Randomized controlled trial testing behavioral weight loss versus multi-modal stepped-care treatment for binge eating disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S163-S163 ◽  
Author(s):  
C. Grilo
Keyword(s):  
Weight Loss ◽  
Eating Disorder ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Mixed Models ◽  
Controlled Trial ◽  
Stepped Care ◽  
Behavioral Weight Loss ◽  
Co Morbidity ◽  
Remission Rates

IntroductionBinge eating disorder (BED) is prevalent, associated with obesity and elevated psychiatric co-morbidity, and represents a treatment challenge.Objective and aimsA controlled comparison of multi-modal, stepped-care versus behavioral-weight-loss (BWL) for BED.MethodsOne hundred and ninety-one patients (71% female, 79% white) with BED and co-morbid obesity (mean BMI 39) were randomly assigned to 6 months of BWL (n = 39) or stepped-care (n = 152). Within stepped-care, patients started BWL for one month; treatment-responders continued BWL while non-responders switched to cognitive-behavioral-therapy (CBT) and all stepped-care patients were additionally randomized to anti-obesity medication or placebo (double-blind) for five months. Independent assessments were performed by research-clinicians at baseline, throughout treatment, and post-treatment (90% assessed) with reliably-administered structured interviews.ResultsIntent-to-treat analyses of remission rates (0 binges/month) revealed BWL and stepped-care did not differ significantly overall (74% vs 64%); within stepped-care, remission rates differed (range 40% - 79%) with medication significantly superior to placebo (P < 0.005) and among initial non-responders switched to CBT (P < 0.002). Mixed-models analyses of binge eating frequency revealed significant time effects but BWL and stepped-care did not differ overall; within stepped-care, medication was significantly superior to placebo overall and among initial non-responders switched to CBT. Mixed models revealed significant weight-loss but BWL and stepped-care did not differ overall; within stepped-care, medication was significantly superior to placebo overall and among both initial responders continued on BWL and non-responders switched to CBT.ConclusionsOverall, BWL and stepped-care treatments produced improvements in binge-eating and weight loss in obese BED patients. Anti-obesity medication enhanced outcomes within a stepped-care model.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals 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

2012 ◽  
Vol 43 (6) ◽  
pp. 1335-1344 ◽  
Author(s):  
C. M. Grilo ◽  
M. A. White ◽  
R. Gueorguieva ◽  
G. T. Wilson ◽  
R. M. Masheb
Keyword(s):  
Eating Disorder ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Controlled Trial ◽  
Prognostic Significance ◽  
Self Esteem ◽  
Obese Patients ◽  
Undue Influence ◽  
Co Morbidity

BackgroundUndue 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).MethodA 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.ResultsParticipants 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.ConclusionsOur 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.

scholarly journals Self-help for bulimic disorders: A randomised controlled trial comparing minimal guidance with face-to-face or telephone guidance

2002 ◽  
Vol 181 (3) ◽  
pp. 230-235 ◽  
Author(s):  
Robert L. Palmer ◽  
Helen Birchall ◽  
Lesley Mcgrain ◽  
Victoria Sullivan
Keyword(s):  
Eating Disorder ◽  
Randomised Controlled Trial ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Controlled Trial ◽  
Stepped Care ◽  
Face To Face ◽  
Self Help ◽  
Randomised Controlled

BackgroundThere is great potential demand for treatment of bulimia nervosa and binge eating disorder. Skilled therapists are in short supply. Self-help and guided self-help based upon books have shown some promise as an economical alternative to full therapy in some cases.AimsTo investigate the efficacy and effectiveness of self-help with and without guidance in a specialist secondary service.MethodA randomised controlled trial comparing three forms of self-help over 4 months with a waiting-list comparison group and measurement of service consumption over the subsequent 8 months.ResultsSelf-help delivered with four sessions of face-to-face guidance led to improved outcome over 4 months. There is also some evidence to support the use of telephone guidance. A minority of participants achieved lasting remission of their disorder in relation to self-help, but there was no significant difference in final outcome between the groups after they had progressed through the stepped care programme. Patients initially offered guided self-help had a lower long-term drop-out rate.ConclusionsGuided self-help is a worthwhile initial response to bulimia nervosa and binge eating disorder. It is a treatment that could be delivered in primary care and in other non-specialist settings.

scholarly journals Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications

2011 ◽  
Vol 42 (4) ◽  
pp. 807-817 ◽  
Author(s):  
C. M. Grilo ◽  
M. A. White ◽  
G. T. Wilson ◽  
R. Gueorguieva ◽  
R. M. Masheb
Keyword(s):  
Weight Loss ◽  
Eating Disorder ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Prognostic Significance ◽  
Post Treatment ◽  
Rapid Response ◽  
Stepped Care ◽  
Clinical Implications ◽  
Eating Disorder Psychopathology

BackgroundWe examined rapid response in obese patients with binge-eating disorder (BED) in a clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL).MethodAltogether, 90 participants were randomly assigned to CBT or BWL. Assessments were performed at baseline, throughout and post-treatment and at 6- and 12-month follow-ups. Rapid response, defined as ⩾70% reduction in binge eating by week four, was determined by receiver operating characteristic curves and used to predict outcomes.ResultsRapid response characterized 57% of participants (67% of CBT, 47% of BWL) and was unrelated to most baseline variables. Rapid response predicted greater improvements across outcomes but had different prognostic significance and distinct time courses for CBT versus BWL. Patients receiving CBT did comparably well regardless of rapid response in terms of reduced binge eating and eating disorder psychopathology but did not achieve weight loss. Among patients receiving BWL, those without rapid response failed to improve further. However, those with rapid response were significantly more likely to achieve binge-eating remission (62% v. 13%) and greater reductions in binge-eating frequency, eating disorder psychopathology and weight loss.ConclusionsRapid response to treatment in BED has prognostic significance through 12-month follow-up, provides evidence for treatment specificity and has clinical implications for stepped-care treatment models for BED. Rapid responders who receive BWL benefit in terms of both binge eating and short-term weight loss. Collectively, these findings suggest that BWL might be a candidate for initial intervention in stepped-care models with an evaluation of progress after 1 month to identify non-rapid responders who could be advised to consider a switch to a specialized treatment.

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