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The Eating Attitudes Test and the Eating Disorder Inventory were developed to measure abnormal eating attitudes and behaviors in patients with eating disorders. This report describes each of these self-report questionnaires and outlines their functions, limitations, and previous use with adolescent subjects.
This article describes details of the development and psychometric characteristics of a brief self-report inventory for assessing attitudes and behaviors symptomatic of eating disorders that is currently in use in a longitudinal study of over 700 families with 11-year-old or 17-year-old twin girls. The Minnesota Eating Behavior Survey (MEBS), formerly the Minnesota Eating Disorder Inventory, is a 30-item measure developed for use with children as young as 10 years as well as adults. An examination of the MEBS's psychometric properties in a large, community sample of girls, women, and men demonstrated good factor congruence, internal consistency reliability, three-year stability, as well as evidence of concurrent and criterion validity. This questionnaire has promise as a screening and assessment measure for eating disturbance in cross-sectional and longitudinal research involving individuals of a wide range of ages.
We conducted an observational study of customers in three different types of lunch settings: a worksite cafeteria, a fast-food restaurant, and a moderately priced restaurant, and assessed the relationship between meal duration and the number of people eating at each table (group size). Results suggest a significant positive correlation between group size and meal duration, collapsing over eating settings. Analysis of variance yielded significant main effects of both eating setting and of group size, indicating that meal durations were longest in the moderately priced restaurant and shortest in the fast-food restaurant. An interaction between group size and eating setting indicates that the magnitude of the group size effect on meal duration differed in the different situations, with the effect of group size on duration being smallest, but still significant, in the fast-food setting compared with the other two settings.
The doubly-labelled water (2H2(18)O) technique was used to assess the long-term rates of energy expenditure and, after accounting for any changes in body composition, the derived rates of energy intake in weight-stable 'large-eating' (n 6) and 'small-eating' (n 6) women. The self-reported energy intakes (approximately 11.2 v. 5.6 MJ/d) and energy expenditures (approximately 8.5 v. 12.4 MJ/d) for the 'large-eating' and 'small-eating' groups respectively, should not be sustainable without significant body-weight changes. 2H2(18)O-assessed rates of energy expenditure for the 'large-eaters' (approximately 8.5 MJ/d) and 'small-eaters' (approximately 11.3 MJ/d) were in close agreement with the results obtained using 5 d, self-reported activity diaries but the derived rates of energy intake for the 'large-' (approximately 8.5 MJ/d) and 'small-eaters' (approximately 10.8 MJ/d) were markedly different from those obtained using self-reported, weighed food diaries. When two 'small-eaters' were supplied with their self-reported energy intakes (approximately 5 MJ/d) for up to 28 d both subjects lost about 0.75 kg body-weight/week. These results provide no support for the existence of 'metabolically efficient' women in the community.
A programme for the assessment and nursing diagnoses of eating difficulties among stroke patients was tested. The patients' experiences regarding eating were expressed in interviews and dialogues. Eating was observed during both a test meal and regular meals. The assessments included the prerequisites for eating as well as oral, pharyngeal and oesophageal functions. General and specific nursing diagnoses as well as life consequences (handicap) were established, based on assessment of disabilities and impairments, and interviewing the patients and their families, respectively. The general nursing diagnoses were formulated on admission after the test meal and these were reformulated to form specific nursing diagnoses after assessments of the functions. The programme presented proved to be useful in clinical practice. It is emphasized that many assessments must be co-ordinated for each individual.
AIM: To evaluate the eating behaviour in normal-weight, overweight, and obese women seeking participation in a diet-based programme of weight reduction or achievement of ideal body weight. METHODS: Thirty-seven obese, 42 overweight, and 14 normal-weight subjects, seen at an Italian university outpatient clinic, were asked to complete the Stunkard and Messick three-factor eating questionnaire (TFEQ). The TFEQ is designed to evaluate three different factors in eating behaviour: restraint, disinhibition, and hunger. Forty-eight mothers of children attending public primary schools (25 normal weight and 23 overweight) served as controls. RESULTS: Significantly altered scores of cognitive restraint were observed both in normal-weight and in overweight subjects of the outpatient clinic as compared with normal-weight and overweight control women. Outpatient clinic overweight women scored significantly higher in terms of disinhibition as compared with overweight control subjects. Among outpatient clinic subjects, overweight women showed higher scores of disinhibition but similar values of cognitive restraint as compared with outpatient clinic normal-weight subjects. In obese patients, the scores of disinhibition and hunger were higher than those observed in outpatient clinic normal-weight subjects, whereas values of cognitive restraint were significantly lower. As compared with outpatient clinic overweight women, obese subjects showed significantly lower values of cognitive restraint. CONCLUSIONS: Alterations in TFEQ results are a frequent feature in subjects seeking participation in programmes of weight reduction or ideal body weight achievement. This may reflect a possible impairment in eating behaviour.
OBJECTIVE: This study examines potential overlaps between psychiatric comorbidity (Axis I and II) and scores on the subscales of the Eating Disorder Inventory (EDI) in women with eating disorders (EDs). METHOD: In a sample of 248 women (72 with anorexia nervosa, 140 with bulimia nervosa, and 36 with eating disorders not otherwise specified), we determined psychiatric comorbidity using the Structured Clinical Interview for DSM-IV. Behavioural and psychological characteristics of EDs were quantified with the EDI. RESULTS: Psychiatric comorbidity was high in both axes (74% for Axis I and 68% for Axis II). While most EDI subscales pertaining to psychological traits showed significant associations with Axis I and II disorders, the subscales concerning eating and perception of weight and shape were much less associated with psychiatric comorbidity. Affective and anxiety disorders, as well as personality disorders of clusters A and C, showed a similar pattern with links to most psychological subscales. The profile for substance-related disorders was different, showing associations with the Ineffectiveness and Interoceptive Awareness scales. Personality disorders of cluster B were related only to the Bulimia subscale and not to any of the psychological subscales. CONCLUSIONS: The EDI appears to primarily reflect Axis I and II disorders related to affective and anxiety problems. Clinicians and researchers employing the EDI should be aware that it is not sensitive for all forms of comorbidity prevalent in ED patients.
Speculation concerning the role of psychiatric disorders in patients undergoing bariatric surgery is abundant in the literature. Psychiatric factors predicting the success or failure of bariatric surgery have not been adequately described. However, an increasing number of cases of eating disorders in the postoperative period are being reported. A concise literature review and 5 cases are presented with the purpose of studying the specific pathological eating habits of these patients. The criteria for Anorexia or Bulimia Nervosa were not fulfilled in most of the reports studied and were not met by the 5 patients described. The criteria for a new eating disorder (Post-Surgical Eating Avoidance Disorder, PSEAD) are proposed.
Clinical experience and research have moved the field toward greater recognition and differentiation of eating disorders as independent categories of mental disorder. Shorter's historical analysis, however, suggests that it may be useful to reconsider the relationship of AN and BN to the broader class of somatoform disorders. Also, by conferring legitimacy on this socially and culturally constructed disorder, mental health professionals may have seriously underestimated their unanticipated influence in propagating eating disorders with publicity aimed at preventing and curing them. Inasmuch as it offers an alternative or complement to the prevailing cultural hypothesis, which focuses on the effect of Western esthetics rather than the sociology of health care institutions, and has important implications for policy and publicity about eating disorders, the question of how culture and Westernization affect the epidemiology and experience of eating disorders also requires further study.
BACKGROUND: The media, mainly TV, play a significant social and cultural role and may affect the prevalence and incidence of eating disorders such as bulimia and anorexia nervosa. Their influence acts mainly by favoring a tall and thin body as the only fashionable for female adolescents: your social success depends primarily and totally by your physical appearance and you can, (and must), shape your body as you like better. Our research aims t analyze the attitude of adolescent people toward the TV and to investigate on: 1) time spent watching TV programs; 2) the influence of TV on the personal choices of goods to buy; 3) the ideal body images; 4) choice of TV programs. METHODS: Sixty-seven healthy adolescents (36 F-31 M) were included in our study as controls together with 24 female adolescents with eating disorders (DCA) diagnosed according to the DSM-IV and EAT/26 criteria. RESULTS: Our results show a psychological dependence of DCA adolescents from the TV (longer period of time spent watching TV programs, buying attitudes more influenced by TV advertising). The thin and tall body image is preferred by the DCA girls as well as by the controls; however the body appearance and proportions have a predominant and utmost importance only for the eating disorder females. The masculine subjects instead have a preference for a female and masculine opulent body appearance. CONCLUSIONS: To prevent the observed increase in prevalence and incidence of eating disorders among adolescents, it is appropriate to control the messages, myths and false hood propagated by media, TV in particular.
OBJECTIVE: To evaluate the cross-cultural validity of the Chinese version of the Eating Disorder Inventory (EDI) in a clinical sample of patients with eating disorders in Hong Kong. METHOD: After comprehensive clinical assessment, a consecutive series (1990-1996) of Chinese patients with bulimia nervosa (N = 17) and broadly diagnosed anorexia nervosa (N = 26) completed the Chinese EDI. Results were compared with those of Chinese female undergraduates (N = 606) and Canadian patients with eating disorders. RESULTS: The EDI profiles of bulimic and fat phobic anorectic patients were remarkably and modestly similar to those of their Canadian counterparts. The EDI meaningfully distinguished bulimic patients and fat phobic anorectic patients from local undergraduates, but exhibited deficient criterion-related validity in nonfat phobic anorectic patients. DISCUSSION: The questionable validity of certain EDI subscales in nonfat phobic patients reflects the ethnospecific constructs upon which they are based, and weakens the efficacy of the EDI in screening for anorexia nervosa in Chinese populations. Apart from illustrating some of the conceptual and methodological issues that need to be tackled in the cross-cultural study of the eating disorders, this study furnishes empirical support for the syndromal homogeneity of bulimia nervosa, and the clinical grouping of anorexia nervosa into fat phobic and nonfat phobic subtypes.
The eating behavior of obese patients and of subjects who had normalized their body weight following biliopancreatic diversion (BPD) was assessed by a three-factor eating questionnaire (TFEQ), constructed to measure cognitive dietary restraint, the tendency to disinhibition, and susceptibility to hunger. In the obese patients higher values of both disinhibition and hunger score were found than in normoweight persons. In BPD subjects a negative association between the time elapsed from the operation and both the disinhibition and hunger score values was observed. In patients operated more than 2 years before, the eating behavior, as assessed by the TFEQ, was similar to that of normoweight persons. After BPD the operated subjects do not have to respect any dietary advice, the loss of weight and the maintenance of a normal body weight occurring in spite of an absolutely free food consumption. Similarity to the control values of disinhibition and hunger score following BPD suggests that in the long term, when the preoccupation with food and diet is abandoned, a normal eating pattern can be achieved.
OBJECTIVE: The current study tested the hypothesis that supplemental dietary protein would reduce binge eating frequency and test meal intake in women with bulimia nervosa (BN) or binge eating disorder (BED). METHOD: Eighteen women with BN or BED ingested high-carbohydrate or high-protein supplements (280 kcal) three times daily over two 2-week periods. On the morning after each period, participants were given a high-protein or high-carbohydrate supplement (420 kcal) 3 hr before an ad libitum meal. RESULTS: Binge eating episodes occurred less frequently during protein supplementation (1.12 episodes per week) than during carbohydrate supplementation (2.94 episodes per week) or baseline (3.01 episodes per week). Participants reported less hunger and greater fullness, and consumed less food at test meals, after protein than after carbohydrate (673 vs. 856 kcal). DISCUSSION: Adding protein to the diets of women with BN and BED reduced food intake and binge eating over a 2-week period. These findings may have implications for the longer-term treatment of these disorders.
OBJECTIVE: The purpose of the study was to compare energy intake and food selection of laboratory binge eating episodes in obese women with and without binge eating disorder (BED). METHOD: Twenty women, 12 meeting BED criteria, and 8 BMI and age matched obese controls, engaged in a laboratory binge eating episode. RESULTS: BED participants consumed significantly more total food in kilocalories than the non-BED obese group and more kilocalories of fat. However, there were no differences between the groups in the proportion of calories from any macronutrient. There was a nonsignificant trend for the BED group to consume more total grams of food. During the binge, the BED group consumed more dairy products. CONCLUSION: Results of the study confirmed that women with BED consumed significantly more total food in kilocalories than the non-BED obese women when they were allowed to have a binge eating episode in a laboratory setting.
This study examined the replicability of findings reported by Lowe, Whitlow and Bellwoar (1991) concerning eating regulation among restrained eaters and dieters. Lowe et al. found that current dieters ate more than restrained non-dieters when not preloaded, and sharply reduced their intake following a high-calorie preload. The present study re-examined these findings and also determined the effect on intake of a high-calorie preload described as low in calories. The results replicated those reported by Lowe et al., with non-preloaded dieters showing increased eating and preloaded dieters showing reduced eating. In the "low-calorie" condition, current dieters ate an intermediate amount. These findings bolster recent arguments (Lowe, 1993) that restraint and dieting are different phenomena which have divergent effects on eating behavior.
The present study examined the psychopathology associated with binge eating disorder (BED), a new diagnostic category proposed for DSM-IV to classify patients with significant binge eating problems in the absence of purging. Self-report measures of psychopathology (e.g., depression, anxiety) and body image disturbance were administered to 72 women who prospectively (1) met criteria for BED (DSM-IV criteria), (2) reported frequent bingeing but did not meet BED criteria, and (3) denied problems with eating. Subjects satisfying BED criteria reported higher levels of psychopathology than normals on all measures and subclinical binge eaters scored between these two groups, but they were closer to subjects without eating problems. The pattern of results was essentially unchanged when corrected for weight. BED subjects and subclinical binge eaters were less satisfied with their bodies than were normal controls. These findings suggest that BED is not only characterized by frequent bingeing, but more importantly is associated with elevated psychopathology. Overall, these results lend support to the diagnostic criteria proposed for BED.
This study explored the functional nature of binge eating through the development of a new self-report instrument called the Binge Eating Adjective Checklist. Participants were 405 adult females who presented to a specialized eating disorders clinic. A subset of participants with bulimia nervosa also completed additional psychometrics and treatment. Those participants who reported greater reductions in negative affective and somatic states during a binge episode were also more distressed on measures of perfectionism, self-esteem, ineffectiveness, and interceptive awareness. They were also less likely to achieve abstinence from bingeing and vomiting over the course of treatment. Thus, the instrument appears to offer a methodology for studying the phenomenology of binge eating and the prediction of therapeutic outcome in bulimia nervosa.
OBJECTIVE: The aim of this study was to evaluate the anger levels and their management in obese patients. METHODS: A total of 103 obese women [51 with Binge Eating Disorder (BED) and 52 without BED] were included in the study and compared to 93 healthy controls. They were assessed with the State-Trait Anger Expression Inventory (STAXI), Beck Depression Inventory (BDI), and Eating Disorder Inventory-2 (EDI-2). RESULTS: The BDI score is higher in obese subjects than in controls and obese binge eaters have higher levels of depression than obese patients without BED. Differences among the three groups can be found in almost all subscales of the EDI-2, even after controlling for the variable depression (BDI). For STAXI, the only difference among the three groups, which remains significant after controlling for depression, is the tendency to express anger outside (AX-OUT), which is higher in obese binge eaters. The correlation study highlights the importance of impulsivity in the group of obese binge eaters, whereas in obese patients without BED, the tendency toward anger suppression (AX-IN) is seen. DISCUSSION: Obese patients with BED might be considered a subgroup deserving greater psychiatric interest, both for the greater severity of the eating disorder and for the comorbidity with subthreshold depressive symptoms and with borderline personality traits. In obese patients without BED, eating behavior seems more correlated to the psychological functioning typical of psychosomatic disorders. Implications for treatment are discussed.