Psychological Medicine

Original Articles

Predictive significance of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up

C. M. Griloa1 c1, M. A. Whitea1, R. Gueorguievaa2, G. T. Wilsona3 and R. M. Masheba1

a1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

a2 Division of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA

a3 Graduate School of Applied and Professional Psychology, Rutgers – The State University of New Jersey, Piscataway, NJ, USA


Background Undue influence of body shape or weight on self-evaluation – referred to as overvaluation – is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating disorder (BED). This study examined the concurrent and predictive significance of overvaluation of shape/weight in obese patients with BED participating in a randomized clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL).

Method A total of 90 participants were randomly assigned to 6-month group treatments of CBT or BWL. Assessments were performed at baseline, throughout- and post-treatment, and at 6- and 12-month follow-ups after completing treatments with reliably administered semi-structured interviews and established measures.

Results Participants categorized with overvaluation (n = 52, 58%) versus without overvaluation (n = 38, 42%) did not differ significantly in demographic features (age, gender and ethnicity), psychiatric co-morbidity, body mass index or binge eating frequency. The overvaluation group had significantly greater levels of eating disorder psychopathology and poorer psychological functioning (higher depression and lower self-esteem) than the non-overvaluation group. Overvaluation of shape/weight significantly predicted non-remission from binge eating and higher frequency of binge eating at the 12-month follow-up, even after adjusting for group differences in depression and self-esteem levels.

Conclusions Our findings suggest that overvaluation does not simply reflect concern commensurate with being obese or more frequent binge eating, but also is strongly associated with heightened eating-related psychopathology and psychological distress, and has negative prognostic significance for longer-term treatment outcomes. Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED as it provides important information about severity and treatment outcome.

(Received June 08 2012)

(Revised August 03 2012)

(Accepted August 06 2012)

(Online publication September 12 2012)

Key words

  • Binge eating;
  • body image;
  • diagnosis;
  • eating disorder;
  • obesity;
  • treatment outcome


c1 Address for correspondence: C. M. Grilo, Ph.D., Yale School of Medicine, 301 Cedar Street (2nd Floor), New Haven, CT 06519, USA. (Email: