Integrated weight loss and cognitive behavioural therapy (CBT) for the treatment of recurrent binge eating and high body mass index: a randomized controlled trial

Abstract

Purpose The association between binge eating and obesity is increasing. Treatments for disorders of recurrent binge eating comorbid with obesity reduce eating disorder (ED) symptoms, but not weight. This study investigated the efficacy and safety of introducing a weight loss intervention to the treatment of people with disorders of recurrent binge eating and a high body mass index (BMI). Methods A single-blind randomized controlled trial selected adults with binge eating disorder or bulimia nervosa and BMI ≥ 27 to < 40 kg/m 2. The primary outcome was sustained weight loss at 12-month follow-up. Secondary outcomes included ED symptoms. Mixed effects models analyses were conducted using multiple imputed datasets in the presence of missing data. Results Ninety-eight participants were randomized to the Health Approach to Weight Management and Food in Eating Disorders (HAPIFED) or to the Cognitive Behavioural Therapy-Enhanced (CBT-E). No between-group differences were found for percentage of participants achieving weight loss or secondary outcomes, except for reduction of purging behaviour, which was greater with HAPIFED (p = 0.016). Binge remission rates specifically at 12-month follow-up favoured HAPIFED (34.0% vs 16.7%; p = 0.049). Overall, significant improvements in the reduction of ED symptoms were seen in both groups and these were sustained at the 12-month follow-up. Conclusion HAPIFED was not superior to CBT-E in promoting clinically significant weight loss and was not significantly different in reducing most ED symptoms. No harm was observed with HAPIFED, in that no worsening of ED symptoms was observed. Further studies should test approaches that target both the management of ED symptoms and the high BMI. Level of evidence Level I, randomized controlled trial Trial registration US National Institutes of Health clinical trial registration number NCT02464345, date of registration 1 June 2015.

The treatment of binge eating disorder with cognitive behavior therapy and other therapies: An overview and clinical considerations

“…As previously mentioned, adjustments and examination are ongoing on a multidisciplinary treatment program that includes CBT, nutritional therapy, and exercise interventions for people with BED and comorbid overweight or obesity (i.e. the HAPIFED program) in order to effectively assist with weight management 58,59 . Moreover, it is important that healthcare professionals that treat obesity understand the complexities of treating people with BED (e.g., severity of comorbidities, rigid and unsupervised dieting that can trigger binge eating) and discuss with other healthcare professionals with different expertise in order to provide the best care.…”

“…Thus, a new treatment—for people with recurrent binge eating and comorbid overweight/obesity—that integrates CBT and behavioral weight loss therapy (i.e., the HAPIFED program) was developed 56,57 . Nonetheless, the first randomized controlled trial that assessed the efficacy of the HAPIFED program versus CBT‐E in a sample of 98 participants with BED/bulimia nervosa and comorbid overweight/obesity showed that while HAPIFED and CBT‐E both reduced binge eating, HAPIFED—like CBT‐E—did not induce significant weight loss in people with recurrent binge eating and overweight/obesity 58 . Adjustments to the treatment protocol are being implemented to potentially enable effective weight loss in people with BED 58 .…”

“…Adjustments to the treatment protocol are being implemented to potentially enable effective weight loss in people with BED 58 . The lack of significant weight loss in the first randomized controlled trial assessing the efficacy of the HAPIFED program may have occurred because of insufficient “dose” of the weight loss intervention, with a concurrent greater focus on the reduction of eating disorder behaviors 58 . This may have occurred due to therapists' being cautious of the risk of weight loss interventions inducing binge eating.…”

Baseline Predictors of Attrition in a Randomised Controlled Trial of a New Group Psychological Intervention for People with Recurrent Binge Eating Episodes Associated to Overweight or Obesity

“…So, both 33% and 75% treatment completions have clinical utilities. However, we also chose 60% treatment completion on the ground that there is no consensus on what is treatment completion or number of sessions for treatment to be completed [1,8]. However late attrition is usually 75% or more of therapy sessions and has been applied in previous studies of the authors [8].…”

Conscious Self-Regulation, Level of Anxiety in Eating Disorders: A Structural Model

“…Eating disorders are the result of a complex interaction of constitutional, biological, social, and psychological factors. Research on eating disorders focuses on the role of mental disorders (Chami et al, 2020;Dawson et al, 2018;Palavras et al, 2020;Weiss et al, 2019) and sociocultural factors (Ordaz et al, 2018;Rodgers et al, 2018;2019Yamamiya et al, 2016). Currently, there are more and more studies that examine various types of mental self-regulation among the significant factors of nutritional behavior (Annesi et al, 2016;Dohle et al, 2018;Eschenbeck et al, 2016;Kennel, 2018;Menzie et al, 2017).…”