BED and Body Image

Vol. 28 / No. 4 — Eating Disorders Review

Patients may benefit from treatment specially directed at overvaluation of weight and shape.

Concerns about body image in BED have been well studied among overweight individuals, but much less is known about people with BED who are of normal weight. A group at Temple University’s Eating Disorders Program compared body image concerns among 189 Philadelphia women with and without BED and 19 normal-weight women without BED (Body Image. 2017; 22: 6).

Overvaluation of shape and weight and body dissatisfaction differ in that “overvaluation of shape and weight refers to a stable influence of shape and weight on one’s self-concept,” according to authors Dr. Angelina Yiu and her colleagues. In contrast, body dissatisfaction is attached to negative attitudes, judgments, and evaluations of one’s body that tend to change based on mood or shape or weight gain or loss.

Dr. Yiu et al. hypothesized that the group with BED would have significantly greater over-evaluation of shape and weight compared to women in the non-BED groups, and that overweight women with BED would report the greatest weight and shape concerns. In order, this concern would be less in the normal-weight women, then the overweight women with BED, and finally normal-weight women without BED. (See also the lead article, “Looking and Lamenting May be Fatal,” elsewhere in this issue.)

The research team used several screening questionnaires, including the Eating Disorder Examination -16.0, the Structured Clinical Interview for the DSM IV-Test Revision (DSM-IV-TR), and the Body Comparison Task. The Body Comparison Task, completed on a laptop computer, asks a series of questions including a pre-test question, ‘How satisfied do you feel about your weight right now?” Participants then view 20 images of slim females dressed in shape-revealing clothing. As the women viewed each image they listened to a recording that instructed them to compare their bodies to the model, and then rated weight satisfaction with the same scale used at baseline.

A role for BED, but not for excess weight

Just as the authors had hypothesized, overvaluation of shape and weight was significantly greater among the women with BED compared to those without it. Regardless of actual weight, decreases in weight satisfaction in response to the body comparison task and overvaluation of shape and weight were highest among the women with BED.

Greater evaluation of shape and weight and decreased weight satisfaction among women with BED highlights a distinction between BED and obesity/overweight. And, the findings underscore that women with BED may benefit from treatment that specifically targets overvaluation of shape and weight.