Body image dissatisfaction in obese women: the importance of binge eating disorder

LETTER TO THE EDITORS

Body image dissatisfaction in obese women: the importance of binge eating disorder

Rodrigo O. Moreira^I; Ana Patrícia C. Batista^II

^IPhysician. Researcher, Obesity and Eating Disorders Group (GOTA), Instituto Estadual de Diabetes e Endocrinologia (IEDE) / Instituto de Psiquiatria – Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil. Researcher, Escola Médica de Pós–Graduação, Pontifícia Universidade Católica do Rio de Janeiro (PUCRJ), Rio de Janeiro, RJ, Brazil

^IIGraduate student in Endocrinology, Escola Médica de Pós–Graduação, PUCRJ, Rio de Janeiro, RJ, Brazil

Dear Editors,

We would like to present some data that have drawn our attention in one of the studies developed by our group. Binge eating disorder (BED) is the most prevalent eating disorder in obesity. It is characterized by recurrent episodes of "binge eating" associated with lack of control and without the presence of compensatory mechanisms. Patients with BED are usually characterized by a psychopathological profile more severe than common obese patients, with higher prevalence of several psychiatric syndromes, including depressive and anxiety disorders.¹

It is currently known that patients with eating disorders, especially anorexia and bulimia nervosa, are characterized by major changes in the perception of body image. In obese patients with BED, there is also a discussion on whether body image dissatisfaction primarily results from BED, i.e. from eating disorder, or whether it is secondary to weight excess. Some authors have suggested that body changes related to obesity could lead to psychopathological changes able to trigger severe conditions of body image disorders and typical psychiatric disorders.²

We consecutively assessed 156 obese women (body mass index – BMI = 39.8 ± 6.4), aged between 18 and 77 years (39.1 ± 11.9), who sought treatment to lose weight at Obesity and Eating Disorders Group of the Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro. The protocol was approved by the ethics committee of the institution. Diagnosis of BED was performed by a trained psychiatrist, according to the Brazilian version of the Structured Clinical Interview for DSM–IV.³ Body image dissatisfaction was assessed using the Brazilian version of the Body Shape Questionnaire (BSQ).

Forty–six patients with BED were identified (29.4%). Women with BED presented, compared with women without BED, same age (38.4 ± 8.4 vs. 39.3 ± 12.0, respectively; p = 0.67) and same BMI (39.7 ± 5.9 vs. 39.8 ± 6.8, respectively; p = 0.96). As to body image, obese women with BED presented significantly higher levels of BSQ than women without BED (148.9 ± 26.7 vs. 133.8 ± 29.8, respectively; p = 0.003).

Our results lead to some interesting conclusions. It seems that body dissatisfaction in obese women is more related to presence of BED than to weight excess. These higher BSQ values could be considered a reflex of psychopathological factors related to BED, such as low self–esteem, depression, extreme concern about appearance, and not about body weight.⁴ The findings demonstrated by Sarwer et al.⁵ and Foster et al.⁶ were similar to our studies, suggesting that BMI is not associated with body dissatisfaction.

The importance of our findings lies in the fact that many articles assessing body image take into account several sociodemographic and anthropometric variables. It is important to stress that a disorder such as BED can be present in up to 30% of a population and it can significantly interfere with the assessment of body image of obese patients, so it should always be considered as confounding factor.

References

1. Fontenelle LF, Vltor Mendlowicz M, de Menezes GB, Papelbaum M, Freitas SR, Godoy–Matos A, et al. Psychiatric comorbidity in a Brazilian sample of patients with binge–eating disorder. Psychiatry Res. 2003;119(1–2):189–94.

2. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12–month prevalence of DSM–III_R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8–19.

3. First MB, Spitzer RL, Gibbom M, Willimas JBW. Structured clinical interview for DSM–IV axis I disorders: patients edition (SCID–IV, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute; 1996.

4. Cash TF, Fleming EC. Body image and social relations. In: Cash TF, Pruzinsky T, eds. Body images: a handbook of theory, research, and clinical practice. New York: Guilford: 2002. p. 277–86.

5. Sarwer DB, Wadden TA, Foster GD. Assessment of body image dissatisfaction in obese women: specificity, severity, and clinical significance. J Consult Clin Psychol. 1998;66(4):651–4.

6. Foster GD, Wadden TA, Vogt RA. Body image in obese women before, during, and after weight loss treatment. Health Psychol. 1997;16(3):226–9.

Publication Dates

• Publication in this collection
  06 Sept 2007
• Date of issue
  Apr 2007