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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
Obes Rev. Author manuscript; available in PMC 2018 Apr 1.
Published in final edited form as:
PMCID: PMC5502406
PMID: 28165655

Are loss of control while eating and overeating valid constructs? A critical review of the literature



Binge eating is a marker of weight gain and obesity, and a hallmark feature of eating disorders. Yet, its component constructs—overeating and loss of control (LOC) while eating—are poorly understood and difficult to measure.


To critically review the human literature concerning the validity of LOC and overeating across the age and weight spectrum.

Data sources

English-language articles addressing the face, convergent, discriminant, and predictive validity of LOC and overeating were included.


LOC and overeating appear to have adequate face validity. Emerging evidence supports the convergent and predictive validity of the LOC construct, given its unique cross-sectional and prospective associations with numerous anthropometric, psychosocial, and eating behavior-related factors. Overeating may be best conceptualized as a marker of excess weight status.


Binge eating constructs, particularly in the context of subjectively large episodes, are challenging to measure reliably. Few studies addressed overeating in the absence of LOC, thereby limiting conclusions about the validity of the overeating construct independent of LOC. Additional studies addressing the discriminant validity of both constructs are warranted.


Suggestions for future weight-related research and for appropriately defining binge eating in the eating disorders diagnostic scheme are presented.

Keywords: Binge eating, loss of control, overeating, validity

Binge eating and overeating are two prevalent obesity-related phenotypes that contribute to excess energy intake and weight gain.1 Binge eating is characterized by the subjective experience of loss of control (LOC) while eating, irrespective of the actual amount of food consumed. Overeating is characterized by eating a large amount of food, irrespective of LOC. Therefore, LOC and overeating are two independent but inter-related constructs.

In addition to being associated with weight-related characteristics, binge eating is a hallmark feature of eating disorders, which affect up to 5% of the population.2 An additional 10–15% of individuals in the community report LOC and overeating behaviors that fail to meet the size and/or frequency thresholds for these diagnoses.3,4 Because LOC and overeating lie at the intersection of obesity and eating disorders, researchers have studied these constructs more closely over the past several decades.

Research suggests that LOC is uniquely related to weight-related and psychosocial outcomes, while overeating may best be conceptualized as a marker of risk for excess weight gain and obesity.5 However, both constructs have been difficult to operationalize and measure reliably because of their complexity and variability in phenotypic presentation. The current paper critically reviews the human literature supporting and challenging the validity of binge eating constructs. Studies related to face, convergent, discriminant, and predictive validity of LOC and overeating are described and synthesized with the goal of highlighting major gaps in the literature and emphasizing priorities for future research.


Searches of PUBMED and PSYCINFO were conducted between November, 2015 and July, 2016 to identify peer-reviewed articles published in English-language journals. No start date was enforced in the search. Search terms included, “loss of control,” “overeating,” “binge eating,” “objective,” “subjective,” and “large.” Reference lists of identified articles were also searched to locate additional studies.

To address whether LOC and overeating are uniquely valid constructs, special efforts were made to identify studies that investigated LOC irrespective of episode size, and overeating irrespective of LOC. Thus, four types of binge eating and overeating episodes were assessed:6 objective binge eating (OBE) involving consumption of an unambiguously large amount of food accompanied by LOC; subjective binge eating (SBE) involving LOC while eating an amount of food that is deemed excessive by the respondent, but is not unusually large according to clinical rating standards; objective overeating (OO) involving consumption of an unambiguously large amount of food in the absence of LOC; and subjective overeating (SO), involving consumption an amount of food that is considered excessive by the respondent, but is not unusually large by clinical rating standards, in the absence of LOC (see Figure 1).

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Matrix of binge eating constructs

Data addressing face validity (the degree to which the measurement of a construct reflects what it is purported to measure) were included if they pertained to individuals’ appraisals of their own or others’ LOC and/or overeating behaviors. Data concerning convergent validity (the extent to which a construct is related to other constructs to which it should theoretically be related) and discriminant validity (the extent to which a construct empirically differs from theoretically unrelated constructs) were included if they pertained to cross-sectional associations among binge eating constructs and other anthropometric, psychosocial, or behavioral constructs. Data addressing predictive validity (the degree to which a construct predicts meaningful outcomes) were included if they referred to longitudinal outcomes of binge eating constructs, that is, if assessment of binge eating constructs preceded assessment of relevant outcomes. EMA data were included with studies of convergent validity, rather than studies of predictive validity, because although analysis of EMA data is often prospective in that it assesses momentary antecedents and consequences of binge eating constructs, extant EMA studies of binge eating constructs are focused on capturing a cross-section of experiences as opposed to investigating how these constructs longitudinally predict experiential outcomes. Across validity domains, studies that did not attempt to parse the unique effects of LOC and overeating (e.g., comparisons of individuals with BED and healthy controls, which are confounded by size, frequency, and duration criteria for the disorder) were not included.

This review focuses primarily on studies of children and adults with overweight and obesity. However, given the relevance of binge eating constructs to eating disorders classification, studies conducted in eating disordered samples are also included. Although analogue studies have been developed to approximate binge eating in animals,7 these studies were beyond the scope of this review and thus were not included.


In order to facilitate an understanding of the ways in which the validity of LOC and overeating have been explored, a detailed description of current methods for measuring binge eating constructs is provided in Table 1. In short, binge eating constructs are most commonly assessed via semi-structured interviews and self-report measures, the latter of which includes pencil-and-paper questionnaires, self-monitoring records, and ecological momentary assessment (EMA). Directly observing binge eating constructs via feeding laboratory paradigms is an alternate methodology that avoids many of the biases inherent in assessments based upon self-report. Emerging research suggests that psychophysiological assessment may also be useful in directly observing objective, in vivo markers of binge eating constructs.

Table 1

Description of tools for measuring binge eating constructs

Respondent-based measures
TitleAgeSample items
Semi-structured interviewsTrained assessors rate behavioral, cognitive, and affective experiences based on information provided by respondents
  • Interviewers can be trained to standardization

  • Time-consuming

  • Extensive training required to administer

  • Rely on retrospective recall

  • May be costly

Eating Disorder Examination614+*
  • I would like you to describe any times when you have felt that you have eaten too much at one time.

  • When you were eating, did you have a sense of loss of control at the time?

Eating Disorders Assessment for DSM-510418+
  • Were there times in the last 3 months when you felt out of control and consumed what was clearly a large amount of food?

Structured Clinical Interview for DSM-IV-TR Axis I Disorders: Patient Edition10518+
  • Have you often had times when your eating was out of control?

  • During these times, do you often eat within any 2 hour period what most people would regard as an unusual amount of food?

Structured Interview for Anorexic and Bulimic Syndromes10618+
  • Did you experience episodes of binge eating during which you ate a large amount of food in a relatively short period of time in the last 3 months or in the past?

  • Did you experience a sense of lack of control over your eating behavior during the binges in the last 3 months or in the past?

Self-report questionnairesRespondents read and independently respond to written questions
  • Low cost

  • Rapid administration

  • Rely on subjective self-report

  • May lack consistency since perceptions of eating-related constructs may vary within and across individuals

Binge Eating Scale10718+
  • (a) I usually am able to stop eating when I want to. I know when “enough is enough;” (b) Every so often, I experience a compulsion to eat which I can’t seem to control; (c) Frequently, I experience strong urges to eat which I seem unable to control, but at other times I can control my eating urges; (d) I feel incapable of controlling urges to eat. I have a fear of not being able to stop eating voluntarily.

Eating Attitudes Test10811–18*
  • I have gone on eating binges where I feel that I might not be able stop… always, very often, often, sometimes, rarely, never.

Eating Disorder Diagnostic Scale10913–65
  • During the past 6 months have there been times when you felt you have eaten what other people would regard as an unusually large amount of food (e.g., a quart of ice cream) given the circumstances?

  • During the times when you ate an unusually large amount of food, did you experience a loss of control (feel you couldn’t stop eating or control what or how much you were eating)?

Eating Disorder Examination-Questionnaire11016+*
  • During how many of the past 28 days have there been times when you have eaten what most people would regard as an unusually large amount of food?

  • During how many of these episodes of overeating did you have a sense of having lost control?

Questionnaire on Eating and Weight Patterns11118+*
  • During the past three months, did you ever eat, in a short period of time--for example, a two hour period-- what most people would think was an unusually large amount of food?

  • When you ate a really big amount of food, did you ever feel that you could not stop eating?

Loss of Control Over Eating scale112
  • In the last four weeks (28 days), how often have you had the following experiences during a time when you were eating?... My eating felt like a ball rolling down a hill that just kept going and going.

Eating Loss of Control scale11318+
  • During the past four weeks, how many times have you felt helpless to control your eating urges?

  • During the past four weeks, how many times have you felt out of control and eaten an unusually large amount of food (for example, eating two full meals; or eating three main courses; or eating an unusually large amount of one food or combination of foods) in a short period of time (1–2 hours)?

Self-monitoringRespondents record the occurrence of target behaviors and their correlates in the natural environment
  • Minimal retrospective recall biases

  • Constructs assessed in natural environment

  • May be paired with objective sensors of eating behavior

  • Rely on subjective self-report

  • Costly

  • Burdensome to complete at frequent intervals

  • Paper-and-pencil records

  • Ecological momentary assessment

Laboratory-based measures
Feeding laboratory paradigmsStandardized test meals designed to model LOC and/or overeating episodes administered under controlled conditions
  • Fewer self-report biases

  • Tighter control over confounds

  • Ability to experimentally manipulate variables related to binge eating constructs

  • Costly

  • Limited ecological validity

  • Energy intake

  • Macronutrient content

  • Meal duration

  • Bite velocity

Physiological assessmentPhysiological responses tracked during exposure to real or imagined food-related cues
  • Minimizes many self-report biases

  • Elucidates potential mechanisms underlying binge eating constructs

  • Assesses activity in real time

  • Costly

  • Difficult to elicit LOC and overeating in most psychophysiological paradigms

  • Limited ecological validity

  • May yield large amount of false positives

  • Functional magnetic resonance imaging

  • Computed tomography

  • Positron emission tomography

  • Electroencephalography

  • Magnetoencephalography

  • Near infrared spectroscopy

  • Pupillometry

  • Eye movement

  • Eye blink response

  • Electrodermal activity

  • Cardiovascular activity

  • Muscular activity

Abbreviations: LOC=loss of control

*Also available in formats adapted for youth.


Face Validity

A total of 8 adult and 2 pediatric studies addressing the face validity of LOC and overeating were identified; results of these studies are summarized in Table 2. 75–90% of adults identified LOC as critical in their personal appraisals of binge eating, and 43–90% identified overeating.810 LOC was identified less frequently than overeating in personal definitions of binge eating among college students and adolescents.1113 Factors that influenced binge ratings included BED status, gender of raters and models, and sample composition (e.g., lay persons, clinicians).11,1416

Table 2

Summary of studies assessing the face validity of binge eating constructs

ReferenceSamplen% femaleAgeBMIProcedureSummary of main findings
10TS: family practice patients24310026.6±5.5NRParticipants completed EDE and a subset defined binge eating in their own words83% of EDE-defined OBE labeled as binges
42% of EDE-defined SBE labeled as binges
19% of EDE-defined OO labeled as binges
13% of EDE-defined SO labeled as binges
93% of participants required large amount of food to classify binge episodes
90% of participants required LOC to classify binge episodes

9TS: bariatric surgery19710039.8±11.243.0±6.7Eating and Exercise Examination interview for quantity/quality of eating episodesLOC predicted self-reported binge eating (B=.16, t=5.19***)
Of women who self-reported binge eating: 75% reported associated LOC; 25% did not report associated LOC; 61% reported consuming ≥6 or more servings of food; 19% reported consuming 1–4 servings of food
Of women who self-reported overeating, 22% reported associated LOC but did not define episodes as binge eating

114NTS: college students9976.825.5NRVignettes of a model eating varied according to quantity, duration, and LOC, and rated on binge scalesLarger size [t(95)=340.05***] and LOC [t(98)=119.10***] predicted judgements of episodes as binges

14NTS: community-based4810038.9±11.434.6Participants recorded type/amount of food and duration of eating episodes for 3 weeks; peer and dietitian judges rated randomly selected eating episodes as binges or non-bingesPeer judges more likely than dietitians to label eating episodes as binges for participants with full- (z=4.61***) and subthreshold BED (z=3.09**)
Peer κ=.39
Dietitian κ=.44
Peer vs. dietitian κ=.40–.48
Participants vs. peer and dietitian κ=.07–.19

15NTS: community-based with BED2395.744.7±10.9NRVignettes of a model eating varied according to quantity, duration, and LOC, and rated on binge scalesEpisodes involving a large quantity of food [F(1,80)=374.93**] or LOC [F(1,80)=109.90***] rated as more binge-like
Episodes rated as more binge-like if a large amount of food consumed when LOC was present [F(1,80)=3.95*]
Participants with BED rated vignettes involving large amounts of food higher on binge scale compared to undergraduates [F(2,80)=4.92**]
NTS: mental health professionals3450.030.2±2.2
NTS: college students2588.040.2±8.1

16NTS: college students sample 123870.020.2±3.022.3±3.7Videotaped eating episodes varied according to model’s gender and quantity of food, and rated as binges/non-bingesLarger size predicted judgements of episodes as binges [Wald χ2(1)=21.22***]
NTS: college students sample 213966.019.8±2.822.4±3.0
NTS: college students sample 38359.020.6±3.723.0±3.4

11NTS: college students96964.0Range=18–40+NRParticipants asked to define binge eating in their own words~10–25% of participants endorsed LOC as necessary to define a binge; ~65–75% identified quantity of food consumed as necessary to define a binge
Individuals with BED identified LOC in defining a binge more frequently than those without BED [χ2(1)=6.57*]
Males and females with and without BED were similarly likely to identify quantity in defining a binge

8NTS: community-based with BED6010042.7±9.936.2±8.4Participants asked to define binge eating in their own words and independent raters coded responses for presence/absence of binge features82% of participants included LOC in binge eating definition
43% of participants included eating a large amount of food binge eating definition

12NTS: school-based25941.714.7NRParticipants asked to define binge eating in their own words72.2% of participants defined binge eating exclusively in terms of quantity of food eaten
12.9% of participants defined binge eating in terms of quantity, duration, and LOC

13NTS: community-based adolescent/mother dyads1910014.5±1.2NRFocus groups with adolescents who reported LOC eating via phone screenFew participants directly endorsed LOC or binge eating
Binge eaters described as “lacking self control”
LOC associated with eating sneakily, negative affective antecedents, short-term relief

Abbreviations: BMI=body mass index (kg/m2); TS=treatment-seeking; NR=not reported; EDE=Eating Disorders Examination; OBE=objective binge eating; SBE=subjective binge eating; OO=objective overeating; SO=subjective overeating; LOC=loss of control; NTS=non-treatment seeking; BED=binge eating disorder


Convergent Validity

A total of 39 adult and 26 pediatric studies addressed the convergent validity of LOC and overeating; results are summarized in Table 3.

Table 3

Summary of studies assessing the convergent validity of binge eating constructs

StudySamplen%FAgeBMIMeasurementConvergence with anthropometric, psychosocial, and behavioral measures

70NTS: obese with BED1210037.9±7.839.6±6.2Energy intakeInterviewOBE>SBE (t=2.71*)
% energy from carbohydrateInterviewOBE>SBE (t=2.79*)
% energy from fatInterviewOBE=SBE (t=2.20)
% energy from proteinInterviewOBE=SBE (t=0.38)

24TS: college students enrolled in weight gain prevention program29410018.2±0.423.7±2.9BMIMeasuredLOC frequency, r=−.03
Total % body fatMeasuredLOC=no-LOC; LOC frequency, r=.04

50TS: AN47197.625.9±7.7NREating-related psychopathologySelf-reportOBE=SBE (F=1.87)
TS: BN836Eating-related QOLSelf-reportOBE=SBE (F=3.42)
TS: EDNOS845Negative affectSelf-reportOBE=SBE (F=0.00)
TS: BED202Global functioningSelf-reportOBE=SBE (F=0.93)
Negative self-imageSelf-reportOBE=SBE (F=0.21)

25Mixed TS/NTS: BN14410025.7±8.822.9±5.2BMISelf-reportOBE-only=SBE-only
Eating-related psychopathologySelf-reportOBE-only=SBE-only [F(1,66)=0.96]
Compensatory behaviorsSelf-reportOBE-only=SBE-only [F(4,63)=0.90]
Mixed TS/NTS: subthreshold BN60Negative affectSelf-reportOBE-only=SBE-only [F(2,64)=2.25]
Interpersonal problemsSelf-reportOBE-only=SBE-only [F(2,65)=2.11]
ImpulsivitySelf-reportSBE-only>OBE-only [F(3,64)=3.42*]

17TS: bariatric surgery18078.344.8±11.244.5±6.8BMISelf-reportBED>SBE>no-LOC*
Body image distressSelf-reportBED>SBE>no-LOC*
Eating-related distressSelf-reportBED>SBE>no-LOC*
TS: weight loss support group9391.455.1±12.432.7±7.3DisinhibitionSelf-reportBED>SBE>no-LOC*
DepressionSelf-reportBED, SBE>no-LOC*
Mental QOLSelf-reportBED>SBE, no-LOC*
NTS: community-based15878.541.3±13.524.8±5.1Physical QOLSelf-reportBED=SBE; SBE=no-LOC; BED>no-LOC*
Energy intakeSelf-reportBED>SBE>no-LOC*
FatSelf-reportBED>SBE, no-LOC*
ProteinSelf-reportBED>SBE, no-LOC*

18TS: underweight eating disorders with OBE3310027.9±6.915.4±1.6BMIMeasuredOBE>SBE, no-LOC (F=8.14**)
Eating-related psychopathologyInterviewOBE, SBE>no-LOC (F=4.60*)
DepressionSelf-reportOBE=SBE=no-LOC (F=1.07)
AnxietySelf-reportOBE=SBE=no-LOC (F=1.14)
TS: underweight eating disorders with SBE3625.8±10.514.0±1.3Novelty seekingSelf-reportOBE=SBE=no-LOC (F=2.85)
Harm avoidanceSelf-reportOBE=SBE=no-LOC (F=0.50)
Reward dependenceSelf-reportOBE=SBE=no-LOC (F=0.32)
PersistenceSelf-reportOBE=SBE=no-LOC (F=1.95)
TS: underweight eating disorders with no LOC3624.3±9.014.4±1.7Self-directednessSelf-reportOBE, SBE<no-LOC (F=6.33**)
CooperativenessSelf-reportOBE=SBE=no-LOC (F=2.93)
Self-transecendenceSelf-reportOBE=SBE=no-LOC (F=0.24)

32TS: diabetes27465.052.5±12.133.9±6.9BMIMeasuredCorrelated with binge eating (r=.27*) but not overeating

20NTS: community-based with LOC1610042.9±10.431.3±6.7BMINRLOC=no-LOC (t=−1.70)
NTS: community-based without LOC1641.0±14.628.5±5.6Eating-related psychopathologyInterviewLOC>no-LOC (t=−4.63***)

53Mixed TS/NTS: PD10110022.4±5.322.3±1.9RestraintSelf-reportLOC frequency, r=−.22
DisinhibitionSelf-reportLOC frequency, r=.35**
HungerSelf-reportLOC frequency, r=.29**
Body imageSelf-reportLOC frequency, r=.21*
Eating-related psychopathologyInterviewLOC frequency, r=.20*
Mood disorderInterviewLOC frequency, r=.16
Anxiety disorderInterviewLOC frequency, r=.23*
Substance use disorderInterviewLOC frequency, r=.27**
Impulse control disorderInterviewLOC frequency, r=.32**
DepressionSelf-reportLOC frequency, r=.32**
State anxietySelf-reportLOC frequency, r=.17
Trait anxietySelf-reportLOC frequency, r=.15
ImpulsivitySelf-reportLOC frequency, r=.07
Negative urgencySelf-reportLOC frequency, r=.44***
Lack of premeditationSelf-reportLOC frequency, r=.25
Lack of perseverenceSelf-reportLOC frequency, r=−.06
Sensation-seekingSelf-reportLOC frequency, r=.20
Eating-related QOLSelf-reportLOC frequency, r=.39**
Global functioningInterviewLOC frequency, r=−.34**

28NTS: community-based with OBE, SBE, and vomiting (1)3010024.3±5.422.7±2.3BMI1=2=3=4 (F=2.15)
NTS: community-based with OBE (2)8624.7±5.425.7±6.0Social functioning1, 2>4 (F=8.94***)
NTS: community-based with SBE (3)3025.2±5.426.7±6.2Psychiatric distress1>4 (F=6.05***)
NTS: community-based with heterogeneous symptoms (4)10224.6±5.725.1±5.3Self-esteem1<4 (F=6.86***)
Alcohol use1=2=3=4 (F=0.15)

19NTS: college students with OBE5210019.3±1.523.5±4.5BMISelf-reportOBE>no pathology; OBE=SBE=OO; SBE=OO=no pathology [F(4,333)=9.2**]
NTS: college students with SBE4019.1±0.822.1±3.6Eating-related psychopathologySelf-reportOBE, SBE>OO, no pathology [F(4,333)=49.7***]
NTS: college students with OO5519.4±2.021.9±3.2Psychiatric distressSelf-reportOBE, SBE>OO, no pathology [F(4,332)=17.8***]
NTS: college students with no pathology14519.3±2.321.7±3.2Eating-related QOLSelf-reportOBE, SBE>OO, no pathology [F(4,333)=48.3***]

51NTS: BN3010025.4±5.5NRRestraintSelf-reportOBE=SBE [F(1,51)=2.0]
Cognitive restraintSelf-reportOBE=SBE [F(1,51)=0.3]
DisinhibitionSelf-reportOBE=SBE [F(1,51)=2.5]
HungerSelf-reportOBE=SBE [F(1,51)=1.7]
Eating-related psychopathologySelf-reportOBE>SBE [F(1,51)=11.1**]
Binge frequencySelf-reportOBE>SBE [F(1,51)=8.0**]
NTS: BN with SBE2421.4±3.4NRPurge frequencySelf-reportOBE>SBE [F(1,51)=8.3**]
DepressionSelf-reportOBE=SBE [F(1,51)=0.6]
State anxietySelf-reportOBE=SBE [F(1,51)=0.0]
Trait anxietySelf-reportOBE=SBE [F(1,51)=0.0]
Alcohol useSelf-reportOBE=SBE [F(1,51)=3.4]
Drug useSelf-reportOBE=SBE [F(1,51)=1.8]
ImpulsivitySelf-reportOBE>SBE [F(1,51)=7.8**]

54NTS: community-based with BED1810028.1±10.627.7±6.5VomitingInterviewOBE frequency, r=.42**; SBE frequency, r=.40**
LaxativesInterviewOBE frequency, r=.22; SBE frequency, r=.05
DiureticsInterviewOBE frequency, r=.21**; SBE frequency, r=.51**
Driven exerciseInterviewOBE frequency, r=.23**; SBE frequency, r=.21**
RestraintInterviewOBE frequency, r=.47**; SBE frequency, r=.41**
Eating concernInterviewOBE frequency, r=.51**; SBE frequency, r=.44**
Weight concernInterviewOBE frequency, r=.50**; SBE frequency, r=.39**
Shape concernInterviewOBE frequency, r=.53**; SBE frequency, r=.40**
NTS: community-based with BN7DepressionSelf-reportOBE frequency, r=.44**; SBE frequency, r=.33**
AnxietySelf-reportOBE frequency, r=.46**; SBE frequency, r=.36**
StressSelf-reportOBE frequency, r=.53**; SBE frequency, r=.38**
Drive for thinnessSelf-reportOBE frequency, r=.46**; SBE frequency, r=.44**
NTS: community-based with subthreshold BN and BED35Interospective awarenessSelf-reportOBE frequency, r=.49**; SBE frequency, r=.30
BulimiaSelf-reportOBE frequency, r=.69**; SBE frequency, r=.32**
Body dissatisfactionSelf-reportOBE frequency, r=.33**; SBE frequency, r=.27
IneffectivenessSelf-reportOBE frequency, r=.46**; SBE frequency, r=.28
Maturity fearsSelf-reportOBE frequency, r=.15; SBE frequency, r=.30**
NTS: community-based with no eating pathology21PerfectionismSelf-reportOBE frequency, r=.15; SBE frequency, r=.08
Interpersonal distrustSelf-reportOBE frequency, r=.24; SBE frequency, r=.18
Cognitive restraintSelf-reportOBE frequency, r=.12; SBE frequency, r=.28
DisinhibitionSelf-reportOBE frequency, r=.53**; SBE frequency, r=.26
HungerSelf-reportOBE frequency, r=.48**; SBE frequency, r=.23

115TS: AN2610026.3±9.021.6±7.3Physical QOLSelf-reportVariance for OBE=NS; variance for SBE: β=.38*
TS: BED1Mental QOLSelf-reportVariance for OBE=NS; variance for SBE=NS
TS: undiagnosed12DepressionSelf-reportVariance for OBE=NS; variance for SBE=NS

63TS: BN2110027.0±9.921.5±2.9Energy intakeInterviewDegree of LOC, r=.57***
VomitingInterviewPositively associated with LOC (estimate=.67; SE=.15***) and energy intake (estimate=.00; SE=.00***)
Hunger prior to eatingInterviewPositively associated with LOC (estimate=.14; SE=.05**) but not energy intake
Feeling compelled to start eatingInterviewPositively associated with LOC (estimate=.58; SE=.05***) but not energy intake
Feeling compelled to continue eatingInterviewPositively associated with LOC (estimate=.67; SE=.04***) but not energy intake
Feeling upset after eatingInterviewPositively associated with LOC (estimate=.56; SE=.04***) but not energy intake
Feeling full after eatingInterviewPositively associated with LOC (estimate=.15; SE=.05***) and energy intake (estimate=.00; SE=.00***)

29NTS: community-based with OBE3710029.4±6.429.0±7.8BMISelf-reportOBE>SBE (t=2.25*)
Eating-related psychopathologySelf-reportOBE=SBE (t=0.08)
Physical QOLSelf-reportOBE=SBE (t=−1.00)
NTS: community-based with SBE5228.6±6.525.7±5.2Mental QOLSelf-reportOBE=SBE (t=0.02)
Psychological distressSelf-reportOBE=SBE (t=−0.24)
Severe mental health impairmentSelf-reportOBE=SBE (χ2=0.04)

26TS: BED10110045.7±11.037.9±7.1BMINROBE=SBE
Binge eating severitySelf-reportOBE=SBE
Psychiatric distressSelf-reportOBE=SBE
Interpersonal problemsSelf-reportOBE=SBE

30NTS: community-based with OBE15410026.2±7.027.4±7.2BMISelf-reportOBE>SBE [F(2,311)=6.7***]
Driven exerciseSelf-reportOBE=SBE=no-LOC (χ2=4.29)
NTS: community-based with SBE6825.6±7.824.1±5.8VomitingSelf-reportOBE=SBE=no-LOC (χ2=0.10)
Eating-related psychopathologySelf-reportOBE, SBE>no-LOC
NTS: community-based with no LOC10825.4±7.625.4±5.4Physical QOLSelf-reportOBE=SBE=no-LOC
Mental QOLSelf-reportOBE=SBE=no-LOC
Negative affectSelf-reportOBE>no-LOC; OBE=SBE; SBE=no-LOC [F(2,321)=8.0***]

27TS: eating pathology with OBE5695.036.3±10.937.1±3.7BMIMeasuredOBE=SBE
Binge eating severitySelf-reportOBE=SBE
TS: eating pathology with SBE1493.039.5±11.737.8±4.5DepressionSelf-reportOBE=SBE
Psychiatric comorbidityInterviewOBE=SBE

116TS: BN17410028.4±7.122.8±4.4BMINROBE+SBE, β=−0.07; OBE-SBE, β=0.08
Weight concernInterviewOBE+SBE, β=0.07; OBE-SBE, β=0.14
Shape concernInterviewOBE+SBE, β=0.18; OBE-SBE, β=0.05
RestraintInterviewOBE+SBE, β=−0.03; OBE-SBE, β=0.05
DepressionInterviewOBE+SBE, β=0.29; OBE-SBE, β=0.02
Self-esteemSelf-reportOBE+SBE, β=0.12; OBE-SBE, β=0.02
Psychiatric distressSelf-reportOBE+SBE, β=0.19; OBE-SBE, β=−0.03
Interpersonal problemsSelf-reportOBE+SBE, β=0.16; OBE-SBE, β=0.03
Social adjustmentSelf-reportOBE+SBE, β=0.16; OBE-SBE, β=0.04
Confidence to resist binge eatingSelf-reportOBE+SBE, β=−0.18; OBE-SBE, β=−0.04
Ability to resist binge eatingSelf-reportOBE+SBE, β=−0.24**; OBE-SBE, β=0.20

55TS: AN-binge/purge subtype7097.129.5±10.616.3±1.7Eating-related psychopathologySelf-reportAN: OBE frequency, r=.21; SBE frequency, r=.12
BN: OBE frequency, r=.39**; SBE frequency, r=.18
TS: BN11098.230.3±8.023.0±6.7Emotional eatingSelf-reportAN: OBE frequency, r=.12; SBE frequency, r=.75**
BN: OBE frequency, r=.69**; SBE frequency, r=.02

21TS: bariatric surgery with LOC12379.043.8±10.950.5±9.2BMIMeasuredLOC=no-LOC (t=−1.50)
Eating-related psychopathologySelf-reportLOC>no-LOC (t=−7.26***)
DepressionSelf-reportLOC>no-LOC (t=−5.42***)
TS: bariatric surgery without LOC10348.9±7.0Physical QOLSelf-reportLOC=no-LOC (t=1.53)
Mental QOLSelf-reportLOC<no-LOC (t=3.63***)
Night eatingSelf-reportLOC>no-LOC (t=−5.51***)
Alcohol useSelf-reportLOC=no-LOC (t=−1.10)

22NTS: community-based, obese BED5362.3F:42.6±11.5
BMISelf-reportBED=subBED=OO=no pathology
Current shapeSelf-reportBED=subBED=OO=no pathology
NTS: community-based, obese subthreshold BED11966.4F:43.2±11.8
Desired shapeSelf-reportBED=subBED=OO=no pathology
Current/ideal differenceSelf-reportBED, subBED>OO, no pathology
Weight dissatisfactionSelf-reportBED, subBED>OO, no pathology
NTS: community-based, obese with OO6035.0F:47.4±8.1
Weight importanceSelf-reportBED>subBED>OO, no pathology
NTS: community-based, obese with no pathology16050.0F:44.1±10.4
StressSelf-reportBED>OO, no pathology (F=3.18*)
SadnessSelf-reportBED>subBED>OO, no pathology (F=8.68***)
Self-esteemSelf-reportBED<subBED, OO, no pathology; subBED<no pathology (F=7.68***)

52NTS: college students with LOC25210020.7±2.0NREating-related QOLSelf-reportOBE-only=SBE-only (OR=1.00)
NTS: college students without LOC297Psychiatric comorbidityInterviewOBE-only=SBE-only (OR=.61)

31TS: BN11298.025.0±9.021.1±2.5BMIMeasuredBN>BN with SBE
Eating-related psychopathologyInterviewBN=BN with SBE
Compensatory behaviorsInterviewBN=BN with SBE
Psychiatric comorbidityInterviewBN=BN with SBE
DepressionSelf-reportBN=BN with SBE
AnxietySelf-reportBN=BN with SBE
TS: BN with SBE2823.5±3.4StressSelf-reportBN=BN with SBE
QOLSelf-reportBN=BN with SBE
Self-esteemSelf-reportBN=BN with SBE
PerfectionismSelf-reportBN=BN with SBE
ImpulsivitySelf-reportBN=BN with SBE
Interpersonal problemsSelf-reportBN=BN with SBE

23TS: bariatric surgery with LOC22186.143.7±10.051.1±8.3BMISelf-reportLOC=no-LOC(F=2.39)
DepressionSelf-reportLOC>no-LOC (F=35.82***)
Mental QOLSelf-reportLOC<no-LOC (F=16.19***)
TS: bariatric surgery without LOC131Physical QOLSelf-reportLOC<no-LOC (F=8.02**)
Eating-related psychopathologySelf-reportLOC>no-LOC (F=59.38***)

33NTS: school-based with BED943.1Range=11–17F:24.1±4.8
Obesity statusMeasuredF: BED=subBED=OO=no pathology (χ2=4.62)
M: BED, sub-BED, OO>no pathology (χ2=17.10***)
NTS: school-based with subthreshold BED2437.9F:24.3±4.9
Body satisfactionSelf-reportF: BED, subBED<OO<no pathology (F=66.94***)
M: BED<OO, no pathology; BED=subBED; subBED=OO (F=17.75***)
NTS: school-based with OO2556.3F:24.4±5.5 M:23.4±5.2DepressionSelf-reportF: BED, subBED>OO>no pathology (F=40.42***)
M: BED, subBED, OO>no pathology (F=10.47***)
NTS: school-based with no pathology41421950F:23.0±4.9 M:23.0±4.7Self-esteemSelf-reportF: BED, subBED>OO>no pathology (F=62.01***)
M: BED, subBED, OO>no pathology (F=27.99***)
SuicidalitySelf-reportF: BED, subBED, OO>no pathology (χ2=111.72***)
M: BED, subBED, OO>no pathology (χ2=36.62***)

34NTS: community-based with LOC6264.512.9 ± 2.81.4±1.0 (z-score)BMIMeasuredLOC>no-LOC***
DepressionSelf-reportLOC>no-LOC (t=−4.91***)
NTS: community-based without LOC15743.913.2 ± 2.80.8±1.1 (z-score)AnxietySelf-reportLOC>no-LOC (t=−6.14***)
Interpersonal problemsParent-reportLOC>no-LOC (t=−3.73***)

58TS: BN with OBE2797.516.1±1.622.1±3.0Compensatory behaviorsInterviewOBE=SBE [F(4,32)=1.79]
Eating pathologyInterviewOBE=SBE [F(1,35)=0.72]
TS: BN with SBE10DepressionSelf-reportOBE<SBE [F(1,35)=6.14*]
Self-esteemSelf-reportOBE=SBE [F(1,35)=0.02]

49TS: BN12896.116.4±1.4114.2±25.6 (%EBW)%EBWMeasuredBN=PD-LOC=PD-noLOC>AN-B/P [F(3,241)=30.72***]
RestraintInterviewBN=PD-LOC=PD-noLOC=AN-B/P [F(3,233)=1.95]
TS: AN-binge/purge3897.415.6±1.878.2±4.8 (%EBW)Shape concernInterviewBN=PD-LOC=PD-noLOC=AN-B/P [F(3,233)=2.19]
Weight concernInterviewBN=PD-LOC=PD-noLOC=AN-B/P [F(3,233)=1.95]
TS: PD with LOC2387.015.3±1.9105.8±15.0 (%EBW)Eating concernInterviewBN>PD-noLOC, AN-B/P; BN=PD-LOC; PD-noLOC=PD-LOC=AN-B/P [F(3,233)=7.53***]
DepressionSelf-reportBN=PD-LOC=PD-noLOC=AN-B/P [F(3,233)=0.77; p=.51]
TS: PD without LOC5691.116.2±1.4106.3±13.5 (%EBW)Self-esteemSelf-reportPD-LOC>BN, PD-noLOC, AN-B/P [F(3,209)=12.45***]

46TS: overweight with BED2676.914.8±0.91.9±0.4 (z-score)BMI z-scoreMeasuredBED=subBED=OO=no pathology
TS: overweight with subthreshold BED1369.215.1±0.91.9±0.6 (z-score)Weight/shape concernsSelf-reportBED, sub BED>OO, no pathology [F(3,95)=9.17***]
TS: overweight with OO1850.015.4±1.11.8±0.6 (z-score)DepressionSelf-reportBED>OO, no-pathology; subBED=OO; subBED>no-pathology; OO=no-pathology [F(3,93)=7.39***]
TS: overweight with no pathology3976.915.2±1.11.8±0.5 (z-score)

3NTS: school-based with OBE22263.512–17NROverweight statusMeasuredF: OBE, OO>no pathology**
M: OBE, OO>no pathology**
Risky weight control behaviorSelf-reportF: OBE>OO>no pathology*
M: OBE, OO>no pathology*
DietingSelf-reportF: OBE, OO>no pathology*
M: OBE, OO>no pathology*
NTS: school-based with OO16561.2Body satisfactionSelf-reportF: OBE, OO<no pathology*
M: OBE<OO<no pathology*
Cigarette useSelf-reportF: OBE=OO=no pathology
M: OO<OBE, no pathology*
Drug and alcohol useSelf-reportF: OBE=OO=no pathology
M: OBE=OO=no pathology
NTS: school-based with no pathology237451.8Self-injurySelf-reportF: OBE>no pathology; OO>no pathology; OBE=OO*
M: OBE, OO>no pathology*
DepressionSelf-reportF: OBE>OO>no pathology*
M: OBE>OO>no pathology*
Self-esteemSelf-reportF: OBE<OO<no pathology*
M: OBE, OO<no pathology*

48TS: overweight with LOC3571.412.9±1.9179.1±25.4 (adjusted)Adjusted BMINRLOC=no-LOC [F(1,194)=3.45]
Eating-related psychopathologyInterviewOBE>no-LOC; OBE=SBE; SBE=no-LOC [F(8,364)=3.08**]
External eatingSelf-reportOBE>no-LOC; OBE=SBE; SBE=no-LOC [F(2,161)=4.36*]
TS: overweight without LOC16159.012.7±1.7169.9±26.8 (adjusted)RestraintSelf-reportOBE=SBE=no-LOC [F(2,161)=1.23]
Emotional eatingSelf-reportOBE>SBE, no-LOC [F(2,161)=14.99***]
DepressionSelf-reportOBE>no-LOC; OBE=SBE; SBE=no-LOC [F(2,163)=8.82***]

35NTS: school-based with LOC10869.413.8±0.919.0±3.2BMISelf-reportLOC>no-LOC (F=2.01)
RestraintSelf-reportOBE, SBE>no-LOC (F=19.62***)
Eating concernSelf-reportOBE, SBE>no-LOC (F=30.91***)
Weight concernSelf-reportOBE, SBE>no-LOC (F=17.56***)
Shape concernSelf-reportOBE, SBE>no-LOC (F=19.28***)
NTS: school-based without LOC53855.813.9±0.918.6±2.5Drive for thinnessSelf-reportOBE, SBE>no-LOC (F=14.07***)
BulimiaSelf-reportOBE, SBE>no-LOC (F=24.24***)
Body dissatisfactionSelf-reportOBE>no-LOC; OBE=SBE; SBE=no-LOC (F=7.57***)
DepressionSelf-reportOBE>SBE>no-LOC (F=4.03***)
Self-esteemSelf-reportOBE>no-LOC; OBE=SBE; SBE=no-LOC (F=6.34**)

57NTS: community-based with LOC6056.710.7±1.523.0±5.0Eating-related psychopathologyInterviewLOC>no-LOC**
EmpathySelf-reportLOC=no-LOC [F(1,59)=0.08]
Risk-takingSelf-reportLOC=no-LOC [F(1,59)=1.40]
ImpulsivitySelf-reportLOC>no-LOC [F(1,59)=8.72**]
Novelty-seekingParent-reportLOC=no-LOC [F(1,59)=3.20]
NTS: community-based without LOC60Harm avoidanceParent-reportLOC=no-LOC [F(1,59)=1.74]
Reward dependenceParent-reportLOC=no-LOC [F(1,59)=1.12]
PersistenceParent-reportLOC=no-LOC [F(1,59)=2.59]
Self-directednessParent-reportLOC<no-LOC [F(1,59)=5.92*]
CooperativenessParent-reportLOC<no-LOC [F(1,59)=5.88*]
Self-transcendenceParent-reportLOC=no-LOC [F(1,59)=0.22]

56TS: overweight with LOC444.010.1±1.633.5±4.5RestraintInterviewLOC=no-LOC
Eating concernInterviewLOC>no-LOC***
TS: overweight without LOC23Weight concernInterviewLOC>no-LOC**
Shape concernInterviewLOC=no-LOC

36NTS: community-based, obese with LOC3722.08.3±1.527.9±4.2BMIMeasuredLOC>no-LOC (F=14.5***)
Eating-related psychopathologySelf-reportLOC>no-LOC (F=7.8**)
Body dissatisfactionSelf-reportLOC>no-LOC (F=4.0*)
NTS: community-based, obese without LOC7538.08.7±1.424.6±4.2AnxietySelf-reportLOC>no-LOC (F=9.9**)
DepressionSelf-reportLOC>no-LOC (F=10.0**)
Behavioral problemsParent-reportLOC=no-LOC (F=0.7)

37Mixed TS/NTS: overweight with OBE7090.015.2±1.527.7±6.5BMIMeasuredLOC>no-LOC (t=2.05*); OBE=SBE (t=0.54)
Systolic blood pressureMeasuredLOC>no-LOC (F=10.36**); OBE=SBE (F=1.27)
Diastolic blood pressureMeasuredLOC=no-LOC (F=0.75); OBE=SBE (F=1.96)
Mixed TS/NTS: overweight with SBE8098.014.5±1.728.2±4.2Waist circumferenceMeasuredLOC=no-LOC (F=0.98); OBE=SBE (F=0.17)
TriglyceridesMeasuredLOC=no-LOC (F=0.03); OBE=SBE (F=1.60)
HDL-cholesterolMeasuredLOC=no-LOC (F=2.76); OBE>SBE (F=4.03*)
Mixed TS/NTS: overweight with no LOC17982.014.8±1.526.2±7.9LDL-cholesterolMeasuredLOC>no-LOC (F=9.90**); OBE>SBE (F=6.30**)
Plasma glucoseMeasuredLOC=no-LOC (F=0.14); OBE=SBE (F=0.83)
Metabolic syndromeMeasuredLOC=no-LOC (χ2=0.00); OBE=SBE (χ2=1.85)

45NTS: community-based with recurrent LOC164384.014.9±2.722.1±3.6BMIMeasuredRecurrent LOC>non-recurrent LOC>no-LOC [F(2,1587)=34.73***]
NTS: community-based with non-recurrent LOC15680.114.8±2.621.1±3.7Eating-related psychopathologySelf-reportRecurrent LOC>non-recurrent LOC>no-LOC [F(2,1640)=240.69***]
NTS: community-based with no LOC22656.515.1±2.820.0±3.1Eating-related QOLSelf-reportRecurrent LOC>non-recurrent LOC>no-LOC [F(2,1640)=264.59***]

38NTS: community-based with OBE4660.912.6±.41.4±.2 (z-score)BMI z-scoreMeasuredOBE, SBE>OO, no pathology (F=5.04**)
NTS: community-based with SBE4261.913.4±.41.4±.2 (z-score)Eating-related psychopathologyInterviewOBE, SBE>OO, no pathology (F=21.79***)
NTS: community-based with OO6850.013.0±.41.0±.1 (z-score)DepressionSelf-reportOBE, SBE>OO, no pathology (F=5.83**)
NTS: community-based with no pathology21141.712.5±.2.8±.1 (z-score)AnxietySelf-reportOBE, SBE>OO, no pathology (F=7.13***)

39Mixed: TS overweight and NTS community-based with OBE10660.213.1±2.6Range of means= 1.3±1.2 to 2.4±0.3 (z-score)BMI z-scoreMeasuredOBE, SBE>no pathology; OBE>OO SBE=OO [F(3,427)=4.8**]
Meal type of episodeInterviewOBE, SBE>OO, normal episode for snack vs. meal [χ2(N=442)=40.3**]
Overeaten/eaten forbidden food before eating episodeInterviewOBE, SBE>OO, normal episode [χ2(N=444)=27.4**]
Negative emotion before episodeInterviewOBE, SBE>OO, normal episode [χ2(N=445)=38.6**]
Mixed: TS overweight and NTS community-based with SBE67Restricting before episodeInterviewOBE=SBE=OO=normal episode [χ2(N=445)=2.6]
Emotional before episodeInterviewOBE=SBE=OO=normal episode [χ2(N=445)=6.6]
Hungry before episodeInterviewOBE=SBE=OO=normal episode [χ2(N=445)=6.3]
Eating despite lack of hunger before episodeInterviewOBE, SBE>OO, normal episode [χ2(N=440)=70.0**]
Tired before episodeInterviewOBE, SBE, OO>normal episode [χ2(N=445)=8.2*]
Mixed: TS overweight and NTS community-based with OO106With whom during episodeInterviewOBE, SBE>OO, normal episode for eating alone [χ2(N=441)=20.8**]
Time of day during episodeInterview2(N=443)=15.4]
Celebration during episodeInterview2(N=443)=4.0]
Secretive during episodeInterviewOBE, SBE>OO, normal episode [χ2(N=444)=38.6**]
Numbing out during episodeInterviewOBE, SBE>OO, normal episode [χ2(N=445)=46.7**]
Mixed: TS overweight and NTS community-based with no pathology166Hiding food during episodeInterviewOBE>SBE, OO, normal episode [χ2(N=442)=18.4**]
Eating quickly during episodeInterviewOBE>SBE, OO, normal episode [χ2(N=444)=43.1**]
Eating more than others during episodeInterviewOBE>SBE, OO, normal episode [χ2(N=441)=57.8**]
Location during episodeInterviewSBE>OBE, OO, normal episode for watching television [χ2(N=439)=32.5**]
Negative emotion after eatingInterviewOBE, SBE>OO, normal episode [χ2(N=445)=53.5**]
Guilt/shame after eatingInterviewOBE, SBE>OO, normal episode [χ2(N=445)=46.2**]
Full after eatingInterviewOBE=SBE=OO=normal episode [χ2(N=445)=5.2]
Sick after eatingInterviewOBE>SBE, OO, normal episode [χ2(N=445)=11.6**]

41NTS: community-based with LOC1844.413.1±2.71.6±0.9 (z-score)BMI z-scoreMeasuredLOC>no-LOC*
Eating in response to depressionSelf-reportLOC>no-LOC (F=13.2***)
NTS: community-based without LOC13754.014.4±2.31.0±1.1 (z-score)Eating in response to anger/anxiety/frustrationSelf-reportLOC>no-LOC (F=5.4*)
Eating in response to feeling unsettledSelf-reportLOC>no-LOC (F=12.4**)

44NTS: community-based with LOC1586.710.0±1.828.2±8.1BMIMeasuredOBE+SBE>OO, no pathology [F(2,158)=3.6*]
Eating-related psychopathologyInterviewOBE+SBE>OO, no pathology [F(2,158)=7.8**]
NTS: community-based with OO3323.8±8.6DepressionSelf-reportOBE+SBE=OO=no pathology [F(2,150)=0.19]
AnxietySelf-reportOBE+SBE=OO=no pathology [F(2,149)=0.24]
NTS: community-based with no pathology11421.9±8.0Behavioral problemsParent-reportOBE+SBE=OO=no pathology [F(2,148)=1.2]

42Mixed TS/NTS: community-based with LOC8163.012.0±2.72.0±0.8 (z-score)BMI z-scoreMeasuredLOC>no-LOC*
Energy intakeInterviewLOC=no-LOC
% energy from carbohydrateInterviewLOC>no-LOC*; OBE=SBE
Mixed TS/NTS: community-based without LOC16851.012.2±2.61.6±1.1 (z-score)% energy from proteinInterviewLOC<no-LOC**; OBE, SBE<OO, no pathology
% energy from fatInterviewLOC=no-LOC; OBE=SBE

43TS: diabetic with BED4269.014.02.4±0.4 (z-score)BMI z-scoreMeasuredBED>OO>no pathology**
TS: diabetic with subthreshold BED13567.42.3±0.5Eating-related psychopathologySelf-reportBED>OO, no pathology**
TS: diabetic with OO16462.22.2±0.5DepressionSelf-reportBED>OO, no pathology**
TS: diabetic with no pathology33765.32.2±0.5QOLSelf-reportBED>OO>no pathology**

Ecological momentary assessment
59,65,117NTS: community-based obese with BED584.043.0±11.940.3±8.5Pre-episode negative affectSelf-reportIncreased prior to OBE* but not SBE or OO65
OBE and OO more likely on days characterized by high or increasing negative affect
Likelihood of SBE did not differ by affect trajectory117
OBE>SBE, OO, normal episode; SBE>normal episode; SBE=OO; OO=normal episode (Wald χ2=15.67**)59
Post-episode negative affectSelf-reportDecreased after OBE* but not SBE or OO65
OBE>SBE, OO, normal episode; SBE>normal episode; SBE=OO; OO=normal episode (Wald χ2=24.39***)59
Pre-episode hungerSelf-reportOBE<SBE, normal episode; OBE=OO; SBE=OO, normal episode (Wald χ2=18.14***)59
Post-episode hungerSelf-reportOBE, OO<SBE, normal episode (Wald χ2=39.75***)59
NTS: community-based obese without BED45Pre-episode cravingsSelf-reportOBE=SBE=OO=normal episode (Wald χ2=8.14)59
Post-episode cravingsSelf-reportOBE<SBE; OBE>OO; OBE=normal episode; SBE>OO; SBE=normal episode; OO<normal episode (Wald χ2=25.87***)59
LocationSelf-reportOBE=SBE=OO=normal episode (Wald χ2=1.22)59
Eating aloneSelf-reportSBE>OBE, OO; SBE=normal eating; normal eating=OBE, OO (Wald χ2=13.2**)59
Eating while watching televisionSelf-reportOBE=SBE=OO=normal episode (Wald χ2=0.92)59
Pre-episode eating because others are eatingSelf-reportOBE=SBE=OO=normal episode (Wald χ2=2.07)59 OBE=SBE=OO=normal episode
Post-episode eating because others are eatingSelf-reportOBE=SBE=OO=normal episode (Wald χ2=5.37)59
Pre-episode alcohol ingestionSelf-reportOBE=SBE=OO=normal episode (Wald χ2=10.55)59
Post-episode stressful eventSelf-reportOBE=SBE=OO=normal episode (Wald χ2=2.81)59

61,62NTS: community-based obese with BED986.435.7±11.938.9±8.7Pre-episode negative affectSelf-reportPositively associated with LOC [t(1,427)=4.61***]61
Not associated with energy intake [t(1,427)=0.82]61
Post-episode negative affectSelf-reportNo main effect for LOC [t(1,427)=1.68]61
No main effect for energy intake [t(1,427)=−1.46]61
Positively associated with energy intake in non-BED [t(1,427)=−2.86**] but not BED61
Positively associated with LOC in BED, irrespective of energy intake, and negatively associated with LOC and energy intake in non-BED [t(1,427)=−2.28*]61
NTS: community-based without BED13Post-meal LOC while eatingSelf-reportPositively associated with BED status (OR=3.60; SE=0.29***), energy intake (OR=1.00; SE=0.00***), and negative affect (OR=1.16; SE=0.04***)

60NTS: AN11810025.3±8.417.2±1.0Negative affectSelf-reportOBE,SBE>avoidant eating, restrictive eating>solitary eating (Wald χ2=88.47***)
Compensatory behaviorsSelf-reportOBE>SBE avoidant eating, restrictive eating; SBE>solitary eating (Wald χ2=87.45***)
Body checkingSelf-reportSolitary eating>OBE, avoidant eating>restrictive eating; SBE=binge eating (Wald χ2=29.00***)
Self-weighingSelf-reportOBE=SBE=avoidant eating=restrictive eating=solitary eating (Wald χ2=4.17)
StressSelf-reportRestrictive eating>OBE, SBE (Wald χ2=65.86***)

67NTS: community-based with LOC5955.910.8±1.523.0±5.1Energy intakeInterviewLOC>no-LOC across meal types [F(1,106)=4.39*]; binge meal in LOC>normal meal in no-LOC [F(1,157)=4.41*]
CarbohydrateInterviewBinge meal>normal meal in LOC [F(1,366)=6.99**]; binge meal in LOC>normal meal in no-LOC [F(1,150)=9.65**]
FatInterviewLOC=no-LOC across meal types; binge meal=normal meal across groups
ProteinInterviewLOC=no-LOC across meal types; binge meal=normal meal across groups
HappyInterviewBinge meals, regular meals<random signal in LOC [F(2,875)=24.98***]; LOC=no-LOC across meal types; binge meal=normal meal across groups
SadInterviewBinge days in LOC>non-binge days in no-LOC [F(1,71)=6.29**]; LOC=no-LOC across meal types; binge meal=normal meal across groups
NTS: community-based without LOC59AfraidInterviewLOC=no-LOC across meal types; binge meal=normal meal across groups
UpsetInterviewLOC=no-LOC across meal types; binge meal=normal meal across groups
Food/eating-related cognitionsInterviewLOC>no-LOC across meal types [F(1,110)=16.62***]; binge meal, normal meal>random signal in LOC [F(2,892)=43.32***]; binge meal in LOC>normal meal in no-LOC [F(1,113)=16.55***]
Body-related cognitionsInterviewLOC>no-LOC across meal types [F(1,116)=10.14**]; binge meal, normal meal>random signal in LOC [F(2,872)=9.22***]; binge meal in LOC>normal meal in no-LOC [F(1,96)=52.73***]
HungerInterviewLOC=no-LOC across meal types; binge meal=normal meal across groups
SatietyInterviewLOC=no-LOC across meal types; binge meal=normal meal across groups

68NTS: community-based overweight with LOC3010014.9±1.536.1±7.5Interpersonal problemsSelf-reportPredictive of LOC eating at between (estimate=0.31; SE=0.14*) and within-subjects level (estimate=0.14; SE=0.07*)
Negative affectSelf-reportNot predictive of LOC eating at between- (estimate=1.21; SE=0.76) or within-subjects level (estimate=0.33; SE=0.34)

69NTS: community-based overweight with LOC1710014.8±1.62.2±0.5 (z-score)HeartrateMeasuredPositively associated with LOC at within- (estimate=0.02; SE=0.00***), but not between-subjects level
Heartrate variabilityMeasuredNegatively associated with LOC at within- (estimate=−0.01; SE=0.00***), but not between-subjects level

Feeding laboratory
71NTS: more obese with BED1210031.7±1.341.5±0.9Energy intakeMeasuredBED: Binge meal>normal meal [t(1,37)=2.45*]
Non-BED: binge meal=normal mean
NTS: more obese without BED635.0±2.840.4±0.5% energy from proteinMeasuredBinge meal=normal meal across groups
NTS: less obese with BED933.7±2.231.1±0.5% energy from carbohydrateMeasuredBinge meal=normal meal across groups
NTS: less obese without BED832.5±1.830.4±0.5% energy from fatMeasuredBinge meal=normal meal across groups
NTS: normal-weight with no pathology731.1±3.421.0±0.7SatietySelf-reportBED: Binge meal>normal meal [t(1,37)=2.45*]
Non-BED: binge meal=normal meal for obese

72TS: BN1110024.2±2.2−1.5±12.4 (%deviation from EBW)Energy intakeMeasuredBinge meal>normal meal across groups [F(1,19)=27.20***]
NTS: No pathology1023.9±4.30.8±10.3 (%deviation from EBW)Rate of energy intakeMeasuredBinge meal>normal meal across groups [F(1,19)=13.23**]

73TS: BN810023.0±3.595.1±12.1 (%EBW)Energy intakeMeasuredMean binge meal>Mean normal meal for multi-course and single item meals (no statistical tests reported)

74TS: BN810024.6±5.019.5±1.8Energy intakeMeasuredBN: binge meal>normal meal [t(14)=4.24***]
College students: Binge meal=normal meal
Rate of eatingMeasuredBN: binge meal>normal meal for multi-item [t(14)=3.63*] but not single-item meal [t(14)=1.26]
College students: binge meal=normal meal
NTS: college students825.3±8.020.2±1.2Pre-episode satietySelf-reportBinge meal=normal meal across groups [F(1,14)=0.71]
Post-episode satietySelf-reportBinge meal=normal meal across groups [F(1,14)=2.82]
Control over eatingSelf-reportBinge meal<normal mea across groupsl [F(1,14)=9.38**]

64NTS: community-based with BED3010043.8±8.734.6±6.1Energy intakeMeasuredDegree of control, r=−.56**
NTS: community-based without BED3044.7±10.432.2±6.3Depressed moodSelf-reportSelf-labeled OBE>self-labeled OO (t=2.51*)
Degree of control, r=−.26*
Anxious moodSelf-reportSelf-labeled OBE=self-labeled OO (t=1.95)
Degree of control, r=−.21*

75TS: BN1210024.1±2.91.6±11.9 (%deviation from EBW)Energy intakeMeasuredMulti-item meal: binge meal>multi-item normal meal*; degree of contol, r=.58** for normal meal and r=.61** for binge meal in BN; degree of control, r=NS for normal meal and binge meal in no pathology group
Single-item meal: degree of contol, r=.17 for normal meal and r=.63** for binge meal in BN; degree of control, r=.02 for normal meal and r=.00 binge meal in no pathology group
NTS: no pathology1023.9±4.30.8±10.3 (%deviation from EBW)% energy from carbohydrateMeasuredMulti-item binge meal=multi-item normal meal across groups
% energy from proteinMeasuredMulti-item binge meal<multi-item normal meal across groups*
% energy from fatMeasuredMulti-item binge meal=multi-item normal meal across groups

76NTS: obese with BED1010036.2±2.640.1±3.4Energy intakeMeasuredBinge meal>normal meal in BED* but not non-BED
% energy from proteinMeasuredBinge meal=normal meal across groups
NTS: obese without BED939.0±2.938.8±1.4% energy from carbohydrateMeasuredBinge meal=normal meal across groups
% energy from fatMeasuredBinge meal=normal meal across groups
LOC while eatingSelf-reportBinge meal=normal meal across groups

77NTS: community-based with LOC6056.710.8±1.523.0±5.0Energy intakeMeasuredParent-child test meal: LOC=no-LOC
Child-only snack: LOC>no-LOC*
Total proteinMeasuredParent-child test meal: LOC=no LOC
Child-only snack: LOC>no-LOC*
Total carbohydrateMeasuredParent-child test meal: LOC=no LOC
Child-only snack: LOC=no LOC
NTS: community-based without LOC60Total fatMeasuredParent-child test meal: LOC=no LOC
Child-only snack: LOC>no-LOC*
LOC while eatingSelf-reportParent-child test meal: LOC=no-LOC
Child-only snack: LOC>no-LOC*

47NTS: overweight with LOC2210010.6±1.82.3±0.4 (z-score)BMI z-scoreMeasuredLOC=no-LOC
Energy intakeMeasuredLOC=no-LOC
NTS: overweight without LOC2210.3±2.02.1±0.4 (z-score)LOC while eatingSelf-reportPredicted by negative affect prior to mood induction in LOC group [α2 (N=22)=7.08*]

66NTS:community-based with LOC11010014.5±1.71.5±0.3 (z-score)Pre-episode negative affectMeasuredEnergy intake, β=NS
Post-episode negative affectMeasuredEnergy intake, β=NS

40NTS: community-based with LOC5064.013.3±2.727.7±9.9BMIMeasuredLOC>no-LOC**
Energy intakeMeasuredBinge meal>normal meal across groups (estimate=−0.04; SE=0.02**); LOC=no-LOC (estimate=0.00; SE=0.03)
% energy from proteinMeasuredLOC<no-LOC across binge and normal meals**
% energy from carbohydrateMeasuredLOC>no-LOC across binge and normal meals*
% energy from fatMeasuredBinge meal=normal meal; LOC=no-LOC
Post-episode anxietySelf-reportBinge meal=normal meal; positively associated with LOC status*
NTS: community-based without LOC12741.713.6±2.823.4±7.3Post-episode angerSelf-reportBinge meal=normal meal across groups
Post-episode confusionSelf-reportBinge meal=normal meal; positively associated with LOC status*
Post-episode depressionSelf-reportBinge meal=normal meal across groups
Post-episode fatigueSelf-reportBinge meal=normal meal across groups
Post-episode tensionSelf-reportBinge meal=normal meal across groups
Post-episode vigorSelf-reportBinge meal=normal meal across groups

Note: Studies using identical samples are grouped together for ease of reading. Age and BMI reported as means unless otherwise stated. Only comparisons involving binge eating constructs are reported.

Abbreviations: F=female; BMI=body mass index (kg/m2); NTS=non-treatment-seeking; BED=binge eating disorder; OBE=objective binge eating; SBE=subjective binge eating; TS=treatment-seeking; LOC=loss of control; QOL=quality of life; AN=anorexia nervosa; BN=bulimia nervosa; EDNOS=eating disorder not otherwise specified; NR=not reported; PD=purging disorder; OO=objective overeating; NS=not significant; SE=standard error; M=male


Anthropometric factors

A total of 17 adult and 16 pediatric studies reported on anthropometric characteristics in relation to LOC and/or overeating.


Of seven adult studies involving controls with no eating pathology, three reported that those with LOC and/or overeating had elevated BMIs relative to those with no LOC or overeating pathology.1719 However, in two of these studies, BMI differences were found only for those with OBE and not those with SBE.18,19 By contrast, four studies found that BMI did not differ in individuals with LOC and/or overeating compared to those with no LOC or overeating pathology.2023 One adult study reported elevated %trunk fat, but not total %body fat or %abdominal fat, in those with LOC relative to those without LOC.24 Of 11 adult studies directly comparing those with different forms of LOC and/or overeating, 6 found that OBE, SBE, and/or OO did not differ on BMI,19,22,2528 while 5 found that BMI was higher in those with OBE relative to those with SBE.17,18,2931 One adult study reported that BMI was correlated with OBE but not OO frequency,32 while another reported no associations between LOC eating frequency and any anthropometric variables.24


Of 16 pediatric studies involving controls with no LOC or overeating pathology, 13 found that indices of cardiovascular risk, including BMI and overweight status, were elevated in youth with OBE and/or SBE relative to healthy controls.3,3345 Of note, in one of these studies, differences in weight status held only for males and not females.33 By contrast, three studies reported no differences in those with OBE, SBE, and/or OO relative to those with no LOC.4648 Seven pediatric studies reported that individuals with OBE did not differ from those with OO3,33,46 or those with SBE3739,49 on BMI. Four studies that compared those with OBE and/or SBE to those with OO reported higher BMI in the former than the latter,38,39,43,44 with the exception that Tanofsky-Kraff and colleauges39 reported that youth reporting SBE were similar to those reporting OO on BMI. No pediatric studies reported BMI differences between those with OBE and those with SBE. Finally, 5 pediatric studies reported that youth with OO did not differ from controls on BMI,38,39,44,46 while 3 reported that those with OO had higher BMIs/rates of overweight or obesity than controls (although again, in one study,33 these results pertained only to males).3,33,43

Psychosocial factors

A total of 21 adult and 15 pediatric studies reported on cross-sectional associations between binge eating constructs and psychosocial factors, including eating-related and general psychopathology, quality of life, personality, and interpersonal functioning.


Of the 21 adult studies, 8 included a control group with no LOC or overeating pathology. All 8 of these studies reported more severe impairment among those with OBE and/or SBE relative to those with no LOC or overeating on at least one index of psychosocial functioning.1723,30 Of 13 adult studies directly comparing individuals with different forms of LOC and/or overeating, 12 found that those with OBE endorsed similar levels of psychosocial impairment as compared to those with SBE across most measures,18,19,2531,5052 while 1 reported greater impairment in those with OBE relative to those with SBE.17 However, the OBE group in this latter study was comprised of individuals with BED; thus, it is unclear whether psychosocial differences were attributable to episode size, frequency, or other diagnostic features of BED. Of only two adult studies reporting on psychosocial functioning in individuals with OO, both found that these individuals endorsed lower impairment than those with LOC, and comparable impairment as compared to those with no eating pathology, on most measures of distress.19,22 Generally, correlations between OBE and SBE frequency and measures of psychosocial impairment were in the moderate to large range.5355


Of the 15 pediatric studies, 13 included a control group with no LOC or overeating pathology. Of these, all 13 studies reported more severe impairment among those with OBE and/or SBE relative to those with no LOC or overeating on at least one index of psychosocial functioning.3,3336,38,4346,48,56,57 There tended to be fewer differences between youth with LOC and controls with no LOC or overeating pathology on measures of dietary restraint48,56 and personality.57 All six pediatric studies directly comparing individuals with different forms of LOC and/or overeating found that those with OBE endorsed similar levels of psychosocial impairment as compared to those with SBE across most measures;35,38,46,48,49,58 youth with OBE reported greater psychosocial impairment than those with SBE on very few measures.48 Of six pediatric studies reporting on psychosocial functioning in individuals with OO, three found that these individuals endorsed lower impairment than those with LOC, and similar levels of impairment as compared to those with no eating pathology, on most measures of distress.38,43,46 Three studies reported that youth with OO endorsed similar impairment as those with LOC, and/or greater psychosocial impairment than those with no eating pathology on most psychosocial measures.3,33,44

Momentary data

In addition to these distal cross-sectional associations, multiple studies of distress and binge eating constructs have found that LOC frequently occurs in response to negative emotions.


In adults, one self-report study reported that SBE frequency was correlated with self-reported emotional eating tendencies in individuals with AN-binge/purge subtype, and OBE frequency was correlated with emotional eating tendencies in individuals with BN.55 Data from three independent EMA studies, one dietary recall study, and one laboratory-based study of adults indicated that LOC, particularly in the context of OBE, was associated with elevated pre- and post-episode negative affect pre-episode.5965 Two adult EMA studies, both of which involved adults with obesity, reported on OO in relation to momentary distress. One of these studies found that that negative affect was not increased prior to OO.65 The other found that pre-episode negative affect was unrelated to energy intake, a potential proxy for OO; post-episode negative affect was related to energy intake in obese individuals without BED, but was unrelated to energy intake in those with BED.61


Three out of three pediatric self-report studies suggested that LOC eating was associated with eating in response to negative affect,39,41,48 although in one of these studies, associations were only significant for youth with OBE and not SBE.48 Of two laboratory-based studies reporting on negative affect in youth with LOC eating, one found that negative mood ratings predicted the degree to which youth reported LOC during a subsequent test meal,47 while the other found no association between energy intake and negative affect.66 Of two EMA studies of negative affect, both reported that negative affect did not precede LOC eating in adolescents.67,68 In one of these studies, happiness was found to be lower during both binge and normal meals of youth with LOC eating relative to random signal events prompted by the investigators, and sadness was higher on binge days in youth with LOC eating relative to non-binge days of youth without LOC eating.67 Cognitive, stress-related, and interpersonal factors may be more consistently associated with LOC eating episodes in youth.6769

Eating behavior


A total of 12 adult studies reported on eating behavior in relation to LOC and/or overeating (as approximated by energy intake), including 5 respondent-based17,59,62,63,70 and 7 laboratory-based studies.64,7176 The one study17 that specifically investigated binge eating constructs among individuals with eating pathology relative to controls with no eating pathology reported higher overall energy intake in those endorsing LOC and/or overeating relative to controls. Four out of four studies reported that degree of control over eating was highly correlated with energy intake during a self-reported or laboratory-based meal.6264,75 OBE episodes were associated with greater energy intake than SBE in two out of two studies.17,70 Binge meals were associated with greater energy intake than non-binge meals in six out of six studies,7176 but, with one exception,72 these findings only applied to individuals with eating disorders and not to healthy controls.


A total of six pediatric studies reported on eating behavior in relation to LOC and/or overeating, including three respondent-based39,42,67 and three laboratory-based studies.40,47,77 Of five studies generally comparing energy intake in youth with LOC relative to non-LOC controls, three reported no differences between the former and the latter40,42,47 and two reported greater energy intake in youth with LOC relative to controls67,77 (although in Hilbert and colleagues’ 2010 study, differences were reported only during a child-only snack meal). Meals involving LOC were associated with greater energy intake than non-LOC meals in two out of two studies.40,67

Adult and pediatric findings regarding other eating behavior-related variables, such as macronutrient composition, hunger, and satiety, are reported in Table 3.

Discriminant Validity

There were no studies that directly addressed the discriminant validity of binge eating constructs.

Predictive Validity

A total of 9 adult and 8 pediatric studies reported on the predictive validity of binge eating constructs; results of these studies are summarized in Table 4.

Table 4

Summary of studies assessing the predictive validity of binge eating constructs

StudySamplen%FAgeBMIPredictorOutcome measure

of F/U¥
81TS: BN8596.529.5±9.122.8±5.8Baseline SBE frequency3yRemission from BN: OR=0.87*Interview
TS: BED13388.043.9±11.938.0±7.3Remission from BED: OR=0.90*

18TS: underweight eating disorders with OBE3310027.9±6.915.4±1.6Baseline LOC status5mIncrease in BMI: OBE, SBE<no-LOC [F(1,2,68)=5.30**]Measured
Decrease in eating-related psychopathology: OBE=SBE=no-LOC [F(1,2,68)=2.24]Interview
Decrease in depression: OBE=SBE=no-LOC [F(1,2,68)=2.97]Self-report
Decrease in anxiety: OBE=SBE=no-LOC [F(1,2,68)=1.82]Self-report
TS: underweight eating disorders with SBE3625.8±10.514.0±1.3Decrease in novelty seeking: OBE=SBE=no-LOC [F(1,2,68)=0.80]Self-report
Decrease in harm avoidance: OBE=SBE=no-LOC [F(1,2,68)=0.60]Self-report
Decrease in reward dependence: OBE=SBE=no-LOC [F(1,2,68)=0.21]Self-report
Decrease in persistence: OBE=SBE=no-LOC [F(1,2,68)=0.70]Self-report
TS: underweight eating disorders with no LOC3624.3±9.014.4±1.7Decrease in self-directedness: OBE=SBE=no-LOC [F(1,2,68)=0.75]Self-report
Decrease in cooperativeness: OBE=SBE=no-LOC [F(1,2,68)=0.28]Self-report
Decrease in self-transecendence: OBE=SBE=no-LOC [F(1,2,68)=0.16]Self-report

78TS: bariatric surgery12980.045.2±11.544.3±6.8Pre-surgical LOC status12m% weight loss: LOC=no-LOCMeasured

79TS: bariatric surgery18383.146.0 (median)45.1Pre-surgical monthly OBE3yWeight change: β=−0.7Measured
Pre-surgical monthly SBEWeight change: β=1.8
Pre-surgical monthly OOWeight change: β=−1.6

83TS: BN809027.3±9.623.9±5.5Baseline to end-of-treatment change in OBE frequency4mDecrease in eating-related psychopathology: B=0.00; SE=0.01Interview
Decrease in depression: B=0.03; SE=0.07Self-report
Decrease in anxiety: B=0.12; SE=0.08Self-report
Increase in self-esteem: B=−0.00; SE=0.01Self-report
Baseline to end-of-treatment change in SBE frequencyDecrease in eating-related psychopathology: B=0.03; SE=0.01**Interview
Decrease in depression: B=0.24; SE=0.08**Self-report
Decrease in anxiety: B=0.37; SE=0.09***Self-report
Increase in self-esteem: B=−0.02; SE=0.01Self-report

80TS: BED placeb-responders14790.341.8±9.635.3±5.3Baseline OBE days4wPlacebo responders<non-responders [t(446)=2.83**]Interview
Baseline SBE daysPlacebo responders>non-responders [t(446)=2.70**]Interview
TS: BED non-placebo-responders304
Baseline OO daysPlacebo responders=non-responders [t(447)=0.05]Interview

30NTS: community-based with OBE15410026.2±7.027.4±7.2Baseline LOC status5yIncrease in BMI: OBE=no-LOC (coefficient=−0.90; SE=0.68); OBE>SBE (coefficient=−2.51; SE=0.79*)Self-report
NTS: community-based with SBE6825.6±7.824.1±5.8Increase in eating-related psychopathology: OBE>no-LOC (coefficient=−0.42; SE=0.12*); OBE=SBE (coefficient=−0.17; SE=0.13)Self-report
Decrease in physical QOL: OBE=no-LOC (coefficient=0.22; SE=0.84); OBE=SBE (coefficient=0.23; SE=0.98)Self-report
NTS: community-based with no LOC10825.4±7.625.4±5.4Decrease in mental QOL: OBE<no-LOC (coefficient=2.16; SE=1.08*); OBE=SBE (coefficient=−0.33; SE=1.25)Self-report
Decrease in negative affect: OBE=no-LOC (coefficient=−1.42; SE=0.77); OBE=SBE (coefficient=1.27; SE=0.89)Self-report

82TS: BED5010042.4±10.134.2±7.1Baseline OBE frequency8wBinge eating remission: B=0.43*Self-report
Baseline SBE frequencyBinge eating remission: NS

23TS: bariatric surgery36186.143.7±10.051.1±8.3Baseline LOC status2y% weight loss at all available F/U: F(1,381)=0.03Self-report
6m LOC status% weight loss at 12m and 24m: F(1,252)=4.75*
12m LOC status% weight loss at 24m: F(1,130)=8.79**

118TS: obesity13262.113.6±2.22.2±0.3 (z-score)Baseline OBE status10mChange in BMI: t=1.11Measured
Attrition: Wald χ2=1.55Measured
Baseline SBE statusChange in BMI: B=0.27Measured
Attrition: Wald χ2=3.96*Measured

84NTS: community-based with LOC6058.310.8±1.523.0±5.0Baseline LOC status5.5yBMI at F/U: t(59)=−1.06Measured
Eating-related psychopathology at F/U: t(59)=−1.22Self-report
NTS: community-based without LOC6055.0Onset of BED: OR=1.39Interview
Depression at F/U: t(59)=−0.10Self-report

85NTS: community-based with LOC5559.810.7±1.524.0±5.5Baseline LOC status2.2yChange in BMI: LOC=no-LOCMeasured
Onset of BED: LOC>no-LOC [t(46)=2.71**]Interview
NTS: community-based with LOC57Change in eating-related psychopathology: LOC=no-LOC [t(46)=1.78]Interview
Change in depression: LOC=no-LOC [t(46)=0.27]Self-report

56TS: overweight with LOC444.010.1±1.633.5±4.5Baseline LOC status4mChange in BMI: LOC=no-LOCMeasured
TS: overweight without LOC23Attrition: LOC=no-LOCMeasured

4NTS: community-based with OBE1688253.512.0±1.6NROBE vs. no overeating status9yOnset of overweight: OR=1.73*Self-report
Onset of high depression symptoms: OR=2.19*
NTS: community-based with OOOnset of binge drinking: OR=1.14Self-report
Onset of marijuana use: OR=1.85*
Onset of other drug use: OR=1.59*Self-report
OO vs. no overeating statusOnset of overweight: OR=1.24
NTS: community-based with no pathologyOnset of high depression symptoms: OR=1.58Self-report
Onset of binge drinking: OR=1.01
Onset of marijuana use: OR=2.67*Self-report
Onset of other drug use: OR=1.89*

86TS: bariatric surgery10172.315.8±1.147.2±0.9Baseline LOC status15mChange in BMI: intercept=0.29; SE=0.14*; slope=0.48; SE=0.08*Measured

88NTS: community-based with LOC4673.910.3±.0125.4±1.1Baseline LOC status4.7yOnset of BED: LOC>no-LOC (OR=10.8*)Interview
Increase in eating-related psychopathology: LOC>noLOC*Interview
NTS: community-based without LOC14952.310.2±0.021.8±0.3Increase in depression: LOC=no-LOCSelf-report
Increase in anxiety: LOC>noLOC*Self-report

87NTS: community-based aged 6–8y2913.38.3±0.620.6±5.9Baseline LOC status4.5yChange in BMI: LOC>no-LOC (estimate=0.61; SE=0.26**)Measured
NTS: community-based aged 9–10y6424.410.1±0.623.1±7.6
NTS: community-based aged 11–12y5019.611.9±0.524.8±6.9

Note: Age and BMI reported as means unless otherwise stated. Only comparisons involving binge eating constructs are reported.

Abbreviations: F=female; BMI=body mass index (kg/m2); F/U=follow-up; TS=treatment-seeking; BN=bulimia nervosa; BED=binge eating disorder; SBE=subjective binge eating; OR=odds ratio; LOC=loss of control; OBE=objective binge eating; OO=objective overeating; SE=standard error; NTS=non-treatment-seeking;

¥y=years; m=months; w=weeks


Of the 9 adult studies reporting on the predictive validity of specific binge eating constructs, 8 were conducted in the context of an intervention. Of four studies reporting on weight-related outcomes following psychological or surgical treatment, three found that baseline OBE, SBE, and/or OO were not predictive of weight change,23,78,79 and one found that baseline LOC predicted lower weight re-gain in underweight individuals with eating disorders.18 In one study, LOC eating following bariatric surgery was predictive of lower weight loss at subsequent time-points.23 Of two studies directly comparing binge eating constructs, one found equivalent weight outcomes in those reporting OBE relative to those reporting SBE,18 while the other found OBE to be associated with greater weight gain than SBE.30

In terms of psychosocial outcomes, findings have been mixed. In one study, baseline OBE predicted placebo non-response while baseline SBE predicted placebo response; OO was equivalent among placebo responders and non-responders.80 One study found higher baseline SBE frequency to be predictive of non-remission from an eating disorder,81 while another found OBE, but not SBE, to predict remission status.82 Finally, while two studies reported that individuals with OBE and SBE generally did not differ from one another or from controls with no LOC eating in terms of changes in eating-related and general psychopathology,18,30 another found that changes in SBE, but not OBE, predicted changes in eating-related and general psychopathology during and after psychological treatment.83


Of eight pediatric studies reporting on the predictive validity of specific binge eating constructs, three were conducted in the context of an intervention. In terms of weight-related outcomes, weight gain was found to be unrelated to LOC eating in four naturalistic or intervention studies,35,56,84,85 while three other studies found that LOC eating predicted poorer weight-related outcomes.4,86,87 OO was not associated with elevated risk for adverse weight outcomes in the single study that reported on this construct.4 LOC eating was associated with poorer psychosocial outcomes, including onset of BED, in most studies,4,85,88 although these associations may not hold up over longer periods of time.84


Emerging evidence supports the validity of binge eating constructs, particularly LOC. Overall, the literature suggests that LOC is a psychopathology construct that is uniquely associated with distress and impairment, disturbed eating behavior, and weight-related factors in both cross-sectional and prospective studies, independent of episode size and body weight. Although research on overeating independent of LOC is underrepresented, overeating may best be conceptualized as a marker of risk for excess body weight.

Summary and Interpretations

Studies generally supported the face validity of binge eating constructs by demonstrating the importance of LOC and overeating in individuals’ appraisals of binge eating. However, results were more consistent in adults than in college students and adolescents, who tended to highlight overeating, but not LOC, as central in their appraisals. Thus, it is crucial to consider developmental factors involved in determining the core attributes of binge eating. Such factors may include one’s ability to understand the meaning of LOC and overeating, and eating-related social comparisons specific to one’s peer group.

Support for the convergent validity of LOC in adults was strong for psychosocial and eating-related factors, but mixed for anthropometric characteristics, which may be a function of differing samples. Associations between LOC and body weight were stronger, and less influenced by episode size, among treatment-seeking relative to community-based adults, which may reflect a tendency for individuals with more severe conditions to present in clinical settings;89 therefore, associations between binge eating and increased body weight may be accounted for by the greater severity of binge eating seen in clinical samples, whereas these associations may be less clear in non-clinical samples in which binge eating may be less severe when present. OBE and SBE were indistinguishable on most measures of psychosocial functioning, suggesting that LOC, irrespective of overeating, may be driving associations between binge eating and distress/impairment; however, some recent research indicates that assessing episode size adds incremental value to the convergent validity of LOC.90 The convergent validity of the overeating construct, independent of LOC, was not addressed in most studies.

Pediatric LOC was consistently related to indices of increased body weight and psychosocial impairment, while results for overeating were less consistent in youth. LOC did not consistently track with youth’s energy intake, which may be related to developmental differences in energy intake associated with LOC episodes, perhaps due to varying nutritional needs91 and differing access to energy dense foods92 in children as compared to adults. However, LOC eating was marked by differences in the composition of eating episodes, suggesting that the experience of LOC in youth may manifest in differing food choices rather than overall increased energy intake.

There were limited data addressing the discriminant validity of LOC and overeating, which may partially reflect a bias against publishing null findings.93 However, it is worth noting that LOC appears distinct from other eating- and weight-related problems. Although LOC may overlap to some extent with overeating and other forms of disinhibited eating (e.g., eating in the absence of hunger), research in adults22,59,94 and children38,46,95 suggests that these are distinct constructs with distinct correlates. Indeed, research has shown that the frequency of OBE episodes is unrelated to the frequency of SBE episodes (r range=.08–.22),54,96 suggesting that LOC and overeating are distinct constructs.

Finally, most, but not all, of the studies reviewed supported the predictive validity of LOC in relation to treatment outcome and naturalistic eating- and weight-related outcomes. An additional point to consider is that several studies have shown that persistent LOC eating is associated with adverse health outcomes in youth;84,88 similarly, in the bariatric surgery literature, post-surgical LOC eating has been concurrently associated with poorer weight outcomes in adults.97 While these studies do not fit neatly into the domain of predictive validity as they are not truly prospective in nature, they provide additional support that LOC eating is associated with adverse health-related outcomes across the age spectrum. Finally, as with other validity domains, the predictive validity of OO has been underexplored. Research is also needed to clarify the impact of specific binge eating constructs on treatment outcome in youth.


Measurement issues comprise the major limitation of this review. For example, overeating was approximated corresponding to energy intake for multiple studies. This is an imperfect proxy since the objectively large/not large distinction is determined by the quantity, not quality or density, of food. Thus, an objectively large episode could contain relatively few calories (e.g., 5 apples) while a subjectively large episode could be calorically dense (e.g., typical fast food meal). More generally, the modest reliability of LOC and overeating is an issue that has been raised by other investigators,98 and represents a point of concern for this review since poor reliability can distort interpretations of validity. The modest reliability of the LOC construct may reflect the inherent difficulty of having participants recall momentary constructs that naturally vary over time and are associated with negative affect and current dietary patterns, and of attempting to obtain precise details about features of LOC and overeating episodes that may or may not be important in identifying their presence (e.g., actual/subjective episode quantity, duration, context). Ultimately, the behavioral aspects of LOC and overeating, while potentially easier to identify, appear to be less important than one’s subjective experience during such episodes, the latter of which is fundamentally more difficult to assess. Therefore, future research on binge eating constructs should seek to improve its measurement in the service of enhanced reliability. Finally, as with other literature reviews, the data described herein may be subject to biases in the peer review system (e.g., publication bias, selective reporting). Therefore, results should be interpreted cautiously.

Future Directions

Several areas related to our understanding of LOC and overeating require additional research. First, sociocultural differences, particularly those related to gender and race/ethnicity, in the presentation of LOC and overeating are underexplored, which is problematic since binge eating is more evenly distributed across these domains than other eating disorder behaviors.24 Second, the limited data on OO and, to an even greater extent, SO has impeded attempts to tease apart the independent contributions of LOC and perceived/actual overeating to weight- and eating-related outcomes. Previous research has suggested that LOC may be confounded by episode size,62 and as a result, it is unclear whether LOC drives eating behavior, or problematic interpretations of one’s eating behavior (e.g., breaking a dietary rule) drive subjective reports of LOC. It is also unclear why OO or SO may occur in the absence of LOC on some occasions but not others, sometimes within the same individual. This lack of clarity has clinical implications in terms of focusing treatments on enhancing control over eating, versus improving problematic perceptions about eating behavior.

Third, it is unclear whether LOC—especially while consuming a subjectively large amount of food—is related to a general tendency to pathologize one’s behaviors and experiences, which may explain cross-sectional associations between LOC and psychopathology. Relatedly, eating disorders involving LOC and other disorders characterized by self-control impairments frequently co-occur,2 but it is unclear whether the underlying experience of LOC is similar across behavioral phenotypes. Indeed, this issue has been raised in regard to the controversial “food addiction” construct,99 a distinct but potentially overlapping construct relative to binge eating. Therefore, a critical yet unanswered question in the literature is the extent to which LOC is specific to eating behavior, or whether the construct represents generalized pathology extending to multiple reinforcers. Inter-disciplinary cross-talk will be critical in starting to answer this question, as differing labels (e.g., “addiction,” “self-control”) used to describe potentially similar constructs may impede the growth of new knowledge regarding how to study and treat behavioral problems.

A fourth research gap is related to the limited assessment of objective markers of the momentary occurrence of LOC and overeating. A significant impediment to identifying biomarkers of these phenomena is that reliable methods for eliciting LOC in particular are limited. Feeding laboratory studies often involve instructing participants to engage in binge eating episodes, and this methodology is fairly consistently associated with objective changes in eating behavior as compared to instructing participants to engage in eating a normal meal, as reviewed in Table 3. However, systematic collection of other objective data in such studies has been limited, thereby impeding knowledge on the extent to which these objective measures are linked specifically to LOC, overeating, or their confluence, and the unique influence of these constructs on weight regulation. Future directions include developing effective methods for eliciting LOC eating across laboratory-based paradigms, including using proxy designs to simulate LOC eating, and more programmatically assessing biomarkers in other momentary data collection designs.

A final point concerns the classification scheme for eating disorders. DSM-5 requires OBE for diagnoses of BED and BN, while individuals reporting SBE in the absence of OBE are relegated to a residual “otherwise specified” category.100 Given that LOC is a valid construct that is uniquely related to psychopathology independent of overeating, this author would argue that both OBE and SBE should be accounted for in the diagnostic scheme. Several investigators have proposed independent diagnoses which would accommodate individuals who engage in SBE (e.g.,101). A more parsimonious alternative might be to relax the DSM binge eating criterion to include both OBE and SBE, as is likely for ICD-11.102 Alternatively, eliminating size-related distinctions all together may be optimal for future diagnostic schemes, especially given evidence that OBE and SBE episodes are similarly predictive of distress, impairment, and other health-related outcomes. Further diagnostically relevant research will hopefully clarify these taxonomic issues.

Ultimately, developing and implementing efficacious interventions for binge eating-related problems across the size and LOC-severity spectrum should be a priority. Research has shown that SBE may be less responsive than OBE to psychological treatments addressing behavioral and affective antecedents,26,83 suggesting that there may be unique triggers of LOC in the absence of overeating that aren’t adequately addressed in current interventions. Treatments focused on improving distorted cognitions about one’s eating behavior (e.g., subjective perceptions that one has eaten an excessive amount of food, which may be related to the experience of LOC)62 as well as increasing mindfulness/intuitive eating practices to enhance awareness of subjective and objective cues around eating and avoid common LOC triggers103 may be particularly helpful.

In summary, accumulating evidence suggests that LOC is a valid construct despite evidence of its modest reliability, particularly when accompanied by subjectively large amounts of food. Overeating appears to be best considered as a potential marker for excess weight. Future research should focus on clarifying the phenomenology, measurement, and unique outcomes of these constructs to inform prevention/early intervention and classification efforts.


Dr. Goldschmidt is supported by NIH grant K23-DK105234. She is grateful to Drs. Andrea E. Kass, Kate Keenan, Stephen A. Wonderlich, Kelly C. Berg, and Carol B. Peterson for their comments and feedback on earlier drafts of this manuscript.


Conflicts of interest: None to report


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