Racial/ethnic differences in binge-eating prevalence, clinical and cognitive symptoms, and treatment retention/outcome in a community hospital weight-management sample
Richards, Lauren Kristi
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Research suggests binge eating (BE) is equally prevalent across racial/ethnic groups. However, the majority of data concerning the assessment and treatment of BE come from clinical trials or specialty clinics where racial/ethnic minorities are underrepresented. Data regarding symptoms and treatment are needed from urban clinical settings where minorities are more likely to seek treatment. The current study assessed racial/ethnic group differences in BE prevalence, clinical and cognitive symptoms, and treatment retention in an ethnically-diverse weight loss treatment-seeking sample. Participants included 127 Hispanic, 204 African-American and 99 Caucasian adults who completed self-report measures of BE frequency, distress, eating-related cognitive symptoms including shape and weight concerns and dietary restraint, depression, stress, and treatment barriers. Data concerning number of treatment sessions attended and body mass index (BMI) were collected at 6-month follow up. The first study developed and validated the Dimensional Assessment of Loss of Control Eating (DALC) scale. The 2-factor DALC demonstrated good internal consistency and convergent, construct and incremental validity. The DALC contributed to variance in eating pathology and depression beyond existing BE measures. The second study examined racial/ethnic differences in BE prevalence, eating-related cognitive symptoms, and BMI. As hypothesized, no racial/ethnic differences in BE frequency were found and the rate of recurrent BE was 20% to 30%; participants with recurrent BE had higher BMIs, levels of depression, and global eating pathology than individuals without; African-American participants with BE had higher BMIs than other racial/ethnic groups, controlling for demographic variables. The hypotheses that Hispanic participants have higher weight and shape concerns, and that African-Americans have higher levels of restraint, were not supported. The third study examined the hypothesis that ethnicity is associated with obesity treatment retention and outcome. African-American participants had lower retention rates than Hispanics and Caucasians combined, and had lower levels of obesity-based stigma, which accounted for their lower retention rates. African-Americans lost less weight than Caucasians but this difference disappeared after accounting for age and income. The findings suggest high BE rates among racial/ethnic minorities at a common entry point for health services utilization. Stigma and African-American ethnicity should be considered when developing retention interventions.