RESULTSâ Although 14% of diabetic subjects versus 4% of nondiabetic subjects reported episodes of binge eating (P < 0.10), there was no difference between ...
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A Comparison of Eating Behaviors in Newly Diagnosed NIDDM Patients and Case-Matched Control Subjects JUSTIN KF.NARDY, PUD MELBA MENSCH, MPH
KERRY BOWEN, MBBS, PHD, FRACP SALLIE-ANNE PEARSON, BSC (HONS)
OBJECTIVE — To determine whether disordered eating may be problematic in non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN A N D METHODS— We contrasted the eating behaviors and attitudes in 50 newly diagnosed NIDDM patients with 50 age-, sex-, and weight-matched control subjects. RESULTS— Although 14% of diabetic subjects versus 4% of nondiabetic subjects reported episodes of binge eating (P < 0.10), there was no difference between diabetic and nondiabetic subjects in the prevalence with which they met criteria for binge eating disorder. Diabetic patients with a history of binge eating were significantly heavier, had younger age at diagnosis, and had more problems with eating in response to situational and emotional cues than did diabetic patients who did not binge. CONCLUSIONS — No support was found for greater prevalence of binge eating disorder in newly diagnosed NIDDM patients than in matched nondiabetic control subjects.
B
inge eating is a feature of several eating-related disorders. Rapid and uncontrolled consumption of a relatively large amount of food is generally considered to define binge eating (1). Past
evidence indicates that eating disorders are present in people with insulin-dependent diabetes mellitus (2), although probably not in excess of population norms (3). There is some indication of the pres-
From the Department of Psychology, University of Newcastle (J.K., S.-A.P.), and the Royal Newcastle Hospital (M.M., K.B.), Callaghan, New South Wales, Australia. Address correspondence and reprint requests to Justin Kenardy, PhD, Department of Psychology, University of Newcastle, Callaghan, New South Wales 2308, Australia. Received for publication 7 July 1993 and accepted in revised form 28 April 1994. NIDDM, non-insulin-dependent diabetes mellitus; BM1, body mass index; BES, Binge Eating Scale; TFF1, Three Factor Fating Inventory; DEC, Diabetic Education Center.
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ence of binge eating in non-insulin-de pendent diabetes mellitus (N1DDM1 (4). Wing et al. (4) used a self-report measure with NIDDM patients who were entering a weight-control program and found that 21% of females had significantly elevated scores. In that study, there was no comparison group and no account taken of the impact of ongoing care. In our present study, the prevalence of binge eating in NIDDM was estimated by assessing eating behaviors through interview and self-report in patients with newly diagnosed NIDDM compared with age-, sex-, and weightmatched nondiabetic control subjects. Also, differences between binge-eating and non-binge-eating diabetic subjects were examined.
RESEARCH DESIGN AND METHODS— A sample of 100 subjects participated in the study, 50 newly diagnosed NIDDM patients and 50 age-, sex-, and body mass index (BMDmatched control subjects. IVMI was matched because weight is known to be related to binge eating (5) and would confound any group comparison. The sample comprised 23 men and 27 women in each group. The subjects' ages ranged from 36 to 80 years with mean ages of 62.74 :+: 9.73 (SD) and 61.12 ± 9.66 years for the experimental and control groups, respectively. The BMIs of the group ranged from 22.13 to 44.97 kg/nr with BMIs of 28.50 ± 4.62 and 28.57 ± 4.67 kg/m' for the experimental and control groups, respectively. All subjects were screened to exclude those with alcohol problems, because alcohol has been reported to disinhibit individuals' eating (6). The study used two measures: interview and self-report. The Iiating and Weight Patterns Interview (7) schedule was developed to identify individuals who have recurrent binge eating problems and would meet the diagnosis oi binge eating disorder. "Overeating" required that the subject reports, in the last 6 months, having eaten within a 2-h pe-
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Eating behaviors and NIDDM
Table 1—Results of classification by the Eating and Weight Patterns Interview and measures of eating behaviors and attitudes
n Overcater Binge eater Binge eating disorder Binge eating severity questionnaire TFHI Cognitive restraint Disinhibition Hunger
Diabetic
Nondiabetic
50 11(22) 7(14) 3(6) 5.58 (0-27)
50 14 (28) 2(4)* 0 3.60 (0-17)t
7.00 ± 4.86 4.18 ± 2.91 3.08 ± 3.00
5.24 ± 3.43t 4.04 ± 2.88 2.70 ± 2.43
TFEI, diabetic subjects were found to have significantly higher levels of cognitive restraint. The group of diabetic subjects was divided into bingers and non-bingers, based on the presence of binge eating in the previous 6 months. Table 2 presents the results of comparisons made between the two groups. These results indicate that bingers were significantly younger at diagnosis, had higher BMI, and had a higher maximum ever BMI than did non-bingers. On the TFEI, bingers had levels of cognitive restraint and hunger similar to non-bingers, but had significantly higher disinhibition.
Data are means ± SD or median (range) or n (%). *P < 0.10. T P < 0.05.
riod what most people would regard as an unusually large amount of food. "Binge eating" required that the overeating include a sense of loss of control during eating. For "binge eating disorder," in addition to the criteria for "binge eating," the subject must indicate binge eating at least twice a week during the last 6 months, marked distress about overeating, and at least three of ftve associated symptoms: 1) rapid eating; 2) eating to discomfort; 3) eating when not hungry; 4) eating alone; and 5) disgust after eating. The Binge Eating Scale (BES) (8) is a 16-item self-report measure designed to assess the severity of binge eating behavior and related attitudes and feelings. The Three Factor Eating Inventory (TFEI) (9) is a measure of attitudes toward eating and dieting. Its three factors are cognitive restraint, disinhibition, and hunger. Diabetic subjects were recruited through the Diabetic Education Center (DEC) at the Royal Newcastle Hospital. Patients were referred to the DEC by general practitioners and specialists throughout Newcastle and the Hunter Region after initial diagnosis. Any patient referred to the DEC who had received a diagnosis of diabetes >2 months before assessment was not approached. For those subjects who were contacted, a brief description of the study was given. Control subjects recruited through clubs and church organizations were weighed, measured for height, screened for elevated blood glu-
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cose, and placed on a waiting list to await matching. Matched nondiabetic control subjects were case-matched for age ( ± 6 years), gender, and BMI (± 1.0). RESULTS— The results of comparisons between diabetic and nondiabetic subjects are presented in Table 1. Similar numbers of diabetic and nondiabetic subjects reported being overeaters. A greater proportion of diabetic subjects reported episodes of binge eating, but this was only significant at the P < 0.10 level. No difference was found between diabetic and nondiabetic subjects in prevalence of binge eating disorder. Matched-pairs Student's t tests performed on the two groups found differences on the BES. However, no subject scored >27, confirming a lack of severe binge eating pathology. When eating attitudes were assessed using the
CONCLUSIONS — In this study, the first to use an interview-based assessment of binge eating disorder in NIDDM, no support was found for greater prevalence of binge eating disorder in newly diagnosed NIDDM patients than in matched nondiabetic control subjects. Furthermore, no subject, diabetic or control, had a score on the BES >27. However, some evidence was found that patients with newly diagnosed NIDDM have greater severity of binge eating than matched control subjects. While the proportion of new NIDDM patients with frequent and distressing episodes of uncontrolled overeating was greater than in matched nondiabetic control subjects, this difference was not sufficient to reach significance. This finding may have been due to an insufficient sample size and associated power. A
Table 2—Results of comparison of classified binge eater and normal eater diabetic patients
Age at diagnosis (years) BMI (kg/m2) Highest BMI (kg/m2) TFEI Cognitive restraint Disinhibition Hunger
Binge eaters
Normal eaters
7 54.14 ± 10.60 33.19 ± 5.56 36.24 ± 6.86
43 64.14 ± 8.95* 27.73 ± 4.02T 30.54 ± 4.06T
8.57 ± 5 . 7 1 7.86 ± 3.34 4.86 ± 4.85
6.74 ± 4.73 3.58 ± 2.38? 2.79 ± 2.55
Data are means ± SD. *P < 0.05. t P < 0.005. fP < 0.001.
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similar proportion in twice the sample size would have easily reached significance. Furthermore, because of the casematched design of this study, any results are unlikely to be accounted for by differences in weight, sex, or age. However, the presence of abnormal eating behaviors may have been associated with increased dietary restraint following diagnosis of NIDDM. This possibility could be evaluated through a prospective study of patients reactions immediately following diagnosis of NIDDM. Differences found between binger and non-binger diabetic patients are of some concern. The results indicate that the bingers have been heavier in the past, are heavier at diagnosis, and are younger at diagnosis. It is possible that age at onset of NIDDM (indicated by age at diagnosis), weight, and binge eating are interrelated in some way and that these findings may be relevant to an understanding of risk factors for diabetes. Significantly higher disinhibition scores indicate that diabetic patients who binge have more difficulty controlling their eating in response to sit-
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litus and eating disorders: a prevalence study. Compr Psychiatry 31:205-210,1990 4. Wing RR, Marcus MD, Hpstein LH, Blair EH, Burton LR: Binge eating in obese patients with type II diabetes. Intj Hating Dis~ ord 8:671-679, 1989 Acknowledgments—The authors express 5. Yanovski SZ: Binge eating disorder: current gratitude to the patients and staff of the Diabeknowledge and future directions. Obcs Res tes Education Center at Royal Newcastle Hos1:1-20, 1993 pital and to the volunteers who served as con6. PolivyJ, Herman CP: Effects of alcohol on trols. eating behaviour: influence of mood and Parts of this study were presented at the 4th perceived intoxication. J Abnorm Psvchol World Congress of Behavior Therapy, Gold 85:601-606, 1976 Coast, Australia, July 1992. 7. Spitzer RL, Devlin M, Walsh BT, Ilasin D, Wing R, Marcus M, Stunkard A, Wadden T, Yanovski S, Agras S, Mitchell J: Binge References eating disorder: a multisite field trial of 1. American Psychiatric Association: Diagnosthe diagnostic criteria. Intj Hating Disord tic and Statistical Manual of Mental Disor11:191-203, 1992 ders. 3rd ed., revised. Washington, DC, 8. GormallyJ, Black S, Daston S, Rardin D: American Psychiatric Association Press, The assessment of binge eating severity 1987 amongst obese persons. Addict Bchav 2. Hudson JI, Wentworth SM, Hudson MS, 5:219-226, 1982 Pope HG: Prevalence of anorexia nervosa 9. Stunkard AJ, Messick S: The Three-Factor and bulimia in young diabetic women. J Eating Questionnaire to measure dietary Clin Psychol 46:88-89, 1985 restraint, disinhibition, and hunger, j Psv3. Powers PS, Malone JI, Coovert DL, Schulchosom Res 29:71-83, 1985 man RG: Insulin-dependent diabetes mel-
uational and emotional cues. This observation may be relevant when planning health-care programs tailored to the particular needs of these patients.
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