Why Favor the Structured Clinical Interview Rather than a Self-Administered Questionnaire to Diagnose Binge Eating?

Didier Quilliot; Claire Nominé-Criqui; Marie-Aude Sirveaux; Alexandre Schwanke; Coralie Gaspard; Pierrette Witkowski

doi:10.37871/jbres1625

ISSN: 2766-2276

Medicine Group . 2022 December 19;3(12):1503-1506. doi: 10.37871/jbres1625.

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Why Favor the Structured Clinical Interview Rather than a Self-Administered Questionnaire to Diagnose Binge Eating?

Didier Quilliot^1,2*, Claire Nominé-Criqui¹, Marie-Aude Sirveaux¹, Alexandre Schwanke¹, Coralie Gaspard^1,2 and Pierrette Witkowski^1,2

¹CHRU-Nancy, Département de Chirurgie Viscérale, Métabolique et Cancérologique (CVMC), Unité Multidisciplinaire de Chirurgie de l'Obésité, Rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France
²CHRU-Nancy, Centre Spécialisé de l’Obésité (CSO) et Service d’Endocrinologie, Diabétologie et Nutrition (EDN), Rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France

*Corresponding author: Didier Quilliot, CHRU-Nancy, Département de Chirurgie Viscérale, Métabolique et Cancérologique (CVMC), Unité Multidisciplinaire de Chirurgie de l'Obésité, Rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France E-mail:

Received: 04 December 2022 | Accepted: 17 December 2022 | Published: 19 December 2022

How to cite this article: Quilliot D, Nominé-Criqui C, Sirveaux MA, Schwanke A, Gaspard C, Witkowski P. Why Favor the Structured Clinical Interview Rather than a Self-Administered Questionnaire to Diagnose Binge Eating? 2022 Dec 19; 3(12): 1503-1506. doi: 10.37871/jbres1625, Article ID: jbres1625

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Binge Eating Disorder (BED) is a frequent occurrence in obese patients [1-3] but also in the general population (3.5% in women and 2.0% in men [4]. Surveys via self-questionnaires in patients scheduled for bariatric surgery showed that BED occurred in 2% to 49% of the patients while subclinical binge eating behavior occurred in 6% to 64% of the patients [5]. The use of different diagnostic tools and criteria for characterizing Binge Eating (BE) and Binge Eating Disorder (BED) in these studies could explain this very wide range. The Binge Eating Scale (BES) questionnaire [6] has been proposed as a screening tool for the diagnosis of BED. However, self-questionnaire-based surveys underestimate the true involvement of BED since part of the BES questionnaire as well as structured interviews (the SCID-I/P [7] and Eating Disorder Examination (EDE) [8,9]) used in these previous studies focused only on the experiences of the last four weeks to three months. Importantly, several studies have shown that patients having experienced a period of BED in the past have a high risk of relapse. This risk is significant in the short term, as has been shown during the COVID-19 pandemic and particularly during confinement, which represented a period of major stress [10]. But it also exists in the longer term, sometimes after several years of remission, for example after a significant life event as was shown especially after bariatric surgery [11-13].

In a previous study, we compared the Binge Eating Scale (BES) [6] and structured clinical interviews [14] adapted for lifelong experiences (SCID- I/P) [15]. The interest of BES as a predictor of BED during lifetime have been tested in a subgroup population of 340 subjects. In this subgroup, SCID- I/P identified 38.2% (n = 130) of the sample with a past or current BED. According to the French version of the BES, 35% (n = 119) of the sample were classified as having a binge eating disorder. While the prevalence appeared similar, the patients involved, were not the same. The mean BES score in the BED group was 17.8 ± 9.1 and 12.2 ± 7.7 in the non-BED group (p < 0.0001). With a cutoff value of 17, the sensitivity (measures the proportion of positives that are correctly identified as such) was 50.8% and the specificity (measures the proportion of negatives that are correctly identified as such) was 74.7%. The Positive Predictive Value (PPV) was 55.4% and the negative predictive value was 71.1%. Hence, the False Positive Rate (FPR) was 44.5% while the False Negative Rate (FNR) was 29%. Of note, 17.5% of these patients reported a past history of BED but no current BED. In this group of patients with past BED without current BED, the sensitivity was lower (33.9%) suggesting that the patients completed the questionnaire by considering the current period and not the past.

Thus, the majority of the patients tested in our population who described experiencing BED in the past were not identified with this questionnaire. Several studies have shown that patients who have had a period of BED in the past have a high risk of relapse, especially after bariatric surgery [11,13]. BED is not constant over the course of a lifetime but varies depending on the occurrence of life events (death, separation, professional or family concerns, etc.). Kalarchian MA, et al. [2] accordingly make this distinction for BED diagnosis and axis 1 diagnosis. In their study, lifetime prevalence of BED was 27.1% while current prevalence was 16%.

Notwithstanding the above, many studies on BED have nevertheless used self-reported questionnaires, the result of which show that they tend to underestimate the prevalence of this condition [16-18]. Other studies of BED have been limited to specific populations (e.g., young women) or were based only on questionnaires, rather than on personal interviews [19]. This disorder has been shown to be more frequent in obese patients [20]. Among patients with grade 3 obesity, based on random-effects estimates of prevalence, BED represented the most common mental health condition (17% (95% CI, 13%-21%)) after depression (19% (95% CI, 14%-25%)) [1]. However, this prevalence based on self-questionnaires, compared to a semi-structured interview, is most likely underestimated [2,3]. In fact, rates of pre-surgical BED were found to range from 2% to 49%, while rates of subclinical binge eating behaviors ranged from 6% to 64% across studies [5]. The variety of assessment tools employed, as well as the inconsistent criteria used to identify eating disorders (i.e., meeting DSM-IV criteria for binge eating disorder vs. subclinical binge eating) likely explain these wide ranges. Conversely, carrying out structured interviews in larger numbers by well-trained interviewers, while costly and time-consuming, nonetheless allows assessing eating behaviors during lifetime and avoids the false negatives estimated at 22% with the Binge Eating Scale questionnaire [21].

Psychiatric disorders and binge eating disorder may contribute to the development of severe obesity in vulnerable individuals. For example, some individuals report overeating or binge eating when depressed, and since depression tends to be recurrent, repeated episodes could contribute to weight gain over time. Certain epidemiological studies furthermore suggest that mood problems antedate weight problems [22].

Several risk factors of relapse have been reported in the literature. We showed that early psychological events are independent predictors of BED [15]. Other studies showed that patients with BED reported significantly higher levels of psychological distress and binge eating severity, compared to the normal weight and participant suffering from obesity without BED. Greater Domineering, Cold, Socially Inhibited and Non-Assertive scale scores, and lower Vindictive scale scores significantly predicted higher binge eating and psychological distress [23]. An early age of onset, before 16-18 years, in relation to a poor treatment outcome have been reported in several studies [24-26]. At short term, higher restraint scores after treatment predict relapse adds to the literature concerning the role of restraint in patients with BED [24].

Finally, patients with a history of BED are at very high risk of relapse and the risk of recurrence is considerable, whether recent or older. It therefore appears important to track BED throughout the lifetime of the patient. Consequently, the BES questionnaire may be an insufficient predictor of relapse.

In clinical practice, it seems also very important to explore the complete history of the eating behavior disorders, to analyze the links with life events and weight history.