Psychiatric comorbidity as predictor and moderator of binge-eating disorder treatment outcomes: an analysis of aggregated randomized controlled trials

2021 ◽  
pp. 1-9
Author(s):  
Janet A. Lydecker ◽  
Carlos M. Grilo
Keyword(s):  
Weight Loss ◽  
Eating Disorder ◽  
Binge Eating ◽  
Treatment Outcomes ◽  
Binge Eating Disorder ◽  
Psychiatric Comorbidity ◽  
Controlled Trials ◽  
Eating Frequency ◽  
Randomized Controlled ◽  
Eating Disorder Psychopathology

Abstract Background Psychiatric comorbidity is common in binge-eating disorder (BED) but effects on treatment outcomes are unknown. The current study aimed to determine whether psychiatric comorbidity predicted or moderated BED treatment outcomes. Methods In total, 636 adults with BED in randomized-controlled trials (RCTs) were assessed prior, throughout, and posttreatment by doctoral research-clinicians using reliably-administered semi-structured interviews, self-report measures, and measured weight. Data were aggregated from RCTs testing cognitive-behavioral therapy, behavioral weight loss, multi-modal (combined pharmacological plus cognitive-behavioral/behavioral), and/or control conditions. Intent-to-treat analyses (all available data) tested comorbidity (mood, anxiety, ‘any disorder’ separately) as predictors and moderators of outcomes. Mixed-effects models tested comorbidity effects on binge-eating frequency, global eating-disorder psychopathology, and weight. Generalized estimating equation models tested binge-eating remission (zero binge-eating episodes during the past month; missing data imputed as failure). Results Overall, 41% of patients had current psychiatric comorbidity; 22% had mood and 23% had anxiety disorders. Psychiatric comorbidity did not significantly moderate the outcomes of specific treatments. Psychiatric comorbidity predicted worse eating-disorder psychopathology and higher binge-eating frequency across all treatments and timepoints. Patients with mood comorbidity were significantly less likely to remit than those without mood disorders (30% v. 41%). Psychiatric comorbidity neither predicted nor moderated weight loss. Conclusions Psychiatric comorbidity was associated with more severe BED psychopathology throughout treatment but did not moderate outcomes. Findings highlight the need to improve treatments for BED with psychiatric comorbidities but challenge perspectives that combining existing psychological and pharmacological interventions is warranted. Treatment research must identify more effective interventions for BED overall and for patients with comorbidities.

Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: a feasibility trial

2020 ◽  
pp. 1-10
Author(s):  
Rayane Chami ◽  
Valentina Cardi ◽  
Natalia Lawrence ◽  
Pamela MacDonald ◽  
Katie Rowlands ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Implementation Intentions ◽  
Effect Sizes ◽  
Post Intervention ◽  
Eating Frequency ◽  
Eating Disorder Psychopathology

Abstract Background This trial examined the feasibility, acceptability, and effect sizes of clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology. Methods Seventy-eight adult participants with bulimia nervosa or binge eating disorder were randomly allocated to receive food-specific, or general, ICT and if-then planning for 4 weeks. Results Recruitment and retention rates at 4 weeks (97.5% and 79.5%, respectively) met the pre-set cut-offs. The pre-set adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (4 weeks) and follow-up (8 weeks), with moderate to large effect sizes. There was a tendency for greater reductions in binge eating frequency and eating disorders psychopathology (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation (post-intervention), food approach (post-intervention and follow-up), anxiety (follow-up), and depression (follow-up). Participants indicated that both interventions were acceptable. Conclusions The study findings reveal that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.

Binge-eating disorder and major depressive disorder co-morbidity: Sequence and clinical significance

2016 ◽  
Vol 33 (S1) ◽  
pp. S163-S163
Author(s):  
C. Grilo ◽  
D. Becker
Keyword(s):  
Major Depressive Disorder ◽  
Eating Disorder ◽  
Depressive Disorder ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Psychiatric Comorbidity ◽  
Consecutive Series ◽  
Major Depressive ◽  
Eating Disorder Psychopathology ◽  
Co Morbidity

IntroductionBinge-eating disorder (BED) is associated with obesity and with elevated rates of co-occurring major depressive disorder (MDD) but the significance of the diagnostic comorbidity is ambiguous—as is the significance of the onset sequence for MDD and BED.Objective and aimsWe compared eating-disorder psychopathology and psychiatric comorbidity in three subgroups of BED patients: those in whom onset of BED preceded onset of MDD, those with onset of MDD prior to onset of BED, and those without MDD or any psychiatric comorbidity.MethodsA consecutive series of 731 treatment-seeking patients meeting DSM-IV-TR research criteria for BED were assessed reliably by doctoral-clinicians with semi-structured interviews to evaluate lifetime psychiatric disorders (SCID-I/P) and ED psychopathology (EDE Interview).ResultsBased on SCID-I/P, 191 (26%) patients had onset of BED preceding onset of MDD, 114 (16%) had onset of MDD preceding onset of BED, and 426 (58%) had BED without co-occurring disorders. Three groups did not differ with respect to age, ethnicity, or education, but a greater proportion of the group without MDD was male. Three groups did not differ in body-mass-index or binge-eating frequency, but groups differed significantly with respect to eating-disorder psychopathology, with both MDD groups having significantly higher levels than the group without co-occurring disorders. The group having earlier onset of MDD had elevated rates of anxiety disorders compared to the group having earlier onset of BED.ConclusionsMDD in combination with BED—with either order of onset—has a meaningful adverse effect on ED psychopathology and overall psychiatric co-morbidity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Change in impulsivity is prospectively associated with treatment outcomes for binge-eating disorder

2021 ◽  
pp. 1-9
Author(s):  
Rebecca G. Boswell ◽  
Ralitza Gueorguieva ◽  
Carlos M. Grilo
Keyword(s):  
Eating Disorder ◽  
Binge Eating ◽  
Treatment Outcomes ◽  
Binge Eating Disorder ◽  
Pharmacological Treatment ◽  
Rapid Change ◽  
Post Treatment ◽  
Controlled Clinical Trial ◽  
Eating Disorder Psychopathology

Abstract Background Impulsivity may be a process underlying binge-eating disorder (BED) psychopathology and its treatment. This study examined change in impulsivity during cognitive-behavioral therapy (CBT) and/or pharmacological treatment for BED and associations with treatment outcomes. Methods In total, 108 patients with BED (NFEMALE = 84) in a randomized placebo-controlled clinical trial evaluating the efficacy of CBT and/or fluoxetine were assessed before treatment, monthly throughout treatment, at post-treatment (16 weeks), and at 12-month follow-up after completing treatment. Patients completed established measures of impulsivity, eating-disorder psychopathology, and depression, and were measured for height and weight [to calculate body mass index (BMI)] during repeated assessments by trained/monitored doctoral research-clinicians. Mixed-effects models using all available data examined changes in impulsivity and the association of rapid and overall changes in impulsivity on treatment outcomes. Exploratory analyses examined whether baseline impulsivity predicted/moderated outcomes. Results Impulsivity declined significantly throughout treatment and follow-up across treatment groups. Rapid change in impulsivity and overall change in impulsivity during treatment were significantly associated with reductions in eating-disorder psychopathology, depression scores, and BMI during treatment and at post-treatment. Overall change in impulsivity during treatment was associated with subsequent reductions in depression scores at 12-month follow-up. Baseline impulsivity did not moderate/predict eating-disorder outcomes or BMI but did predict change in depression scores. Conclusions Rapid and overall reductions in impulsivity during treatment were associated with improvements in specific eating-disorder psychopathology and associated general outcomes. These effects were found for both CBT and pharmacological treatment for BED. Change in impulsivity may be an important process prospectively related to treatment outcome.

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.

scholarly journals Lisdexamfetamine Dimesylate for Adults with Moderate to Severe Binge Eating Disorder: Results of Two Pivotal Phase 3 Randomized Controlled Trials

2015 ◽  
Vol 41 (5) ◽  
pp. 1251-1260 ◽  
Author(s):  
Susan L McElroy ◽  
James Hudson ◽  
M Celeste Ferreira-Cornwell ◽  
Jana Radewonuk ◽  
Timothy Whitaker ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Binge Eating ◽  
Randomized Controlled Trials ◽  
Binge Eating Disorder ◽  
Controlled Trials ◽  
Phase 3 ◽  
Pivotal Phase ◽  
Lisdexamfetamine Dimesylate ◽  
Randomized Controlled

scholarly journals The efficacy of eHealth interventions in treating adults diagnosed with full and subthreshold binge eating disorder: A Meta-analysis (Preprint)

2020 ◽  
Author(s):  
Elnaz Moghimi ◽  
Caroline Davis ◽  
Michael Rotondi
Keyword(s):  
Eating Disorder ◽  
Binge Eating ◽  
Randomized Controlled Trials ◽  
Binge Eating Disorder ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Wait List ◽  
Randomized Controlled ◽  
Short Period ◽  
Significant Difference

BACKGROUND There has been a recent rise in the use of eHealth treatments for a variety of psychological disorders, including eating disorders. OBJECTIVE This meta-analysis of randomized controlled trials is the first to evaluate the efficacy of eHealth interventions specifically for the treatment of binge eating disorder (BED)– characterized by compulsive overconsumption of food, in a relatively short period of time and without compensatory behaviors like purging or fasting. METHODS A search on the electronic databases PubMed, Web of Science, Embase, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was conducted for randomized controlled trials that compared the efficacy of eHealth treatment interventions to wait-list controls. From the databases searched, three studies met the inclusion criteria, and all the interventions administered were forms of internet-based guided cognitive behavioral therapy. RESULTS The results of the analysis demonstrate that when compared to wait list controls, eHealth interventions reduce objective binge episodes (OBE; SMD is -0.77, 95% CI, -1.38 to -0.16) and eating disorder psychopathology (SMD -0.71, 95% CI -1.20 to -0.22), which include shape (SMD -0.61, 95% CI -1.01 to -0.22) and weight concerns (SMD -0.91, 95% CI -1.33 to -0.48). There was no significant difference in body mass index between eHealth interventions and controls (SMD -0.01, 95% CI, -0.40 to 0.39). CONCLUSIONS These findings provide promising results for the use of internet-based CBT for BED treatment and support the greater need for future research to explore the efficacy of these eHealth interventions.

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