Eating Behaviors 17 (2015) 86–89

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Eating Behaviors

A comparison of eating disorder psychopathology, appearance satisfaction, and self-esteem in overweight and obese women with and without binge eating Sylvia Herbozo a,⁎, Lauren M. Schaefer b, J. Kevin Thompson b a b

Department of Psychology, Loma Linda University, 11130 Anderson Street, Loma Linda, CA 92350, United States Department of Psychology, University of South Florida, 4202 East Fowler Avenue, Tampa, FL 33620, United States

a r t i c l e

i n f o

Article history: Received 29 July 2014 Received in revised form 15 December 2014 Accepted 28 January 2015 Available online 4 February 2015 Keywords: Binge eating Overweight/obese College students

a b s t r a c t This study investigated the differences in eating disorder psychopathology, appearance satisfaction, and selfesteem between 194 overweight/obese college women with and without binge eating. Participants were categorized as binge eating (BE; n = 56) or non-binge eating (NBE; n = 138) based on reports of binge eating at least once per week on average for the past 28 days and no episodes of vomiting or laxative use in the past 28 days. The BE group had significantly greater levels of eating, weight, and shape concerns and lower levels of appearance satisfaction and self-esteem than the NBE group. For the BE group, binge eating frequency was negatively correlated with dietary restraint. Results are generally consistent with studies utilizing clinical and community samples. The findings extend such research by examining binge eating in a sample of overweight and obese college women and indicating that overall appearance satisfaction is lower among women with binge eating. Study findings also highlight potential issues to address in obesity and binge eating intervention efforts for college populations. Future research is needed to replicate these findings in additional samples of college women and men. © 2015 Published by Elsevier Ltd.

1. Introduction Binge eating disorder (BED) has a lifetime prevalence estimate of 3.5% in adult women (Hudson, Hiripi, Pope, & Kessler, 2007) and may occur at higher rates among college students. In college women, the prevalence of severe binge eating symptoms and BED has been estimated at 44% and 8.4%, respectively (Napolitano & Himes, 2011). College students may have an elevated risk for binge eating onset given the average age of binge eating and BED onset occurs between 18 and 25 (Stice, Killen, Hayward, & Taylor, 1998; Stice, Marti, & Rohde, 2013). Longitudinal research has shown that college students are also at an increased risk for weight gain, especially during early college years (Lloyd-Richardson, Bailey, Fava, & Wing, 2009; Racette, Deusinger, Strube, Highstein, & Deusinger, 2005), which may lead to overweight and obesity. Binge eating is strongly associated with overweight and obesity (Wilfley, Wilson, & Agras, 2003). In clinical samples, 23%–46% of obese individuals report binge eating (Bulik, Sullivan, & Kendler, 2002). There is also evidence indicating that higher body mass index (BMI) is linked to greater binge eating severity in college women with overweight and obese women at an increased risk for BED (Napolitano & Himes, 2011). Further, binge eating is associated with elevated eating disorder ⁎ Corresponding author. E-mail address: [email protected] (S. Herbozo).

http://dx.doi.org/10.1016/j.eatbeh.2015.01.007 1471-0153/© 2015 Published by Elsevier Ltd.

psychopathology (Wonderlich, Gordon, Mitchell, Crosby, & Engel, 2009), increased body dissatisfaction (Ahrberg, Trojca, Nasrawi, & Vocks, 2011) and decreased self-esteem (Pasold, McCracken, & WardBegnoche, 2013). Although obesity is itself associated with negative outcomes (Haslam & James, 2005), clinical studies indicate that among obese individuals, those with BED experience greater eating disorder psychopathology, psychiatric and medical comorbidity, impairment in social and occupational functioning, and reduced quality of life than those without BED (Bulik et al., 2002; Wilfley et al., 2003). Thus, binge eating seems to compound physical and psychosocial problems among obese individuals. While several studies have examined binge eating (Bulik et al., 2002; Wonderlich et al., 2009), relatively few studies have been conducted with college students. This is particularly true for overweight and obese college students, a subgroup of the college population in which binge eating is likely to occur at higher rates. Extant studies utilizing college samples have investigated binge eating in first-year college students (e.g., Barker & Galambos, 2007) and gender and ethnic groups (e.g., Mitchell & Mazzeo, 2004; Napolitano & Himes, 2011), with little attention to weight groups. Research examining binge eating and its correlates among overweight and obese college students is warranted given that these individuals may be at greater risk for BED. Such research can inform both obesity and binge eating intervention efforts by highlighting areas to address during a critical period when college students are susceptible to weight gain.

S. Herbozo et al. / Eating Behaviors 17 (2015) 86–89

The current study investigated eating disorder psychopathology, appearance satisfaction, and self-esteem in overweight/obese college women with and without binge eating. Based on prior research, we hypothesized that women with binge eating would report greater eating disorder psychopathology and less appearance satisfaction and self-esteem than women without binge eating. Further, consistent with studies examining correlates of binge eating, it was expected that greater binge eating as indexed by binge eating frequency would be associated with greater eating disorder psychopathology and lower appearance satisfaction and self-esteem in women with binge eating. 2. Materials and methods 2.1. Participants Participants were 194 overweight (n = 114) or obese (n = 80) undergraduate women from a sample of 1151 undergraduate women who participated in a study examining appearance attitudes. The following inclusion criteria were used for the current study: a) ages 18 to 30, b) BMI of 25 or higher, c) either at least one episode of binge eating per week on average in the past 28 days or no such episodes, and d) no episodes of vomiting or laxative use in the past 28 days. Participants' mean age was 20.39 (SD = 2.51). Fifty percent of the sample was nonHispanic White, 20.6% African American, 13.9% Hispanic, 2.1% Asian American, and 11.3% other. BMI ranged from 25.06 to 46.60 (M = 29.92, SD = 4.37). 2.2. Measures 2.2.1. Demographics Participants reported age, height, weight, and ethnicity. Based on research indicating good reliability between self-reported and measured height and weight in college samples (Quick et al., 2014), self-reported height and weight were used to calculate BMI. 2.2.2. EDE-Q The Eating Disorder Examination — Questionnaire (EDE-Q; Fairburn & Beglin, 1994) is the self-report version of the Eating Disorder Examination (EDE; Fairburn & Cooper, 1993) that focuses on the main features of eating disorders occurring in the past 28 days and contains four subscales: Dietary Restraint, Eating Concern, Weight Concern, and Shape Concern. This questionnaire was used to assess frequency of objective binge episodes (i.e., consuming a large amount of food accompanied by loss of control) and eating disorder psychopathology. The EDE-Q has received empirical support for the assessment of binge eating (Mond, Hay, Rogers, Owen, & Beumont, 2004) and has demonstrated adequate internal consistency and test–retest reliability (Luce &

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Crowther, 1999). In the current study, the EDE-Q subscales had good internal consistencies (Cronbach's alphas = .82–.91). 2.2.3. MBSRQ-AE The 7-item Multidimensional Body–Self Relations Questionnaire — Appearance Evaluation subscale (MBSRQ-AE; Brown, Cash, & Mikulka, 1990) assesses the respondent's satisfaction with overall physical appearance using a 5-point Likert scale ranging from definitely disagree to definitely agree. All subscale items were used in scoring. The MBSRQAE has shown adequate internal consistency (Brown et al., 1990). High internal consistency (Cronbach's alpha = .92) was found for the MBSRQ-AE in the current study. 2.2.4. RSES The 10-item Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1965) is a measure of global self-esteem. It uses a 4-point Likert-type scale ranging from strongly agree to strongly disagree. All items were used in scoring. The RSES has shown adequate internal consistency and high test–retest reliability (Robins, Hendin, & Trzesniewski, 2001). In the current study, the RSES demonstrated high internal consistency (Cronbach's alpha = .91). 2.3. Procedure Participants were recruited online from the undergraduate psychology research pool at a large southeastern university. Students interested in completing the study provided electronic informed consent and responded to questionnaires online. This method of data collection is widely-used and has been validated with numerous psychological measures (Vallejo, Jordan, Diza, Comeche, & Ortega, 2007). Participants received extra course credit as compensation. This study was approved by the university's institutional review board. 2.4. Data analysis Two groups were created based on responses to the EDE-Q item assessing frequency of binge eating. Consistent with the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; APA, 2013) frequency criteria for BED, participants who reported at least one objective binge episode per week on average and no episodes of vomiting or laxative use for the past 28 days were categorized into the binge eating (BE) group (n = 56). Participants who indicated no episodes of binge eating, vomiting, or laxative use in the past 28 days were categorized into the non-binge eating (NBE) group (n = 138). This method of identifying clinical versus control groups has been utilized in prior research on binge eating (Masheb, Grilo, & White, 2011). Group differences in BMI, eating disorder psychopathology, appearance satisfaction, and self-esteem were examined using independent samples t-tests with Bonferroni adjustments. Each comparison was

Table 1 Comparisons of BE and NBE groups on body mass indices, eating disorder features, appearance satisfaction, and self-esteem. BE (n = 56)

Body mass index Overweight (%) Obese (%) EDE-Q binge episodes/month⁎ EDE-Q Restraint EDE-Q Eating Concern⁎ EDE-Q Shape Concern⁎ EDE-Q Weight Concern⁎ MBSRQ-AE⁎ RSES⁎

NBE (n = 138)

t-Test

Effect size

M

SD

M

SD

df

30.79 46.4 53.6 9.07 3.44 3.31 5.23 4.91 2.52 2.72

5.02

29.56 63.8 36.2 0.00 2.83 1.71 3.92 3.80 2.94 3.10

4.04

192

1.79

.075

0.270

0.00 1.62 .95 1.72 1.59 .95 .59

192 190 220 217 217 218 218

19.28 2.34 8.79 5.09 4.56 2.77 4.12

b.001 .020 b.001 b.001 b.001 .006 b.001

2.163 0.368 1.256 0.852 0.757 0.449 0.689

5.93 1.69 1.53 1.33 1.33 .92 .51

t

p

Cohen's d

Note. BE = binge eating group; NBE = non-binge eating group; EDE-Q = Eating Disorder Examination — Questionnaire. MBSRQ-AE = Multidimensional Body–Self Relations Questionnaire — Appearance Evaluation subscale; RSES = Rosenberg Self-Esteem Scale. ⁎ Significant difference between BE and NBE based on Bonferroni correction alpha level of 0.007.

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Table 2 Correlations of body mass indices, eating disorder features, appearance satisfaction, and self-esteem by group.

1. Body mass index 2. EDE-Q binge episodes/month 3. EDE-Q Restraint 4. EDE-Q Eating Concern 5. EDE-Q Shape Concern 6. EDE-Q Weight Concern 7. MBSRQ-AE 8. RSES

1

2

3

4

5

6

7

8

– .21⁎ −.20 −.23 .17 .17 −.36⁎⁎ −.12

– – −.35⁎⁎ −.01 −.11 −.19 .11 .07

.08 – – .50⁎⁎ .56⁎⁎ .53⁎⁎ −.40⁎⁎ −.37⁎⁎

.14 – .55⁎⁎ – .73⁎⁎ .67⁎⁎ −.53⁎⁎ −.55⁎⁎

.14 – .50⁎⁎ .61⁎⁎ – .88⁎⁎ −.74⁎⁎ −.47⁎⁎

.21⁎ – .52⁎⁎ .65⁎⁎ .92⁎⁎ – −.63⁎⁎ −.52⁎⁎

−.20⁎ – −.43⁎⁎ −.43⁎⁎ −.75⁎⁎ −.70⁎⁎ – .58⁎⁎

−.04 – −.30⁎⁎ −.31⁎⁎ −.39⁎⁎ −.38⁎⁎ .40⁎⁎ –

Note. BMI = body mass index; EDE-Q = Eating Disorder Examination — Questionnaire. MBSRQ-AE, Multidimensional Body–Self Relations Questionnaire — Appearance Evaluation subscale; RSES = Rosenberg Self-Esteem Scale. Intercorrelations for the binge eating group are presented in the lower diagonal and values in upper diagonal represent the non-binge eating group. ⁎ p b .05. ⁎⁎ p b .01.

tested at a significance level of .007 (.05/7). Associations between variables were examined for each group using Pearson product–moment correlations. 3. Results Significant group differences were found on eating disorder psychopathology, appearance satisfaction, and self-esteem (see Table 1). The BE group had greater eating, shape, and weight concerns and lower appearance satisfaction and self-esteem compared to the NBE group. The two groups did not differ significantly on BMI or dietary restraint. Table 2 summarizes correlations between binge eating frequency, eating disorder psychopathology, appearance satisfaction, and self-esteem. For the BE group, binge eating frequency was negatively correlated with dietary restraint. 4. Discussion As predicted, overweight/obese college women with binge eating reported greater eating disorder psychopathology and less appearance satisfaction and self-esteem than overweight/obese college women without binge eating. More specifically, women with binge eating reported more eating concern (e.g., fear of losing control over eating, preoccupation with food) compared to women without binge eating, which coincides with research utilizing clinical samples (Wilfley, Schwartz, Spurrell, & Fairburn, 2000). Notably, the binge eating and non-binge eating groups exhibited similar levels of dietary restraint. This supports research indicating that while elevated dietary restraint is characteristic of anorexia nervosa and bulimia nervosa, BED is not associated with dietary restraint and levels of such restraint are similar between BED patients and overweight patients (Wilfley et al., 2000). Consistent with prior research (Pasold et al., 2013; Wilfley et al., 2000), overweight/obese college women with binge eating also indicated more distress and preoccupation regarding their shape and weight and lower overall appearance satisfaction and self-esteem in comparison to women without binge eating. The effect sizes for these group differences (.45–1.26) were in the recommended minimum to moderate effect size range based on guidelines for interpreting effect sizes (Ferguson, 2009). Longitudinal research suggests that body dissatisfaction may place individuals at risk for subsequent increases in binge eating, unhealthy weight control behaviors, and weight gain (NeumarkSztainer, Paxton, Hannan, Haines, & Story, 2006). Further, improvements in body satisfaction and self-esteem have been shown to longitudinally predict binge eating cessation (Goldschmidt, Wall, Loth, Bucchianeri, & Neumark-Sztainer, 2014). These findings suggest the increased appearance concerns and low self-esteem in overweight/obese college women with binge eating may pose a barrier to weight loss efforts. Special attention may be given to addressing such issues in order to allow for better weight loss outcomes among this group.

Interestingly, although overweight/obese college women with binge eating reported poorer body image, frequency of binge eating was not associated with eating concern, body image concerns, or self-esteem. This is somewhat inconsistent with literature on college samples indicating that binge eating severity is associated with body dissatisfaction and weight concern (Barker & Galambos, 2007; Barker, Williams, & Galambos, 2006). Importantly, these studies utilized the Binge Eating subscale of the Minnesota Eating Behavior survey (von Ranson, Klump, Iacono, & McGue, 2005), which assesses the presence or absence of binge eating symptoms, such as feeling out of control while eating and eating when upset, not captured by the EDE-Q binge eating frequency item. This EDE-Q item also does not include all eating episodes with loss of control (i.e., subjective binges in which an individual does not consume an objectively large amount of food, but experiences a sense of losing control), nor does it reflect the severity of the loss of control while eating. Thus, it is possible that body image concerns may be more closely related to emotions and cognitions associated with binge eating rather than binge eating frequency. Limitations of the current study include: 1) the use of a self-report questionnaire to identify binge eating, which did not include supplemental definitions of binge eating and may have overestimated the episodes of binge eating; 2) lifetime history of compensatory behaviors were not assessed, which does not allow for prior episodes of such behaviors to be ruled out; 3) the inclusion of only women, limiting the generalizability of the results to men; and 4) the use of a crosssectional design, which does not allow for the examination of causal relationships. Given the relative dearth of research on binge eating in overweight and obese college populations who are at increased risk for binge eating, the use of a non-clinical overweight/obese college sample as well as an ethnically diverse sample are notable strengths of the current study. To our knowledge, this is the first study to examine eating disorder psychopathology, appearance satisfaction, and self-esteem among overweight/obese college women with and without binge eating. Study findings suggest that college women with elevated BMI values and clinical levels of binge eating evidence greater eating and body image concerns as well as lower self-esteem which may be potential issues to target in obesity and binge eating intervention efforts for at-risk college students. Future research with additional samples of college women and men is needed to inform the development of interventions that result in decreased weight gain and binge eating in college populations. Role of funding sources No financial support was provided for this study.

Contributors Sylvia Herbozo designed the study, conducted the analyses, and wrote the manuscript. Lauren Schaefer supervised data collection and wrote the manuscript. Kevin Thompson contributed to the discussion and reviewed/edited the manuscript. All authors contributed to and have approved the final manuscript.

S. Herbozo et al. / Eating Behaviors 17 (2015) 86–89 Conflict of interest There are no conflicts of interest by any author. Acknowledgments There are no acknowledgments.

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