Public and Healthcare Professionals' Knowledge and Attitudes toward Binge Eating Disorder: A Narrative Review.

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obesity 795 is associated with elevated psychosocial and functional impairment, and is associated strongly with obesity and related medical comorbidities. The aim is to provide a brief, state-of-the-art review of the major
obesity 5054 [[15]]. Although BED can occur across the BMI spectrum, it is significantly associated with risk of obesity and related comorbidities [[11],[16],[17]]. Data from the National Comorbidity Survey Replication (NCS-R)
obesity 5256 Replication (NCS-R) indicated that 42% of patients meeting the DSM-IV criteria for BED were classified with obesity [[10]]. Obesity, however, is not a diagnostic requirement for BED. Among US adults with obesity (BMI
obesity 5352 with obesity [[10]]. Obesity, however, is not a diagnostic requirement for BED. Among US adults with obesity (BMI ≥ 30 kg/m2) in the Collaborative Psychiatric Epidemiology Surveys, the prevalence of BED was
obesity 5544 prevalence of BED was 5.5% in women 2.9% in men [[18]]. Evidence strongly suggests that among people with obesity , those meeting the DSM-5 BED diagnostic criteria constitute a meaningful and distinct subgroup [[19]],
obesity 9970 stigmatization of BED has received particularly little attention relative to stigma associated with obesity or the other eating disorders, yet this field of study is emerging and timely. From the outset, the
obesity 14294 survey. A fictional case vignette was read aloud to participants describing a 32-year old female with obesity who engaged in binge eating. Following the vignette, participants were forced to select 1 of 12 responses
obesity 15396 undergraduate students (N = 376) were assigned randomly to read one of six scenarios depicting a woman with obesity either with or without the presence of binge eating. Participants assigned to the obesity with binge
obesity 15486 woman with obesity either with or without the presence of binge eating. Participants assigned to the obesity with binge eating condition rated the character more negatively, as having a worse prognosis, and being
obesity 15653 negatively, as having a worse prognosis, and being more likely to drop-out of treatment than a woman with obesity without BED. The fictional woman who engaged in binge eating was rated as less attractive and more blameworthy,
obesity 16269 world” beliefs (i.e., people get what they deserve in life) and stigmatizing attitudes toward ED and obesity . Participants were 447 university students assigned randomly to read a vignette depicting a character
obesity 16400 university students assigned randomly to read a vignette depicting a character with AN, BN, BED, or obesity . Assessments of stigmatizing attitudes, just world beliefs, causal beliefs, and acquaintance with the
obesity 16749 parenting and a lack of self-discipline were positively correlated with stigma toward AN, BN, BED, and obesity (rs = 0.35 to 0.41). Participants who were acquainted with someone with BED showed a similar level of
obesity 17101 prejudice. A study by Ebneter and Latner [[57]] compared stigmatizing attitudes across AN, BN, BED, obesity , and major depressive disorder (MDD). Over 400 university undergraduates viewed case vignettes, followed
obesity 17396 impairment/distrust. Lack of self-discipline was perceived to contribute more to the development of BED and obesity than to the development of AN, BN, or MDD. The target with BED was blamed more than other EDs or depression,
obesity 17676 as the most impaired and least personally responsible for their illness, whereas the vignette with obesity was rated the most personally responsible for their illness. Of note, the target with obesity and BED
obesity 17770 with obesity was rated the most personally responsible for their illness. Of note, the target with obesity and BED was held less personally responsible than the vignette with obesity but without BED. Star et
obesity 17846 Of note, the target with obesity and BED was held less personally responsible than the vignette with obesity but without BED. Star et al. [[62]] investigated perceived discrimination toward an underweight female
obesity 18023 discrimination toward an underweight female with AN, a normal-weight male with atypical ED, and a female with obesity and BED. Participants (N = 3047) were asked, “Do you think that (name of character) would be discriminated
obesity 18380 professional?” Results showed that the majority (66%) of participants believed the vignette with obesity and BED would be discriminated against, compared to 48% for the AN vignette, and 35% for the male vignette
obesity 18803 participants (aged 35–54) than younger participants (under 35) believed the vignette with comorbid obesity and BED would be discriminated against (58% vs. 71%, respectively). Notably, this age-related trend
obesity 20144 Murakami, Essayli, and Latner [[63]] investigated the relative stigmatization of eating disorders and obesity using male and female vignettes. A total of 318 undergraduates were randomly assigned to read case vignettes
obesity 20336 assigned to read case vignettes depicting either a male or female character diagnosed with AN, BN, BED, or obesity without BED. Stigmatizing attitudes and perceived mental health of the vignette were analyzed according
obesity 20504 health of the vignette were analyzed according to the target gender and target diagnosis. Targets with obesity were held more personally responsible compared to targets with AN, while BN, BED, and obesity were found
obesity 20598 with obesity were held more personally responsible compared to targets with AN, while BN, BED, and obesity were found similarly blameworthy for their conditions. Those with BED were rated as less impaired than
obesity 20769 with BED were rated as less impaired than targets with AN and BN, yet more impaired than targets with obesity without BED. The vignette with BN was more negatively judged and elicited more discomfort with proximity
obesity 23910 study by Crow et al. investigated physicians’ assessment and treatment practices for binge eating and obesity [[53]]. The sample was cross-disciplinary and consisted of 272 physicians, of whom 43.8% were in family
obesity 24279 never assessed for binge eating, and an additional 42.8% estimated that 0 to 20% of their patients with obesity engaged in binge eating behavior. McNicholas et al. [[54]] conducted a web-based survey investigating
obesity 27233 psychologists, psychiatrists, and registrars). Participants (N = 175) were randomly assigned to either a BED or obesity -only condition (BMI = 35.0 in both vignettes) and then completed items related to diagnostic knowledge,
obesity 27488 alternatives. Over 80% correctly identified BED as the presenting problem and 77.1% correctly recognized obesity -only. However, only a quarter of participants (26.6%) in the BED condition also correctly recognized
obesity 27622 quarter of participants (26.6%) in the BED condition also correctly recognized the comorbid presence of obesity . Further, participants in the BED condition had less knowledge of potential physical complications than
obesity 27747 participants in the BED condition had less knowledge of potential physical complications than those in the obesity -only condition, despite the similar BMI. Approximately half of the participants in the BED condition
obesity 32091 might differentiate, or add incrementally to, stigmatizing attitudes encountered by individuals with obesity . Although few studies specified exact BMIs in the case descriptions, all of the BED vignettes were described
obesity 32290 vignettes were described as “overweight” or as having difficulties with weight management. People with obesity face pervasive societal exposure to weight discrimination [[71]], as well as self-directed, or internalized,
obesity 33094 the opposite effect [[57]]. In one study, societal discrimination toward individuals with comorbid obesity and BED was widely anticipated; however, the vast majority (84%) in a community study believed that
obesity 35575 [[55]]. Of note, only one-quarter of healthcare professionals accurately recognized the presence of obesity when co-occurring with BED [[52]], despite being shown a vignette with a BMI of 35. Moreover, participants
obesity 35765 35. Moreover, participants demonstrated less knowledge of physical complications when BED accompanied obesity . For instance, nearly 100% of participants recognized high blood pressure in the obesity-only condition,
obesity 35854 accompanied obesity. For instance, nearly 100% of participants recognized high blood pressure in the obesity -only condition, but this rate dropped to 60% when BED was present, despite the similar BMIs. As many
obesity 36277 investigations should continue to address the effects of a complex comorbid presentation of BED and obesity on screening, assessment, referral, and treatment practices. It is also important to evaluate the influence
obesity 38380 to differentiate or detect incremental effects of stigma that are likely associated with overweight/ obesity versus BED specifically. This is an important issue, given the enormity of the weight of stigma and
obesity 38751 interventions for BED would benefit from educational elements garnered from research on stigma and obesity , as weight bias is a concept that is important for well-being across eating and weight-related issues
obesity 39352 Findings[[59]]Australia1031Community Case vignette32-year old female with binge eating behavior and obesity Only 11.7% viewed an eating problem as “main” pxTwo-thirds felt either depression or low self-esteem
obesity 39587 px4.6% felt CBT would be most helpful treatment[[56]]USA376University studentsCase vignetteFemale with obesity (each with 3 causal scenarios: biological, psychological, or ambiguous): With binge eating Without binge
obesity 39720 scenarios: biological, psychological, or ambiguous): With binge eating Without binge eatingVignette with obesity + BE rated more negatively, having a worse prognosis, less attractive, more blameworthyParticipants
obesity 39879 prognosis, less attractive, more blameworthyParticipants desired greater social distance from vignette with obesity + BEMale respondents held more stigmatizing attitudes against the vignette with obesity + BE [[58]]USA447University
obesity 39967 vignette with obesity + BEMale respondents held more stigmatizing attitudes against the vignette with obesity + BE [[58]]USA447University studentsCase vignette19-year old female with: ANBNBED (“overweight”)ObesityStigma
obesity 40614 less impaired than other Eds or depressionLack of self-discipline was perceived to contribute more to obesity and BEDTarget with comorbid obesity-BED was held less personally responsible than target wtih obesity
obesity 40650 depressionLack of self-discipline was perceived to contribute more to obesity and BEDTarget with comorbid obesity -BED was held less personally responsible than target wtih obesity only[[62]]Australia3047General populationCase
obesity 40716 obesity and BEDTarget with comorbid obesity-BED was held less personally responsible than target wtih obesity only[[62]]Australia3047General populationCase vignetteAN, female, underweightAtypical ED, male, normal
obesity 40842 only[[62]]Australia3047General populationCase vignetteAN, female, underweightAtypical ED, male, normal wtBED, female, obesity 66% believed the BED/obesity target would be discriminated againstOf these, 84% believed discrimination
obesity 40870 vignetteAN, female, underweightAtypical ED, male, normal wtBED, female, obesity66% believed the BED/ obesity target would be discriminated againstOf these, 84% believed discrimination would be weight-based, not
obesity 41532 versions: ANBNBED (unknown BMI)ObesityTargets with BED were found similarly blameworthy as AN, BN and obesity BED was rated as less impaired than AN and BN but more impaired than obesity-onlyBED was more positively
obesity 41608 blameworthy as AN, BN and obesityBED was rated as less impaired than AN and BN but more impaired than obesity -onlyBED was more positively judged than BN, and elicited less discomfort[[60]]Ireland290High school
obesity 43155 never assessed by 40% of physicians An additional 42.8% estimated that 0 to 20% of their patients with obesity engaged in binge eating [[54]]Ireland171Healthcare professionalsCase vignette15-year old gender-neutral: ANBNBED
obesity 43707 know” or “not likely/would not assess, they were shown:Case #2b. 46-year old male with BED and obesity 92% were “very likely, likely, or somewhat likely” to assess for an EDOf these, 74% correctly identified
obesity 44062 would recommend CBT[[52]]Australia175Healthcare professionalsCase vignette 19-year old female: BED- obesity Obesity82.3% correctly identified BEDOnly 26.6% in BED condition recognized comorbid obesityLess knowledge
obesity 44154 female: BED-obesityObesity82.3% correctly identified BEDOnly 26.6% in BED condition recognized comorbid obesity Less knowledge of physical complications in BED 87% endorsed CBT as treatment option for BEDAN = anorexia

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