Cognitive–behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: A randomized controlled trial.

TLDR

Cognitive‑behavioral therapy is the established treatment for binge‑eating disorder but does not lead to weight loss, while the effectiveness of behavioral weight‑loss programs in obese patients with BED remains unclear. The study aimed to compare the efficacy of CBT, BWL, and a sequential CBT+BWL approach in obese patients with binge‑eating disorder. 125 obese BED patients were randomized to one of the three manualized group treatments delivered in groups. CBT achieved higher binge‑eating remission (51%) than BWL (36%) and CBT+BWL (40%) at 12 months, while BWL produced greater percent BMI loss during treatment, and the sequential CBT+BWL approach did not yield additional benefits beyond CBT alone.

Abstract

Cognitive-behavioral therapy (CBT) is the best established treatment for binge-eating disorder (BED) but does not produce weight loss. The efficacy of behavioral weight loss (BWL) in obese patients with BED is uncertain. This study compared CBT, BWL, and a sequential approach in which CBT is delivered first, followed by BWL (CBT + BWL).125 obese patients with BED were randomly assigned to 1 of the 3 manualized treatments delivered in groups. Independent assessments were performed posttreatment and at 6- and 12-month follow-ups.At 12-month follow-up, intent-to-treat binge-eating remission rates were 51% (CBT), 36% (BWL), and 40% (CBT + BWL), and mean percent BMI losses were -0.9, -2.1, and 1.5, respectively. Mixed-models analyses revealed that CBT produced significantly greater reductions in binge eating than BWL through 12-month follow-up and that BWL produced significantly greater percent BMI loss during treatment. The overall significant percent BMI loss in CBT + BWL was attributable to the significant effects during the BWL component. Binge-eating remission at major assessment points was associated significantly with greater percent BMI loss cross-sectionally and prospectively (i.e., at subsequent follow-ups).CBT was superior to BWL for producing reductions in binge eating through 12-month follow-up, while BWL produced statistically greater, albeit modest, weight losses during treatment. Results do not support the utility of the sequential approach of providing BWL following CBT. Remission from binge eating was associated with significantly greater percent BMI loss. Findings support BWL as an alternative treatment option to CBT for BED.