Binge-eating disorder (BED), estimated to afflict 2% to 3% of the population, contributes to high rates of overweight and obesity and is frequently accompanied by comorbid psychiatric difficulties. Psychological treatments are generally more effective than medications and include behavioral weight-loss programs and cognitive-behavioral, interpersonal, and dialectical behavioral therapies. In a 20-week group-treatment study, 259 BED patients were randomized to therapist-led, therapist-assisted, or structured self-help groups, or a wait-list control (mean group size, 6; 88% women).
The CBT-based treatments consisted of 15 sessions, each lasting 80 minutes. Patients with psychosis, substance abuse, or other significant psychiatric or medical comorbidities were excluded, but patients on stable doses of antidepressant medications ( 6 weeks) were enrolled (79% of randomized patients). The average body-mass index was 39.0.
Abstinence from binge eating differed significantly between control and therapy groups at 20 weeks, with therapist-led and -assisted treatments showing the most improvement (rates: therapist-led treatment, 52%; therapist-assisted treatment, 33%; self-help treatment, 18%; waiting list, 10%), but rates no longer differed by treatment group (excluding wait-list patients) at 1-year follow-up (range, 21%–27%). Similarly, binge-eating frequency decreased significantly in the therapist-led group at week 20, but no group differences were seen at follow-up. Treatment did not affect weight, depression, or quality of life.
Comment: These findings underscore that BED is amenable to treatment, but this chronic disorder may need longer-term treatment or systematic interventions to prevent relapse. Because all treatments improved initial abstinence more than waiting list, these findings also offer partial support for self-help groups where therapist-led or -assisted groups are unavailable. That these interventions had little impact on weight is not surprising, in part because weight loss was not a targeted outcome. Developing programs that help obese patients maintain long-term weight loss remains a daunting task.
— Joel Yager, MD
Published in Journal Watch Psychiatry December 21, 2009
Citation(s):
Peterson CB et al. The efficacy of self-help group treatment and therapist-led group treatment for binge eating disorder. Am J Psychiatry 2009 Dec; 166:1347.
