A Pilot Test for Detecting BED Among Children

Binge eating disorder, or BED, can manifest differently in children than in adults. For example, the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for defining “loss of control of eating” is very hard to define among children. Some children may report losing control of eating after consuming a small amount of food (even a single cookie), while others may feel a loss of control after eating a much larger amount of food, such as a full box of cereal.

Children may also find it hard to recall binge-eating episodes; for example, if symptoms have lasted longer than 3 months, the month of onset is usually inaccurately reported. When symptoms have lasted a year, a child often can’t name the year that symptoms began. Although many studies have shown that BED starts in late adolescence, some individuals have reported that they began binge eating earlier, for example, between 11 and 13 years of age.

A briefer, structured test just for children

Dr. Jennifer R. Shapiro and colleagues at the University of North Carolina, Chapel Hill, recently tested a brief, structured interview-based scale specifically designed to detect BED among children (Int J Eat Disord 2007; 40:82). The Children’s Binge Eating Disorder Scale (C-BEDS) is a simple, relatively short, and easy-to-understand interview for assessing binge eating in children. Seven questions were developed, based on the seven critical behaviors proposed by Marcus and Kalarchian (Int J Eat Disord 2003; 34 (suppl) S47-S57 (see table).

Study design

Fifty-five children participated as part of a larger intervention aimed at promoting healthy eating and activity. After parents underwent a brief telephone screening interview, parents and child were screened with a 30-minute interview, during which they completed a series of questionnaires. Eligible children then met individually with the interviewer for a structured diagnostic interview, which included the BED section of the Structured Clinical Interview for the DSM (SCID) and the C-BEDS questionnaire.

The average age of the children participating in the study was 8.7 years (range: 5-13 years). Sixty-percent were female, and 58% were white. The boys had a mean height of 54.7 in. and a mean weight of 118.3 lb, with a mean body mass index (BMI, or g/kg2) of 26.6 and were in the 94.8 BMI percentile, which is in the overweight range. The girls had a mean height of 55 in. and their mean BMI was 26.6 kg/m2. Most of the parents were women, and these mothers had a mean BMI of 32.1 kg/m2; the 5 fathers who participated had a mean BMI of 34.3 kg/m2.

C-BEDS and SCID: Comparing the results

Five (9%) of the children met full SCID diagnostic criteria for BED. In comparison, with the amended provisional criteria of the C-BEDS, 16, or 29%, of the children met the diagnostic criteria for BED.

The authors note that the very subjective nature of a binge-eating episode makes BED difficult to diagnose among adults, and particularly challenging among children. With the exception of the Children’s Eating Disorders Examination (ChEDE), which is comprehensive but lengthy and requires special training to administer, there are no other readily available interview tools for children that can measure BED. In addition, according to the authors, the nature of BED among children is still largely unexplored territory, and the measures used in adults may not be appropriate for children.

Almost half reported eating when not hungry

Using the C-BED, the authors found that about half of the children reported that they sometimes eat when not hungry; once they start eating they cannot stop; and they want food as a reward for doing something well (see table). Sixty-three percent reported eating because of negative emotions. There were some limitations: all the participants were children who were interested in increasing their healthy eating and activity, and although the study was open to all children, those who participated were in the overweight range and their parents were in the obese range. No differences were noted by gender.

The authors stress that the C-BEDS is a preliminary tool that will be refined with further study. Some of the questions, such as using food as a reward, might apply to normal behavior and might be too sensitive to be an indication of binge eating.