ObjectivePrimary-care (PC) settings may be an opportune place to deliver obesity interventions. Scalable interventions utilizing motivational interviewing (MI), supported by internet resources, may overcome obstacles to effective obesity treatment dissemination. This study was a randomized controlled trial (RCT) testing two web-supported interventions, motivational interviewing (MIC) and nutrition psychoeducation (NPC), an attention-control intervention, to usual care (UC).Design and Methods89 overweight/obese patients, with and without binge eating disorder (BED), were randomly assigned to MIC, NPC, or UC for 3 months in PC. Patients were assessed independently at post-treatment and at 3-month follow-upResultsWeight, triglyceride levels, and depression scores decreased significantly in NPC when compared to UC but not MIC; UC and MIC did not differ significantly. Weight-loss results maintained at 3-month follow-up: approximately 25% MIC and NPC patients achieved at least 5% weight-loss which did not differ by BED status. Fidelity ratings were high and treatment adherence was associated with weight loss.ConclusionsThis is the first RCT in PC testing MI for obesity to include an attention-control intervention (NPC). NPC, but not MI, showed a consistent pattern of superior benefits relative to UC. BED status was not associated but treatment adherence was associated with weight loss outcomes.

Summary Motivational interviewing (MI) is a client-centred method of intervention focused on enhancing intrinsic motivation and behaviour change. A previous review of the literature and meta-analyses support the effectiveness of MI for weight loss. None of these studies, however, focused on the bourgeoning literature examining MI for weight loss among adults within primary care settings, which confers unique barriers to providing weight loss treatment. Further, the current review includes 19 studies not included in previous reviews or meta-analyses. We conducted a comprehensive review of PubMed, MI review papers, and citations from relevant papers. A total of 24 adult randomized controlled trials were identified. MI interventions typically were provided individually by a range of clinicians and compared with usual care. Few studies provided adequate information regarding MI treatment fidelity. Nine studies (37.5%) reported significant weight loss at post-treatment assessment for the MI condition compared with control groups. Thirteen studies (54.2%) reported MI patients achieving at least 5% loss of initial body weight. There is potential for MI to help primary care patients lose weight. Conclusions, however, must be drawn cautiously as more than half of the reviewed studies showed no significant weight loss compared with usual care and few reported MI treatment fidelity.

This study assessed “normative discontent,” the concept that most women experience weight dissatisfaction, as an emerging societal stereotype for women and men (Rodin, Silberstein, & Streigel-Moore, 1984). Participants (N = 472) completed measures of stereotypes, eating disorders, and body image. Normative discontent stereotypes were pervasive for women and men. Endorsing stereotypes varied by sex and participants’ own disturbance, with trends towards eating disorder symptomotology being positively correlated with stereotype endorsement. Individuals with higher levels of body image and eating disturbance may normalize their behavior by perceiving that most people share their experiences. Future research needs to test prevention and intervention strategies that incorporate the discrepancies between body image/eating-related stereotypes and reality with focus on preventing normalization of such experiences.

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Objective The objective was to determine whether treatments with demonstrated efficacy for binge eating disorder (BED) in specialist treatment centers can be delivered effectively in primary care settings to racially/ethnically diverse obese patients with BED. This study compared the effectiveness of self-help cognitive-behavioral therapy (shCBT) and an anti-obesity medication (sibutramine), alone and in combination, and it is only the second placebo-controlled trial of any medication for BED to evaluate longer-term effects after treatment discontinuation. Method 104 obese patients with BED (73% female, 55% non-white) were randomly assigned to one of four 16-week treatments (balanced 2-by-2 factorial design): sibutramine (N=26), placebo (N=27), shCBT+sibutramine (N=26), or shCBT+placebo (N=25). Medications were administered in double-blind fashion. Independent assessments were performed monthly throughout treatment, post-treatment, and at 6- and 12-month follow-ups (16 months after randomization). Results Mixed-models analyses revealed significant time and medication-by-time interaction effects for percent weight loss, with sibutramine but not placebo associated with significant change over time. Percent weight loss differed significantly between sibutramine and placebo by the third month of treatment and at post-treatment. After the medication was discontinued at post-treatment, weight re-gain occurred in sibutramine groups and percent weight loss no longer differed among the four treatments at 6- and 12-month follow-ups. For binge-eating, mixed-models revealed significant time and shCBT-by-time interaction effects: shCBT had significantly lower binge-eating frequency at 6-month follow-up but the treatments did not differ significantly at any other time point. Demographic factors did not significantly predict or moderate clinical outcomes. Discussion Our findings suggest that pure self-help CBT and sibutramine did not show long-term effectiveness relative to placebo for treating BED in racially/ethnically diverse obese patients in primary care. Overall, the treatments differed little with respect to binge-eating and associated outcomes. Sibutramine was associated with significantly greater acute weight loss than placebo and the observed weight-regain following discontinuation of medication suggests that anti-obesity medications need to be continued for weight loss maintenance. Demographic factors did not predict/moderate clinical outcomes in this diverse patient group.

Objective The objective was to examine the effectiveness of a self-help treatment as a first line primary care intervention for binge eating disorder (BED) in obese patients. This study compared the effectiveness of a usual care plus self-help version of cognitive behavioral therapy (shCBT) to usual care (UC) only in ethnically/racially diverse obese patients with BED in primary care settings in an urban center. Method 48 obese patients with BED were randomly assigned to either shCBT (N=24) or UC (N=24) for four months. Independent assessments were performed monthly throughout treatment and at post-treatment. Results Binge-eating remission rates did not differ significantly between shCBT (25%) and UC (8.3%) at post-treatment. Mixed models of binge eating frequency determined using the Eating Disorder Examination (EDE) revealed significant decreases for both conditions but that shCBT and UC did not differ. Mixed models of binge eating frequency from repeated monthly EDE-questionnaire assessments revealed a significant treatment-by-time interaction indicating that shCBT had significant reductions whereas UC did not during the four-month treatments. Mixed models revealed no differences between groups on associated eating disorder psychopathology or depression. No weight loss was observed in either condition. Conclusions Our findings suggest that pure self-help CBT did not show effectiveness relative to usual care for treating BED in obese patients in primary care. Thus, self-help CBT may not have utility as a front-line intervention for BED for obese patients in primary care and future studies should test guided-self-help methods for delivering CBT in primary care generalist settings.

Objective Given the prevalence and health significance of binge eating disorder (BED) it is important to determine if time-efficient self-reports can adequately assess BED and its features in primary care settings. We compared the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire for Eating and Weight Patterns-Revised (QEWP-R), administered to obese patients with BED in primary care to the Eating Disorder Examination interview (EDE). Method Sixty-six participants completed questionnaires and were interviewed Results The EDE was significantly correlated with the EDE-Q (binge eating, four subscales, global score) and QEWP-R (binge eating, distress, body image). The EDE-Q yielded significantly lower estimates of binge eating and significantly higher scores on the EDE subscales. The QEWP-R yielded significantly higher scores on the behavioral indicators and distress about binge eating and body image variables. Discussion These findings suggest that these two self-report measures have potential utility for identifying BED in obese patients in primary care.

Objective: This study evaluated individuals' language preferences for discussing obesity and binge eating. Method: Participants (N = 817; 68.3% female) were an online community sample. They rated the desirability of terms related to obesity and binge eating, and also completed psychometrically established eating-disorder measures. In addition to examining participants' preferences, analyses explored whether preferences differed by socio-demographic variables, weight status and binge-eating status. Results: Preferred obesity-related terms were weight and BMI, although women rated undesirable obesity-related terms even lower than did men. Participants with obesity and binge eating rated weight, BMI, unhealthy BMI and large size as less desirable than participants with obesity but not binge eating. Binge-related terms were generally ranked neutrally; preferred descriptions were kept eating even though not physically hungry and loss of control. Conclusions: Preferred terms were generally consistent across sex, weight status and binge-eating status. Using terms ranked more preferably and avoiding terms ranked more undesirably may enhance clinical interactions, particularly when discussing obesity with women and individuals reporting binge eating, as these groups had stronger aversion to some non-preferred terms. Findings that the selected binge-related descriptions were rated neutrally on average provide support for their use by clinicians. What's known• Individuals prefer the terms 'weight' and 'BMI' when talking about obesity.