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ABSTRACT The study by Dang and colleagues in this issue is a timely reminder of the need for careful consideration when it comes to the inclusion of putative new diagnoses in the diagnostic and statistical manual of mental disorders (DSM). The authors conclude that findings from their systematic review and meta‐analysis of recent literature bearing on the DSM‐5 other specified feeding and eating disorders (OSFED) category “support the conceptualization of atypical AN, PD and NES as clinically significant EDs with similar severity to full‐threshold EDs.” This commentary attempts to provide some additional context, historical context in particular, that the author believes may be helpful when considering the potential implications of Dang and colleagues' findings. This is achieved through reference to the construct, well‐known in the sociology and feminist literature, of medicalization and by highlighting certain issues relevant to the determination of “clinical significance.” I hope that readers approaching Dang and colleagues' research from the currently dominant, medical‐model perspective might be persuaded of the importance of considering alternative perspectives when interpreting findings from research of this kind. [ABSTRACT FROM AUTHOR]

Abstract Background Weight bias is widespread and has numerous harmful consequences. The internalization of weight bias has been associated with significant psychological impairment. Other forms of discrimination, such as racial and anti-gay bias, have been shown to be associated with physical health impairment. However, research has not yet examined whether internalized weight bias is associated with physical as well as psychological impairment in health-related quality of life. Methods Participants included 120 treatment-seeking overweight and obese adults (mean body mass index = 35.09; mean age = 48.31; 68% female; 59% mixed or Asian ethnicity). Participants were administered measures of internalized weight bias and physical and mental health-related quality of life, and they were assessed for the presence of chronic medical conditions, use of prescription and non-prescription medications, and current exercise. Results Internalized weight bias was significantly correlated with health impairment in both physical (r = −.25) and mental (r = −.48) domains. In multivariate analyses controlling for body mass index, age, and other physical health indicators, internalized weight bias significantly and independently predicted impairment in both physical (β = −.31) and mental (β = −.47) health. Conclusions Internalized weight bias was associated with greater impairment in both the physical and mental domains of health-related quality of life. Internalized weight bias also contributed significantly to the variance in physical and mental health impairment over and above the contributions of BMI, age, and medical comorbidity. Consistent with the association between prejudice and physical health in other minority groups, these findings suggest a link between the effects of internalized weight-based discrimination and physical health. Research is needed on strategies to prevent weight bias and its internalization on both a societal and individual level.

Levels of eating disorder psychopathology, impairment in psycho-social functioning and use of health services were compared among probable cases of binge eating disorder (BED) with and without extreme weight or shape concerns ('undue influence of weight or shape on self-evaluation') recruited from a large community sample of women. Data for obese non-binge eaters (n = 457), also recruited from the community sample, and for a clinical sample of eating disorder patients (n = 128), recruited separately, were included for comparative purposes. BED cases who reported extreme weight or shape concerns (n = 51, 46.4%) had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not report such concerns (n = 59), after controlling for between-group differences in age and body weight. In addition, BED cases who reported extreme weight or shape concerns were more likely to have sought treatment for an eating or weight problem than those who did not. Whereas levels of eating disorder psychopathology and functional impairment were markedly elevated among BED cases with extreme weight or shape concerns, BED cases who did not report extreme weight or shape concerns resembled obese non-binge eaters in most respects. The findings support the inclusion of an undue influence of weight or shape on self-evaluation as a diagnostic criterion for BED. In the absence of this influence, eating disorders that otherwise resemble BED do not appear to be 'clinically significant'. Keywords: Eating disorders; Binge eating; Weight or shape concerns; Undue influence; Classification

Nonresponse bias in a two-phase epidemiologic study of eating-disordered behavior is investigated. It is indicated that nonresponse bias among individuals declining to be interviewed is unlikely to pose a problem in two-phase epidemiologic studies of eating disorders.

Face-to-face interviews were conducted to examine the beliefs of women concerning the helpfulness of various possible interventions for bulimia nervosa. The respondents indicated that general practitioners were perceived as the individuals likely to be most helpful for the problem described, whereas counseling was regarded as the most helpful treatment, with a minority of the participants believing that anti-depressant medication would be helpful.

Objective: Few studies of eating disorder (ED) symptoms among young people in Iran have been conducted. This cross‐sectional study examined ED symptoms, assessed by the Eating Disorder Examination Questionnaire (EDE‐Q). Method: Adolescent boys (n = 498) and girls (n = 607) aged 12–19 years, recruited from schools in four different regions of Iran, completed a survey that included the EDE‐Q. ED symptoms, namely, EDE‐Q global scores and the occurrence of specific ED behaviors, were compared between boys and girls. Results: Girls had higher global scores and were more likely to report regular extreme dietary restriction than boys (16.6 vs. 12.0%). The effect sizes for these differences were small. The regular occurrence of other behaviors (girls vs. boys—binge eating: 21.1 vs. 18.8%; self‐induced vomiting: 3.3 vs. 5.4%; laxative misuse: 6.1 vs. 7.6%; excessive exercise: 5.3 vs. 4.4%) did not significantly differ by gender. Twelve percent of boys and 12.9% of girls met criteria for an operational definition of "probable ED case." Conclusion: ED symptoms appear to be relatively common among Iranian adolescent boys and girls. Programs designed to reduce the occurrence and adverse impact of these symptoms may therefore be increasingly important. [ABSTRACT FROM AUTHOR]

The original, theoretically derived factor structure of the Eating Disorder Examination–Questionnaire (EDE-Q) has received limited empirical support and there is no consensus on an appropriate alternative. Moreover, there is a paucity of data on the factor structure of the EDE-Q across sexes. The goals of the current study were to evaluate models of the EDE-Q factor structure and to assess the best-fitting model for differences by sex. Twelve models were compared using confirmatory factor analysis in a sample of 940 undergraduates. Confirmatory factor analysis did not support the original factor structure. A four-factor model fit the data reasonably well with factors corresponding to themes of (a) dietary restraint, (b) preoccupation and restriction, (c) weight and shape concern, and (d) eating shame. The EDE-Q was found to be invariant by sex across all factors except Factor 3. The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]