Binge Eating in Obese Persons
SUSAN Z. YANOVSKI
Binge eating is a common and serious problem in individuals with obesity. Depending on how it is defined, more than one-third of obese individuals undergoing weight loss treatment report difficulties with binge eating, although far fewer meet criteria for binge eating disorder (BED) when assessed by a clinical interview (see Chapters 18 and 31).
Binge eating, according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, is characterized by eating, in a discrete period of time, an amount that is larger than most others would consume in similar circumstances, and is accompanied by a sense of loss of control over what or how much one is eating. Both of these criteria (objectively large amount of food and loss of control) are necessary for an episode to be considered an objective binge. Many people report loss of control alone (without consuming a large amount of food), objective overeating without loss of control, or both loss of control and overeating, and it is common for individuals to report all three types of episodes at different times. When binge eating is frequent (i.e., more than twice weekly) and accompanied by behavioral indicators of loss of control and distress, BED may be diagnosed.
Occasional binge eating is commonly reported by overweight as well as nonoverweight persons. It is not known whether subthreshold binge eating carries the same prognostic significance as that of binge eating disorder. Some studies suggest similar psychopathology and distress.
Binge eating in obese persons who do not purge or engage in other inappropriate compensatory behaviors appears to differ somewhat from the binge eating seen in those with