Childhood binge eating: Families, feeding, and feelings

In order to put childhood binge eating into context, a new systematic review from the University of Illinois identifies two potential risk factors for binge eating in children under the age of 12. With family being the most proximal and influential setting affecting behaviors and attitudes in children, the study reports that parental non-involvement or emotional unresponsiveness and weight-related teasing in the family are behaviors consistently associated with childhood binge eating.

Jaclyn Saltzman, a doctoral researcher in human development and family studies, and a scholar in the Illinois Transdisciplinary Obesity Prevention Program, explains that childhood binge eating can lead to many weight and eating behavior problems as the child grows and in to adulthood. "Intervening early to address binge eating may not only help prevent an eating disorder from emerging but also prevent lifetime habits of unhealthy weight-related behaviors," she says.

Saltzman stresses that binge eating is not the same as feeling you have had too much dessert at dinner. "Binge eating is feeling like you are not in control when you are eating. You are eating past the point of fullness and to the point of discomfort. You are experiencing a lot of emotional distress because of it," she explains.

She adds that binge eating is associated with depression and obesity.

Saltzman and Janet M. Liechty, a professor of medicine and of social work at U of I, reviewed studies on childhood binge eating spanning the last 35 years. They found that very few studies had been done over the last decade on kids and binge eating in the family context.

"We quickly found out that we had to focus specifically on family correlates and risk factors for childhood binge eating, because we were struck by how little research had explored contextual influences, especially in comparison to a much larger body of literature on individual psychological, behavioral, and biological influences. We thought there was a need for a more nuanced understanding of the context in which childhood binge eating develops," Saltzman says.

Initially, the researchers identified over 700 studies, to which they applied strict inclusion criteria to locate studies that looked at outcomes in children under age 12, using reliable instruments, and assessing the constructs of interest. "That left us with 15 studies, which we screened with a tool to assess risk for bias so that we could comment on the strengths and limitations in the studies," she adds.

In their review, the researchers focused on binge eating and loss-of-control eating behavior. Loss of control is traditionally considered a symptom of binge eating in adults, but Saltzman explains that, according to recent research in the field, loss of control is used as a proxy for binge eating in young children, although this is not yet officially recognized in diagnostic manuals.

"Loss of control is something that researchers have used to describe binge eating in young children," she says. "The idea is that the size of the binge--the amount of food they eat--is less important than the feelings of being out of control or the stress about that eating behavior, especially in young kids, because they don't have all that much control over the food that they have access to. But they do have control of their emotions around eating and how much they eat and the sense of being out of control."

Although they found parent ignoring, under-involvement, emotional non-responsiveness and weight-related teasing in the family to be associated with childhood binge eating, Saltzman says that parent weight, education, economic situation, race, or ethnicity, are not correlated. "Actually, no studies found any association between these constructs and childhood binge eating," she says.

"This study found that childhood binge eating is really associated with parents' weight-related beliefs, but not their actual weight, and their emotional availability but not necessarily the income availability," she adds.

Weight teasing is being made fun of, mocked, or "kidded with" about one's weight, usually for being perceived as being overweight, Saltzman explains. "Family-based weight teasing would be any of those behaviors perpetrated by a family member, like a parent or a sibling."

Despite finding that behavior in the family is an important context for childhood binge eating, Saltzman stresses that this does not indicate that parents are to blame for children's binge eating behaviors. "Even though weight-related teasing was a correlate of childhood binge eating, it would be counterproductive and incorrect to blame parents for childhood binge eating behavior. In light of these findings, the large body of literature linking childhood binge eating to psychological factors such as negative affect, and other research studies our lab has done, we want to stress the importance of shifting the paradigm from focusing on weight alone--which is what weight teasing does--to addressing beliefs about weight and emotional coping strategies in the family."

This study was limited in that it focused only on peer-reviewed, English-language articles, and that it could not use meta-analytic techniques to identify the magnitude of associations between the identified correlates and childhood binge eating. Despite these limitations, the review finds evidence to suggest that focus on the emotional context of eating is critical to understanding childhood binge eating.

"We want to emphasize to parents that weight isn't the 'be all end all,' and that focusing on weight too much can be damaging. Instead, focusing on giving kids the tools they need to manage their emotions, particularly emotions around eating and weight, can help strengthen children's coping skills so they are less likely to need binge eating." Saltzman says.