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What Aberrant Eating Patterns Can Promote Overweight in Youths?

Aberrant overeating patterns involve eating for reasons that are not motivated by biological hunger and refer to a range of eating behaviors that involve a lack of ability to regulate food intake, including binge eating, LOC eating, emotional eating, eating in secret, and eating in the absence of hunger (EAH).

Binge Eating

According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000), binge eating is defined as eating an objectively large amount of food and experiencing a sense of loss of control over eating. Both of these criteria (loss of control and objective overeating) must be present to diagnose a binge episode. LOC eating, an aberrant eating behavior that is defined later in this chapter, differs from binge eating because only the experience of LOC is required, with or without the consumption of unambiguously large amounts of food. At this time, prevalence estimates of binge eating are 2% to 40% in youths depending on age and characteristics (e.g., community vs. weight-loss treatment seeking) of the sample studied (Glasofer et al., 2006; Lamerz et al., 2005; Tanofsky-Kraff et al., 2004).

Binge eating disorder, however, is relatively uncommon in youths, with a rate of approximately 1% (Ackard, Fulkerson, & Neumark-Sztainer, 2007; Decaluwe & Braet, 2003). The current fourth text revision of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) requires the presence of objective binge eating at least twice a week, on average, for a duration of 6 months for a diagnosis of binge eating disorder (BED) to be made, thus excluding youths who report objective binge eating at a lower frequency or those who report recurrent subjective binge eating. It has been suggested that in the upcoming fifth edition of the Diagnostic and Statistical Manual, the frequency threshold for objective binge eating be lowered to once per week, but this change would still exclude individuals reporting subjective binge episodes. Low prevalence rates are likely related to stringent diagnostic criteria that exclude youths who report binge eating at a lower frequency than defined or who only endorse subjective binge eating, defined as LOC eating episodes that are not unambiguously large but are considered large by the respondent. Furthermore, the criteria for BED were developed for adults and thus may not include eating disturbances that may present differently in youth disorders (Marcus & Kalarchian, 2003; Tanofsky-Kraff, Marcus, Yanovski, & Yanovski, 2008).

Cross-sectional data have suggested that a clear relationship exists between binge eating episodes and overweight or obesity in childhood. Among young children, parent reports of a child's binge eating were correlated with the child's overweight status (Lamerz et al., 2005). In a large school-based study, an adolescent's self-report of binge eating in the past month was associated with higher body weight (Field, Colditz, & Peterson, 1997). In another school-based sample, overweight adolescents were more likely to report binge eating than their normal-weight peers (Neumark-Sztainer, Butler, & Palti, 1995). Similar findings have been reported in other adolescent school-based samples using survey methods (Ackard et al., 2003). Children and adolescents with binge eating also tend to have increased psychopathology (e.g., depressive symptoms and disordered eating attitudes) compared with children and adolescents who do not binge eat (Goossens, Braet, & Decaluwe, 2007; Goossens, Soenens, & Braet, 2009; Tanofsky-Kraff, 2008).

Longitudinal studies have shown that binge eating predicts weight gain among youths. Binge eating was associated with weight gain (Stice, Cameron, Killen, Hayward, & Taylor, 1999) and obesity onset (Stice, Presnell, & Spangler, 2002) over a 4-year period in a sample of community youths. In another large community study of youths ages 9 to 14, boys, but not girls, who reported binge eating gained significantly more weight than those who do not binge eat (Field et al., 2003). Among 6- to 12-year-old children who were overweight or who had a parent who was overweight, self-reported binge eating episodes predicted greater increases in body fat mass (Tanofsky-Kraff et al., 2006). Additionally, binge eating predicted depressive symptoms in a community sample of adolescents (Presnell, Stice, Seidel, & Madeley, 2009). However, depressive symptoms were also predictive of eating pathology, suggesting that depressive and binge eating symptomatology may reciprocally influence one another over time.

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