Abstract
Background:
This study examined ethnic/racial differences in reported utilization of weight-loss methods/treatments and weight loss among adults with binge-eating disorder (BED) with co-existing obesity.
Methods:
Participants were 400 adults (non-Hispanic Black: n = 99, Hispanic: n = 38, non-Hispanic White: n = 263) seeking treatment for BED in Connecticut from 2007-2012. Participants were asked about prior weight-loss methods/treatments and resulting weight losses.
Results:
Overall, self-help diets were utilized most; mental-health services were utilized least. While non-significant differences for most methods/treatments were observed by ethnicity/race, significant differences emerged for self-help diets and supervised programs with non-Hispanic Whites, in general, utilizing these diets more frequently and losing more weight on these types of diets.
Conclusions:
Among treatment-seeking patients with BED and obesity, non-Hispanic White patients reported histories of greater weight-loss treatment utilization and weight loss than non-White patients for supervised and self-help diets. Findings highlight the need for greater understanding of treatment utilization and outcomes among minority patients with obesity and BED.
Keywords: binge-eating disorder, obesity, eating disorders, ethnicity, race, treatment, weight loss
Introduction
Binge-eating disorder (BED) is the most prevalent eating disorder and is associated strongly with obesity (Udo & Grilo, 2018). BED is characterized by eating an objectively large amount of food in a discrete period of time with a subjective experience of loss of control over eating (American Psychiatric Association [APA], 2013) and marked distress. BED is associated with psychiatric comorbidities such as mood, anxiety, and substance use disorders (Grilo, White, & Masheb, 2009; Udo & Grilo, 2019; Welch et al., 2016), various metabolic and medical conditions (Udo & Grilo, 2019), and impaired quality of life (Agh et al., 2016), including poorer psychosocial functioning (Udo & Grilo, 2018).
Lifetime estimates of BED range from 0.85% (Udo & Grilo, 2018) to 2.60% (Kessler et al., 2013) and epidemiological studies have, in contrast to clinical/lay beliefs, found that BED is distributed fairly comparably across ethnic and racial groups (Hudson, Hiripi, Pope Jr, & Kessler, 2007; Marques et al., 2011; Udo & Grilo, 2018). Studies examining differences in BED clinical profiles by ethnicity/race report increased severity of eating-disorder symptoms in ethnic/racial minorities (Franko et al., 2012; Lydecker & Grilo, 2016), including greater frequency of binge-eating episodes in non-Hispanic Black participants compared to non-Hispanic White participants (Lydecker & Grilo, 2016; Pike, Dohm, Striegel-Moore, Wilfley, & Fairburn, 2001) and higher eating-disorder psychopathology in Hispanic participants compared to non-Hispanic White participants (Franko et al., 2012).
Studies have reported trends to under-utilize mental health care for general mental health (Bender et al., 2007), and specifically for BED (Coffino, Udo, & Grilo, 2019; Striegel-Moore et al., 2003; Wilfley, Pike, Dohm, Striegel-Moore, & Fairburn, 2001) by non-Hispanic Black and Hispanic individuals. Additionally, Hispanic and non-Hispanic Black women seeking treatment from a healthcare professional are less likely to be referred for eating-disorder treatment (Cachelin & Striegel-Moore, 2006; Pike et al., 2001), which could reflect various biases or limited understanding among health care providers of either the distribution of BED across ethnic/racial groups (Udo & Grilo, 2018) or perhaps ethnic/racial differences in the clinical presentations of those with BED (Pike et al., 2001). For example, some studies have found that non-Hispanic Black women with BED report lower concerns about weight/shape despite higher frequency of binge eating and higher weight compared to non-Hispanic White women (Pike et al., 2001).
It appears that persons with BED have for decades been more likely to be referred to weight-loss treatment rather than to specialist eating-disorder treatment (Cachelin, Rebeck, Veisel, & Striegel-Moore, 2001; Mond, Hay, Rodgers, & Owen, 2007; Mond et al., 2009; Pike et al., 2001), a problem that echoes people’s own naturalistic help-seeking behaviors (Coffino et al., 2019). This perhaps reflects the high rate of co-existing obesity in treatment-seeking persons with BED or limited recognition and understanding of BED by healthcare providers (Kornstein, Kunovac, Herman, & Culpepper, 2016; Supina, Herman, Frye, & Shillington, 2016). Furthermore, many individuals with BED are interested in weight loss as well as in reducing binge eating itself (Brody, Masheb, & Grilo, 2005) and have medical conditions comorbid with obesity (Udo & Grilo, 2019), some of which might improve with weight loss. In addition to being less likely to receive treatment specifically targeting BED, significantly fewer non-Hispanic Black patients receive evidence-supported treatments for weight loss (Tsai et al., 2009) and eating-related concerns (Pike et al., 2001), despite the disproportionately high rates of obesity in ethnic/racial minorities (Flegal, Carroll, Ogden, & Curtin, 2010; Petersen, Pan, & Blanck, 2019; Wang & Beydoun, 2007). Examining the utilization of weight-loss methods/treatments in an ethnically and racially diverse group of patients with obesity and BED will help us better understand potential disparities. Thus, the present study examined histories of weight-loss treatment utilization, and related weight loss achieved, by persons with current obesity and BED by ethnicity/race. It was hypothesized that non-Hispanic White patients would utilize a wider variety of methods/treatments at a greater frequency, and report more weight loss, compared to non-Hispanic Black and Hispanic patients.
Methods
Participants
Participants were adults with obesity seeking treatment for BED and weight loss (N = 400). Data from the present study were obtained from participants who had been screened for possible participation in two treatment trials for BED at the same institution. To participate in the studies, participants were required to be between 18 and 65 years old, have obesity (body mass index [BMI] ≥ 30 kg/m2), and exceed DSM-5 criteria (the stricter duration criterion of binge eating once weekly for 6 months from the DSM-IV-TR was used, as opposed to 3 months) for BED. Participants were not eligible to participate in the study if they were pregnant or breastfeeding, currently receiving treatment for eating/weight problems, were taking antidepressant medication, or if they had severe medical (e.g., uncontrolled hypertension) or psychiatric conditions (e.g., schizophrenia, bipolar disorder, and current substance use disorder). BED diagnosis was based on the Structured Clinical Interview (First, Spitzer, Robert, Gibbon, & Williams, 1996) and confirmed with the Eating Disorder Examination interview (Cooper & Fairburn, 1987).
Procedures
The current study received approval by the Institutional Review Board and participants provided written informed consent prior to study procedures. All participants met criteria for the DSM-IV-TR BED (APA, 2000). Because the DSM-IV-TR BED criteria had more stringent frequency and duration stipulations relative to the current DSM-5, all participants enrolled also met current DSM-5 criteria for BED (APA, 2013). All participants completed a semi-structured interview regarding prior weight-loss treatment utilization. Assessment procedures were performed by trained doctoral-level research-clinicians.
Interview
Weight Loss Treatment Seeking Interview.
Participants were administered a semi-structured clinical interview assessing previous weight-loss treatment utilization and weight loss during treatment. Participants were asked “approximately how many diets, which have lasted at least three consecutive days, have you been on, whether or not you have succeeded?” Participants also were asked about the frequency of specific dieting attempts (whether or not they had “succeeded”): 1. Self-help (own idea, magazine, book, friend), 2. Fad/Crash Diet (cabbage soup, liquid diets, etc.), 3. Supervised Program (Weight Watchers, Jenny Craig, Overeaters Anonymous), 4. Prescribed Diet Pills (Amphetamines, Redux, Fen-phen), 5. Over-the-Counter (OTC) Diet Pills (Dexatrim), 6. Dietician/Nutritionist-Led Program, and 7. Psychologist/Psychiatrist/Other Mental Health. Finally, participants were asked about the most weight lost for each dieting/treatment category noted above. The most weight lost for each category refers to the maximum weight lost (lbs.) for any one attempt (i.e., it was not the sum of weight lost in multiple attempts).
Statistical Analyses
Baseline characteristics were compared between groups (ethnicity/race) using chi-square tests for categorical variables and analysis of variance (ANOVA) for continuous variables. Pairwise comparisons between groups were compared post-hoc to determine the nature of significant main effects. Data were examined for normality using normal probability plots. The distributions for each specific diet attempt frequency were highly skewed with clumping effects. Transformations were unsuccessful and general linear model alternatives (e.g., negative binomial) did not fit these outcomes well. Therefore, we categorized attempts on an ordinal scale (0, 1-2, 3-4, 5+ attempts) and analyzed using ordinal regression with a cumulative logit. The proportionality of odds assumptions was satisfied for each outcome and odds ratios of increased use were estimated pairwise between groups. Due to baseline differences, age and sex were controlled for in the model. The Maximum Weight Lost variable for each diet were skewed but successfully log-transformed for analysis and compared between groups using analysis of covariance (ANCOVA) controlling for age and sex. Model residual plots confirmed model fit.
Results
This study included 400 participants who reported their race as non-Hispanic White (n = 263, 65.8%), non-Hispanic Black (n = 99, 24.8%), and Hispanic (n = 38, 9.5%). Participants were on average, middle-aged (M = 46.6, SD = 10.7) adults (male n = 113, 28.2%, female n = 287, 71.8%) with obesity (M BMI = 39.2, SD = 5.8, range = 30.2 - 56.5 kg/m2) seeking treatment for BED and weight loss.
Demographic characteristics by ethnicity/race are shown in Table 1. Ethnicity/race groups differed significantly by age with non-Hispanic White participants being older than the other groups. Non-Hispanic Black participants were represented by a greater number of females (82.8%) compared to non-Hispanic White participants (66.5%). There were no significant BMI differences by ethnicity/race.
Table 1.
Age, Sex, and BMI by Ethnicity/race
| Non-Hispanic Black (n=99) M (SD)/n (%) |
Hispanic (n=38) M (SD)/n (%) |
Non-Hispanic White (n=263) M (SD)/n (%) |
Main Effect | |
|---|---|---|---|---|
| Age | 44.2 (10.8)b | 39.2 (10.5) | 48.5 (10.1)ab | F 2, 397 = 17.0; p < .001 |
| BMI | 40.0 (6.3) | 39.1 (5.2) | 38.9 (5.7) | F 2, 397 = 1.4; p = .25 |
| Sex | χ2 (2) = 10.5; p = .005 | |||
| Male | 17 (17.2) | 8 (21.1) | 88 (33.5)a | |
| Female | 82 (82.8) | 30 (78.9) | 175 (66.5) |
Note:
indicates significantly different from non-Hispanic Black
indicates significant different from Hispanic
Overall, self-help diets were the most frequently utilized method/treatment and treatment involving mental health professionals the least frequently utilized (Table 2). Both Hispanic participants (OR = 2.2) and non-Hispanic White participants (OR = 2.5) had significantly greater odds of utilizing self-help diets more frequently compared to non-Hispanic Black participants. Non-Hispanic White participants had 5.5 greater odds of utilizing supervised diets more frequently compared to non-Hispanic Black participants and 3.2 greater odds compared to Hispanic participants.
Table 2.
Ethnic/racial Differences in History of Weight Loss Treatment Utilization among Patients with Obesity and Binge-eating Disorder
| Diet | Overall Sample (n=400) |
Non- Hispanic Black (n=99) |
Hispanic (n=38) |
Non- Hispanic White (n=263) |
Racemain effect | Post-hocs | ||
|---|---|---|---|---|---|---|---|---|
| n (%) | Diet (M±SD) n (%) |
Diet (M±SD) n (%) |
Diet (M±SD) n (%) |
χ2(2) (p) | H vs. B1 OR (95% CI) |
W vs. B1 OR (95% CI) |
W vs. H1 OR (95% CI) |
|
| Self-help | 10.2±37.2 | 21.7±69.6 | 25.6±60.3 | 15.7 (.0004) | 2.2 (1.0, 4.7)* | 2.5 (1.6, 4.0)*** | 1.1 (0.6, 2.3) | |
| 0 times | 44 (11.9) | 18 (19.8) | 4 (12.5) | 22 (8.9) | ||||
| 1-2 times | 90 (24.4) | 32 (35.2) | 9 (28.1) | 49 (19.9) | ||||
| 3-4 times | 44 (11.9) | 9 (9.9) | 2 (6.3) | 33 (13.4) | ||||
| 5+ times | 191 (51.8) | 32 (35.2) | 17 (53.1) | 142 (57.7) | ||||
| Fad/crash | 4.1 ±10.3 | 4.8 ±17.5 | 6.2 ±19.5 | 0.5 (0.8) | 1.3 (0.6, 2.8) | 1.1 (0.7, 1.8) | 0.9 (0.4, 1.8) | |
| 0 times | 178 (48.2) | 45 (50.0) | 16 (50.0) | 117 (47.4) | ||||
| 1-2 times | 84 (22.8) | 23 (25.6) | 6 (18.8) | 55 (22.3) | ||||
| 3-4 times | 34 (9.2) | 8 (8.9) | 5 (15.6) | 21 (8.5) | ||||
| 5+ times | 73 (19.8) | 14 (15.6) | 5 (15.6) | 54 (21.9) | ||||
| Supervised Diets | 2.0 ±5.5 | 2.5 ±5.0 | 5.4 ±12.7 | 46.9 (< .0001) | 1.7 (0.8, 3.9) | 5.5 (3.3, 9.2) *** | 3.2 (1.5, 6.6)** | |
| 0 times | 128 (34.6) | 52 (57.8) | 18 (54.6) | 58 (23.5) | ||||
| 1-2 times | 110 (29.7) | 24 (26.7) | 6 (18.2) | 80 (32.4) | ||||
| 3-4 times | 44 (11.9) | 6 (6.7) | 3 (9.1) | 35 (14.2) | ||||
| 5+ times | 88 (23.8) | 8 (8.9) | 6 (18.2) | 74 (30.0) | ||||
| Prescribed Meds | 0.4 ±1.2 | 0.4 ±1.3 | 0.5 ±1.6 | 0.9 (0.6) | 0.8 (0.3, 2.4) | 1.2 (0.7, 2.2) | 1.5 (0.6, 4.1) | |
| 0 times | 284 (76.8) | 70 (77.8) | 28 (84.9) | 186 (75.3) | ||||
| 1-2 times | 72 (19.5) | 18 (20.0) | 3 (9.1) | 51 (20.7) | ||||
| 3-4 times | 7 (1.9) | 1 (1.1) | 1 (3.0) | 5 (2.0) | ||||
| 5+ times | 7 (1.9) | 1 (1.1) | 1 (3.0) | 5 (2.0) | ||||
| Nutritionist-led | 0.5 ±1.3 | 0.6±0.9 | 0.8±2.2 | 2.7 (0.3) | 2.0 (0.9, 4.5) | 1.1 (0.7, 1.9) | 0.6 (0.3, 1.2) | |
| 0 times | 240 (64.7) | 62 (68.9) | 19 (57.6) | 159 (64.1) | ||||
| 1-2 times | 110 (29.7) | 24 (26.7) | 12 (36.4) | 74 (29.8) | ||||
| 3-4 times | 15 (4.0) | 3 (3.3) | 2 (6.1) | 10 (4.0) | ||||
| 5+ times | 6 (1.6) | 1 (1.1) | 0 (0.0) | 5 (2.0) | ||||
| Mental health | 0.1 ±0.4 | 0.1 ±0.2 | 0.2 ±0.5 | 4.3 (0.1) | 2.3 (0.4, 14.8) | 3.6 (1.1, 12.0) | 1.5 (0.3, 7.0) | |
| 0 times | 335 (90.5) | 87 (96.7) | 31 (93.9) | 217 (87.9) | ||||
| 1-2 times | 32 (8.7) | 2 (2.2) | 2 (6.1) | 28 (11.3) | ||||
| 3-4 times | 3 (0.8) | 1 (1.1) | 0 (0.0) | 2 (0.8) | ||||
| 5+ times | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||||
| OTC Meds | 5.3 ±12.8 | 3.9 ±12.4 | 3.6 ±9.3 | 1.6 (0.5) | 0.5 (0.2, 1.5) | 0.8 (0.4, 1.5) | 1.6 (0.6, 4.5) | |
| 0 times | 121 (50.0) | 17 (39.5) | 9 (56.3) | 95 (51.9) | ||||
| 1-2 times | 64 (26.5) | 15 (34.9) | 5 (31.3) | 44 (24.0) | ||||
| 3-4 times | 17 (7.0) | 3 (7.0) | 0 (0.0) | 14 (7.7) | ||||
| 5+ times | 40 (16.5) | 8 (18.6) | 2 (12.5) | 30 (16.4) | ||||
Note: All analyses adjusted for age and sex
p<.05
p≤.01
p≤.001; in the post hoc columns
signifies the reference group; OTC meds = over the counter medications; analyses based on log transformed data; n’s listed in the table represent the subset of participants who utilized the various treatment options
Relative to non-Hispanic Black participants, non-Hispanic White participants reported significantly higher Maximum Weight Lost while using self-help diets (d = .44) (Table 3). Non-Hispanic White participants also reported higher Maximum Weight Lost while under supervised diets compared to both non-Hispanic Black (d = .33) and Hispanic participants (d = .65). No significant differences were observed for Maximum Weight Lost during fad/crash diets, diets using prescribed or OTC medications, and nutritionist-led or professional-led diets.
Table 3.
Ethnic/racial Differences in self-reported Maximum Weight Lost (lbs.) During Treatment
| Overall Sample (n=400) |
Non- Hispanic Black (n=99) |
Hispanic (n=38) |
Non-Hispanic White (n=263) |
Effect Size |
|
|---|---|---|---|---|---|
| Self-help diets | |||||
| Mean (SD) | 23.9 (23.0) | 19.4 (22.0) | 22.9 (22.0) | 25.5 (23.4)a | ηp2 = .04 |
| Median (25th-75th percentile) | 15.0 (10.0-32.0) | 10.0 (5.0-26.5) | 15.0 (4.3-39.5) | 20.0 (10.0-35.0) | |
| Fad/crash diets | |||||
| Mean (SD) | 14.6 (15.2) | 14.0 (14.9) | 16.8 (19.1) | 14.6 (14.8) | ηp2 = .00 |
| Median (25th-75th percentile) | 10.0 (5.0-20.0) | 10.0 (4.0-20.0) | 8 (4.5-33.0) | 10.0 (5.0-16.3) | |
| Supervised diets | |||||
| Mean (SD) | 32.6 (26.2) | 28.0 (28.2) | 20.5 (25.0) | 34.4 (25.7)a,b | ηp2 = .04 |
| Median (25th-75th percentile) | 30.0 (12.5-43.5) | 19.0 (9.3-41.3) | 13.0 (8.0-28.0) | 30.0 (15.0-45.0) | |
| Prescribed medications | |||||
| Mean (SD) | 24.3 (21.3) | 23.4 (25.4) | 29.4 (40.0) | 24.1 (18.1) | ηp2 = .02 |
| Median (25th-75th percentile) | 20.0 (10.0-32.5) | 17.5 (0.0-37.5) | 15.0 (6.0-60.0) | 20.0 (10.0-32.8) | |
| Nutritionist-led | |||||
| Mean (SD) | 20.3 (25.9) | 11.1 (13.0) | 22.8 (19.5) | 22.8 (29.2) | ηp2 = .02 |
| Median (25th-75th percentile) | 12.0 (0.0-28.0) | 7.5 (0.0-19.3) | 21.5 (4.8-35.3) | 15.0 (0.0-31.5) | |
| Mental health professionals | |||||
| Mean (SD) | 17.3 (15.8) | 20.0 (15.0) | 5.0 (7.1) | 17.9 (16.2) | ηp2 = .07 |
| Median (25th-75th percentile) | 12.0 (5.0-30.0) | 20.0 (5.0-20.0)* | 5.0 (0.0-5.0)* | 13.5 (5.3-30.0) | |
| OTC medications | |||||
| Mean (SD) | 13.8 (17.5) | 14.5 (16.1) | 4.9 (4.3) | 14.3 (18.5) | ηp2 = .01 |
| Median (25th-75th percentile) | 9.0 (0.0-20.0) | 10.0 (3.8-20.0) | 3.0 (1.0-10.0) | 5.0 (0.0-20.0) |
Note: All analyses adjusted for age and sex; weight loss indicates self-reported Maximum Weight Lost during treatment; non-transformed weight loss is shown; effect sizes are based on log transformed data
represents 25th-50th percentile
represents significantly different from non-Hispanic Black
represents significantly different from Hispanic; OTC = over the counter; suggested norms for partial eta-squared: small = 0.01; medium = 0.06; large = 0.14 (Cohen, 1988).
Furthermore, a secondary data analysis revealed that the top three diets resulting in the most weight loss (collapsed across participants) were supervised diets (M lbs. = 32.6, SD = 26.2), prescribed medications (M lbs. = 24.3, SD = 21.3), and self-help diets (M lbs. = 23.9 SD = 23.1). Specifically, supervised diets exhibited greater weight loss compared to prescribed medication and self-help diets while each of these were associated with reports of greater weight loss compared to each of the other diets.
Discussion
The present study examined ethnic and racial differences in self-reported histories of utilizing various weight-loss methods/treatments and corresponding weight losses among treatment-seeking patients with BED and co-existing obesity. Overall, this treatment-seeking patient group with BED reported histories of having utilized several weight-loss methods/treatments, some at high frequencies. Nearly all (96.2%) patients reported having attempted some form of dieting, with self-help diets reported as the most commonly utilized method/treatment for weight loss and mental health professionals as the least utilized method/treatment for weight loss. Despite the overall high frequency of weight-loss attempts by this treatment-seeking group, most patients reported having never seen a nutritionist, mental health professional, or taken prescribed weight-loss medications. These findings suggest that patients seeking treatment for BED and weight loss have long previous histories of frequent dieting attempts, highlighting the chronicity of obesity in this patient group. Overall, patients reported losing the most weight on supervised diets, prescribed medications, and self-help diets and the least amount of weight on OTC medications.
While non-significant differences for most methods/treatments were observed by ethnicity/race, significant ethnic/racial differences were observed for self-help diets and supervised programs. Specifically, non-Hispanic Whites reported utilizing self-help diets and supervised programs more frequently and reported losing more weight on these two specific methods/treatments.
Prior studies have demonstrated that when ethnic/racial minorities do seek weight-loss treatment they often report utilizing fewer effective methods compared to non-Hispanic White patients (Tsai et al., 2009). For example, non-Hispanic Black patients tend to lose less weight in weight-loss programs compared to non-Hispanic White patients across various weight-loss interventions (Kumanyika, 2002; West, Prewitt, Bursac, & Felix, 2008; Wing & Anglin, 1996). Relatedly, although ethnic/racial minorities with BED infrequently seek (or perhaps are less frequently referred to) evidence-based treatments for BED, they appear to achieve similar improvements on binge-eating outcomes as their non-Hispanic White counterparts, although Black individuals are less likely to attain 5% weight loss (Lydecker, Gueorguieva, Masheb, White, & Grilo, 2019). Furthermore, a recent treatment study with loss-of-control eating (core feature of binge eating) following bariatric surgery reported similar findings with Black individuals being less likely to attain 5% weight loss despite similar reductions in loss-of-control eating behaviors (Grilo, Ivezaj, Duffy, & Gueorguieva, 2021).
Strengths of this study include the administration of semi-structured interviews by trained doctoral-level assessors to diagnose BED and assess histories of weight-loss treatment among a large diverse treatment-seeking patient group with comorbid BED and obesity. In addition, current BMI was calculated from measured weight and height. To our knowledge there are no studies that specifically examine histories of weight-loss treatment utilization and corresponding weight loss in patients with BED and obesity by ethnicity/race. Limitations of this study should also be noted. This was a treatment-seeking sample at a university program and therefore these individuals may be more likely to have sought treatment previously and the rates may not generalize to persons with BED who seek treatment at different types of facilities. There is limited power based on the small number of patients utilizing certain methods/treatments (i.e., OTC medications and mental health services) and certain null findings may be due to small sample sizes, particularly for use of mental health professionals.
Non-Hispanic White and Hispanic patients differed in age by 10 years, which may account for some of the frequency discrepancies; however, analyses adjusted for age. Additionally, the higher treatment utilization in non-Hispanic White patients could be due to their more frequent rates of repeated dieting attempts. For example, patients who have repeated failed weight loss attempts using self-help methods may be more likely to attempt more formal treatment options such as supervised/mental health treatment; however, future research is needed to examine this speculation. Furthermore, the timing and long-term success of the diet attempts were not assessed, which does not allow us to determine whether participants’ weight loss attempts were successful in the long term. Moreover, previous weight loss during dieting attempts was based on retrospective recall, which is limited by recall biases and underestimation of weight; however, individuals with BED are fairly accurate reporters of weight (Barnes, White, Masheb, & Grilo, 2010). In addition, we did not collect information on other variables that will be important to include in future research such as weight lost during less successful weight-loss attempts, any specialist/multidisciplinary treatments, or history of treatments specifically for BED and/or associated comorbidities. Furthermore, we did not operationalize diet in any particular way and did not specifically assess for their motivation for dieting (i.e., improve health independent of shape/weight). Future research should include this information to gain a more nuanced understanding of treatment utilization and weight loss attempts among patients with obesity and BED. We also did not collect information on income or health insurance, and this could influence access to different types of treatment utilization. BED diagnosis was based on DSM-IV-TR criteria, which involved stricter duration and frequency criteria. Furthermore, the duration and quality of reported treatments is unknown. Nonetheless, our findings highlight lower odds of attempting frequent supervised and self-help diets and less self-reported weight loss among ethnic/racial minorities with BED and obesity as compared to their non-Hispanic White counterparts.
Due to the many consequences associated with obesity, increased utilization of more effective weight-loss treatment in ethnic/racial minorities may reduce overall health disparities. Binge-eating disorder, along with other forms of eating disorders, are often undetected among minority groups potentially due to a lack of knowledge among health care providers, which may contribute to a lower likelihood of minority groups receiving appropriate or targeted treatments. Findings highlight the need for greater understanding of weight-loss treatment barriers and accessibility among different minority groups, specifically in those persons who seek treatment for BED. Future research should determine why certain diets are associated with greater ethnic/racial discrepancies in utilization and in weight loss than other diets in this patient group. Additional research should also seek to better understand and reduce treatment-seeking barriers, including gaining a better understanding of the clinical presentation of BED in ethnic/racial minorities and developing culturally relevant weight loss interventions.
Acknowledgments
This research was supported by National Institutes of Health grants R01 DK49587, R01 DK112771, and R01 DK114075. The authors declare no conflicts of interest.
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