Participants and Procedures
The current study was a secondary data analysis of baseline data from two ongoing clinical trials for binge eating. Participants were recruited from the community using radio and social media advertising and completed a phone screen with a trained assessor to determine initial eligibility. Participants then completed a baseline assessment where final eligibility was determined via the Eating Disorder Examination interview . Participants were included if they were at least 18 years old and experienced at least one objectively- or subjectively-large binge-eating episode per week over the past three months. Participants were excluded if they had recent changes in any psychiatric medications, were pregnant or planning to become pregnant, or were currently enrolled in or planning to enroll in other psychotherapy for binge eating or weight loss treatment. Self-report measures of alcohol consumption and ADEBs were administered at the baseline assessment. Baseline assessments took place remotely via videoconferencing software. All study procedures were approved by the university Institutional Review Board, and all participants provided informed consent and were compensated for their participation.
The sample for the current study included 166 treatment-seeking adults with at least one binge-eating episode per week. 4 participants did not complete the self-report questionnaires and were excluded from the sample. 70.4% participants identified as women, with others identifying as men (19.1%), non-binary (3.1%), transgender (0.6%), questioning or unsure (2.5%), or none of the above (0.6%); 6 participants did not complete the item. Participants were between the ages of 18 – 70 years old (M (SD) = 42.81 (13.82)) years old. The majority of the sample identified as White (70.4%), with others identifying as Black or African American (13.6%), Asian (7.4%), American Indian/Alaskan Native (0.6%), more than one race (6.2%), or unknown or prefer not to say (3.1%); 13 participants did not complete the item. Participants received the following eating disorder diagnoses at baseline: Bulimia Nervosa (BN; 21.0%), Binge-Eating Disorder (BED; 35.8%), Other Specified Feeding or Eating Disorders - BN of low frequency (OSFED-BN; 21.6%), OSFED - BED of low frequency (OSFED-BED; 21.6%).
Eating Pathology. The EDE 17.0 , a semi-structured diagnostic interview, was used to assess binge eating frequency and weight and shape concerns. Binge eating frequency was calculated as the total number of objectively and subjectively large binge-eating episodes in the past three months. EDE Weight Concerns and Shape Concerns subscales were calculated. Subscale scores ranged from 0 – 6, and higher scores indicated greater weight and shape concerns. The EDE is a valid and reliable instrument that has been used extensively in studies of individuals with eating disorders.
Alcohol Consumption. Alcohol consumption over the past three months was assessed via the National Institute on Alcohol Abuse and Alcoholism (NIAAA) three question screener. Participants were provided with examples of a standard alcoholic drink and asked to rate the frequency of drinking episodes (Likert scale from 0 (“Never”) to 8 (“Every day”)) and typical number of drinks per episode (Likert scale from 1 (“1 drink”) to 10 (“25 or more drinks”)) over the past three months. Alcohol consumption was calculated by multiplying the frequency of drinking episodes over the past three months by the typical number of drinks per episode (range 0 – 80). These screening items are consistent with items used in other brief alcohol screeners (e.g., Alcohol Use Disorders Identification Test-Concise) which have demonstrated validity and reliability in a variety of samples [13,11].
Alcohol-Related Disordered Eating Behaviors (ADEBs). ADEBs was assessed using self-report items from the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) . Participants reported how often they skipped meals, limited food intake, or exercised before and after drinking to avoid weight gain over the past three months. Frequency was rated on a Likert scale from 0 (“Never”) to 4 (“Almost all the time”). ADEBs frequency for the current study was calculated as the average of the 6 items. The CEBRACS has been demonstrated sound psychometric properties [15,14].
SPSS 26.0 was used for all analyses. Analysis of variance (ANOVAs) were used to assess whether ADEBs frequency was related to demographic characteristics (i.e., gender, age, eating disorder diagnosis). There were no significant differences in ADEBs frequency based on gender or age. ADEBs frequency significantly differed by eating disorder diagnosis (F(3, 117) = 9.87, p < .001). Post-hoc analyses found that participants with BN reported significantly more ADEBs than participants with BED or OSFED-BED, but did not significantly differ from participants with OSFED-BN. Based on these analyses, eating disorder diagnosis was included as a covariate in all regression analyses.
Descriptive statistics were calculated to characterize the type and frequency of ADEBs in the sample in Aim 1. Stepwise linear regressions were used for Aims 2 and 3. In all regression models, eating disorder diagnosis was included as a covariate in Step 1, and presence of ADEBs or ADEBs frequency was added as a predictor in Step 2.