International Journal of Behavioral Medicine

, Volume 22, Issue 6, pp 792–798 | Cite as

Dietary Adherence, Glycemic Control, and Psychological Factors Associated with Binge Eating Among Indigenous and Non-Indigenous Chileans with Type 2 Diabetes

  • Sylvia Herbozo
  • Patricia M. Flynn
  • Serena D. Stevens
  • Hector Betancourt



Despite the strong association between obesity and binge eating, limited research has examined the implications of binge eating on dietary adherence and psychological factors in ethnically diverse type 2 diabetes patients.


This study investigated the prevalence of binge eating and its association with dietary adherence, glycemic control, and psychological factors among indigenous and non-indigenous type 2 diabetes patients in Chile.


Participants were 387 indigenous (Mapuche) and non-indigenous (non-Mapuche) adults with type 2 diabetes. Self-report measures of binge eating, dietary adherence, diet self-efficacy, body image dissatisfaction, and psychological well-being were administered. Participants’ weight, height, and glycemic control (HbA1c) were also obtained.


Approximately 8 % of the type 2 diabetes patients reported binge eating. The prevalence among Mapuche patients was 4.9 %, and among non-Mapuche patients, it was 9.9 %. Compared to non-binge eaters, binge eating diabetes patients had greater body mass index values, consumed more high-fat foods, were less likely to adhere to their eating plan, and reported poorer body image and emotional well-being.


Results of this study extend previous research by examining the co-occurrence of binge eating and type 2 diabetes as well as the associated dietary behaviors, glycemic control, and psychological factors among indigenous and non-indigenous patients in Chile. These findings may increase our understanding of the health challenges faced by indigenous populations from other countries and highlight the need for additional research that may inform interventions addressing binge eating in diverse patients with type 2 diabetes.


Binge eating Type 2 diabetes Dietary adherence Glycemic control 



This study was part of a larger research project supported by funding from the Government of Chile, through its National Council for Scientific and Technological Research (CONICYT), FONDECYT project 1090660 to the last author. The authors thank the FONDECYT project research team, particularly Tamara Hernandez Otzen, Gloria Muñoz, and Ligia Orellana, whose contribution made the data collection for this study possible.

Conflict of Interest

Sylvia Herbozo, Patricia M. Flynn, Serena D. Stevens, and Hector Betancourt declare that they have no conflict of interest.


  1. 1.
    Ricca V, Mannucci E, Moretti S, Di Bernardo M, Zucchi T, Cabras PL, et al. Screening for binge eating disorder in obese outpatients. Compr Psychiatry. 2000;41:111–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkard A, et al. Binge eating disorder: its further validation in a multisite study. Int J Eat Disord. 1993;13:137–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Hudson JI, Lalonde JK, Coit CE, Tsuang MT, McElroy SL, Crow SJ, et al. Longitudinal study of the diagnosis of components of the metabolic syndrome in individuals with binge-eating disorder. Am J Clin Nutr. 2010;91:1568–73.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Hudson JI, Hiripi E, Pope Jr HG, Kessler RC. The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psychiatry. 2007;61:348–58.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, et al. The prevalence and correlates of binge eating disorder in the World Health Organization Mental Health Surveys. Biol Psychiatry. 2013;73:904–14.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Rosenberger PH, Dorflinger L. Psychosocial factors associated with binge eating among overweight and obese male veterans. Eat Behav. 2013;14:401–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Ahrberg M, Trojca D, Nasrawi N, Vocks S. Body image disturbance in binge eating disorder: a review. Eur Eat Disord Rev. 2011;19:375–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Mitchell KS, Mazzeo SE. Binge eating and psychological distress in ethnically diverse undergraduate men and women. Eat Behav. 2004;5:157–69.CrossRefPubMedGoogle Scholar
  9. 9.
    Wilfley DE, Wilson GT, Agras WS. The clinical significance of binge eating disorder. Int J Eat Disord. 2003;34(S1):S96–106.CrossRefPubMedGoogle Scholar
  10. 10.
    Young-Hyman DL, Davis CL. Disordered eating behavior in individuals with diabetes: importance of context, evaluation, and classification. Diabetes Care. 2010;33:683–9.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Crow S, Kendall D, Praus B, Thuras P. Binge eating and other psychopathology in patients with type II diabetes mellitus. Int J Eat Disord. 2001;30:222–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Kenardy J, Mensch M, Bowen K, Green B, Walton J, Dalton M. Disordered eating behaviors in women with type 2 diabetes mellitus. Eat Behav. 2001;2:183–92.CrossRefPubMedGoogle Scholar
  13. 13.
    TODAY Study Group. Binge eating, mood, and quality of life in youth with Type 2 diabetes: baselines data from the TODAY study. Diabetes Care. 2011;34:858–60.CrossRefGoogle Scholar
  14. 14.
    Gorin A, Niemeier HM, Hogan P, Coday M, Davis C, DiLillo V, et al. Binge eating and weight loss outcomes in overweight and obese individuals with type 2 diabetes: results from the Look AHEAD study. Arch Gen Psychiatry. 2008;65:1447–55.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Wing RR, Marcus MD, Epstein LH, Blair EH, Burton LR. Binge eating in obese patients with type II diabetes. Int J Eat Disord. 1989;8:671–9.CrossRefGoogle Scholar
  16. 16.
    Meneghini LF, Spadola J, Florez H. Prevalence and associations of binge eating disorder in a multiethnic population with type 2 diabetes. Diabetes Care. 2006;29:2760.CrossRefPubMedGoogle Scholar
  17. 17.
    Gonzalez JS, Esbitt SA, Schneider HE, Osborne PJ, Kupperman EG. Psychological issues in adults with type 2 diabetes. In: Pagoto S, editor. Psychological co-morbidities of physical illness: a behavioral medicine perspective. Worcester: Springer Science; 2011. p. 73–121.CrossRefGoogle Scholar
  18. 18.
    Yach D, Stuckler D, Brownell KD. Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nat Med. 2006;12:62–6.CrossRefPubMedGoogle Scholar
  19. 19.
    World Health Organization. Overweight/obesity [online graph]. 2011. Accessed 15 Sept 2014.
  20. 20.
    Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94:311–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Pérez-Bravo F, Carrasco E, Santos JL, Calvillán M, Larenas G, Albala C. Prevalence of type 2 diabetes and obesity in rural Mapuche population from Chile. Nutrition. 2001;17:236–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Philco LP, Serón SP, Muñoz NS, Navia BP, Lanas ZF. Risk factors for metabolic syndrome in a case control study in Temuco, Chile. Rev Med Chil. 2012;140:334–9.CrossRefGoogle Scholar
  23. 23.
    Yanovski SZ. Binge eating disorder: current knowledge and future directions. Obes Res. 1993;1:306–24.CrossRefPubMedGoogle Scholar
  24. 24.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.Google Scholar
  25. 25.
    Toobert DJ, Hampson SE, Glasgow AR. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–50.CrossRefPubMedGoogle Scholar
  26. 26.
    Del Castillo Arreola A. Apoyo social, síntomas depresivos, autoeficacia, y beinstar psichologico en pacientes con diabetes tipe 2 [dissertation]. Universidad Nacional Autonoma de Mexico, 2010.Google Scholar
  27. 27.
    Bandura A. Self-efficacy. New York: W. H. Freeman and Company; 1997.Google Scholar
  28. 28.
    Elder KA, Grilo CM. The Spanish language version of the eating disorder examination questionnaire: comparison with the Spanish language version of the eating disorder examination and test-retest reliability. Behav Res Ther. 2007;45:1369–77.CrossRefPubMedGoogle Scholar
  29. 29.
    Lucas‐Carrasco R. Reliability and validity of the Spanish version of the world health organization‐five well‐being index in elderly. Psychiatry Clin Neurosci. 2012;66:508–13.CrossRefPubMedGoogle Scholar
  30. 30.
    Awata S, Bech P, Yoshida S, Hirai M, Suzuki S, Yamashita M, et al. Reliability and validity of the Japanese version of the world health organization‐five well‐being index in the context of detecting depression in diabetic patients. Psychiatry Clin Neurosci. 2007;61:112–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Abdi H. Holm’s sequential Bonferroni procedure. In: Salkind N, editor. Encyclopedia of research design. Thousand Oaks: Sage; 2010. p. 1–8.Google Scholar
  32. 32.
    Kenardy J, Mensch M, Bowen K, Pearson SA. A comparison of eating behaviors in newly diagnosed NIDDM patients and case-matched control subjects. Diabetes Care. 1994;17:1197–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Webb JB, Applegate KL, Grant JP. A comparative analysis of Type 2 diabetes and binge eating disorder in a bariatric sample. Eat Behav. 2011;12(3):175–81.CrossRefPubMedGoogle Scholar
  34. 34.
    Allison S, Timmerman GM. Anatomy of a binge: food environment and characteristics of nonpurge binge episodes. Eat Behav. 2007;8:31–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Wilson PL, O’Connor DP, Kaplan CD, Bode S, Mama SK, Lee RE. Relationship of fruit, vegetable, and fat consumption to binge eating symptoms in African American and Hispanic or Latina women. Eat Behav. 2012;13:179–82.PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Yanovski S. Sugar and fat: cravings and aversions. J Nutr. 2003;133:835S–7.PubMedGoogle Scholar
  37. 37.
    Shreck E, Gonzalez JS, Cohen HW, Walker EA. Risk perception and self-management in urban, diverse adults with type 2 diabetes: the improving diabetes outcomes study. Int J Behav Med. 2014;12:88–98.CrossRefGoogle Scholar
  38. 38.
    Zendegui EA, West JA, Zandberg LJ. Binge eating frequency and regular eating pattern in cognitive behavioral guided self-help. Eat Behav. 2014;15:241–3.CrossRefPubMedGoogle Scholar
  39. 39.
    Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27:2154–60.CrossRefPubMedGoogle Scholar
  40. 40.
    Boyle SH, Surwit RS, Georgiades A, Brummett BH, Helms MJ, Barefoot JC. Depressive symptoms, race, and glucose concentrations: the role of cortisol as mediator. Diabetes Care. 2007;30:2484–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Fisher EB, Chan JC, Nan H, Sartorius N, Oldenburg B. Co-occurrence of diabetes and depression: conceptual considerations for an emerging global health challenge. J Affect Disord. 2012;142:S56–66.CrossRefPubMedGoogle Scholar
  42. 42.
    Riesco M. Latin America: a new developmental welfare state model in the making? Int J Soc Welf. 2009;18(s1):S22–36.CrossRefGoogle Scholar
  43. 43.
    Anderson-Fye EP, Becker AE. Sociocultural aspects of eating disorders. In: Thompson JK, editor. Handbook of eating disorders and obesity. Hoboken: Wiley; 2004. p. 565–89.Google Scholar
  44. 44.
    Uauy R, Albala C, Kain J. Obesity trends in Latin America: transitioning from under- to overweight. J Nutr. 2001;131:893S–9S.PubMedGoogle Scholar
  45. 45.
    Sepúlveda A, Alfonso J. Principios de alimentación Mapuche como un aporte a la soberanía alimentaria. 2005. Accessed 12 March 2014
  46. 46.
    Neel JV, Weder AB, Julius S. Type II diabetes, essential hypertension, and obesity as syndrome of impaired genetic homeostasis. Perspect Biol Med. 1998;42:44–74.CrossRefPubMedGoogle Scholar
  47. 47.
    Celis-Morales CA, Perez-Bravo F, Ibañes L, Sanzana R, Hormazabal E, Gill JMR. Insulin resistance in Chileans of European and Indigenous decent: evidence for an ethnicity x environment interaction. PLoS ONE. 2011;6:e24690.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Wang Z, Hoy H. Hypertension, dyslipidemia, body mass index, diabetes and smoking status in Aboriginal Australians in a remote community. Ethn Dis. 2003;13:324–30.PubMedGoogle Scholar
  49. 49.
    Dyck R, Osgood N, Lin T, Gao A, Stang M. Epidemiology of diabetes mellitus among first nations and non-first nations adults. Can Med Assoc J. 2010;182:249–56.CrossRefGoogle Scholar
  50. 50.
    Barnes P, Adams P, Powell-Griner E. Health characteristics of the American Indian and Alaska native adult population: United States 2004–2008. Centers for Disease Control and Prevention. 2010. Accessed 12 March 2014.
  51. 51.
    Hay PJ, Carriage C. Eating disorder features in indigenous Aboriginal and Torres Strait Islander Australian peoples. BMC Public Health. 2012. doi: 10.1186/1471-2458-12-233.Google Scholar
  52. 52.
    Lynch WC, Heil DP, Wagner E, Havens MD. Ethnic differences in BMI, weight concerns, and eating behaviors: comparison of native American, white, and Hispanic adolescents. Body Image. 2007;4:179–90.CrossRefPubMedGoogle Scholar
  53. 53.
    Vicente B, Kohn R, Rioseco P, Saldivia S, Torres S. Psychiatric disorders among the Mapuche in Chile. Int J Soc Psychiatry. 2005;51:119–27.CrossRefPubMedGoogle Scholar
  54. 54.
    Berry JW, Kalin R. Multicultural and ethnic attitudes in Canada: an overview of the 1991 National Survey. Can J Behav Sci. 1995;27:301–20.CrossRefGoogle Scholar
  55. 55.
    Borges MBF, Morgan CM, Claudino AM, da Silveira DX. Validation of the Portuguese version of the questionnaire on eating and weight patterns—revised (QEWP-R) for the screening of binge eating disorder. Rev Bras Psiquiatr. 2005;27:319–22.CrossRefPubMedGoogle Scholar
  56. 56.
    Gagnon C, Aimé A, Bélanger C, Markowitz JT. Comorbid diabetes and eating disorders in adult patients: assessment and considerations for treatment. Diabetes Educ. 2012;38:537–42.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2015

Authors and Affiliations

  • Sylvia Herbozo
    • 1
    • 3
  • Patricia M. Flynn
    • 1
  • Serena D. Stevens
    • 1
  • Hector Betancourt
    • 1
    • 2
  1. 1.Loma Linda UniversityLoma LindaUSA
  2. 2.Universidad de La FronteraTemucoChile
  3. 3.Department of PsychologyLoma Linda UniversityLoma LindaUSA

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