Original Article Obesity

CLINICAL TRIALS AND INVESTIGATIONS

Examining Binge-Eating Disorder and Food Addiction

in Adults with Overweight and Obesity
Valentina Ivezaj1, Marney A. White1,2, and Carlos M. Grilo1,3,4

Objective: To compare four subgroups of adults with overweight/obesity: those with binge-eating disor-
der (BED) only, food addiction (FA) only, both BED 1 FA, and neither.
Methods: For this study, 502 individuals with overweight/obesity (body mass index >25 kg/m2) com-
pleted a Web-based survey with established measures of eating and health-related behaviors. Most were
female (n 5 415; 83.2%) and White (n 5 404; 80.8%); mean age and body mass index were 38.0
(SD 5 13.1) years and 33.6 (SD 5 6.9) kg/m2, respectively.
Results: Among 502 participants with overweight/obesity, 43 (8.5%) met BED criteria, 84 (16.6%) met FA
criteria, 51 (10.1%) met both BED 1 FA criteria, and 328 (64.8%) met neither (control). The three groups
with eating pathology (BED, FA, and BED 1 FA) had significantly greater disturbances on most measures
(eating disorder psychopathology, impulsivity, and self-control) than the control group, while the FA and
BED 1 FA groups reported significantly higher depression scores relative to the control group. The three
eating groups did not differ significantly from each other.
Conclusions: In this online survey, of those with overweight/obesity, nearly one third met criteria for BED, FA,
or BED 1 FA, and these forms of disordered eating were associated with greater pathology relative to individu-
als with overweight/obesity without BED and FA. Future research should examine whether the presence of
BED, FA, or co-occurring BED 1 FA requires tailored interventions in individuals with overweight or obesity.
Obesity (2016) 24, 2064-2069. doi:10.1002/oby.21607

Introduction BED in individuals with obesity has been associated with significant
increased risk for psychosocial, psychiatric, and medical problems
Obesity is prevalent (1,2) and is considered one of the leading (3)
(7,8,10). While BED is currently categorized as a formal eating disorder
and costliest (4) causes of morbidity and mortality in the United
in the Diagnostic and Statistical Manual of Mental Disorders, 5th edi-
States and worldwide (5). Obesity is a heterogeneous problem, and
tion (DSM-5) (9), some individuals with BED describe binge eating as a
this includes a diverse range of problematic patterns of eating (6).
form of “food addiction” (FA) (11). Indeed, behavioral markers of BED
Research has increasingly highlighted the importance of better
mirror defining features of substance use disorders or traditional addic-
understanding problematic eating behaviors and particularly binge-
tions (12,13). BED and FA, as currently conceptualized and measured,
eating disorder (BED), which is associated strongly with obesity in
appear to overlap and share many similarities, the exact nature of which
the United States (7) and globally (8).
remains uncertain. For example, individuals who engage in binge-eating
behavior often consume larger amounts of food than intended and expe-
BED is characterized by recurrent binge-eating episodes (eating an
rience strong cravings for food (11,12). Whether binge eating constitutes
unusually large quantity of food in a discrete period of time coupled
addictive eating, however, is still a matter of debate.
with a subjective sense of loss of control while eating), lack of compen-
satory behaviors, marked levels of distress, and three of five associated
features (i.e., speed of eating, embarrassment while eating, eating when Emerging research has suggested that binge eating and FA, while
not physically hungry, eating until uncomfortably full, guilt, depression, sharing many commonalities, might have important distinctions (14).
or disgust associated with binge-eating episodes) (9). The presence of Preliminary evidence from both specialty (15) and primary care (16)

1
Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Correspondence: Valentina Ivezaj (valentina.ivezaj@yale.edu)
2
Social and Behavioral Sciences Division, Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
3
Department of Psychology, Yale University, New Haven, Connecticut, USA 4 National Center on Addiction and Substance Abuse, New Haven,
Connecticut, USA.

Funding agencies: This research was supported, in part, by the National Institutes of Health grant K24 DK070052 (to CMG).
Disclosure: VI and MAW have nothing to disclose. CMG reports personal fees from Shire, personal fees from Sunovion, other from American Psychological Association,
other from Guilford Press Publishers, other from Taylor & Francis Publishers, other from Vindico CME, other from American Academy CME, and other from Medscape and
Global Medical CME outside the submitted work.
Author contributions: VI, MAW, and CMG designed the study; MAW collected the data; VI performed the statistical analyses. VI, MAW, and CMG interpreted the
analyses. VI wrote the first draft of the manuscript, and all authors contributed to revising and finalizing the manuscript. All authors have approved the final manuscript.
Received: 11 April 2016; Accepted: 12 June 2016; Published online 25 August 2016. doi:10.1002/oby.21607

2064 Obesity | VOLUME 24 | NUMBER 10 | OCTOBER 2016 www.obesityjournal.org

Original Article
CLINICAL TRIALS AND INVESTIGATIONS
settings suggests that treatment-seeking patients with obesity and
BED report high frequencies of FA, and that the co-occurrence of
BED and FA may represent a more disturbed BED subgroup.
Among individuals seeking treatment for BED and obesity in a spe-
cialty clinic, over half met criteria for FA, and those with FA
reported greater levels of depression, negative affect, emotion dysre-
gulation, eating disorder psychopathology, and lower self-esteem
than those without FA (15). These findings parallel results from a
primary care study of treatment-seeking individuals with obesity and
BED, although rates of FA were slightly lower in the primary care
(41.5%) than the specialty clinic (57%) settings. Notably, in both
studies (15,16), FA was associated with binge-eating frequency.
Less is known, however, about the overlapping and nonoverlapping
nature of BED and FA in persons with excess weight and this is
particularly the case in nontreatment-seeking samples. One
community-based study (17) directly compared individuals with obe-
sity and FA with individuals with obesity only (without FA). Of the
72 participants with obesity, 18 (25%) met criteria for FA, and of
those, 72.2% also met criteria for BED. The group with co-
occurring FA and obesity was significantly more likely to meet cri-
teria for severe depression, childhood ADHD, impulsivity, and
addictive personality traits than the non-FA group with obesity.
Notably, however, both the FA and non-FA groups with obesity
included individuals with BED, with a significantly higher propor-
tion of individuals with BED in the FA group relative to the non-FA
group. Importantly, it is unclear how the co-occurrence of BED and
FA influenced these results. A second study with community partici-
pants (18) examined the relationship among FA, BED, bulimia nerv-
osa, and body mass index (BMI) across the entire weight spectrum
and found that FA was related to greater BMI, binge-eating behav-
iors, and associated eating disorder psychopathology. To further
examine these eating issues in persons with excess weight, it would
be important to compare BED without FA, FA without BED, and
concurrent BED and FA relative to those with neither. Moreover,
such studies would need to include measures of non-eating
disordered constructs that might have clinical significance. For
example, it would seem important to examine difficulties with
impulsivity and self-control.
In summary, BED and FA appear to overlap and to be common in
individuals with excess weight. This study compared four groups of
individuals with excess weight: those with BED but not FA, those
with FA but not BED, those with both, and those with neither. We
compared these four groups on measures of eating pathology, impul-
sivity, and self-control in light of recent neurological findings and
correlates of BED (19-21).
Methods
Participants
Participants were 502 individuals who participated in an online
study seeking adults aged 18 years or older to complete a survey of
eating and health-related behaviors. Participants who met criteria for
overweight/obesity (BMI >25 kg/m2) were included in this study.
Participants included 84 (16.8%) men and 415 (83.2%) women (3
were missing); race/ethnicity was 80.8% (n 5 404) White, 5.4% (n
5 27) Hispanic, 8.6% (n 5 43) Black, 2.4% (n 5 12) Asian, 2.8%
(n 5 14) “other,” and two missing. Mean age and BMI were 38.0
www.obesityjournal.org
Obesity
(SD 5 13.1) years and 33.6 (SD 5 6.9) kg/m2, respectively. Of the
502 participants, 59.6% (n 5 299) met criteria for obesity and
40.4% (n 5 203) met criteria for overweight.
Procedures and assessments
Advertisements were placed on Craiglists Internet ads. Participants
completed an anonymous online survey consisting of demographic
information, self-reported height and weight, and self-report ques-
tionnaires through SurveyMonkey, a secure online data-gathering
platform. The study was approved by the Yale Human Investigations
Committee.
BMI was calculated using self-reported height and weight (kg/m2).
The Eating Disorder Examination-Questionnaire (EDE-Q) (22)
assesses the frequency of objective binge episodes (OBEs; defined
as feeling a loss of control while eating unusually large quantities of
food; this definition corresponds to the DSM-V criteria for binge
eating), subjective binge episodes (SBEs; defined as feeling a loss
of control while eating, but without eating unusually large quantities
of food), and inappropriate weight control and purging methods over
the past 28 days; it comprises four subscales (Restraint, Eating Con-
cern, Weight Concern, and Shape Concern) and a Global total score.
The EDE-Q has good test-retest reliability (23), convergence with
the EDE interview (24), and good performance in community stud-
ies (25).
The Yale Food Addiction Scale (YFAS) (12) is a 25-item self-report
measure of addictive eating. Items correspond to substance-
dependence criteria from DSM-IV (APA) (26). The YFAS has
adequate internal reliability, convergent validity, and incremental
validity in predicting binge eating (12,27).
The Beck Depression Inventory (BDI) (28) assesses depressive
symptoms and levels; it has strong psychometric support (29) and
performs well as a marker for severity and distress (30).
The Barratt Impulsiveness Scale 211 (BIS-11) (31) consists of 30
items measuring three domains and six subdomains of impulsivity:
attentional (attention and cognitive instability), motor (motor and
perseverance), and nonplanning (self-control and cognitive complex-
ity) impulsivity. Higher scores are indicative of greater impulsivity.
The Brief Self-Control Scale (BSCS) (32) consists of 13 items
measuring self-control over thoughts, emotions, impulse control, per-
formance regulation, and habit breaking. Higher scores are indica-
tive of better self-control.
Creation of study groups
Participants who met criteria for overweight or obesity but did not
meet criteria for BED or FA were categorized as the control group.
Participants who met criteria for BED based on responses to the
EDE-Q per DSM-V criteria and did not meet criteria for FA were
classified as the BED group. Participants who met criteria for FA
based on YFAS responses, but did not meet DSM-V BED criteria,
were categorized as the FA group. Participants who met criteria for
both BED and FA were categorized as the comorbid BED 1 FA
group. Participants with clinically significant purging behaviors
were excluded.
Obesity | VOLUME 24 | NUMBER 10 | OCTOBER 2016 2065
Obesity BED and FA in Adults with Overweight and Obesity Ivezaj et al.

Figure 1 Rates of BED, FA, and co-occurring BED 1 FA in overweight or obesity.

Statistical analysis
v2 and analysis of variance (ANOVA) statistics were used to com-
pare groups on categorical and dimensional variables. When
ANOVAs revealed significant group differences, Games Howell
post hoc tests (which account for unequal group sizes) were used to
analyze specific group differences. ANCOVAs were performed to
covary for BMI. Effect sizes and partial g2 were calculated.
Results
BED and FA rates among persons with excess
weight
Of the overall participant group with overweight or obesity, 12.0% (n 5
60) metBED criteria and 26.7% (n 5 134) met FA criteria. Of those
who met BED criteria, 61.7% (n 5 37) also met FA criteria. Of those
who met FA criteria, 27.6% (n 5 37) also met BED criteria (Figure 1).
Of the overall participant group with overweight or obesity, 68.7%
(n 5 345) were classified as the control group, 4.6% (n 5 23) as
the BED only group, 19.3% (n 5 97) as the FA only group, and
7.4% (n 5 37) as the comorbid BED 1 FA group. The four groups
did not significantly differ on age, sex, or race (Table 1), but
significantly differed on BMI (Table 2). Post hoc tests revealed that
the FA and comorbid BED 1 FA groups had significantly higher
BMI than the control group; the three eating groups did not signifi-
cantly differ from each other on BMI.
Comparisons between the control and
eating groups
The three eating groups differed significantly from the control group
on all clinical variables. First, the three eating groups reported ele-
vated scores on the EDE-Q Global and three EDE-Q subscales (eat-
ing concern, shape concern, and weight concern), OBEs, SBEs, and
YFAS scores relative to the control group. Only the FA group
reported significantly greater EDE-Q Restraint scores than the con-
trol group (Table 2). Second, all three eating groups reported signifi-
cantly lower BSCS scores (indicating poorer self-control) than the
control group, whereas both the FA and comorbid BED 1 FA groups
reported significantly greater BDI scores than the control group
(Table 3). Finally, results varied based on impulsivity total and sub-
scale scores. With respect to BIS total scores, the BED and FA
groups each had significantly higher scores than the control group;
however, results differed based on higher-order impulsivity domains
(attentional, motor, and nonplanning) (refer to Table 3).

TABLE 1 Demographic characteristics across four study groups with excess weight

Control, overweight/ BED FA BED1FA Test

obesity (n 5 345) (n 5 23) (n 5 97) (n 5 37) Statistic g2 Post hoc

Age, mean (SD) 37.5 (13.2) 36.8 (12.1) 38.4 (12.9) 42.0 (12.7) F(3,437) 5 1.19 0.008 NS
Female, no (%) 279 (81.6%) 19 (82.6%) 84 (86.6%) 33 (89.2%) v2 (3, n 5 499) 5 2.40 0.069 NS
White, no (%) 277 (80.3%) 19 (82.6%) 74 (76.3%) 34 (91.9%) v2 (3, n 5 502) 5 4.23 0.092 NS

N 5 502.

2066 Obesity | VOLUME 24 | NUMBER 10 | OCTOBER 2016 www.obesityjournal.org

Original Article Obesity
CLINICAL TRIALS AND INVESTIGATIONS

TABLE 2 Comparison of BMI and eating disorder psychopathology across four study groups with excess weight

Control, overweight/ BED FA BED 1 FA

obesity (n 5 345) (n 5 23) (n 5 97) (n 5 37) ANOVA ANCOVA BMI

M (SD) M (SD) M (SD) M (SD) F g2 Post hoc g2

BMI 32.7 (6.5) 34.4 (6.7) 36.0 (7.4) 36.0 (7.4) 8.10* 0.047 3,4 > 1 –
EDE-Q Global 2.5 (1.1) 3.7 (0.8) 3.7 (1.0) 3.8 (0.9) 51.78* 0.238 2,3,4 > 1 0.222
Restraint 2.1 (1.4) 2.6 (1.7) 2.5 (1.5) 2.5 (1.3) 4.18** 0.025 3>1 0.026
Eating concern 1.3 (1.1) 3.0 (1.0) 3.2 (1.4) 3.4 (1.1) 94.35* 0.362 2,3,4 > 1 0.345
Shape concern 3.6 (1.5) 5.0 (0.9) 4.9 (1.1) 5.1 (0.9) 34.25* 0.171 2,3,4 > 1 0.154
Weight concern 3.1 (1.3) 4.2 (0.9) 4.3 (1.1) 4.4 (0.9) 37.75* 0.185 2,3,4 > 1 0.165
OBE 0.8 (2.1) 8.2 (6.4) 4.4 (11.1) 10.4 (8.7) 43.19* 0.206 2,3,4 > 1; 4 > 3 0.204
SBE 1.5 (2.8) 7.9 (5.8) 5.4 (11.7) 11.1 (9.1) 35.91* 0.178 2,3,4 > 1; 4 > 3 0.173
YFAS 2.4 (1.5) 4.6 (1.7) 5.3 (1.4) 5.5 (1.4) 145.08* 0.466 2,3,4 > 1 0.441

N 5 502.
EDE-Q, Eating Disorder Examination-Questionnaire; OBE, objective binge episodes (binge-eating frequency); SBE, subjective binge episodes; YFAS, Yale Food Addiction Scale.
*p < 0.0005; **p < 0.01. df (3, 498).

Comparisons among the three eating groups
(BED, FA, and BED 1 FA)
When comparing the three eating groups, the groups significantly
differed from each other on OBEs and SBEs. Specifically, the
comorbid BED 1 FA group had significantly more OBEs and SBEs
than the FA only group. Otherwise, the three eating groups did not
statistically differ on EDE-Q total and subscale scores, YFAS, BDI,
BIS total or subscale scores, or BSCS scores. Partial g2 ranged from
0.025 (EDE-Q Restraint) to 0.466 (YFAS), signifying small to large
effect sizes. Co-varying for BMI did not result in substantive
changes in findings or in attenuation of effect sizes, which ranged
from 0.026 (EDE-Q Restraint) to 0.441 (YFAS).
Discussion
In this online convenience sample of community volunteers with
overweight or obesity, BED and FA were common. A recent U.S.-
based population study of women reported that 5.8% of those

TABLE 3 Comparison of mood, impulsivity, and self-control across four study groups with excess weight

Control, overweight/ BED FA BED 1 FA ANCOVA

obesity (n 5 345) (n 5 23) (n 5 97) (n 5 37) ANOVA BMI

M (SD) M (SD) M (SD) M (SD) F g2 Post hoc g2

BDI 13.1 (9.0) 15.8 (7.6) 19.7 (8.6) 20.7 (10.8) 18.50* 0.101 3,4 > 1 0.081
BIS 62.6 (11.4) 72.5 (7.6) 71.1 (12.1) 69.3 (12.6) 12.04* 0.102 2,3 > 1 0.094
Attentional 16.4 (4.1) 19.4 (4.1) 18.6 (4.2) 19.6 (4.6) 10.10* 0.080 3,4 > 1a 0.078
Attention 10.3 (2.8) 12.8 (2.9) 11.5 (2.6) 11.8 (2.7) 7.99* 0.064 2,3 > 1 0.063
Cog. instability 6.0 (2.0) 6.8 (1.9) 7.0 (2.0) 7.4 (1.8) 8.69* 0.069 3,4 > 1 0.068
Motor 21.9 (4.4) 25.5 (5.4) 24.7 (5.6) 23.2 (4.7) 8.06* 0.066 3>1 0.060
Motor 14.6 (3.3) 16.9 (3.6) 16.7 (4.3) 15.3 (3.7) 7.36* 0.060 3 > 1b 0.055
Perseverance 7.3 (2.1) 8.6 (2.3) 8.0 (2.0) 7.9 (2.0) 4.29** 0.035 3>1 0.033
Nonplanning 24.5 (5.3) 29.4 (3.5) 27.6 (4.9) 26.9 (6.5) 9.10* 0.075 2,3 > 1 0.069
Self-control 13.2 (3.5) 15.7 (1.8) 15.2 (3.4) 14.4 (3.7) 8.31* 0.068 2,3 > 1 0.062
Cog. complex 11.4 (2.7) 14.1 (2.4) 12.5 (2.4) 12.7 (3.5) 7.87* 0.064 2,3 > 1 0.060
BSCS 40.0 (8.2) 32.1 (4.8) 33.4 (8.6) 33.0 (6.3) 18.12* 0.138 2,3,4 < 1 0.126

N 5 502.
a
2, 3, 4 > 1 when covarying for BMI.
b
2, 3 > 1 when covarying for BMI.
*p < 0.0005; **p < 0.01.
BDI, Beck Depression Inventory; BIS, Barratt Impulsivity Scale; Cog. complex, cognitive complexity; Cog. instability, cognitive instability; BSCS, Brief Self-Control Scale.
df for BDI, BIS, and BSCS were (3, 493), (3, 319), and (3, 339), respectively.

www.obesityjournal.org Obesity | VOLUME 24 | NUMBER 10 | OCTOBER 2016 2067

Obesity
surveyed met criteria for FA using a modified brief version of the
YFAS (33). We note that the prevalence of FA observed in the cur-
rent sample of participants with excess weight is much higher than
that observed by Flint et al. (33), although not surprising given that
prior studies have identified increasing rates of FA among groups
defined by overweight or obesity. In this study, BED and FA were
associated with greater psychopathology relative to the group with
excess weight without either form of disordered eating. Nearly one
third of the participant group with overweight or obesity met criteria
for BED, FA, or both. Overall, FA was more common than BED;
26.7% and 12.0% met FA and BED criteria, respectively. Over 60%
of those with BED also met FA criteria, and this finding approxi-
mates the proportion of FA in a treatment-seeking group of individ-
uals with BED and obesity (15). The three eating groups with BED,
FA, and co-occurring BED and FA reported significantly greater
levels of eating disorder psychopathology, impulsivity, and self-
control than their counterparts with overweight/obesity only, even
after adjusting for BMI. The presence of different forms of problem-
atic eating seem to represent important subtypes of persons with
excess weight, although there was little support for the distinction of
BED, FA, and co-occurring BED and FA, which differed minimally
from each other. These findings of individuals with overweight/obe-
sity are generally consistent with those reported by Gearhardt et al.
(18), which included a study group of bulimia nervosa in a sample
representing the full weight range.
As expected, all three eating groups (BED, FA, and comorbid BED-
1 FA) reported greater levels of eating disorder psychopathology,
binge eating, loss-of-control eating, and FA than the control group
with overweight/obesity. Contrary to expectations, the three eating
groups did not differ from each other on various measures of eating-
related concerns and features. BED, FA, and co-occurring BED-
1 FA had similar FA scores and did not differ on measures of
eating disorder psychopathology (including weight and shape con-
cerns) but did show differences on overeating behaviors. The BED-
1 FA group reported significantly greater frequency of both objec-
tive (M 5 10.4) and subjective (M 5 11.1) binge-eating episodes
than the FA group (M 5 4.4 and M 5 5.4, respectively). Finally,
with respect to BMI, the FA and comorbid BED 1 FA groups had
significantly higher BMIs than the control group; however, BMI did
not statistically differ among the three groups with disordered
eating.
In addition to examining weight and eating disorder psychopathol-
ogy, this study sought to better understand non-eating-specific clini-
cal domains that have been found to be associated with disordered
eating including depression, impulsivity, and self-control. With
respect to depression, the FA and BED 1 FA groups reported signif-
icantly greater depressive levels (scores in the borderline to moder-
ate depression range) than the control group with overweight/obesity
(scores in the mild mood disturbance range). While depressive
symptoms in the BED group did not significantly differ from the
control group with overweight or obesity, BED depressive scores
matched depressive scores in a treatment-seeking sample of individ-
uals with BED and obesity (16).
Within the impulsivity domain, the general patterning suggested the
eating groups had higher scores on various impulsivity domains
compared with the control group with overweight/obesity. Again,
the three eating groups, however, did not significantly differ from
each other on overall or subdomains of impulsivity. Relative to the
2068 Obesity | VOLUME 24 | NUMBER 10 | OCTOBER 2016
BED and FA in Adults with Overweight and Obesity Ivezaj et al.
control group with overweight or obesity, all eating groups reported
higher levels of attentional impulsivity, which is indicative of diffi-
culty focusing or concentrating on tasks, while the BED and FA
groups reported significantly higher levels of motor impulsivity
(tendency to act on the spur of the moment without thinking) and
nonplanning impulsivity (less careful thinking/planning or lack of
future orientation). Our findings for BED replicate and extend previ-
ous literature suggesting greater motor impulsivity among individu-
als with binge eating and obesity when using a laboratory test meal
design (34) and fMRI technology (35). In addition, higher BED
scores on the cognitive complexity subdomain are consistent with an
emerging literature suggesting that changes in cognitive processing
may underlie the development of BED (19).
In contrast to two previous clinical studies with treatment-seekers
(15,16), which found that the presence of FA in BED represented a
more disturbed subgroup than BED without FA, our present findings
with a community sample do not show elevated clinical disturbance
in the comorbid BED 1 FA group. The discrepancy may be due to
different assessment methods (self-report vs. interview for BED) and
different samples (clinical treatment-seekers vs. nonclinical),
although the BDI scores were similar across the studies.
These findings should be interpreted in light of the study strengths
and limitations. A strength of our study was the relatively large sam-
ple size, which allowed for group comparisons and fine grained
analyses. However, the sample size for some groups may have not
allowed for the detection of small between-group effects. Our find-
ings are cross-sectional and were gathered from community respond-
ents interested in research. Future studies should use prospective and
experimental designs to further tease apart these questions. In addi-
tion, our study relied on self-report measures which may be biased;
alternatively, anonymity may help individuals disclose private or
embarrassing behaviors, particularly related to disordered-eating
behaviors (36). BMI was also calculated using self-reported height
and weight. Although individuals tend to underestimate weight and
overestimate height (37), overall measured and self-reported weight
are highly correlated, and the magnitude of actual differences tend
to be small (38). Moreover, research with persons with disordered
eating has found that they are generally accurate reporters of
weight/height (39) and that the generally small magnitude of report-
ing errors is not systematically related to eating disorder psychopa-
thology (40).
Conclusion
This study of an online convenience sample of community volun-
teers with overweight/obesity found that BED and FA are common,
that BED and FA frequently co-occur with each other, and that the
presence of BED, FA, or both is associated with significantly greater
psychopathology. These findings add to the well-established evi-
dence base suggesting BED is a distinct clinical entity from obesity
and, importantly, provide new evidence suggesting that FA is also
distinct from obesity. Disordered eating in the form of FA or BED
signals elevated distress and these groups may require additional tar-
geted intervention. Given that FA is not a formally recognized diag-
nosis, our findings suggest that a significant proportion of individu-
als with overweight/obesity with such concerns may go undetected
in clinical and research settings. Future research should examine
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Original Article
CLINICAL TRIALS AND INVESTIGATIONS
whether tailored treatment approaches for these distinct obesity sub-
types are warranted.O
C 2016 The Obesity Society
V 2013;21:367-377.
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Obesity | VOLUME 24 | NUMBER 10 | OCTOBER 2016 2069