Dieting, Dietary Restraint, and Binge Eating Disorder among Overweight Adolescents in Turkey

Article excerpt


Eating disorders are characterized by severe disturbances in eating behavior. During the past 20 years, a great deal of attention has been devoted to eating disorders in women. The number of publications on anorexia nervosa and binge eating disorder has grown exponentially during this period. According to a report from the World Health Organization (1998), obesity is increasing worldwide at an alarming rate in both developed and developing countries. This is a matter of concern because obesity increases the risks for many serious illnesses, such as diabetes, mellitus, hypertension, dyslipedemia, coronary artery disease, and some forms of cancer (Solomon & Manson, 1997).

Further, the findings of a recent study (Croll, Neumark-Sztainer, Story, & Ireland, 2002) suggest that disordered eating is very prevalent among youth, with at least one of the following--fasting, skipping meals to lose weight, use of diet pills, vomiting, taking laxatives, smoking cigarettes, and binge eating--being recently reported by a staggering 56% of 9th-grade females and 28% of 9th-grade males. Reports of dieting, fear of fatness, body image concerns, and weight loss attempts, as well as cases of more serious eating disorders have been documented in children as young as seven years of age (Ricciardelli & McCabe, 2001). Accordingly, these authors identify several potential risk factors grouped into five broad categories. Based on this analysis the present study included measures of demographics (age, degree of obesity), weight history (age of obesity onset), social/environmental influences (peer interpersonal relationships), cognitive factors (body image dissatisfaction, self-esteem) and eating behavior (dieting, binge eating). The TFEQ was developed by Sunkard and Messick in 1985; it consists of three different scales: restraint, disinhibition, and susceptibility to hunger. The restraint scale is designed to assess only cognitive eating restraint. It has been hypothesized that social class differences in eating behaviors and cognitions, such as dietary restraint, might account for part of the gradient in overweight and obesity (Sobel & Stunkar, 1989; Wardle & Griffith, 2001). Restraint theory (Herman & Mack, 1975; Herman & Polivy, 1984) was developed as a way to understand the psychological basis of eating behaviors and disorders, including obesity and anorexia. Restrained eaters are individuals who consciously restrict their dietary intake as a means of losing or maintaining weight (Polivy & Herman, 1985).

Although dietary restraint is recognized as an important risk variable, a clearer understanding of the association between dietary restraint and other personal characteristics is needed before decisions for prevention can be made. Recently Carter, Stewart, Dunn, and Fairburn (1997) demonstrated that a school-based eating disorder prevention program, designed to reduce dietary restraint in schoolgirls, did more harm than good. Fairburn et al. (1998) investigated dieting vulnerability factors in a community-based study and found that, among other things, childhood obesity and exposure to negative comments about weight, shape or eating were more prevalent among bulimia cases and in binge eaters.

Current findings point to a direct association in the increase in BMI with concerns about eating, weight, and shape with dietary restraint and with binge eating. Moreover, half the subjects who reported binge eating were above the 90th percentile for BMI. Hence, further strength is added to the suggestion that being overweight might predispose persons to or be a consequence of disturbed eating (Fombonne, 1995). Clearly, development of self-esteem as a protective factor against body dissatisfaction and disordered eating was strongly identified in the late 1980s and early 1990s (O'dea, 2004). Because there is evidence that obese children and adolescents who are binge eaters are different from the obese non-binge eaters in self-esteem and in a broad range of eating-related characteristics (Decaluwe, Braet, & Fairburn, 2003), special strategies that focus on the problems of obese binge eaters might be warranted. …