Characteristics Associated With Binge Eating in Children: A Systematic Review

Purpose:  Binge Eating Disorder (BED) has the highest prevalence of all clinical eating disorders, and is a distinct diagnostic category in the new DSM-5. According to the National Comorbidity Study, lifetime prevalence of BED (1.6%) is more than four times that of Anorexia Nervosa (0.3%) and almost twice that of Bulimia Nervosa (0.9%). Despite this, current research on Child BED (C-BED) has many gaps and limitations, compounded by the lack of specified diagnostic criteria for children in DSM-IV-TR and DSM-5. The purpose of this study was to systematically review the literature on correlates of C-BED, identify gaps, and make recommendations for interdisciplinary research that can inform practice and prevention efforts.          

Method: PubMed and PsycInfo were searched systematically for English-language, peer-reviewed articles published between 1980 and 2013 that included binge-eating behaviors among children (aged 12 and under) as study variables. The PRISMA Statement informed the methodology of this review. After the preliminary search (n=73), additional studies (n=53) meeting criteria were identified from bibliographies (n=126). After exclusionary criteria were applied, 96 full-text articles were included in the analysis. Five categories of characteristics emerged from the literature and were used to classify studies, organize the analysis, and synthesize findings: (1) eating and weight-related behaviors (n=34 studies); (2) cognitive and psychological characteristics (n=45); (3) social and environmental characteristics (n=20); (4) bio-physiological characteristics (n=21); and (5) fixed characteristics (n=25) (categories were not mutually exclusive).

Results: Based on the Kraemer et al. (1997) taxonomy of risk factors, most of the studies examined were cross-sectional and examined correlates of child binge eating. Few risk factors have been determined for C-BED due to a dearth of longitudinal and intervention studies. Inconsistent criteria for C-BED across studies were common, partly because DSM-IV/DSM-5 adult criteria may not be appropriate for children; thus, researchers must adapt criteria for the age group studied. Criteria are still evolving, and the state of the research reflects the changing nature of diagnostic criteria for BED. Several gaps in C-BED research were identified. Dieting was one of the most commonly assessed behaviors related to C-BED, however no studies have assessed the differential effects of perceived dieting and actual caloric deficits on binge eating. Additionally, though Loss of Control (LOC) eating is a symptom of BED, there have been no RCTs assessing the effect of treating LOC on C-BED outcomes.  Last, little consideration has been given to malleable environmental characteristics such as family mealtimes and school-food environments. Findings suggest that effective prevention and treatment of C-BED will require further interdisciplinary examination of symptomology in children, especially of sex differences in symptom manifestation. Second, more longitudinal studies are necessary to establish correlates and risk factors according to established taxonomies. Last, intervention studies are needed to establish evidence-based treatment practices.

Implications: As awareness of C-BED continues to grow, Social Workers will play an essential role in early identification, prevention and treatment of C-BED in families and schools, and will be needed to advocate for more healthful food environments to support positive growth and development of children.