title: Replication and evaluation of a proposed two-factor Binge Eating Scale (BES) structure in a sample of bariatric surgery candidates.
abstract: BACKGROUND
  The Binge Eating Scale (BES) is a widely-used self-report measure of binge eating severity. Hood et al. reported a 2-factor structure for the BES in a sample of bariatric surgery candidates, with factors labeled feelings/cognitions and behavioral manifestations. The present study aims to replicate and extend the factor structure obtained by Hood et al. by testing the utility of a bifactor model that removes binge eating severity variance, which the total BES score purports to assess, in another sample of bariatric surgery candidates.
  
  
  METHODS
  Bariatric surgery candidates (n = 517; 71.2% women; mean body mass index = 49.50 kg/m(2); SD = 10.17) were sampled. Twenty-four percent met DSM-IV-TR diagnostic criteria for binge eating disorder.
  
  
  RESULTS
  Consistent with previous research, a 2-factor structure for the BES was supported; however, the 2 factors were substantially correlated (r = .89). A bifactor model significantly improved model fit, supporting the presence of a higher-order severity factor accounting for a significant amount of variance. This factor was primarily marked by binge eating severity as demonstrated by associations with number of objective binge eating episodes and DSM-IV-TR diagnosis. In the bifactor model, the feelings/cognitions factor was modestly associated with self-reported mood psychopathology. However, contrary to expectations, the behavioral manifestation factor was not associated with empirically derived behavioral problems.
  
  
  CONCLUSIONS
  The current findings partially converge with those of Hood et al. However, the use of the BES as a 2-factor measure is not recommended at this point because of lack of incremental validity demonstrated by the behavioral manifestation factor. Continued use of the BES as a unidimensional measure of binge eating severity, in conjunction with a comprehensive clinical interview, can provide useful guidance for presurgical treatment recommendations.
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, Ohio. Electronic address: rmarek1@kent.edu.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Marek
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, Ohio.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Tarescavage
authors.affiliation: Department of Psychological Sciences, Kent State University, Kent, Ohio.
authors.forename: Yossef S
authors.initials: YS
authors.lastname: Ben-Porath
authors.affiliation: Department of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ashton
authors.affiliation: Department of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Heinberg
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D056912:Binge-Eating Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology / Q000601:surgery*; D010555:Personality Inventory; D011594:Psychometrics; D011795:Surveys and Questionnaires
keywords: Assessment; Bariatric surgery; Binge eating scale; MMPI-2-RF; Presurgical psychological screening; Structural equation modeling; Validity