پ رخوری و تنش روانی: آیا درجه چاقی یک عامل بحساب می آید؟

The purpose of the present study was to examine whether individuals with Binge Eating Disorder (BED) demonstrate comparable levels of eating pathology and psychological distress independent of weight status. Male and female participants with BED (N=96) completed the Questionnaire on Eating and Weight Patterns-Revised; Beck Depression Inventory (BDI), Symptom Checklist (SCL)-90-Revised, and Eating Disorder Inventory-2 (EDI-2). Participants were divided into categories of normal/overweight, obese, and severely obese based on their body mass index (BMI). Analysis of variance was performed using scores on the psychological measures with subjects grouped according to weight status. Participants with BED did not differ on any of the measures of psychological or eating symptoms regardless of weight status. These results replicate and extend previous findings, suggesting that binge eating pathology independent of weight status, accounts for psychological distress among binge eaters.

A number of studies have found that severity of binge eating is associated with body weight (Brody et al., 1994, de Zwann et al., 1994, Fitzgibbon & Blackman, 2000, Kolotkin et al., 1987, Spitzer et al., 1992, Spitzer et al., 1993, Telch et al., 1988 and Yanovski et al., 1993). Specifically, findings from community, clinical and population samples suggest that degree of binge eating increases with body mass index (BMI) (Bruce & Agras, 1992, Fairburn et al., 2000, Smith et al., 1998 and Striegel-Moore et al., 2000). However, other studies have failed to support this association (Goldfein et al., 1993, Gormally et al., 1982, Striegel-Moore et al., 1998, Wadden et al., 1993 and Wilson et al., 1993). One reason that the research may support the association between obesity and binge eating is that the majority of investigations have been conducted with obese populations (Brody et al., 1994, de Zwann et al., 1994, Goldfein et al., 1993, Gormally et al., 1982, Kolotkin et al., 1987 and Striegel-Moore et al., 1998; Telch & Agras, 1988; Wadden et al., 1993, Wilson et al., 1993 and Yanovski et al., 1993). Whereas there has been a history of restricting the inclusion criteria to obese individuals without a clear rationale, recent data suggest among both community and clinic studies that many individuals who meet criteria for Binge Eating Disorder (BED) are not obese, and almost half are not even overweight (Barry et al., 2003, Fairburn et al., 2000, Grilo, 2002 and Spitzer et al., 1992). Thus, the reliance on obese samples in the study of BED limits the generalizability of findings. More importantly, reliance on only obese samples may obscure important differences among normal weight and obese patients with BED. In fact, it has been suggested that there may be differences in the clinical presentation of eating pathology and psychological distress of BED patients at varying points along the BMI continuum (Brody et al., 1994). Therefore by restricting the range of binge eating samples to obese participants, differences in psychological and eating symptoms may not emerge. Studies that have found a positive relationship between body weight and severity of binge eating have been significantly larger than used in those that have failed to find this relationship. Sample sizes of studies that have found positive results ranged from 69 (Brody et al., 1994) to almost 2000 participants (Spitzer et al., 1992). Sample sizes used in studies that have failed to find a relationship between weight status and binge eating ranged from 20 (Goldfein et al., 1993) to 132 participants (Wadden et al., 1993). Furthermore, larger sample sizes among those studies that have found a positive relationship between weight and binge eating have included participants with a greater weight range. Body mass indices of participants have been in the moderately to severely obese range (Brody et al., 1994 and de Zwann et al., 1994). By comparison, studies that have failed to find a relationship between weight and binge eating have generally been isolated to moderately obese. Across all studies, only one included normal weight binge eaters (Telch et al., 1988). Unfortunately, this study did not examine participants whose BMI was in the lower range of normal weight (BMI<23). Taken together, these results suggest that the larger range used in studies that found a positive relationship between binge eating and weight status may account for the positive association found between weight and binge eating status. Regardless of weight status, it does appear that increased binge eating is associated with a significant amount of distress and dysfunction (Grilo, 2002, Wilfley et al., 2001 and Yanovski et al., 1993). It has been suggested that this distress may be better accounted for by the severity of binge eating rather than the degree of obesity. For example, Telch and Agras (1994) compared obese women (BMI>30) diagnosed via self-report with BED. Participants were divided into moderate or severe binge eaters based on their scores on the Binge Eating Scale (Gormally et al., 1982), with higher scores indicating greater severity of binge behavior. Binge eating severity was significantly associated with greater psychological distress, higher depression scores, greater interpersonal problems and lower self-esteem. However, the range of BED patients has been restricted to obese participants therefore far less is known if these results are comparable across the entire weight spectrum. Given the contradictory results on the role of weight in BED, this study sought to assess the impact of weight, as measured by body mass index (BMI), on eating pathology, and general psychological distress. In the present study, severely obese, obese and normal weight participants diagnosed with BED were compared. This study sought to extend the current findings on the relationship between binge eating and weight to normal/over weight men and women not included among previous samples and to replicate prior findings among obese and severely obese individuals. The aim of this study was to examine whether individuals with BED demonstrate comparable levels of eating pathology and psychological distress independent of weight status. Positive results would support earlier findings that obesity may be the result of, but not necessary for a diagnosis of BED (Devlin, Goldfein, & Dobrow, 2003), and bolster results that obesity is not associated with disturbed eating behavior and psychiatric distress.