age was not associated with clinical BED (P =.23).

The researchers compared the participants' answers on the questionnaire with the results of the clinical interviews to assess the questionnaire's ability to identify BED.

The first 2 survey questions had to be answered by all participants and were designed to determine whether the rest of the BED questions would need to be answered. The questions asked about: eating in the absence of hunger or after satiation, and whether the participants felt a lack of control over eating.

Participants who answered "yes" to at least 1 of the 2 first questions (n=74; 78.7%) were asked to answer the 8 additional questions; 69 participants (93.2%) completed the full questionnaire. Those diagnosed with BED answered "yes" to an average of 5.0 of the 8 questions, those diagnosed with subclinical BED answered "yes" to an average of 3.8 of the 8 questions, and those without BED answered "yes" to an average of 3.1 of the 8 questions (P <.0001, Kruskal-Wallis test).

"The risk of having a diagnosis of BED was significantly associated with the number of positive answers," the investigators wrote.

Three of the additional questions were associated more significantly with a risk for clinical BED. These questions were question 3d ("eating more or the perception of eating more than others"), question 3e ("negative affect following eating"), and question 4 ("≥2-3 times a week"). Patients who responded positively to these 3 questions were at high risk of having clinical BED (n=8/10; 80%).

A positive answer to either question 1 or 2 was significantly associated with subclinical or clinical BED status (P <.0001). The questions' negative predictive values in identifying clinical BED were greater than 90%, and their sensitivity was greater than 85%.

None of the participants who answered both of the first questions negatively (n=20; 21.2%) had clinical BED, and only 2 of those participants (10.0%) were diagnosed with subclinical BED.

The positive predictive value of questions 1 and 2 for clinical BED was approximately 35%.

The first question was more indicative of BED than the second question (sensitivity, 85.7%). Subjectivity of question phrasing may have been a limitation, however, as adolescents may have been unsure exactly what "a loss of control over eating" meant.

However, answering "yes" to 1 of these 2 questions was not in itself predictive of BED (specificity, 27.4%).

"Indeed, many adolescents without BED have these eating behaviors," the researchers wrote."As reported by other studies, adolescents with clinical BED differ from those without binge eating in the fact that this behavior is more frequent, and that they experiment more disturbed eating cognitions and higher emotional distress."2,3 

Summary

"This preliminary study demonstrates that a simple auto-questionnaire based on Tanofsky-Kraff et al criteria may be a good screening instrument for the identification of BED in a population of adolescents with obesity," the investigators wrote.4

"Adolescents who respond[ed] positively to questions 1 and/or 2 and have 6 or more positive answers to the 8 additional questions definitely need to be referred to a specialist for further evaluation and treatment," they concluded.

Limitations

  • The clinical interviews were based on the BED portion of the Structured Clinical Interview for DSM Disorders, which is meant for adults, but is the only diagnostic interview validated and available in French.
  • Loss of control eating disorder criteria were developed to better characterize binge eating in children, and it is unclear to what extent they apply to those above the age of 12 years. Adolescents may present criteria mixed between what is seen in children and adults, which may partially explain the lack of specificity in the ADO-BED questionnaire.
  • The lack of association between BED and questions 3-6 may be the result of a lack of statistical power, rather than a lack of pertinence of the questions. These results must therefore be confirmed before it can be concluded that only 5 questions are needed to screen for BED.

References

  1. Chamay-Weber C, Combescure C, Lanza L, Carrard I, Haller DM. Screening obese adolescents for binge eating disorder in primary care: the adolescent binge eating scale [published online March 10, 2017]. J Pediatr. doi:10.1016/j.jpeds.2017.02.038
  2. Schluter N, Schmidt R, Kittel R, Tetzlaff A, Hilbert A. Loss of control eating in adolescents from the community. Int J Eat Disord. 2015;49:413-420.
  3. Glasofer DR, Tanofsky-Kraff M, Eddy KT, et al. Binge eating in overweight treatment-seeking adolescents.J Pediatr Psychol. 2006;32:95-105.
  4.  Tanofsky-Kraff M, Marcus MD, Yanovski SZ, Yanovski JA. Loss of control eating disorder in children age 12 years and younger: proposed research criteria. Eat Behav. 2008;9:360-365.
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