Weight Loss is Not Effective Treatment for Obese Binge EatersTuesday, January 5, 2010
As blogged before, binge eating disorder (BED) can be diagnosed in as many as in one in four patients presenting in bariatric centres for weight loss.
Typical BED is characterized by frequent and persistent episodes of binge eating accompanied by feelings of loss of control and marked distress in the absence of regular compensatory behaviors. The disorder is associated with specific psychopathology (eg. dysfunctional body shape and weight concerns), psychiatric comorbidity (depression and anxiety disorders), and significant health and psychosocial impairments.
In my experience, the vast majority of patients with BED present with impressive histories of weight cycling, sometimes losing substantial amount of weight, only to soon gain it back. As do many obese patients, including those without BED, they fully believe that losing weight is the only solution to their often complex problems.
Just how futile weight loss attempts can be for patients with BED without primarily addressing the underlying psychopathology is nicely illustrated by Terence Wilson and colleagues from Rutgers University, New Jersey, just published in the Archives of General Psychiatry.
In this study, 205 women and men with a body mass index between 27 and 45 who met DSM-IV criteria for BED were randomised to twenty sessions of behavioural weight loss with moderate caloric restriction and exercise (BWL) or interpersonal psychotherapy (IPT) or 10 sessions of guided self-help cognitive behavioural therapy (CBTgsh) during 6 months.
At the end of the 6 month intervention, a substantially greater number of BWL patients achieved a 5% reduction in body weight (41%) than with IPT (15%) or CBTgsh (15%). At this time, all patients reported a similar reduction in binge-eating episodes.
However, two years later the picture looked quite different: while there were no longer significant weight differences between the groups (which means that the BWL patients regained virtually all the weight they lost), both IPT and CBTgsh were more likely to remain in remission from binge eating than BWL patients. The odds ratios for low and high global Eating Disorder Examination scores were 2.8 for BWL, 2.9 for CBTgsh, and 0.73 for IPT.
Although there was no significant association between sustained remission from binge eating and percent change in weight, a significantly greater proportion (31%) of patients with sustained remission from binge eating during follow-up lost a minimum of 5% of their baseline weight compared with patients who were never in remission (10%).
Not only does this study clearly show that behavioural weight loss is substantially less effective in long-term control of BED than psychological treatments, it also shows that simply losing weight is not a solution. Indeed, because conventional behavioural lifestyle treatments generally focus on dietary restraint, they are far more likely to ultimately promote binge eating than reduce it.
Not surprisingly, the authors conclude that guided self-help based on cognitive behavior therapy should be a first-line treatment option for most patients with BED, with IPT (or full cognitive behavior therapy) used for patients with low self-esteem and high eating disorder psychopathology.
Clearly, simply joining the next weight-loss challenge is not the solution.