Meal patterning in the treatment of bulimia nervosa

Ellison, Jo M.; Simonich, Heather; Wonderlich, Stephen A.; Crosby, Ross D.; Cao, Li; Mitchell, James E.; Benjamin, Lorna Smith; Klein, Marjorie H.; Crow, Scott J.; Peterson, Carol B.

doi:10.1016/j.eatbeh.2015.11.008

Cited by 19 publications

(16 citation statements)

References 20 publications

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“…Studies specifically examining meal patterns in BN indicate that individuals with BN eat fewer meals, particularly lunches, than those with BED or no eating disorder, 13 and that regular evening meal consumption may be important for reducing binge eating and purging. 26 Our results with this Latina sample did not support these prior observations from research conducted with predominantly White female samples. We did observe differences in results between our BED and BN samples, with more frequent evening snack consumption being associated with greater weight and shape concerns, and less dietary restriction within the BN group only.…”

Section: Discussioncontrasting

confidence: 99%

“…Studies specifically examining meal patterns in BN indicate that individuals with BN eat fewer meals, particularly lunches, than those with BED or no eating disorder, and that regular evening meal consumption may be important for reducing binge eating and purging . Our results with this Latina sample did not support these prior observations from research conducted with predominantly White female samples.…”

Section: Discussionmentioning

confidence: 99%

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Associations between meal patterns, binge eating, and weight for Latinas

Cachelin

Vela

Gil‐Rivas

2016

Intl J Eating Disorders

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Establishing a regular pattern of eating is a core element of treatment for binge eating, yet no research to date has examined meal patterns of Latina women. Objective Compare eating patterns of Latinas who binge eat and those who do not, and examine associations between meal patterns and binge episodes, associated distress and concerns, and body mass index (BMI). Method One-hundred fifty-five Latinas (65 BED, 22 Bulimia Nervosa [BN], 68 with no eating disorder) were assessed with the Eating Disorder Examination. Results There were no significant differences in eating patterns between groups. Breakfast was the least and dinner the most consumed meal. For the BED group: greater frequency of lunch consumption was associated with higher BMI while more frequent evening snacking was associated with lower BMI and with less weight importance; more frequent breakfast consumption, mid-morning snack consumption and total meals were associated with greater distress regarding binge eating. For the BN group: evening snack frequency was associated with less dietary restriction and more weight and shape concern; total snack frequency was associated with more weight concern. Regular meal eaters reported more episodes of binge eating than those who did not eat meals regularly. Discussion Associations with meal patterns differed by eating disorder diagnosis. Study findings mostly are not consistent with results from prior research on primarily White women. CBT treatments may need to be tailored to address the association between binge eating and regular meal consumption for Latinas. Culturally appropriate modifications that address traditional eating patterns should be considered.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Associations between meal patterns, binge eating, and weight for Latinas

Cachelin

Vela

Gil‐Rivas

2016

Intl J Eating Disorders

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“…Regular eating has consistently been associated with decreased frequency of binge eating (Ellison et al, 2016; Shah, Passi, Bryson, & Agras, 2005; Waller, Evans, & Pugh, 2013; Wilson, Fairburn, Agras, Walsh, & Kraemer, 2002; Zendegui, West, & Zandberg, 2014). However, this is the first study to assess change in both variables on a weekly basis.…”

Section: Discussionmentioning

confidence: 99%

Mediators of change in cognitive behavior therapy and interpersonal psychotherapy for eating disorders: A secondary analysis of a transdiagnostic randomized controlled trial

Sivyer

Allen

Cooper

et al. 2020

Intl J Eating Disorders

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Objective: Understanding the mechanisms of action of psychological treatments is a key first step in refining and developing more effective treatments. The present study examined hypothesized mediators of change of enhanced cognitive behavior therapy (CBT-E) and interpersonal psychotherapy for eating disorders (IPT-ED). Method: A series of mediation studies were embedded in a randomized controlled trial (RCT) comparing 20 weeks of CBT-E and IPT-ED in a transdiagnostic, nonunderweight sample of patients with eating disorders (N = 130) consecutively referred to the service. Three hypothesized mediators of change in CBT-E (regular eating, weighing frequency, and shape checking) and the key hypothesized mediator of IPT-ED (interpersonal problem severity) were studied. Results: The data supported regular eating as being a mediator of the effect of CBT-E on binge-eating frequency. The findings were inconclusive regarding the role of the other putative mediators of the effects of CBT-E; and were similarly inconclusive for interpersonal problem severity as a mediator of the effect of IPT-ED. Discussion: This research highlights the potential benefits of embedding mediation studies within RCTs to better understand how treatments work. The findings supported the role of regular eating in reducing patients' binge-eating frequency.

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“…One reason many patients may fail to achieve remission from CBT for BN is suboptimal levels of therapeutic skill acquisition (ie, the ability to successfully perform a skill learned in treatment) and skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) [3,4]. Acquisition and utilization of therapeutic skills designed to reduce dietary restraint (eg, regular eating) consistently predict treatment outcomes [4][5][6][7]. In addition, numerous studies have demonstrated that reduction of dietary restraint is a key mechanism of action in CBT for BN [2,[8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study

Juarascio¹,

Srivastava²,

Presseller³

et al. 2021

JMIR Form Res

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Background Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (ie, the ability to successfully perform a skill learned in treatment). However, rates of utilization and acquisition of key treatment skills (eg, regular eating, urge management skills, and mood management skills) by the end of the treatment are frequently low; as a result, outcomes from CBT for BN are affected. Just-in-time adaptive interventions (JITAIs) may improve skill acquisition and utilization by delivering real-time interventions during algorithm-identified opportunities for skill practice. Objective In this manuscript, we describe a newly developed JITAI system called CBT+ that is designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation. We also present feasibility, acceptability, and preliminary outcomes data from a small proof-of-concept pilot trial (n=5 patients and n=3 clinicians) designed to identify opportunities for iterative development of CBT+ ahead of a larger ongoing randomized controlled trial. Methods A total of 5 individuals with BN received 16 sessions of outpatient CBT for BN while using the CBT+ app. Data were collected from patients and clinicians to evaluate the feasibility (eg, app use and user adherence), acceptability (eg, qualitative patient and clinician feedback, including usefulness ratings of CBT+ on a 6-point Likert scale ranging from 1=extremely useless to 6=extremely useful), and preliminary outcomes (eg, improvements in skill utilization and acquisition and BN symptoms) of the CBT+ system. Results Patients reported that CBT+ was a relatively low burden (eg, quick and easy-to-use self-monitoring interface), and adherence to in-app self-monitoring was high (mean entries per day 3.13, SD 1.03). JITAIs were perceived as useful by both patients (median rating 5/6) and clinicians (median rating 5/6) for encouraging the use of CBT skills. Large improvements in CBT skills and clinically significant reductions in BN symptoms were observed post treatment. Although preliminary findings indicated that the CBT+ system was acceptable to most patients and clinicians, the overall study dropout was relatively high (ie, 2/5, 40% patients), which could indicate some moderate concerns regarding feasibility. Conclusions CBT+, the first-ever JITAI system designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation, was shown to be feasible and acceptable. The results indicate that the CBT+ system should be subjected to more rigorous evaluations with larger samples and should be considered for wider implementation if found effective. Areas for iterative improvement of the CBT+ system ahead of a randomized controlled trial are also discussed.

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Meal patterning in the treatment of bulimia nervosa

Cited by 19 publications

References 20 publications

Associations between meal patterns, binge eating, and weight for Latinas

Associations between meal patterns, binge eating, and weight for Latinas

Mediators of change in cognitive behavior therapy and interpersonal psychotherapy for eating disorders: A secondary analysis of a transdiagnostic randomized controlled trial

A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study

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