title: Recognizing disordered eating in primary care patients with obesity.
abstract: OBJECTIVE
  In clinical practice, behavioral approaches to obesity treatment focus heavily on diet and exercise recommendations. However, these approaches may not be effective for patients with disordered eating behaviors. Little is known about the prevalence of disordered eating behaviors in primary care patients with obesity or whether they affect difficulty making dietary changes.
  
  
  METHODS
  We conducted a telephone interview of 337 primary care patients aged 18-65 years with BMI ≥ 35 kg/m(2) in Greater Boston, 2009-2011 (58% response rate, 69% women). We administered the Three-Factor Eating Questionnaire R-18 (scores 0-100) and the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) (scores 0-100). We measured difficulty making dietary changes using four questions regarding perceived difficulty changing diet (Scores 0-10).
  
  
  RESULTS
  50% of the patients reported high emotional eating (score>50) and 28% reported high uncontrolled eating (score>50). Women were more likely to report emotional [OR=4.14 (2.90, 5.92)] and uncontrolled eating [OR=2.11 (1.44, 3.08)] than men. African-Americans were less likely than Caucasians to report emotional [OR=0.29 (95% CI: 0.19, 0.44)] and uncontrolled eating [OR=0.11 (0.07, 0.19)]. For every 10-point reduction in QOL score (IWQOL-lite), emotional and uncontrolled eating scores rose significantly by 7.82 and 5.48, respectively. Furthermore, participants who reported emotional and uncontrolled eating reported greater difficulty making dietary changes.
  
  
  CONCLUSIONS
  Disordered eating behaviors are prevalent among obese primary care patients and disproportionately affect women, Caucasians, and patients with poor QOL. These eating behaviors may impair patients' ability to make clinically recommended dietary changes. Clinicians should consider screening for disordered eating behaviors and tailoring obesity treatment accordingly.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Chacko
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Chiodi
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Electronic address: cwee@bidmc.harvard.edu.
authors.forename: Christina C
authors.initials: CC
authors.lastname: Wee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001900:Boston; D003430:Cross-Sectional Studies; D004032:Diet; D005006:Ethnicity / Q000523:psychology; D005247:Feeding Behavior / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology / Q000523:psychology*; D011320:Primary Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Disordered eating; Obesity; Primary care