Binge Eating Scale (BES)

Abstract

The Binge Eating Scale (BES), developed by Gormally and colleagues in 1982, is a well-established self-report instrument designed to quantify the severity of binge eating symptoms. Initially validated among obese persons, the scale provides a comprehensive assessment by capturing both observable behavioral manifestations (e.g., rapid consumption, overeating) and the internal, distressing affective/cognitive aspects associated with these episodes, such as feelings of guilt, shame, and perceived loss of control. The BES functions as a dimensional measure of symptom severity, serving as a critical screening tool for clinical identification and an effective instrument for monitoring treatment outcomes across diverse clinical and nonclinical populations.

Keywords

Binge Eating Scale, BES, Binge eating, Obesity, Eating disorders, Affective symptoms, Cognitive symptoms, Screening tool, Severity measure, Psychometrics, Self-report, Treatment outcomes.

Authors

Gormally, J., Black, S., Daston, S., Rardin, D.

Purpose

The primary purpose of the Binge Eating Scale (BES) is to offer a reliable, efficient, and quantifiable method for assessing the severity of binge eating behaviors and related psychological distress. The scale was initially conceptualized and validated using cohorts of obese patients and candidates for bariatric surgery, aiming to reliably distinguish individuals who exhibit clinically relevant binge eating from those who do not. This makes the BES a valuable, practical alternative or supplement to labor-intensive, investigator-administered clinical interviews, such as the Eating Disorder Examination (EDE).

Functionally, the BES extends beyond simple categorical screening, operating as a dimensional measure that allows researchers and clinicians to accurately track minute changes in symptom intensity over time. This functionality is crucial for evaluating the efficacy of pharmacological or psychological interventions targeting the reduction of binge frequency and severity. Furthermore, recent research efforts have successfully expanded the scale’s applicability by validating its use and examining its structural integrity in nonclinical cohorts, including the general population and college students.

Construct

The BES is structured to measure the multidimensional construct of binge eating severity. This construct is operationalized across 16 items that systematically assess two primary clusters of symptoms: Behavioral Manifestations and Affective/Cognitive Symptoms. Behavioral items capture observable actions, such as consuming large quantities of food, eating rapidly, and eating until uncomfortably full. Affective and Cognitive items address the internal experience, including feelings of shame, regret, guilt, preoccupation with food, and the subjective experience of loss of control during eating episodes.

The instrument utilizes a weighted response format where each item presents 3 to 4 statements, each corresponding to an increasing level of severity for the measured characteristic. The summation of these weighted responses yields a total score, which ranges from 0 to 46, reflecting the continuum of symptom severity. The scale provides empirically established cut scores for categorization, enabling clinicians to place individuals into three severity groups:

• No or minimal binge eating (score ≤ 17)
• Mild to moderate binge eating (score 18–26)
• Severe binge eating (score ≥ 27)

Validity

The Binge Eating Scale demonstrates robust evidence of validity across diverse clinical and nonclinical settings, proving its utility in populations ranging from obese persons and those diagnosed with Binge Eating Disorder (BED) to general population samples. Empirical studies consistently confirm its high discriminatory power, showing that the BES can effectively differentiate between binge eaters and non-binge eaters with results comparable to established, reliable semi-structured interviews.

Specifically regarding concurrent validity, the BES exhibited high precision in identifying clinically significant cases of binge eating. When validated against the Eating Disorder Examination (EDE 16.0D), using the cut-off score of ≤ 17, the scale achieved a 96.7% rate of correctly classified cases. Furthermore, the scale demonstrated high sensitivity and specificity (81.8% and 97.8%, respectively). This accuracy was statistically affirmed by Receiver Operating Characteristic (ROC) curve analysis, yielding a strong Area Under the Curve (AUC) of .90 (p < .001). Additionally, the scale exhibits good convergent validity, supported by an Average Variance Extracted (AVE) value of .61, confirming that the items reliably converge on and measure the intended psychological construct.

Reliability

The reliability of the BES is consistently supported by strong empirical data. Measures of internal consistency, assessed via Cronbach’s alpha, confirmed a high value of .88 in a validation study utilizing a large general population sample. Item analysis further demonstrated the quality of the scale components, with most individual items showing strong correlation with the total scale score, typically exceeding .42. This indicates that the items are suitable and consistent measures of the overall construct of binge eating severity.

In terms of advanced statistical reliability, the Composite Reliability (CR) was calculated at .96, signifying an exceptionally high level of construct reliability. The scale also demonstrated significant temporal stability, evidenced by a high positive correlation (r = .84) between scores obtained during initial and subsequent administrations. Paired t-tests confirmed this stability over time, showing no significant difference in mean scores between the two assessment points (t(29) = .05, p = .962).

Factor Analysis

Despite its widespread adoption, comprehensive research into the dimensionality and full psychometric properties of the BES, particularly its applicability to nonclinical samples, has historically been limited. To address this gap, recent academic work has focused on examining the scale’s factorial structure. A critical study verified the theoretical structure using a Confirmatory Factor Analysis (CFA).

This CFA was essential for confirming that the scale’s intended structure remained sound when applied to a large, diverse sample of women from the general Portuguese population. This rigorous examination ensured that the BES structure was robust and maintained consistency outside of the specific clinical and obese samples for which it was originally standardized, thereby broadening confidence in its generalizability.

Instrument

Test Type: Self-report questionnaire / Dimensional severity measure

Format: The instrument consists of 16 items. Each item provides 3 to 4 weighted response options reflecting increasing severity of the symptom. Participants are instructed to select the statement that most accurately describes their personal experience.

Language Available: English (Original), European Portuguese (Adapted validation version).

Population Group: Utilized across clinical populations (including obese patients, bariatric surgery candidates, and individuals with Binge Eating Disorder) and nonclinical populations (such as college students and general population samples).

Age Group: Typically utilized with adult and college-age populations.

Population Details: The scale was originally standardized on cohorts of obese persons. Subsequent validation efforts have expanded its use, including large samples of women from the general population and various specific clinical subgroups, ensuring broad applicability.

Test Methodology: Total scores range from 0 to 46. A higher total score signifies more severe binge eating symptoms. Established cut scores are used to categorize severity:

• No or minimal binge eating: Score ≤ 17
• Mild to moderate binge eating: Score 18–26
• Severe binge eating: Score ≥ 27

Keywords

Self-report, Diagnostic screening, Affective symptoms, Behavioral symptoms, Temporal stability, Convergent validity, Composite Reliability, ROC curve, EDE, Binge Eating Disorder, Dimensional assessment.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

Test Year: 1982 (Original publication)

Permissions: Prior permission for the use of the Binge Eating Scale (BES) must be formally obtained from the authors of the original version of the scale (Gormally et al., 1982).

Fee: Information regarding associated fees is not provided in the source content.

Reference’s

• Gormally, J; Black, S; Daston, S; Rardin, D (1982). "The assessment of binge eating severity among obese persons". Addictive behaviors 7 (1): 47–55.
• Marcus, M. D., Wing, R. R., & Lamparski, D. M. (1985). Binge eating and dietary restraint in obese patients. Addictive Behaviors, 10(2), 163-168.
• Dezhkam. Mahmood, Moloodi. Reza, Mootabi. Fereshteh, Omidvar. Nasrin, (2009). Standardization of the Binge Eating Scale among Iranian Obese Population. Iran J Psychiatry 2009; 4:143-146.
• Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16(4), 363-370.
• Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50.

Items of the Binge Eating Scale (BES)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. • I do not think about my weight or size when I’m around other people.
   • I worry about my appearance, but it does not make me unhappy.
   • I think about my appearance or weight and I feel disappointed in myself.
   • I frequently think about my weight and feel great shame and disgust.
2. • I have no difficulty eating slowly.
   • I may eat quickly, but I never feel too full.
   • Sometimes after I eat fast I feel too full.
   • Usually I swallow my food almost without chewing, then feel as if I ate too much.
3. • I can control my impulses towards food.
   • I think I have less control over food than the average person.
   • I feel totally unable to control my impulses toward food.
   • I feel totally unable to control my relationship with food and I try desperately to fight my impulses toward food.
4. • I do not have a habit of eating when I am bored.
   • Sometimes I eat when I am bored, but I can often distract myself and not think about food.
   • I often eat when I am bored, but I can sometimes distract myself and not think about food.
   • I have a habit of eating when I am bored and nothing can stop me.
5. • Usually when I eat it is because I am hungry.
   • Sometimes I eat on impulse without really being hungry.
   • I often eat to satisfy hunger even when I know I’ve already eaten enough. On these occasions I can’t even enjoy what I eat.
   • Although I have not physically hungry, I feel the need to put something in my mouth and I feel satisfied or only when I can fill my mouth (for example with a piece of bread).
6. After eating too much:
   • I do not feel guilty or regretful at all.
   • I sometimes feel guilty or regretful.
   • I almost always feel a strong sense of guilt or regret.
7. • When I’m on a diet, I never completely lose control of food, even in times when I eat too much.
   • When I eat a forbidden food on a diet, I think I’ve failed and eat even more.
   • When I’m on a diet and I eat to much, I think I’ve failed and eat even more.
   • I am always either binge eating or fasting.
8. • It is rare that I eat so much that I felt uncomfortably full.
   • About once a month I eat so much that I felt uncomfortably full.
   • There are regular periods during the month when I eat large amounts of food at meals or between meals.
   • I eat so much that usually, after eating, I feel pretty bad and I have nausea.
9. • The amount of calories that I consume is fairly constant over time.
   • Sometimes after I eat too much, I try to consume few calories to make up for the previous meal.
   • I have a habit of eating too much at night. Usually I’m not hungry in the morning and at night I eat too much.
   • I have periods of about a week in which I imposed starvation diets, following periods of when I ate too much. My life is made of binges and fasts.
10. • I can usually stop eating when I decide I’ve had enough.
    • Sometimes I feel an urge to eat that I cannot control.
    • I often feel impulses to eat so strong that I cannot win, but sometimes I can control myself.
    • I feel totally unable to control my impulses to eat.
11. • I have no problems stopping eating when I am full.
    • I can usually stop eating when I feel full, but sometimes I eat so much it feels unpleasant.
    • It is hard for me to stop eating once I start, I usually end up feeling too full.
    • It is a real problem for me to stop eating and sometimes I vomit because I feel so full.
12. • I eat the same around friends and family as I do when I am alone.
    • Sometimes I do not eat what I want around others because I am aware of my problems with food.
    • I often eat little around other people because I feel embarrassed.
    • I’m so ashamed of overeating; I only eat at times when no one sees me. I eat in secret.
13. • I eat three meals a day and occasionally a snack.
    • I eat three meals a day and I usually snack as well.
    • I eat many meals, or skip meals regularly.
    • There are times when I seem to eat continuously without regular meals.
14. • I don’t think about impulses to eat very much.
    • Sometimes my mind is occupied with thoughts of how to control the urge to eat.
    • I often spend much time thinking about what I ate or how not to eat.
    • My mind is busy most of the time with thoughts about eating.
    • I seem to be constantly fighting not to eat.
15. • I don’t think about food any more than most people.
    • I have strong desires for food, but only for short periods.
    • There are some days when I think of nothing but food.
    • Most of my days is filled with thoughts of food. I feel like I live to eat.
16. • I usually know if I am hungry or not. I know what portion sizes are appropriate.
    • Sometimes I do not know if I am physically hungry or not. In these moments, I can hardly understand how much food is appropriate.
    • Even if I knew how many calories should I eat, I would not have a clear idea of what is, for me, a normal amount of food.