Examining Body Image Constructs in Adults With Eating, Weight Disorders

Investigators examined different body image constructs and clinical measures in individuals with eating and/or weight disorders.

Adults with bulimia nervosa were found to have higher levels of body image disturbances compared with adults with other eating or weight disorders, according to study results published in the Journal of Psychosomatic Research.

A total of 1017 adult patients (mean age, 36.3 years; 85.3% women) completed the Eating Disorder Examination Questionnaire to measure body image and eating disorder psychopathology, as well as the Beck Depression Inventory. Investigators categorized patients into 3 groups: overweight/obesity (n=511), bulimia nervosa (n=167), and binge-eating disorder (n=339).

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Investigators at Yale University in New Haven, Connecticut, compared the 3 groups on body image constructs (dissatisfaction, overvaluation, preoccupation, and fear of weight gain) and clinical measures (body mass index, binge eating frequency, eating concern and restraint, and depression) with a general linear model analysis of variance. In the 3 groups, analyses showed medium effect sizes for dissatisfaction, overvaluation, and fear and a large effect size for preoccupation. Post-hoc analyses showed a consistent severity gradient for overvaluation, preoccupation, and fear of weight gain and for all clinical measures.

Body image disturbances were highest in subjects with bulimia nervosa, followed by patients with binge-eating disorder and then by the overweight/obesity group. Body dissatisfaction was lower in the overweight/obesity group than in the bulimia nervosa and binge-eating disorder groups, which did not differ significantly from each other. Significant patterns across all groups included dissatisfaction with body mass index, preoccupation and fear with eating concerns and restraint, and overvaluation with depression.

The investigators noted that the findings were gathered online from respondents in the community, potentially making them not generalizable to populations seeking treatment.

The study carries possible ramifications for treatment. The investigators stated, “Our findings that depressive distress is strongly associated with overvaluation across all three groups…could suggest that clinicians help patients identify depression not just as a symptom but as a potential trigger.”


Grilo CM, Ivezaj V, Lydecker JA, White MA. Toward an understanding of the distinctiveness of body-image constructs in persons categorized with overweight/obesity, bulimia nervosa, and binge-eating disorder. J Psychosom Res. 2019;126:109757.