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.

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.

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