Randomized controlled trial testing the effectiveness of adaptive “SMART” stepped-care treatment for adults with binge-eating disorder comorbid with obesity.

White

Ivezaj

et al. 2020

Obesity

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Objective This study aimed to examine longer‐term effects of behavioral weight loss (BWL) and Stepped Care for binge‐eating disorder and obesity through 12‐month follow‐up after completing treatments. Methods A total of 191 patients with binge‐eating disorder/obesity were randomized to 6 months of BWL (n = 39) or Stepped Care (n = 152). Within Stepped Care, patients began BWL (1 month), treatment responders continued BWL, nonresponders switched to cognitive behavioral therapy, and all were randomized (double‐blind) to weight‐loss medication or placebo (5 months). Patients were independently assessed throughout/after treatment and at 6‐ and 12‐month follow‐ups. Results Intent‐to‐treat analyses of remission rates revealed that BWL and Stepped Care did not differ significantly at posttreatment (74.4% vs. 66.5%), 6‐month follow‐up (38.2% vs. 33.3%), or 12‐month follow‐up (44.7% vs. 41.0%). Mixed models of binge‐eating frequency indicated significant reductions through posttreatment but no significant changes or differences between BWL and Stepped Care during follow‐up. Mixed models revealed significant weight loss with no differences between BWL and Stepped Care (5.1% vs. 5.8%) at posttreatment and significant time effects (larger percent weight loss at 6‐month than at 12‐month follow‐up) with no differences between BWL and Stepped Care (−5.1% vs. −5.2% and −3.4% vs. −5.0%, respectively). Conclusions Binge‐eating improvements and weight loss produced by BWL and adaptive Stepped Care did not differ significantly 12 months after completing treatments.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Randomized Controlled Trial of Behavioral Weight Loss and Stepped Care for Binge‐Eating Disorder: 12‐Month Follow‐up

White

Ivezaj

et al. 2020

Obesity

Self Cite

Clinical moderators and predictors of cognitive‐behavioral therapy by guided‐self‐help versus therapist‐led for binge‐eating disorder: Analysis of aggregated clinical trials

Intl J Eating Disorders

Thompson‐Brenner

Shingleton

et al. 2021

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Objective: Cognitive-behavioral therapy (CBT)-therapist-led (CBTth) and guidedself-help (CBTgsh)-has efficacy for binge-eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods. Method: Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treatments for BED in the U.S. Predictors and moderators of outcomes (treatment completion and binge-eating remission) were examined in N = 457 participants who received either CBTgsh (N = 164) or CBTth (N = 293). Results: Analyses, adjusting for demographic/clinical variables, indicated CBTth was significantly superior to CBTgsh for treatment completion (odds ratio [OR] = 20.0)and remission (OR = 14.6). For remission, analyses revealed significant predictors (age, treatment length, Weight Concern), a moderator (weight concern [OR = 5.13]), and a significant interaction between CBT-type and treatment length (OR = 2.66).For CBTgsh, longer treatment was associated with less remission, whereas for CBTth, longer treatment was associated with greater remission. For CBTgsh, 44.1% with low weight concern versus 56.3% with high weight concern achieved remission whereas for CBTth, 43.5% with high weight concern and 61.0% with low weight concern achieved remission.Discussion: Analyses of aggregated RCT BED data, adjusting for demographic/clinical characteristics, indicated superiority (large effect-sizes) in treatment outcomes of CBTth over CBTgsh and that Weight Concern moderated outcomes.

24‐Monthfollow‐upof randomized controlled trial of guided‐self‐helpfor loss‐of‐controleating after bariatric surgery

Intl J Eating Disorders

Ivezaj

Duffy

et al. 2022

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Background Loss‐of‐control (LOC)‐eating postoperatively predicts suboptimal longer‐term outcomes following bariatric surgery. This study examined longer‐term effects through 24‐month follow‐ups after completing treatments in a randomized controlled trial testing guided‐self‐help treatments (cognitive‐behavioral therapy [gshCBT] and behavioral weight‐loss [gshBWL]) and control (CON) delivered postoperatively for LOC‐eating. Methods 140 patients with LOC‐eating 6 months after bariatric surgery were randomized (5:5:2 ratio) to 3‐months of gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24) delivered by trained allied‐health clinicians. Independent assessments were performed throughout/after treatments and at 6‐, 12‐, 18‐, and 24‐month follow‐ups; 83% of patients were assessed at 24‐month follow‐up. Results Intention‐to‐treat analyses comparing the three groups (gshCBT vs. gshBWL vs. CON) in LOC‐eating abstinence at posttreatment (30%, 27%, 38%), 12‐month follow‐up (34%, 32%, 42%), and 24‐month follow‐up (45%, 32%, 38%) revealed no significant differences. Mixed‐models revealed significantly reduced LOC‐eating frequency through posttreatment, no significant changes in LOC‐eating frequency during follow‐up, and no differences between the three groups. Weight reduced significantly, albeit modestly, through posttreatment but increased significantly and substantially during follow‐ups, with no differences between groups. Conclusions Overall, the 12‐week scalable guided‐self‐help treatments did not differ from each other or control, were associated with significantly reduced frequency of LOC‐eating and modest weight loss at posttreatment but were followed by significant weight gain during the 24‐month follow‐up. Weight gain was substantial and nearly universal whereas the frequency of LOC‐eating did not change over time (i.e., LOC‐eating reductions and abstinence rates were well maintained through 24‐moth follow‐ups). Patients with postoperative LOC‐eating require more intensive adjunctive treatments. Public significance Loss‐of‐control (LOC) eating postoperatively predicts poorer bariatric surgery outcomes and the longer‐term effects of postoperative adjunctive postoperative interventions for LOC eating are unknown. In this 24‐month follow‐up of a controlled study of scalable guided‐self‐help treatments and a control condition, improvements in LOC‐eating frequency, eating‐disorder psychopathology, and depression during treatment were maintained well, with no differences between the three groups. Proportion of patients achieving abstinence from LOC‐eating at the 24‐month follow‐up ranged from 38% to 45% across the three groups. In contrast, weight increased significantly during the 24‐month follow‐ups, with no differences between the three groups. Findings suggest LOC‐eating following bariatric surgery might represent a “marker” for a subgroup of patients that are at risk for substantial weight gains over time. LOC eating following bariatric surgery is challenging to treat with low‐intensity scalable treatments and...