0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Article |

Binge Eating and Weight Loss Outcomes in Overweight and Obese Individuals With Type 2 Diabetes:  Results From the Look AHEAD Trial FREE

Amy A. Gorin, PhD; Heather M. Niemeier, PhD; Patricia Hogan, MS; Mace Coday, PhD; Cralen Davis, MS; Vicki G. DiLillo, PhD; Marci E. Gluck, PhD; Thomas A. Wadden, PhD; Delia S. West, PhD; Donald Williamson, PhD; Susan Z. Yanovski, MD; Look AHEAD Research Group
[+] Author Affiliations

Author Affiliations: Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, Storrs (Dr Gorin); Brown Medical School, The Miriam Hospital, Providence, Rhode Island (Dr Niemeier); Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina (Ms Hogan and Mr Davis); Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis (Dr Coday); Department of Psychology, Ohio Wesleyan University, Delaware (Dr DiLillo); Obesity and Diabetes Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona (Dr Gluck); Department of Psychiatry, University of Pennsylvania, Philadelphia (Dr Wadden); Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock (Dr West); Pennington Biomedical Research Center, Louisiana State University, Baton Rouge (Dr Williamson); and Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland (Dr Yanovski).


Arch Gen Psychiatry. 2008;65(12):1447-1455. doi:10.1001/archpsyc.65.12.1447.
Text Size: A A A
Published online

Context  Binge eating (BE) is common in overweight and obese individuals with type 2 diabetes mellitus, but little is known about how BE affects weight loss in this population.

Objective  To determine whether BE was related to 1-year weight losses in overweight and obese individuals with type 2 diabetes participating in an ongoing clinical trial.

Design, Setting, and Participants  The Look AHEAD (Action for Health in Diabetes) trial is a randomized controlled trial examining the long-term effect of intentional weight loss on cardiovascular disease in overweight and obese adults with type 2 diabetes. A total of 5145 overweight and obese individuals aged 45 to 76 years with type 2 diabetes participated in this study.

Interventions  Participants were randomly assigned to an intensive lifestyle intervention or to enhanced usual care (a diabetes support and education control condition).

Main Outcome Measures  At baseline and 1 year, participants had their weight measured and completed a fitness test and self-report measures of BE and dietary intake. Four groups were created based on BE status at baseline and 1 year (yes/yes, no/no, yes/no, and no/yes). Analyses controlled for baseline differences between binge eaters and non–binge eaters.

Results  Most individuals (85.4%) did not report BE at baseline or 1 year (no/no), 7.5% reported BE only at baseline (yes/no), 3.7% reported BE at both times (yes/yes), and 3.4% reported BE only at 1 year (no/yes), with no differences between intensive lifestyle intervention and diabetes support and education conditions (P = .14). Across intensive lifestyle intervention and diabetes support and education, greater weight losses were observed in participants who stopped BE at 1 year (mean [SE] weight loss, 5.3 [0.4] kg) and those who reported no BE at either time (mean [SE] weight loss, 4.8 [0.1] kg) than in those who continued BE (mean [SE] weight loss, 3.1 [0.6] kg) and those who began BE at 1 year (mean [SE] weight loss, 3.0 [0.6] kg) (P < .001). Post hoc analyses suggested that these differences were due to changes in caloric intake.

Conclusion  Overweight and obese individuals with type 2 diabetes who stop BE appear to be just as successful at weight loss as non–binge eaters after 1 year of treatment.

Trial Registration  clinicaltrials.gov Identifier: NCT00017953

Figures in this Article

Binge eating (BE) is common among overweight and obese individuals seeking weight loss treatment,1,2 and there is some indication that it is associated with poor treatment compliance.36 Some have suggested that BE needs to be addressed prior to weight loss,7,8 but empirical support for this recommendation is lacking. Research indicates that behavioral weight loss treatment does not exacerbate or precipitate BE,9,10 that BE status is not associated with weight loss outcomes,5,11,12 and that BE may in fact improve with weight loss treatment.13,14

Binge eating is prevalent in overweight and obese individuals with type 2 diabetes mellitus,13,15,16 with rates of binge eating disorder (BED) in this population ranging from 1.4% to 9%.1719 A recent study17 examining 845 overweight and obese individuals with type 2 diabetes seeking entry into weight loss treatment found that 5.6% of individuals reported 8 or more objective BE episodes in the prior month and 1.4% met full diagnostic criteria for BED. Despite the frequency of BE in overweight and obese individuals with type 2 diabetes, little is known about how this behavior affects weight loss outcomes in this high-risk population. Gaining a better understanding of this relationship is clinically relevant and may have implications for future treatment recommendations.

The Look AHEAD (Action for Health in Diabetes) trial provides a unique opportunity to examine BE in overweight and obese individuals with type 2 diabetes because of its large and demographically diverse patient population. Look AHEAD is a randomized controlled trial examining the long-term effects of interventions designed to produce weight loss on cardiovascular morbidity and mortality in more than 5000 individuals with type 2 diabetes followed for up to 11.5 years.20 In this study, we examined whether Look AHEAD participants who reported BE at study entry differed from those who did not on baseline demographics, anthropometrics, health-related and lifestyle variables, and psychosocial factors. We examined the stability of BE and whether weight loss treatment was associated with the development of BE during the first year of study participation. We also assessed whether 1-year weight loss outcomes were related to baseline BE status or changes in BE status during the first year of treatment.

PARTICIPANTS

The Look AHEAD trial design and study participants have been described in detail elsewhere.20 Briefly, individuals with type 2 diabetes interested in weight loss were recruited from 16 clinical centers in the United States. To participate, individuals had to be aged 45 to 76 years and have a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or higher (≥27 if receiving insulin). Individuals with inadequate diabetes control (ie, a glycated hemoglobin level >11%) or with factors likely to affect intervention adherence, safety (eg, underlying serious medical or psychological conditions), or retention (eg, plans to move out of the area) were excluded from the trial. All of the participants provided informed consent as approved by each site's institutional review board.

Eligible participants (n = 5145) were randomly assigned to an intensive lifestyle intervention (ILI) or to a diabetes support and education (DSE) control condition. The ILI was modeled after the Diabetes Prevention Program lifestyle intervention.21 The goals of the intervention were to produce a mean weight loss of at least 7% of initial weight through caloric restriction (ie, diet of 1200-1800 kcal/d) and increased physical activity (≥175 minutes per week of moderately intense activity).22 To achieve these goals, ILI participants were offered 3 group meetings and 1 individual meeting each month during months 1 through 6 and 2 group meetings and 1 individual session per month during months 7 through 12. The DSE participants were offered 3 group meetings per year and were given basic information on diabetes, nutrition, and physical activity.

DEFINITION OF BE GROUPS

Binge eating was assessed via a self-report questionnaire based on the Questionnaire on Eating and Weight Patterns.23 We identified participants who indicated having any episode(s) of eating a large amount of food in a short amount of time, reported feeling out of control, and denied any compensatory behaviors (559 participants [11.7%]) during the past 6 months. For the comparison group, we identified participants who reported no BE episodes or compensatory behaviors (4222 participants [88.3%]). Individuals who reported compensatory behaviors (ie, purging or excessive exercise; 332 participants) or were missing data on the items used to determine BE behavior (32 participants) were excluded. We chose to examine BE behavior as opposed to full-criteria BED as defined by the DSM-IV for several reasons. First, many more participants reported BE behavior (11.7%) than met DSM-IV criteria for BED (n = 123; 2.6%), allowing for more power to complete analyses. In addition, very little research has examined the effects of these behaviors (in the absence of an eating disorder) in the context of a behavioral weight study among type 2 diabetic individuals. Also, examining BE behavior, which is easily assessed via self-report, rather than a diagnosis of BED, which is best done via structured interview, may have more clinical applications among health care professionals.

MEASURES
Demographics and Anthropometric Characteristics

Participants provided basic demographic information regarding sex, race/ethnicity, marital status, and educational background at baseline. Weight was measured at baseline and 1 year on a digital scale in lightweight clothing. Height was measured at baseline on a wall-mounted stadiometer.

Diabetes Variables

At baseline, participants indicated the number of years since being diagnosed with diabetes and their current diabetes treatment regimen (ie, diet only, oral medications without insulin, or insulin). Plasma was collected at baseline and glycated hemoglobin level (measured by a dedicated ion-exchange high-performance liquid chromatography instrument [Bio-Rad Variant 11; Bio-Rad Laboratories, Hercules, California]) was used as a measure of glycemic control during the past 3-month period.

Dietary Intake

Reported dietary intake was assessed on a subsample of the Look AHEAD participants (n = 2411) using a self-administered 130-item food frequency questionnaire, modified from the Insulin Resistance Atherosclerosis Study,24 that assessed usual consumption during the prior 6-month period. We examined reported daily intake of energy as well as percentage of energy intake from fat, protein, and carbohydrates for those participants included in the subsample at baseline and 1 year.

Fitness Level

Participants completed a graded exercise test that was designed to elicit maximal effort at baseline and submaximal effort at 1 year.25 Peak exercise capacity expressed as metabolic equivalents was estimated from treadmill speed and grade.

Weight Loss History

At baseline, participants indicated the number of times (0, 1-2, 3-4, 5-6, or ≥7 times) they had intentional weight losses of 5 to 9 lbs, 10 to 19 lbs, 20 to 49 lbs, 50 to 79 lbs, 80 to 99 lbs, and 100 lbs or more (to convert pounds to kilograms, multiply by 0.45). We examined the number of previous weight loss attempts (using the lower end of the frequency intervals and summing across categories) and the total amount of past intentional weight loss (defined as the frequency of weight loss attempts multiplied by the amount of weight loss achieved, using the lower end of the frequency and amount intervals and summing across categories).26

Mood and General Health

The Beck Depression Inventory II was used to measure depressive symptoms.26 The Beck Depression Inventory II has been shown to have high internal consistency, test-retest reliability, and construct validity.27 The 36-Item Short Form Health Survey version 2, a widely used, validated measure, was used to assess general health.28 Participants also reported the number of prescription medications they were currently receiving. These measures were assessed at baseline.

Tobacco and Alcohol Use

Tobacco and alcohol use was assessed at baseline and 1 year by self-report. Participants indicated whether they were a current smoker, a former smoker, or had never smoked cigarettes. Participants also reported how many alcoholic drinks (including wine, beer, and hard liquor) they typically consume per week. Binge drinking was assessed with a single item that asked participants how many days during the past month they had consumed 5 or more drinks on the same occasion.

STATISTICAL ANALYSES

Baseline characteristics were compared between binge eaters and non–binge eaters with the use of t tests for continuous variables and χ2 tests for categorical variables. To examine change in self-reported BE status over time, participants were classified according to BE status at baseline and 1 year, yielding 4 categories: those who indicated no BE at both times (no/no), those who reported BE at baseline but not at 1 year (yes/no), those who indicated no BE at baseline and reported it at 1 year (no/yes), and those who reported BE at both times (yes/yes). Multiple logistic regression was used to examine the relationship between BE at 1 year and treatment group assignment. We determined the odds ratio and 95% confidence interval of BE at 1 year associated with treatment group assignment controlling for baseline BE separately and in combination with age, race/ethnicity, sex, education level, baseline weight, number of previous weight loss attempts, total amount of weight lost, depressive symptoms, self-reported general health, number of prescription medications, and binge drinking.

Multiple linear regression was used to model the effect of BE status on weight loss at 1 year controlling for age, race/ethnicity, sex, education level, baseline weight, number of previous weight loss attempts, total amount of weight lost, depressive symptoms, self-reported general health, number of prescription medications, maximum metabolic equivalents, and binge drinking. Models were fitted for the overall cohort (also controlling for intervention group) and separately by treatment group assignment. In addition, the same models were fitted controlling for dietary covariates (reported caloric intake, percentage of fat intake, and percentage of carbohydrate intake) for the subsample of participants furnishing baseline dietary data. To further explore the weight loss differences detected among the BE status groups, we modeled the effect of BE status on change in total reported caloric intake and change in fitness controlling for the same variables noted earlier.

We also ran the primary model examining the association between BE status and weight loss outcomes using DSM-IV BED criteria rather than BE behavior. The patterns of weight loss were identical between the 2 models; however, because of reduced sample size, the BED model was not significant (P = .09) and the data are not presented. Additionally, among those reporting BE at baseline, we used the primary model to determine the relationship between baseline BE frequency and weight loss at 1 year as well as the relationship between baseline BE frequency and change in reported caloric intake.

Statistical analyses were performed with SAS statistical software version 9 (SAS Institute, Inc, Cary, North Carolina).

At baseline, 11.7% of our cohort reported having 1 or more episodes in the past 6 months when they ate a large amount of food in a short period of time and felt they could not control what or how much they were eating. Of those who reported BE episodes, 41.3% did so less than 1 day per week, 49.6% reported BE episodes on 1 to 3 days per week, and 9.2% reported BE episodes on 4 or more days per week in the past 6 months. Only 123 participants (2.6%) met DSM-IV criteria for BED based on self-report.

BASELINE DIFFERENCES

Individuals who reported any episodes of BE at baseline were younger (P < .001) and more likely to be female (P = .008), white (P < .001), and college educated (P = .003) than their non-BE counterparts (Table 1). Individuals who reported BE were also heavier (P < .001) at entry into the Look AHEAD trial and had a more extensive weight loss history both in terms of number of weight loss attempts (P < .001) and total amount lost (P < .001) (Table 2). Baseline dietary intake differed between the 2 groups, with binge eaters reporting a higher daily caloric intake (P < .001) and a greater percentage of calories from fat (P = .03). Fitness levels did not differ between the groups (for maximum metabolic equivalents, P = .66) (Table 2).

Table Graphic Jump LocationTable 1. Demographic Characteristics of Study Sample
Table Graphic Jump LocationTable 2. Baseline Weight, Diet, and Fitness Levels

Individuals reporting BE drank fewer alcoholic beverages per week (P = .02) and were less likely to report binge drinking (P = .02) than individuals who indicated no BE. Individuals reporting BE at baseline also had higher levels of depressive symptoms (P < .001), reported worse general health (P < .001), and were receiving more medications (P = .03) than individuals who indicated no BE, but there were no group differences in glycated hemoglobin level, number of years since the diabetes diagnosis, or current diabetes treatment regimen (Table 3).

Table Graphic Jump LocationTable 3. Baseline Psychological and Physical Health Variables
1-YEAR OUTCOMES

At 1 year, weight data were available for 96.4% of participants and weight and questionnaire data were available for 88.3% of participants. Individuals reporting BE at baseline were less likely to complete the full 1-year assessment (weight and questionnaire data) compared with non–binge eaters (85.2% vs 88.7%, respectively; P = .02).

Most individuals (85.4% overall; 84.9% with ILI and 85.9% with DSE) reported no BE at baseline or 1 year (no/no), 7.5% (8.3% with ILI and 6.8% with DSE) reported BE at baseline but not at 1 year (yes/no), 3.7% (4.0% with ILI and 3.5% with DSE) reported BE at both times (yes/yes), and 3.4% (2.9% with ILI and 3.8% with DSE) did not report BE at baseline but did at 1 year (no/yes). These patterns did not differ between the ILI and DSE conditions (P = .14). Overall, of those individuals who reported BE at baseline, the majority (66.8% overall; 67.6% with ILI and 65.9% with DSE) did not report the behavior at 1 year. The frequency of BE behavior at baseline (<2 days per week vs ≥2 days per week) was not associated with whether BE continued at 1 year (P = .12).

Participants randomly assigned to ILI were no more likely to binge eat at 1 year than those randomized to DSE (odds ratio for ILI vs DSE, 0.85; 95% confidence interval, 0.66-1.09; P = .20) controlling for baseline BE. After adjusting for additional covariates, ILI participants were marginally less likely to binge eat at 1 year compared with DSE participants (odds ratio, 0.77; 95% confidence interval, 0.59-1.01; P = .06). As expected, baseline BE was the most important predictor of behavior at 1 year (P < .001).

As shown in Figure 1, after controlling for baseline differences between binge eaters and non–binge eaters, there were statistically significant differences in 1-year weight losses based on BE behavior over time (P < .001) (Table 4). Specifically, individuals who reported BE at baseline but had stopped at 1 year (yes/no; mean [SE], 5.3 [0.4] kg) and individuals who reported no BE at either time (no/no; mean [SE], 4.8 [0.1] kg) had significantly better weight losses than those who continued BE (yes/yes; mean [SE], 3.1 [0.6] kg) and those who began BE by 1 year (no/yes; mean [SE], 3.0 [0.6] kg) (P < .001). There were no weight loss differences between those who reported no BE at either time and those who reported BE at baseline but not at 1 year (P = .21). Similar patterns were observed when looking separately at the ILI and DSE conditions.

Place holder to copy figure label and caption
Figure 1.

One-year weight loss by binge eating status. Yes/no indicates that the participant reported binge eating at baseline but not at 1 year; no/no, the participant did not report binge eating at either time; yes/yes, the participant reported binge eating at both times; and no/yes, the participant did not report binge eating at baseline but did at 1 year. ILI indicates intensive lifestyle intervention; DSE, diabetes support and education; and error bars, standard error. Groups with different lowercase letters are statistically different from each other.

Graphic Jump Location
Table Graphic Jump LocationTable 4. Relationship of 1-Year Weight Loss, Caloric Intake Decline, and Fitness Change to Binge Eating Behavior at Baseline and 1 Year

Given the differences in weight loss across the BE status groups, post hoc analyses were conducted to examine group differences in self-reported caloric change from baseline to 1 year in the subsample (n = 1954) who completed the dietary measure. As shown in Figure 2, participants who reported no BE at either time (no/no) and those who reported BE at baseline but not at 1 year (yes/no) reported greater decreases in caloric intake from baseline to 1 year than those who reported BE at both times (yes/yes) or those who did not report BE at baseline but did at 1 year (no/yes) (P < .001 for specific contrast and overall) (Table 4). The pattern was similar when looking separately at the ILI and DSE conditions, although some of the comparisons between BE categories were no longer significant. In addition to dietary data, we also conducted post hoc analyses to examine whether there were group differences in changes in fitness levels; however, no group differences were observed (P = .43) (Table 4).

Place holder to copy figure label and caption
Figure 2.

One-year change in reported caloric intake by binge eating status. Yes/no indicates that the participant reported binge eating at baseline but not at 1 year; no/no, the participant did not report binge eating at either time; yes/yes, the participant reported binge eating at both times; and no/yes, the participant did not report binge eating at baseline but did at 1 year. ILI indicates intensive lifestyle intervention; DSE, diabetes support and education; and error bars, standard error. Groups with different lowercase letters are statistically different from each other.

Graphic Jump Location

Among those who reported BE at baseline, there was a significant association showing that higher frequencies of self-reported BE episodes were associated with smaller 1-year weight losses (P = .03); this pattern held true when examining the ILI condition separately (P = .048) but was not found in the DSE condition (P = .62). In the subsample providing dietary intake information, there was also a trend for higher baseline BE frequency to be associated with greater caloric declines during the 1-year period among those reporting baseline BE (P = .05). This trend was more evident in the ILI condition (P = .04) than in the DSE condition (P = .35).

Finally, because of the influence substance use can have on weight, we examined whether the BE groups differed at 1 year in tobacco and alcohol use. There were no differences among the BE status groups at 1 year in the percentage of individuals who were currently smoking (P = .40) or who reported binge drinking in the past month (P = .19).

Approximately 1 in 10 overweight and obese individuals with type 2 diabetes participating in the Look AHEAD trial reported having 1 or more episodes of BE in the 6 months prior to study entry. These individuals were younger and more likely to be female, white, and college educated than their non-BE counterparts, demographic differences that are consistent with prior reports of BE in individuals with type 2 diabetes.13,15,16 As described by others,5,15 individuals reporting BE at study entry had more difficulties with weight control, were heavier, and had more extensive weight loss histories. They also consumed a diet higher in total calories and fat, replicating prior work by Yanovski and Sebring29 and by Yanovski et al.30

Individuals reporting BE in our sample reported higher levels of depressive symptoms, again consistent with the existing BE literature5,13,16; however, depression levels in this sample were quite low even among individuals reporting BE. Binge drinking was also infrequent in this sample. Of interest, however, is that at study entry we found significantly lower rates of binge drinking in binge eaters compared with non–binge eaters, a finding that supports a recent report that obese individuals are less likely to have substance use disorders than nonobese individuals.31 While concerns have been raised about shifting addictions or symptom substitution such that the dietary restrictions accompanying weight loss may lead to increases in substance use,32 our study suggests that the modest weight losses produced by a behavioral intervention are not associated with increases in either alcohol or tobacco use.

Individuals reporting BE at study entry had worse physical health, both by self-report and by medication use, than non–binge eaters, but there were no differences in glycated hemoglobin level, years since the diabetes diagnosis, or diabetes treatment regimen. Studies to date examining the connection between BE and glycemic control have found mixed results.13,15,16 This study, which examines this relationship in a much larger and more demographically diverse sample, indicates that while overall physical health may be affected by BE, diabetes control per se is not.

Fewer than 4% of participants in either the ILI or DSE group who reported no BE at baseline reported the behavior at 1-year follow-up, suggesting as others have found9,14 that behavioral weight loss treatment does not generally lead to initiation of BE behavior. In fact, those who participated in the ILI were marginally less likely to be engaging in BE behavior at 1 year than those in the DSE group. In addition, in both conditions, the majority of individuals (66.8%) who reported BE at baseline were no longer engaging in the behavior at 1 year. The reason for the instability of BE behavior is not clear. It could reflect a true improvement in BE as a result of participating in a structured program or it could mirror the natural course of BE, which has been shown to remit without treatment in many individuals in community samples.33,34

Perhaps most interesting is that 1-year weight losses were equivalent in individuals who indicated no BE at either baseline or 1 year and in individuals who reported BE at baseline but had ceased BE at 1 year. Weight losses in both of these groups were significantly better than in individuals who reported BE at both times or who started BE during the 1-year period, suggesting that BE is only problematic if it persists or starts during treatment. The differences in weight loss between those who stopped BE and those who continued or started BE, while relatively small (2 kg), may have important health implications, particularly if maintained in the long term. These improved weight losses appear to be explained by greater decreases in caloric intake in those with no BE and those who stopped BE during treatment. Many prior studies have assessed BE at the start of treatment only, perhaps accounting for some of the mixed weight loss results reported in the literature. Our findings confirm current recommendations14 that individuals who binge eat should not be discouraged from entering behavioral weight loss programs. It also supports other studies suggesting that abstinence from BE is associated with better weight loss outcomes at 1 year compared with those who continue BE.35 Given that individuals who continued BE and those who started BE during treatment did not fare as well, it would appear useful to assess BE throughout treatment rather than simply at entry into a program and to provide additional support as needed.

A limitation of this study is that we relied on a self-report measure of BE behavior. The gold standard for the assessment of BE is the Eating Disorder Examination interview.36 Self-report measures of BE are most appropriately used as a screening measure for BE behavior as opposed to a diagnostic tool. However, the brevity and minimal cost of the self-report tool used in this study increase the likelihood that screening for BE could be conducted in primary care settings or repeatedly throughout a weight loss program. In addition, self-reported BE has been shown to be consistent with the Eating Disorder Examination interview in overweight individuals who binge eat.37,38 It is also important to note that our sample was composed entirely of overweight individuals with type 2 diabetes who were seeking help to lose weight and were willing and able to participate in a long-term study. These individuals were likely very motivated to change their eating behaviors to improve their health and may not be representative of overweight individuals with type 2 diabetes as a whole. Moreover, because of the Look AHEAD trial's focus on cardiovascular outcomes, participants were required to be between the ages of 45 and 76 years, a group that may be less prone to BE than younger individuals.16,39 These individuals had also been diagnosed with diabetes on average 7 years prior to study entry and may differ from newly diagnosed patients in eating habits and diabetes management. Our results should be interpreted with these limitations in mind.

This study adds to the literature by showing that BE still occurs with some frequency in overweight and obese older adults with type 2 diabetes. Although individuals reporting BE also reported a more depressed mood and worse physical health than their non-BE peers, their diabetes control and management did not differ. Most individuals who reported BE at baseline stopped BE by 1 year, and these individuals were just as successful at weight loss as those individuals who reported no BE on both occasions. Also, few individuals started BE during the 1-year period. This study lends further support to the recommendation that BE is not exacerbated by behavioral weight loss treatment and in fact may be improved by participating in a structured weight loss program targeting lifestyle changes.

Correspondence: Amy A. Gorin, PhD, Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT 06269-1248 (amy.gorin@uconn.edu).

Submitted for Publication: March 7, 2008; final revision received July 8, 2008; accepted July 25, 2008.

Financial Disclosure: None reported.

Funding/Support: This study is supported by the Department of Health and Human Services through the following cooperative agreements from the National Institutes of Health: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, and DK56992. The following federal agencies have contributed support: National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Center on Minority Health and Health Disparities; Office of Research on Women's Health; and the Centers for Disease Control and Prevention. This research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. Additional support was received from the Johns Hopkins Medical Institutions Bayview General Clinical Research Center (grant M01RR02719); the Massachusetts General Hospital Mallinckrodt General Clinical Research Center (grant M01RR01066); the University of Colorado Health Sciences Center General Clinical Research Center (grant M01RR00051) and Clinical Nutrition Research Unit (grant P30 DK48520); the University of Tennessee at Memphis General Clinical Research Center (grant M01RR0021140); the University of Pittsburgh General Clinical Research Center (grant M01RR000056 44); the National Institutes of Health (grant DK046204); the University of Washington/Veterans Affairs Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; and the Frederic C. Bartter General Clinical Research Center (grant M01RR01346). The following organizations have committed to making major contributions to the Look AHEAD trial: FedEx Corp; Health Management Resources Corp; LifeScan, Inc, Johnson & Johnson; Optifast, Nestlé HealthCare Nutrition, Inc; Roche Pharmaceuticals; Ross Product Division, Abbott Laboratories; and Slim-Fast Foods Co.

Previous Presentation: This paper was presented at the 29th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine; March 27, 2008; San Diego, California.

Box Section Ref ID

Look AHEAD Research Group Members

Clinical Sites

Frederick L. Brancati, MD, MHS (principal investigator), Jeff Honas, MS (program coordinator), Lawrence Cheskin, MD (coinvestigator), Jeanne M. Clark, MD, MPH (coinvestigator), Kerry Stewart, EdD (coinvestigator), Richard Rubin, PhD (coinvestigator), Jeanne Charleston, RN, Kathy Horak, RD, The Johns Hopkins Medical Institutions, Baltimore, Maryland; George A. Bray, MD (principal investigator), Kristi Rau (program coordinator), Allison Strate, RN (program coordinator), Brandi Armand, LPN (program coordinator), Frank L. Greenway, MD (coinvestigator), Donna H. Ryan, MD (coinvestigator), Amy Bachand, Michelle Begnaud, Betsy Berhard, Elizabeth Caderette, Barbara Cerniauskas, David Creel, Diane Crow, Helen Guay, Nancy Kora, Kelly LaFleur, Kim Landry, Missy Lingle, Jennifer Perault, Mandy Shipp, RD, Marisa Smith, Elizabeth Tucker, Pennington Biomedical Research Center, Baton Rouge, Louisiana; Cora E. Lewis, MD, MSPH (principal investigator), Sheikilya Thomas, MPH (program coordinator), Monika Safford, MD (coinvestigator), Charlotte Bragg, MS, RD, LD, Amy Dobelstein, Stacey Gilbert, MPH, Stephen Glasser, MD, Sara Hannum, MA, Anne Hubbell, MS, Jennifer Jones, MA, DeLavallade Lee, Ruth Luketic, MA, MBA, MPH, Karen Marshall, L. Christie Oden, Janet Raines, MS, Cathy Roche, RN, BSN, Janet Truman, Nita Webb, MA, Audrey Wrenn, MAEd, The University of Alabama at Birmingham; David M. Nathan, MD (principal investigator), Heather Turgeon, RN, BS, CDE (program coordinator), Kristina Schumann, BA (program coordinator), Enrico Cagliero, MD (coinvestigator), Linda Delahanty, MS, RD (coinvestigator), Kathryn Hayward, MD (coinvestigator), Ellen Anderson, MS, RD (coinvestigator), Laurie Bissett, MS, RD, Richard Ginsburg, PhD, Valerie Goldman, MS, RD, Virginia Harlan, MSW, Charles McKitrick, RN, BSN, CDE, Alan McNamara, BS, Theresa Michel, DPT, DSc CCS, Alexi Poulos, BA, Barbara Steiner, EdM, Joclyn Tosch, BA, Massachusetts General Hospital, Boston; Edward S. Horton, MD (principal investigator), Sharon D. Jackson, MS, RD, CDE (program coordinator), Osama Hamdy, MD, PhD (coinvestigator), A. Enrique Caballero, MD (coinvestigator), Sarah Bain, BS, Elizabeth Bovaird, BSN, RN, Ann Goebel-Fabbri, PhD, Lori Lambert, MS, RD, Sarah Ledbury, MEd, RD, Maureen Malloy, BS, Kerry Ovalle, MS, RCEP, CDE, Joslin Diabetes Center, Boston; George Blackburn, MD, PhD (principal investigator), Christos Mantzoros, MD, DSc (coinvestigator), Kristinia Day, RD, Ann McNamara, RN, Beth Israel Deaconess Medical Center, Boston; James O. Hill, PhD (principal investigator), Marsha Miller, MS, RD (program coordinator), JoAnn Phillipp, MS (program coordinator), Robert Schwartz, MD (coinvestigator), Brent Van Dorsten, PhD (coinvestigator), Judith Regensteiner, PhD (coinvestigator), Salma Benchekroun, MS, Ligia Coelho, BS, Paulette Cohrs, RN, BSN, Elizabeth Daeninck, MS, RD, Amy Fields, MPH, Susan Green, April Hamilton, BS, CCRC, Jere Hamilton, BA, Eugene Leshchinskiy, Michael McDermott, MD, Lindsey Munkwitz, BS, Loretta Rome, TRS, Kristin Wallace, MPH, Terra Worley, BA, University of Colorado Health Sciences Center, Denver; John P. Foreyt, PhD (principal investigator), Rebecca S. Reeves, DrPH, RD (program coordinator), Henry Pownall, PhD (coinvestigator), Ashok Balasubramanyam, MBBS (coinvestigator), Peter Jones, MD (coinvestigator), Michele Burrington, RD, Chu-Huang Chen, MD, PhD, Allyson Clark, RD, Molly Gee, MEd, RD, Sharon Griggs, Michelle Hamilton, Veronica Holley, Jayne Joseph, RD, Patricia Pace, RD, Julieta Palencia, RN, Olga Satterwhite, RD, Jennifer Schmidt, Devin Volding, LMSW, Carolyn White, Baylor College of Medicine, Houston, Texas; Mohammed F. Saad, MD (principal investigator), Siran Ghazarian Sengardi, MD (program coordinator), Ken C. Chiu, MD (coinvestigator), Medhat Botrous, Michelle Chan, BS, Kati Konersman, MA, RD, CDE, Magpuri Perpetua, RD, School of Medicine, University of California at Los Angeles; Karen C. Johnson, MD, MPH (principal investigator), Helen Lambeth, RN, BSN (program coordinator), Carolyn M. Gresham, RN (program coordinator), Abbas E. Kitabchi, MD, PhD (coinvestigator), Stephanie A. Connelly, MD, MPH (coinvestigator), Lynne Lichtermann, RN, BSN, The University of Tennessee Health Science Center, Memphis; Robert W. Jeffery, PhD (principal investigator), Carolyn Thorson, CCRP (program coordinator), John P. Bantle, MD (coinvestigator), J. Bruce Redmon, MD (coinvestigator), Richard S. Crow, MD (coinvestigator), Scott Crow, MD (coinvestigator), Susan K. Raatz, PhD, RD (coinvestigator), Kerrin Brelje, MPH, RD, Carolyne Campbell, Jeanne Carls, MEd, Tara Carmean-Mihm, BA, Emily Finch, MA, Anna Fox, MA, Elizabeth Hoelscher, MPH, RD, CHES, La Donna James, Vicki A. Maddy, BS, RD, Therese Ockenden, RN, Birgitta I. Rice, MS, RPh, CHES, Tricia Skarphol, BS, Ann D. Tucker, BA, Mary Susan Voeller, BA, Cara Walcheck, BS, RD, University of Minnesota, Minneapolis; Xavier Pi-Sunyer, MD (principal investigator), Jennifer Patricio, MS (program coordinator), Stanley Heshka, PhD (coinvestigator), Carmen Pal, MD (coinvestigator), Lynn Allen, MD, Diane Hirsch, RNC, MS, CDE, Mary Anne Holowaty, MS, CN, St Luke’s–Roosevelt Hospital Center, New York, New York; Thomas A. Wadden, PhD (principal investigator), Barbara J. Maschak-Carey, MSN, CDE (program coordinator), Stanley Schwartz, MD (coinvestigator), Gary D. Foster, PhD (coinvestigator), Robert I. Berkowitz, MD (coinvestigator), Henry Glick, PhD (coinvestigator), Shiriki K. Kumanyika, PhD, RD, MPH (coinvestigator), Johanna Brock, Helen Chomentowski, Vicki Clark, Canice Crerand, PhD, Renee Davenport, Andrea Diamond, MS, RD, Anthony Fabricatore, PhD, Louise Hesson, MSN, Stephanie Krauthamer-Ewing, MPH, Robert Kuehnel, PhD, Patricia Lipschutz, MSN, Monica Mullen, MS, RD, Leslie Womble, PhD, MS, Nayyar Iqbal, MD, University of Pennsylvania, Philadelphia; David E. Kelley, MD (principal investigator), Jacqueline Wesche-Thobaben, RN, BSN, CDE (program coordinator), Lewis Kuller, MD, DrPH (coinvestigator), Andrea Kriska, PhD (coinvestigator), Janet Bonk, RN, MPH, Rebecca Danchenko, BS, Daniel Edmundowicz, MD (coinvestigator), Mary L. Klem, PhD, MLIS (coinvestigator), Monica E. Yamamoto, DrPH, RD, FADA (coinvestigator), Barb Elnyczky, MA, George A. Grove, MS, Pat Harper, MS, RD, LDN, Janet Krulia, RN, BSN, CDE, Juliet Mancino, MS, RD, CDE, LDN, Anne Mathews, MS, RD, LDN, Tracey Y. Murray, BS, Joan R. Ritchea, Jennifer Rush, MPH, Karen Vujevich, RN-BC, MSN, CRNP, Donna Wolf, MS, University of Pittsburgh, Pittsburgh, Pennsylvania; Rena R. Wing, PhD (principal investigator), Renee Bright, MS (program coordinator), Vincent Pera, MD (coinvestigator), John Jakicic, PhD (coinvestigator), Deborah Tate, PhD (coinvestigator), Kara Gallagher, PhD (coinvestigator), Amy Bach, PhD, Barbara Bancroft, RN, MS, Anna Bertorelli, MBA, RD, Richard Carey, BS, Tatum Charron, BS, Heather Chenot, MS, Kimberley Chula-Maguire, MS, Pamela Coward, MS, RD, Lisa Cronkite, BS, Julie Currin, MD, Maureen Daly, RN, Caitlin Egan, MS, Erica Ferguson, BS, RD, Linda Foss, MPH, Jennifer Gauvin, BS, Don Kieffer, PhD, Lauren Lessard, BS, Deborah Maier, MS, J. P. Massaro, BS, Tammy Monk, MS, Rob Nicholson, PhD, Erin Patterson, BS, Suzanne Phelan, PhD, Hollie Raynor, PhD, RD, Douglas Raynor, PhD, Natalie Robinson, MS, RD, Deborah Robles, Jane Tavares, BS, The Miriam Hospital/Brown Medical School, Providence, Rhode Island; Steven M. Haffner, MD (principal investigator), Maria G. Montez, RN, MSHP, CDE (program coordinator), Carlos Lorenzo, MD (coinvestigator), The University of Texas Health Science Center at San Antonio; Steven Kahn, MB, ChB (principal investigator), Brenda Montgomery, RN, MS, CDE (program coordinator), Robert Knopp, MD (coinvestigator), Edward Lipkin, MD (coinvestigator), Matthew L. Maciejewski, PhD (coinvestigator), Dace Trence, MD (coinvestigator), Terry Barrett, BS, Joli Bartell, BA, Diane Greenberg, PhD, Anne Murillo, BS, Betty Ann Richmond, MEd, April Thomas, MPH, RD, University of Washington/Veterans Affairs Puget Sound Health Care System, Seattle; William C. Knowler, MD, DrPH (principal investigator), Paula Bolin, RN, MC (program coordinator), Tina Killean, BS (program coordinator), Cathy Manus, LPN, Jonathan Krakoff, MD (coinvestigator), Jeffrey M. Curtis, MD, MPH (coinvestigator), Justin Glass, MD (coinvestigator), Sara Michaels, MD (coinvestigator), Peter H. Bennett, MB, FRCP (coinvestigator), Tina Morgan (coinvestigator), Shandiin Begay, MPH, Bernadita Fallis, RN, RHIT, CCS, Jeanette Hermes, MS, RD, Diane F. Hollowbreast, Ruby Johnson, Cathy Manus, LPN, Maria Meacham, BSN, RN, CDE, Julie Nelson, RD, Carol Percy, RN, Patricia Poorthunder, Sandra Sangster, Nancy Scurlock, MSN, ANP-C, CDE, Leigh A. Shovestull, RD, CDE, Janelia Smiley, Katie Toledo, MS, LPC, Christina Tomchee, BA, Darryl Tonemah, PhD, Southwestern American Indian Center, Phoenix, Arizona, and Shiprock, New Mexico; Anne Peters, MD (principal investigator), Valerie Ruelas, MSW, LCSW (program coordinator), Siran Ghazarian Sengardi, MD (program coordinator), Kathryn Graves, MPH, RD, CDE, Kati Konersman, MA, RD, CDE, Sara Serafin-Dokhan, University of Southern California, Los Angeles.

Coordinating Center

Mark A. Espeland, PhD (principal investigator), Judy L. Bahnson, BA (program coordinator), Lynne Wagenknecht, DrPH (coinvestigator), David Reboussin, PhD (coinvestigator), W. Jack Rejeski, PhD (coinvestigator), Alain Bertoni, MD, MPH (coinvestigator), Wei Lang, PhD (coinvestigator), Gary Miller, PhD (coinvestigator), David Lefkowitz, MD (coinvestigator), Patrick S. Reynolds, MD (coinvestigator), Paul Ribisl, PhD (coinvestigator), Mara Vitolins, DrPH (coinvestigator), Michael Booth, MBA (program coordinator), Kathy M. Dotson, BA (program coordinator), Amelia Hodges, BA (program coordinator), Carrie C. Williams, BS (program coordinator), Jerry M. Barnes, MA, Patricia A. Feeney, MS, Jason Griffin, BS, Lea Harvin, BS, William Herman, MD, MPH, Patricia Hogan, MS, Sarah Jaramillo, MS, Mark King, BS, Kathy Lane, BS, Rebecca Neiberg, MS, Andrea Ruggiero, MS, Christian Speas, BS, Michael P. Walkup, MS, Karen Wall, AAS, Michelle Ward, Terri Windham, Wake Forest University, Winston-Salem, North Carolina.

Central Resources Centers

Michael Nevitt, PhD (principal investigator), Susan Ewing, MS, Cynthia Hayashi, Jason Maeda, MPH, Lisa Palermo, MS, MA, Michaela Rahorst, Ann Schwartz, PhD, John Shepherd, PhD, DXA Reading Center, University of California at San Francisco; Santica M. Marcovina, PhD, ScD (principal investigator), Greg Strylewicz, MS, Central Laboratory, Northwest Lipid Research Laboratories, University of Washington, Seattle; Ronald J. Prineas, MD, PhD (principal investigator), Teresa Alexander, Lisa Billings, Charles Campbell, AAS, BS, Sharon Hall, Susan Hensley, Yabing Li, MD, Zhu-Ming Zhang, MD, ECG Reading Center, EPICARE, Wake Forest University School of Medicine, Winston-Salem; Elizabeth J. Mayer-Davis, PhD (principal investigator), Robert Moran, PhD, Diet Assessment Center, Arnold School of Public Health, Center for Research in Nutrition and Health Disparities, University of South Carolina, Columbia; Richard Foushee, PhD, Nancy J. Hall, MA, Hall-Foushee Communications, Inc, Minneapolis.

Federal Sponsors

Barbara Harrison, MS, Van S. Hubbard, MD, PhD, Mary Evans, PhD, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; Lawton S. Cooper, MD, MPH, Jeffrey Cutler, MD, MPH, Eva Obarzanek, PhD, MPH, RD, National Heart, Lung, and Blood Institute, Bethesda; Edward W. Gregg, PhD, David F. Williamson, PhD, Ping Zhang, PhD, Centers for Disease Control and Prevention, Atlanta, Georgia.

Dingemans  AEBruna  MJvan Furth  EF Binge eating disorder: a review. Int J Obes Relat Metab Disord 2002;26 (3) 299- 307
PubMed Link to Article
de Zwaan  M Binge eating disorder and obesity. Int J Obes Relat Metab Disord 2001;25 ((suppl 1)) S51- S55
PubMed Link to Article
Elfhag  KRössner  S Who succeeds in maintaining weight loss? a conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev 2005;6 (1) 67- 85
PubMed Link to Article
Marcus  MDWing  RRHopkins  J Obese binge eaters: affect, cognitions, and response to behavioural weight control. J Consult Clin Psychol 1988;56 (3) 433- 439
PubMed Link to Article
Sherwood  NEJeffery  RWWing  RR Binge status as a predictor of weight loss treatment. Int J Obes Relat Metab Disord 1999;23 (5) 485- 493
PubMed Link to Article
Teixeira  PJGoing  SBHoutkooper  LBCussler  ECMetcalfe  LLBlew  RMSardinha  LBLohman  TG Pretreatment predictors of attrition and successful weight management in women. Int J Obes Relat Metab Disord 2004;28 (9) 1124- 1133
PubMed Link to Article
Blaine  BRodman  J Responses to weight loss treatment among obese individuals with and without BED: a matched-study meta-analysis. Eat Weight Disord 2007;12 (2) 54- 60
PubMed Link to Article
Bruce  BWilfley  D Binge eating among the overweight population: a serious and prevalent problem. J Am Diet Assoc 1996;96 (1) 58- 61
PubMed Link to Article
Wadden  TAFoster  GDSarwer  DBAnderson  DAGladis  MSanderson  RSLetchak  RVBerkowitz  RIPhelan  S Dieting and the development of eating disorders in obese women: results of a randomized controlled trial. Am J Clin Nutr 2004;80 (3) 560- 568
PubMed
Butryn  MLWadden  TA Treatment of overweight in children and adolescents: does dieting increase the risk of eating disorders? Int J Eat Disord 2005;37 (4) 285- 293
PubMed Link to Article
Delinsky  SSLatner  JDWilson  GT Binge eating and weight loss in a self-help behavior medication program. Obesity (Silver Spring) 2006;14 (7) 1244- 1249
PubMed Link to Article
Teixeira  PJGoing  SBSardinha  LBLohman  TG A review of psychosocial pre-treatment predictors of weight control. Obes Rev 2005;6 (1) 43- 65
PubMed Link to Article
Wing  RRMarcus  MEpstein  LBlair  EBurton  L Binge eating in obese patients with type II diabetes. Int J Eat Disord 1989;8 (6) 671- 679
Link to Article
National Task Force on Prevention and Treatment of Obesity, Dieting and the development of eating disorders in overweight and obese adults. Arch Intern Med 2000;160 (17) 2581- 2589
PubMed Link to Article
Kenardy  JMensch  MBowen  KGreen  BWalton  JDalton  M Disordered eating behaviours in women with Type 2 diabetes mellitus. Eat Behav 2001;2 (2) 183- 192
PubMed Link to Article
Meneghini  LFSpadola  JFlorez  H Prevalence and associations of binge eating disorder in a multiethnic population with type 2 diabetes. Diabetes Care 2006;29 (12) 2760
PubMed Link to Article
Allison  KCCrow  SJReeves  RRWest  DSForeyt  JPDiLillo  VGWadden  TAJeffery  RWVan Dorsten  BStunkard  AJ Binge eating disorder and night eating syndrome in adults with type 2 diabetes. Obesity (Silver Spring) 2007;15 (5) 1287- 1293
PubMed Link to Article
Mannucci  ETesi  FRicca  VPierazzuoli  EBarciulli  EMoretti  SDi Bernardo  MTravaglini  RCarrara  SZucchi  TPlacidi  GFRotella  CM Eating behavior in obese patients with and without type 2 diabetes mellitus. Int J Obes Relat Metab Disord 2002;26 (6) 848- 853
PubMed Link to Article
Herpertz  SAlbus  CWagener  RKocnar  MWagner  RHenning  ABest  FFoerster  HSchulze Schleppinghoff  BThomas  WKohle  KMann  KSenf  W Comorbidity of diabetes and eating disorders: does diabetes control reflect disturbed eating behavior? Diabetes Care 1998;21 (7) 1110- 1116
PubMed Link to Article
Ryan  DHEspeland  MAFoster  GDHaffner  SMHubbard  VSJohnson  KCKahn  SEKnowler  WCYanovski  SZLook AHEAD Research Group, Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003;24 (5) 610- 628
PubMed Link to Article
Diabetes Prevention Program Research Group, The Diabetes Prevention Program: design and methods for a clinical trial in the prevention of type 2 diabetes [published correction appears in Diabetes Care. 1999;22(8):1389]. Diabetes Care 1997;22 (4) 623- 634
PubMed
Wadden  TAWest  DSDelahanty  LJakicic  JRejeski  JWilliamson  DBerkowitz  RIKelley  DETomchee  CHill  JOKumanyika  SLook AHEAD Research Group, The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it [published correction appears in Obesity (Silver Spring). 2007;15(5):1339]. Obesity (Silver Spring) 2006;14 (5) 737- 752
PubMed Link to Article
 Spitzer RL, Yanovski SZ, Marcus MD. Binge eating disorder clinical interview (Health and Psychosocial Instruments database record). Pittsburgh, PA Behavioral Measurement Database Services1994;
Block  GWoods  MPotosky  AClifford  C Validation of a self-administered diet history questionnaire design using multiple diet records. J Clin Epidemiol 1990;43 (12) 1327- 1335
PubMed Link to Article
Ribisl  PMLang  WJaramillo  SAJakicic  JMStewart  KJBahnson  JBright  RCurtis  JFCrow  RSSoberman  JELook AHEAD Research Group, Exercise capacity and cardiovascular/metabolic characteristics of overweight and obese individuals with type 2 diabetes: the Look AHEAD clinical trial. Diabetes Care 2007;30 (10) 2679- 2684
PubMed Link to Article
Jeffery  RWFrench  SA Socioeconomic status and weight control practices among 20- to 45-year-old women. Am J Public Health 1996;86 (7) 1005- 1010
PubMed Link to Article
Beck  ATSteer  RABrown  GK Beck Depression Inventory II Manual.  San Antonio, TX Psychological Corp1996;
Ware  JESherbourne  CD The MOS 36-item short-form health survey (SF-36), I: conceptual framework and item selection. Med Care 1992;30 (6) 473- 483
PubMed Link to Article
Yanovski  SZSebring  NG Recorded food intake of obese women with binge eating disorder before and after weight loss. Int J Eat Disord 1994;15 (2) 135- 150
PubMed Link to Article
Yanovski  SZLeet  MYanovski  JAFlood  MGold  PWKissileff  HRWalsh  BT Food selection and intake of obese women with binge eating disorder. Am J Clin Nutr 1992;56 (6) 975- 980
PubMed
Simon  GEVon Korff  MSaunders  KMiglioretti  DLCrane  PKvan Belle  GKessler  RC Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 2006;63 (7) 824- 830
PubMed Link to Article
Wang  GJVolkow  NDThanos  PKFowler  JS Similarity between obesity and drug addiction as assessed by neurofunctional imaging: a concept review. J Addict Dis 2004;23 (3) 39- 53
PubMed Link to Article
Fairburn  CGCooper  ZDoll  HANorman  PO’Connor  M The natural course of bulimia nervosa and binge eating disorder in young women. Arch Gen Psychiatry 2000;57 (7) 659- 665
PubMed Link to Article
Cachelin  FMStriegel-Moore  RHElder  KAPike  KMWilfley  DEFairburn  CG Natural course of a community sample of women with binge eating disorder. Int J Eat Disord 1999;25 (1) 45- 54
PubMed Link to Article
Yanovski  SZ Binge eating and obesity in 2003: could treating an eating disorder have a positive effect on the obesity epidemic? Int J Eat Disord 2003;34 ((suppl)) S117- S120
PubMed Link to Article
Fairburn  CGBeglin  SJ Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 1994;16 (4) 363- 370
PubMed
Grilo  CMMasheb  RMWilson  GT A comparison of different methods for assessing the features of eating disorders in patients with binge eating disorder. J Consult Clin Psychol 2001;69 (2) 317- 322
PubMed Link to Article
Kalarchian  MAWilson  GTBrolin  REBradley  L Assessment of eating disorders in bariatric surgery candidates: self-report questionnaire vs interview. Int J Eat Disord 2000;28 (4) 465- 469
PubMed Link to Article
Reagan  PHersch  J Influence of race, gender, and socioeconomic status on binge eating frequency in a population-based sample. Int J Eat Disord 2005;38 (3) 252- 256
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

One-year weight loss by binge eating status. Yes/no indicates that the participant reported binge eating at baseline but not at 1 year; no/no, the participant did not report binge eating at either time; yes/yes, the participant reported binge eating at both times; and no/yes, the participant did not report binge eating at baseline but did at 1 year. ILI indicates intensive lifestyle intervention; DSE, diabetes support and education; and error bars, standard error. Groups with different lowercase letters are statistically different from each other.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

One-year change in reported caloric intake by binge eating status. Yes/no indicates that the participant reported binge eating at baseline but not at 1 year; no/no, the participant did not report binge eating at either time; yes/yes, the participant reported binge eating at both times; and no/yes, the participant did not report binge eating at baseline but did at 1 year. ILI indicates intensive lifestyle intervention; DSE, diabetes support and education; and error bars, standard error. Groups with different lowercase letters are statistically different from each other.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Demographic Characteristics of Study Sample
Table Graphic Jump LocationTable 2. Baseline Weight, Diet, and Fitness Levels
Table Graphic Jump LocationTable 3. Baseline Psychological and Physical Health Variables
Table Graphic Jump LocationTable 4. Relationship of 1-Year Weight Loss, Caloric Intake Decline, and Fitness Change to Binge Eating Behavior at Baseline and 1 Year

References

Dingemans  AEBruna  MJvan Furth  EF Binge eating disorder: a review. Int J Obes Relat Metab Disord 2002;26 (3) 299- 307
PubMed Link to Article
de Zwaan  M Binge eating disorder and obesity. Int J Obes Relat Metab Disord 2001;25 ((suppl 1)) S51- S55
PubMed Link to Article
Elfhag  KRössner  S Who succeeds in maintaining weight loss? a conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev 2005;6 (1) 67- 85
PubMed Link to Article
Marcus  MDWing  RRHopkins  J Obese binge eaters: affect, cognitions, and response to behavioural weight control. J Consult Clin Psychol 1988;56 (3) 433- 439
PubMed Link to Article
Sherwood  NEJeffery  RWWing  RR Binge status as a predictor of weight loss treatment. Int J Obes Relat Metab Disord 1999;23 (5) 485- 493
PubMed Link to Article
Teixeira  PJGoing  SBHoutkooper  LBCussler  ECMetcalfe  LLBlew  RMSardinha  LBLohman  TG Pretreatment predictors of attrition and successful weight management in women. Int J Obes Relat Metab Disord 2004;28 (9) 1124- 1133
PubMed Link to Article
Blaine  BRodman  J Responses to weight loss treatment among obese individuals with and without BED: a matched-study meta-analysis. Eat Weight Disord 2007;12 (2) 54- 60
PubMed Link to Article
Bruce  BWilfley  D Binge eating among the overweight population: a serious and prevalent problem. J Am Diet Assoc 1996;96 (1) 58- 61
PubMed Link to Article
Wadden  TAFoster  GDSarwer  DBAnderson  DAGladis  MSanderson  RSLetchak  RVBerkowitz  RIPhelan  S Dieting and the development of eating disorders in obese women: results of a randomized controlled trial. Am J Clin Nutr 2004;80 (3) 560- 568
PubMed
Butryn  MLWadden  TA Treatment of overweight in children and adolescents: does dieting increase the risk of eating disorders? Int J Eat Disord 2005;37 (4) 285- 293
PubMed Link to Article
Delinsky  SSLatner  JDWilson  GT Binge eating and weight loss in a self-help behavior medication program. Obesity (Silver Spring) 2006;14 (7) 1244- 1249
PubMed Link to Article
Teixeira  PJGoing  SBSardinha  LBLohman  TG A review of psychosocial pre-treatment predictors of weight control. Obes Rev 2005;6 (1) 43- 65
PubMed Link to Article
Wing  RRMarcus  MEpstein  LBlair  EBurton  L Binge eating in obese patients with type II diabetes. Int J Eat Disord 1989;8 (6) 671- 679
Link to Article
National Task Force on Prevention and Treatment of Obesity, Dieting and the development of eating disorders in overweight and obese adults. Arch Intern Med 2000;160 (17) 2581- 2589
PubMed Link to Article
Kenardy  JMensch  MBowen  KGreen  BWalton  JDalton  M Disordered eating behaviours in women with Type 2 diabetes mellitus. Eat Behav 2001;2 (2) 183- 192
PubMed Link to Article
Meneghini  LFSpadola  JFlorez  H Prevalence and associations of binge eating disorder in a multiethnic population with type 2 diabetes. Diabetes Care 2006;29 (12) 2760
PubMed Link to Article
Allison  KCCrow  SJReeves  RRWest  DSForeyt  JPDiLillo  VGWadden  TAJeffery  RWVan Dorsten  BStunkard  AJ Binge eating disorder and night eating syndrome in adults with type 2 diabetes. Obesity (Silver Spring) 2007;15 (5) 1287- 1293
PubMed Link to Article
Mannucci  ETesi  FRicca  VPierazzuoli  EBarciulli  EMoretti  SDi Bernardo  MTravaglini  RCarrara  SZucchi  TPlacidi  GFRotella  CM Eating behavior in obese patients with and without type 2 diabetes mellitus. Int J Obes Relat Metab Disord 2002;26 (6) 848- 853
PubMed Link to Article
Herpertz  SAlbus  CWagener  RKocnar  MWagner  RHenning  ABest  FFoerster  HSchulze Schleppinghoff  BThomas  WKohle  KMann  KSenf  W Comorbidity of diabetes and eating disorders: does diabetes control reflect disturbed eating behavior? Diabetes Care 1998;21 (7) 1110- 1116
PubMed Link to Article
Ryan  DHEspeland  MAFoster  GDHaffner  SMHubbard  VSJohnson  KCKahn  SEKnowler  WCYanovski  SZLook AHEAD Research Group, Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003;24 (5) 610- 628
PubMed Link to Article
Diabetes Prevention Program Research Group, The Diabetes Prevention Program: design and methods for a clinical trial in the prevention of type 2 diabetes [published correction appears in Diabetes Care. 1999;22(8):1389]. Diabetes Care 1997;22 (4) 623- 634
PubMed
Wadden  TAWest  DSDelahanty  LJakicic  JRejeski  JWilliamson  DBerkowitz  RIKelley  DETomchee  CHill  JOKumanyika  SLook AHEAD Research Group, The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it [published correction appears in Obesity (Silver Spring). 2007;15(5):1339]. Obesity (Silver Spring) 2006;14 (5) 737- 752
PubMed Link to Article
 Spitzer RL, Yanovski SZ, Marcus MD. Binge eating disorder clinical interview (Health and Psychosocial Instruments database record). Pittsburgh, PA Behavioral Measurement Database Services1994;
Block  GWoods  MPotosky  AClifford  C Validation of a self-administered diet history questionnaire design using multiple diet records. J Clin Epidemiol 1990;43 (12) 1327- 1335
PubMed Link to Article
Ribisl  PMLang  WJaramillo  SAJakicic  JMStewart  KJBahnson  JBright  RCurtis  JFCrow  RSSoberman  JELook AHEAD Research Group, Exercise capacity and cardiovascular/metabolic characteristics of overweight and obese individuals with type 2 diabetes: the Look AHEAD clinical trial. Diabetes Care 2007;30 (10) 2679- 2684
PubMed Link to Article
Jeffery  RWFrench  SA Socioeconomic status and weight control practices among 20- to 45-year-old women. Am J Public Health 1996;86 (7) 1005- 1010
PubMed Link to Article
Beck  ATSteer  RABrown  GK Beck Depression Inventory II Manual.  San Antonio, TX Psychological Corp1996;
Ware  JESherbourne  CD The MOS 36-item short-form health survey (SF-36), I: conceptual framework and item selection. Med Care 1992;30 (6) 473- 483
PubMed Link to Article
Yanovski  SZSebring  NG Recorded food intake of obese women with binge eating disorder before and after weight loss. Int J Eat Disord 1994;15 (2) 135- 150
PubMed Link to Article
Yanovski  SZLeet  MYanovski  JAFlood  MGold  PWKissileff  HRWalsh  BT Food selection and intake of obese women with binge eating disorder. Am J Clin Nutr 1992;56 (6) 975- 980
PubMed
Simon  GEVon Korff  MSaunders  KMiglioretti  DLCrane  PKvan Belle  GKessler  RC Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 2006;63 (7) 824- 830
PubMed Link to Article
Wang  GJVolkow  NDThanos  PKFowler  JS Similarity between obesity and drug addiction as assessed by neurofunctional imaging: a concept review. J Addict Dis 2004;23 (3) 39- 53
PubMed Link to Article
Fairburn  CGCooper  ZDoll  HANorman  PO’Connor  M The natural course of bulimia nervosa and binge eating disorder in young women. Arch Gen Psychiatry 2000;57 (7) 659- 665
PubMed Link to Article
Cachelin  FMStriegel-Moore  RHElder  KAPike  KMWilfley  DEFairburn  CG Natural course of a community sample of women with binge eating disorder. Int J Eat Disord 1999;25 (1) 45- 54
PubMed Link to Article
Yanovski  SZ Binge eating and obesity in 2003: could treating an eating disorder have a positive effect on the obesity epidemic? Int J Eat Disord 2003;34 ((suppl)) S117- S120
PubMed Link to Article
Fairburn  CGBeglin  SJ Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 1994;16 (4) 363- 370
PubMed
Grilo  CMMasheb  RMWilson  GT A comparison of different methods for assessing the features of eating disorders in patients with binge eating disorder. J Consult Clin Psychol 2001;69 (2) 317- 322
PubMed Link to Article
Kalarchian  MAWilson  GTBrolin  REBradley  L Assessment of eating disorders in bariatric surgery candidates: self-report questionnaire vs interview. Int J Eat Disord 2000;28 (4) 465- 469
PubMed Link to Article
Reagan  PHersch  J Influence of race, gender, and socioeconomic status on binge eating frequency in a population-based sample. Int J Eat Disord 2005;38 (3) 252- 256
PubMed Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 21

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
JAMAevidence.com

Users' Guides to the Medical Literature
Clinical Resolution

Users' Guides to the Medical Literature
Clinical Scenario