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Nyman SJ, Vogel ME, Heller GM, Hella JR, Illes RA, Kirkpatrick HA. Development and Evaluation of a Health Behavior Change Clinic in Primary Care: An Interdisciplinary Partnership. J Clin Psychol Med Settings 2023; 30:909-923. [PMID: 36869987 PMCID: PMC9985097 DOI: 10.1007/s10880-023-09945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
Providing effective healthy behavior change interventions within primary care presents numerous challenges. Obesity, tobacco use, and sedentary lifestyle negatively impact the health quality of numerous medical patients, particularly in underserved patient populations with limited resources. Primary Care Behavioral Health (PCBH) models, which incorporate a Behavioral Health Consultant (BHC), can offer point-of-contact psychological consultation, treatment, and also provide opportunities for interdisciplinary psychologist-physician clinical partnerships to pair a BHC's health behavior change expertise with the physician's medical care. Such models can also enhance medical training programs by providing resident physicians with live, case-based learning opportunities when partnered with a BHC to address patient health behaviors. We will describe the development, implementation, and preliminary outcomes of a PCBH psychologist-physician interdisciplinary health behavior change clinic within a Family Medicine residency program. Patient outcomes revealed significant reductions (p < .01) in weight, BMI, and tobacco use. Implications and future directions are discussed.
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Affiliation(s)
- Scott J. Nyman
- Department of Clinical Health Psychology, Ascension Genesys Hospital, Grand Blanc, MI USA
- Departments of Family Medicine and Psychiatry, Michigan State University College of Human Medicine, Lansing, MI USA
- Department of Psychology, Ascension Genesys Family Health Center, 1460 N. Center Rd, Burton, MI 48509 USA
| | - Mark E. Vogel
- Department of Clinical Health Psychology, Ascension Genesys Hospital, Grand Blanc, MI USA
- Departments of Family Medicine and Psychiatry, Michigan State University College of Human Medicine, Lansing, MI USA
| | - Grant M. Heller
- Spectrum Health Lakeland, Saint Joseph, MI USA
- Department of Psychiatry, Michigan State University College of Osteopathic Medicine, Lansing, MI USA
| | - Jennifer R. Hella
- Department of Research, Ascension Genesys Hospital, Grand Blanc, MI USA
| | - Rose A. Illes
- Florida State University Family Medicine Residency Program at Lee Health, Fort Myers, FL USA
| | - Heather A. Kirkpatrick
- Department of Clinical Health Psychology, Ascension Genesys Hospital, Grand Blanc, MI USA
- Departments of Family Medicine and Psychiatry, Michigan State University College of Human Medicine, Lansing, MI USA
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Monsour DL, Kimball TG, Henley EL. Navigating challenges to providing eating disorder support in collegiate recovery programs. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:984-987. [PMID: 32693709 DOI: 10.1080/07448481.2020.1790576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
There is a significant need for eating disorder support on college campuses. Collegiate recovery programs (CRPs) are providing specialized support for students in recovery from substance use disorders (SUDs) but struggle to support students with eating disorders, despite the high co-occurring rates of SUDs and eating disorders. This is a brief report describing Texas Tech University's experience in delivering eating disorder support in their CRP, outlining the challenges they have recognized, and providing recommendations and resources for overcoming them.
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Affiliation(s)
- Diana L Monsour
- Center for Collegiate Recovery Communities, Texas Tech University, Lubbock, Texas, USA
| | - Thomas G Kimball
- Community Family and Addiction, Sciences, Center for Collegiate Recovery Communities, Texas Tech University, Lubbock, Texas, USA
| | - Emmy Lu Henley
- Center for Collegiate Recovery Communities, Texas Tech University, Lubbock, Texas, USA
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Donofry SD, Jakicic JM, Rogers RJ, Watt JC, Roecklein KA, Erickson KI. Comparison of Food Cue-Evoked and Resting-State Functional Connectivity in Obesity. Psychosom Med 2020; 82:261-271. [PMID: 32267660 PMCID: PMC8057093 DOI: 10.1097/psy.0000000000000769] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Obesity is associated with differences in task-evoked and resting-state functional brain connectivity (FC). However, no studies have compared obesity-related differences in FC evoked by high-calorie food cues from that observed at rest. Such a comparison could improve our understanding of the neural mechanisms of reward valuation and decision making in the context of obesity. METHODS The sample included 122 adults (78% female; mean age = 44.43 [8.67] years) with body mass index (BMI) in the overweight or obese range (mean = 31.28 [3.92] kg/m). Participants completed a functional magnetic resonance imaging scan that included a resting period followed by a visual food cue task. Whole-brain FC analyses examined seed-to-voxel signal covariation during the presentation of high-calorie food and at rest using seeds located in the left and right orbitofrontal cortex, left hippocampus, and left dorsomedial prefrontal cortex. RESULTS For all seeds examined, BMI was associated with stronger FC during the presentation of high-calorie food, but weaker FC at rest. Regions exhibiting BMI-related modulation of signal coherence in the presence of palatable food cues were largely located within the default mode network (z range = 2.34-4.91), whereas regions exhibiting BMI-related modulation of signal coherence at rest were located within the frontostriatal and default mode networks (z range = 3.05-4.11). All FC results exceeded a voxelwise threshold of p < .01 and cluster-defining familywise error threshold of p < .05. CONCLUSIONS These dissociable patterns of FC may suggest separate neural mechanisms contributing to variation in distinct cognitive, psychological, or behavioral domains that may be related to individual differences in risk for obesity.
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Affiliation(s)
- Shannon D Donofry
- From the Department of Psychiatry (Donofry), University of Pittsburgh School of Medicine; Departments of Psychology (Donofry, Watt, Roecklein, Erickson) and Health and Physical Activity (Jakicic, Rogers), and Healthy Lifestyle Institute (Jakicic, Rogers), University of Pittsburgh; and The Center for the Neural Basis of Cognition (Roecklein, Erickson), Pittsburgh, Pennsylvania
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Kunzler LS, Naves LA, Casulari LA. The Effect of Cognitive-Behavioral Therapy on Acromegalics After a 9-Month Follow-Up. Front Endocrinol (Lausanne) 2019; 10:380. [PMID: 31244782 PMCID: PMC6581695 DOI: 10.3389/fendo.2019.00380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/28/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: The quality of life of acromegalics is compromised. Treatment with the "Think healthy and feel the difference" technique has been described as effective in the improvement of the quality of life of these patients in the short term. However, its effectiveness in the long term needs to be evaluated. Objective: The purpose of this study was to evaluate whether the good results obtained from the "Think healthy and feel the difference" technique in the short term persists in the long term, after the end of the treatment. Method: This is a non-randomized longitudinal study with 23 acromegalic divided into two groups: an intervention group with 10 patients and a control group with 13 patients. The intervention itself covered nine group sessions, organized weekly, using a technique called "Think healthy and feel the difference." The control group did not receive the aforementioned treatment. The Short Form 36 Question Health Survey (SF-36) and the Beck Depression Inventory were administered before the sessions began, at the end of the nine therapy sessions and at the 9-month follow-up. Results: At the end of the treatment, the results of the SF-36 showed improvement in the mental health of the intervention group compared to the control group. The effects of therapy were maintained at the 9 month follow-up. Conclusion: Cognitive-behavioral therapy, applied in a group format, can improve the quality of life of acromegalic patients in the short- and long-term.
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Affiliation(s)
- Lia Silvia Kunzler
- Directory of Health, University of Brasilia, Brasilia, Brazil
- *Correspondence: Lia Silvia Kunzler
| | - Luciana Ansaneli Naves
- Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | - Luiz Augusto Casulari
- Endocrinology Service of the Brasilia University Hospital, Brasilia, Brazil
- Clinic of Neurology and Endocrinology, Brasilia, Brazil
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Potential psychological & neural mechanisms in binge eating disorder: Implications for treatment. Clin Psychol Rev 2018; 60:32-44. [DOI: 10.1016/j.cpr.2017.12.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 02/08/2023]
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Alexander KE. Attachment anxiety is associated with a fear of becoming fat, which is mediated by binge eating. PeerJ 2017; 5:e3034. [PMID: 28286709 PMCID: PMC5345385 DOI: 10.7717/peerj.3034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022] Open
Abstract
Background Previous work demonstrated that individuals with higher levels of attachment anxiety are prone to increased binge eating (Alexander & Siegel, 2013). Given that our society rejects obese individuals and individuals with higher levels of attachment anxiety tend to be highly sensitive to rejection (Downey & Feldman, 1996), it follows that those with increased attachment anxiety may be especially fearful of becoming fat. Methods Undergraduate psychology students (n = 148) completed surveys measuring attachment, binge eating, and fear of becoming fat. Results The data demonstrate that attachment anxiety is positively associated with a fear of becoming fat (β = .30, p < .001) and binge eating mediates this relationship. In other words, binge eating underlies the fear of becoming fat. Discussion These findings contribute to a more refined understanding of binge eating which may create pathways for professionals to develop targeted interventions.
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Pinto-Gouveia J, Carvalho SA, Palmeira L, Castilho P, Duarte C, Ferreira C, Duarte J, Cunha M, Matos M, Costa J. BEfree: A new psychological program for binge eating that integrates psychoeducation, mindfulness, and compassion. Clin Psychol Psychother 2017; 24:1090-1098. [PMID: 28124451 PMCID: PMC6686162 DOI: 10.1002/cpp.2072] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/26/2016] [Accepted: 12/22/2016] [Indexed: 11/11/2022]
Abstract
Binge eating disorder (BED) is associated with several psychological and medical problems, such as obesity. Approximately 30% of individuals seeking weight loss treatments present binge eating symptomatology. Moreover, current treatments for BED lack efficacy at follow‐up assessments. Developing mindfulness and self‐compassion seem to be beneficial in treating BED, although there is still room for improvement, which may include integrating these different but complimentary approaches. BEfree is the first program integrating psychoeducation‐, mindfulness‐, and compassion‐based components for treating women with binge eating and obesity. Objective To test the acceptability and efficacy up to 6‐month postintervention of a psychological program based on psychoeducation, mindfulness, and self‐compassion for obese or overweight women with BED. Design A controlled longitudinal design was followed in order to compare results between BEfree (n = 19) and waiting list group (WL; n = 17) from preintervention to postintervention. Results from BEfree were compared from preintervention to 3‐ and 6‐month follow‐up. Results BEfree was effective in eliminating BED; in diminishing eating psychopathology, depression, shame and self‐criticism, body‐image psychological inflexibility, and body‐image cognitive fusion; and in improving obesity‐related quality of life and self‐compassion when compared to a WL control group. Results were maintained at 3‐ and 6‐month follow‐up. Finally, participants rated BEfree helpful for dealing with impulses and negative internal experiences. Conclusions These results seem to suggest the efficacy of BEfree and the benefit of integrating different components such as psychoeducation, mindfulness, and self‐compassion when treating BED in obese or overweight women. Key Practitioner Message The current study provides evidence of the acceptability of a psychoeducation, mindfulness, and compassion program for binge eating in obesity (BEfree); Developing mindfulness and self‐compassionate skills is an effective way of diminishing binge eating, eating psychopathology and depression, and increasing quality of life in women with obesity; Integrating psychoeducation, mindfulness, and compassion seem to be effective in diminishing binge eating, with results maintained up to 6‐month postintervention.
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Affiliation(s)
- José Pinto-Gouveia
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Sérgio A Carvalho
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Lara Palmeira
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Paula Castilho
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Cristiana Duarte
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Cláudia Ferreira
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Joana Duarte
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Marina Cunha
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal.,ISMT, Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Marcela Matos
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Joana Costa
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
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da Luz FQ, Swinbourne J, Sainsbury A, Touyz S, Palavras M, Claudino A, Hay P. HAPIFED: a Healthy APproach to weIght management and Food in Eating Disorders: a case series and manual development. J Eat Disord 2017; 5:29. [PMID: 28824810 PMCID: PMC5558732 DOI: 10.1186/s40337-017-0162-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/14/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is a high prevalence of overweight or obesity in people with eating disorders. However, therapies for eating disorders, namely binge eating disorder and bulimia nervosa, do not address weight management. Conversely, weight loss treatments for people with overweight or obesity do not address psychological aspects related to eating disorders. Thus we developed a new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa, entitled HAPIFED (a Healthy APproach to weIght management and Food in Eating Disorders). This paper describes HAPIFED and reports a case series examining its feasibility and acceptability. METHODS Eleven participants with overweight or obesity and binge eating disorder or bulimia nervosa were treated with HAPIFED in two separate groups (with once or twice weekly meetings). Weight, body mass index (BMI) and eating disorder symptoms, as well as depression, anxiety and stress, were assessed at baseline and at the end of the 20-session HAPIFED intervention. RESULTS Eight of the 11 participants completed the intervention, with diverse results. Six of the 8 participants who completed HAPIFED reduced their weight between baseline and the end of the intervention. Median scores on the Eating Disorder Examination Questionnaire for binge eating, restraint, and concerns about eating or weight and shape, were reduced in the group overall between baseline and the end of the intervention. One participant, who at baseline was inducing vomiting and misusing laxatives in an attempt to lose weight, reduced these behaviors by the end of the intervention. Three participants at baseline were undertaking episodes of compulsive exercise, and they reduced or stopped this behavior, but one participant commenced episodes of compulsive exercise by the end of the intervention. All participants who completed the intervention rated the suitability and success of HAPIFED as 7 or more out of 10 (0 = not at all suitable/successful; 10 = extremely suitable/successful). CONCLUSION This case series supports the feasibility and acceptability of HAPIFED as a potential new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa. Clinical trials are necessary to examine the efficacy and effectiveness of HAPIFED. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (Universal Trial Number): U1111-1149-7766. Date of registration: 4th November 2013.
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Affiliation(s)
- Felipe Q da Luz
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia.,The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia.,CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70040-020 Brazil
| | - Jessica Swinbourne
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia
| | - Amanda Sainsbury
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia.,The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia
| | - Stephen Touyz
- The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia
| | - Marly Palavras
- Program of Orientation and Attention of Eating Disorders, Federal University of São Paulo, São Paulo, Brazil
| | - Angelica Claudino
- Program of Orientation and Attention of Eating Disorders, Federal University of São Paulo, São Paulo, Brazil
| | - Phillipa Hay
- Centre for Health Research, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Stein RI, Saelens BE, Dounchis JZ, Lewczyk CM, Swenson AK, Wilfley DE. Treatment of Eating Disorders in Women. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000001295004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reviews the most recent treatment literature for anorexia nervosa, bulimia nervosa, and binge eating disorder and serves as a guide for recommended readings and therapist resources. The primary focus is on empirically tested treatment modalities; for each of these approaches reviewed, the theoretical background, nature of the intervention, and existing empirical support are summarized. The article also presents less researched, albeit promising, approaches to eating disorder treatment, describing the rationale and available research. A focus on multicultural issues, including the paucity of eating disorder treatment research among participants of color, and suggestions for building research and enhancing treatment effectiveness with ethnic minority clients, is incorporated throughout. Recommendations concerning pressing research needs are made, and a summary of clinical recommendations for each disorder is formulated.
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Affiliation(s)
- Richard I. Stein
- San Diego State University and University of California, San Diego,
| | | | - Jennifer Zoler Dounchis
- San Diego State University; University of California, San Diego; and Minneapolis Veterans Affairs Medical Center, Minnesota
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Pacanowski CR, Senso MM, Oriogun K, Crain AL, Sherwood NE. Binge eating behavior and weight loss maintenance over a 2-year period. J Obes 2014; 2014:249315. [PMID: 24891946 PMCID: PMC4033559 DOI: 10.1155/2014/249315] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/12/2014] [Accepted: 04/15/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the relationship between binge eating behavior and weight loss maintenance over a two-year period in adults. DESIGN Secondary data analysis using the Keep It Off study, a randomized trial evaluating an intervention to promote weight loss maintenance. PARTICIPANTS 419 men and women (ages: 20 to 70 y; BMI: 20-44 kg/m2) who had intentionally lost ≥10% of their weight during the previous year. MEASUREMENTS Body weight was measured and binge eating behavior over the past 6 months was reported at baseline, 12 months and 24 months. Height was measured at baseline. RESULTS Prevalence of binge eating at baseline was 19.4% (n = 76). Prevalence of binge eating at any time point was 30.1% (n = 126). Although rate of weight regain did not differ significantly between those who did or did not report binge eating at baseline, binge eating behavior across the study period (additive value of presence or absence at each time point) was significantly associated with different rates of weight regain. CONCLUSION Tailoring weight loss maintenance interventions to address binge eating behavior is warranted given the prevalence and the different rates of weight regain experienced by those reporting this behavior.
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Affiliation(s)
- Carly R. Pacanowski
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454, USA
- *Carly R. Pacanowski:
| | - Meghan M. Senso
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454, USA
- HealthPartners Institute for Education and Research, 8170 33rd Avenue South, Bloomington, MN 55425, USA
| | - Kristin Oriogun
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454, USA
| | - A. Lauren Crain
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454, USA
- HealthPartners Institute for Education and Research, 8170 33rd Avenue South, Bloomington, MN 55425, USA
| | - Nancy E. Sherwood
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454, USA
- HealthPartners Institute for Education and Research, 8170 33rd Avenue South, Bloomington, MN 55425, USA
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Cassin SE, Sockalingam S, Wnuk S, Strimas R, Royal S, Hawa R, Parikh SV. Cognitive Behavioral Therapy for Bariatric Surgery Patients: Preliminary Evidence for Feasibility, Acceptability, and Effectiveness. COGNITIVE AND BEHAVIORAL PRACTICE 2013. [DOI: 10.1016/j.cbpra.2012.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Substantial weight gains are common prior to treatment-seeking in obese patients with binge eating disorder. Compr Psychiatry 2013; 54:880-4. [PMID: 23639407 PMCID: PMC3779527 DOI: 10.1016/j.comppsych.2013.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 03/02/2013] [Accepted: 03/19/2013] [Indexed: 11/22/2022] Open
Abstract
This study examined weight trajectories in obese patients with binge eating disorder (BED) during the year prior to treatment initiation and explored potential correlates of these weight changes. One hundred thirty (N=130) consecutive, treatment-seeking, obese patients with BED were assessed with structured interviews and self-report questionnaires. Eighty-three percent (83%; n=108) of treatment seeking obese BED patients gained weight, and 65% (n=84) gained a clinically significant amount of weight (greater than or equal to 5% body weight), in the year preceding treatment. Overall, participants reported a mean percent weight gain of 8% (16.6 pounds) during the 12months prior to treatment with a wide range of weight changes across participants (from a 52% weight gain to a 13% weight loss). A substantial proportion of patients (35%), categorized as High Weight Gainers (defined as gaining more than 10% of body weight during previous year), reported gaining an average of 16.7% of body weight. Low Weight Gainers (defined as gaining greater than 5%, but less than 10%) comprised 29% of the sample and were characterized by a mean gain of 6.9% of body weight. Weight Maintainers/Losers (defined as having maintained or lost weight during the 12months prior to treatment) comprised 17% of the sample and reported losing on average 2.8% of body weight. These three groups did not differ significantly in their current weight and eating behaviors or eating disorder psychopathology. The majority of treatment-seeking obese patients with BED reported having gained substantial amounts of weight during the previous year. These findings provide an important context for interpreting the modest weight losses typically reported in treatment studies of BED. Failure to produce weight loss in these studies may be reinterpreted as stabilization of weight and prevention of further weight gain.
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Castellini G, Fioravanti G, Lo Sauro C, Rotella F, Lelli L, Ventura L, Faravelli C, Ricca V. Latent profile and latent transition analyses of eating disorder phenotypes in a clinical sample: a 6-year follow-up study. Psychiatry Res 2013; 207:92-9. [PMID: 23021908 DOI: 10.1016/j.psychres.2012.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 07/18/2012] [Accepted: 08/25/2012] [Indexed: 11/28/2022]
Abstract
The DSM-IV classification of Eating Disorders (EDs) identifies clinical entities showing considerable overlap and diagnostic instability across time. Latent profile analysis (LPA) allows the identification of underlying groups of individuals according to their patterned responses across a set of features. LPA was applied to data regarding EDs symptoms of a clinical sample of 716 EDs patients, with a current DSM-IV diagnosis of threshold and subthreshold EDs. Latent transition analysis (LTA) was used to examine the longitudinal stability of the obtained profiles. The latent profiles were compared for psychopathological variables and long-term outcomes (recovery, relapse), based on a 6-year follow-up after a cognitive behavioural treatment. Five different phenotypes were identified: "severe binging", "moderate binging", "restricted eating", "binge and moderate purging", and "binge and severe purging". The relevance of this characterization was confirmed by the differences in terms of psychopathological features and outcomes. Over the long term, a three-profile solution was adopted, clustering the subjects into "binge eating", "binge eating and purging", and "restricted eating". Latent profiles showed a moderate stability over the 6-year period, with probability estimates of stability within status over time of 0.57 for "binge eating", 0.40 for "binge eating and purging", and 0.41 for "restricted eating". The implications for DSM 5 were discussed, and the relative high rate of transition within phenotypes confirmed the significant instability of EDs phenomenology.
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Affiliation(s)
- Giovanni Castellini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, Largo Brambilla 3, 50134 Firenze, Italy
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Erb S, Farmer A, Mehlenbeck R. A Condensed Dialectical Behavior Therapy Skills Group for Binge Eating Disorder: Overcoming Winter Challenges. J Cogn Psychother 2013; 27:338-358. [DOI: 10.1891/0889-8391.27.4.338] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although binge eating disorder (BED) is a recent diagnostic category, research for efficacious and effective treatment is well underway. This case study describes a dialectical behavior therapy (DBT) skills group for BED implemented in an outpatient community clinic. Although based on Safer, Telch, and Chen’s (2009) manual for BED and bulimia nervosa (BN), notable adaptations included shortening the group’s duration from 20 to 12 weeks, adding an interpersonal effectiveness module and DBT-informed “Holiday Plan” worksheets, and providing inclement weather alternatives. Despite the added challenges associated with winter treatment of BED (e.g., holiday meals, weather-related schedule interruptions), the 3 women who completed treatment no longer met criteria for BED at termination and their feedback suggested that the treatment was highly acceptable. Group members demonstrated clinically significant reductions in disordered eating behavior and improvements in self-esteem, emotion regulation, and quality of life. Treatment gains were maintained at 1-year follow-up. Our discussion includes treatment implications and recommendations for future research.
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Munsch S, Meyer AH, Biedert E. Efficacy and predictors of long-term treatment success for Cognitive-Behavioral Treatment and Behavioral Weight-Loss-Treatment in overweight individuals with binge eating disorder. Behav Res Ther 2012; 50:775-85. [DOI: 10.1016/j.brat.2012.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 08/28/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
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The Prevention Of WEight Regain in diabetes type 2 (POWER) study: the effectiveness of adding a combined psychological intervention to a very low calorie diet, design and pilot data of a randomized controlled trial. BMC Public Health 2012; 12:1026. [PMID: 23176668 PMCID: PMC3599599 DOI: 10.1186/1471-2458-12-1026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/18/2012] [Indexed: 11/12/2022] Open
Abstract
Background Obesity is of major pathogenetic importance to type 2 diabetes, it contributes to poor glycemic control and increases the risk of cardiovascular disease. Over 80% of patients with diabetes type 2 are overweight. To achieve a more favourable risk profile, changes in diet and lifestyle are needed. However, current treatment programs for obese DM type 2 patients are not effective in the long term. In this RCT, we compare the effectiveness of a Combined Psychological Intervention (CPI) and usual care in maintaining the favourable effects on weight and risk profile during 2 years of follow-up after a Very Low Calorie Diet (VLCD). Methods and design In a randomised parallel group intervention study, 140 patients with type 2 diabetes and overweight (BMI>27 kg/m2) will be recruited from the outpatient department of the Erasmus Medical Centre. After obtaining ≥5% of weight loss with a VLCD, participants will be randomly assigned to CPI or usual care for 10 weeks. CPI consists of cognitive behaviour therapy, problem solving therapy and proactive coping. Primary outcome measure is weight change (kg). Other outcome measures are Body Mass Index (BMI = weight (kg)/length (m)2), waist circumference (cm), systolic blood pressure (mmHg), HbA1c (mmol/mol), lipid levels (LDL, HDL, TG (mmol/l) and chol/HDL-ratio), antidiabetic agents and doses, cardiovascular risk profile (UKPDS), lifestyle and quality of life (EuroQol EQ-5D). Psychosocial parameters are also studied, as secondary outcomes as well as determinants for weight loss. When successful, we want to conduct an analysis of the cost effectiveness of the intervention as compared to usual care. Discussion We expect that a CPI after a VLCD will be effective in maintaining weight loss and improving cardiovascular risk and glycaemic control, while being cost-effective and improving quality of life in patients with type 2 diabetes. Clinical trials registration trialregister.nl NTR2264
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Pimenta F, Leal I, Maroco J, Ramos C. Brief cognitive-behavioral therapy for weight loss in midlife women: a controlled study with follow-up. Int J Womens Health 2012; 4:559-67. [PMID: 23091402 PMCID: PMC3474154 DOI: 10.2147/ijwh.s35246] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT) has proven to be effective in weight reduction. This study explores whether individual, 8-session CBT can promote weight loss in midlife women. METHODS Anthropometric (weight, abdominal perimeter, and body mass index calculation), psychological (health-related and sexual quality of life, stress, anxiety, and depression), and behavioral measures (binge eating disorder and restrained, external, and emotional eating) were assessed at baseline (T1), posttreatment (T2), and 4-month follow-up (T3), for a total of 21 women at baseline; the CBT group (n = 11) and the control group (n = 10; waiting list) were compared. RESULTS Statistically significant effects that were dependent on the intervention were observed on weight (F = 4.402; P = 0.035; η(p) (2) = 0.404; π = 0.652) and body mass index (F = 3.804; P = 0.050; η(p) (2) = 0.369; π = 0.585); furthermore, marginally significant effects were observed on external eating (F = 2.844; P = 0.095; η(p) (2) = 0.304; π = 0.461). At follow-up, women in the CBT group presented with lower weight, abdominal perimeter, body mass index, and external eating; higher health-related quality-of-life and restrained eating were also observed in this group. Most differences identified were at a marginally significant level. Moreover, at follow-up, none of the participants of the CBT group met the criteria for binge eating disorder, whereas the number of women with binge eating disorder in the control group remained the same through all three assessments. CONCLUSION An effective, though small, weight loss was achieved. Changes in quality of life were also observed. Moreover, changes in external eating behavior were successful.
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Affiliation(s)
- Filipa Pimenta
- Psychology and Health Research Unit, ISPA – Instituto Universitário, Lisbon, Portugal
| | - Isabel Leal
- Psychology and Health Research Unit, ISPA – Instituto Universitário, Lisbon, Portugal
| | - João Maroco
- Psychology and Health Research Unit, ISPA – Instituto Universitário, Lisbon, Portugal
| | - Catarina Ramos
- Psychology and Health Research Unit, ISPA – Instituto Universitário, Lisbon, Portugal
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Devlin MJ, Goldfein JA, Petkova E, Jiang H, Raizman PS, Wolk S, Mayer L, Carino J, Bellace D, Kamenetz C, Dobrow I, Walsh BT. Cognitive Behavioral Therapy and Fluoxetine as Adjuncts to Group Behavioral Therapy for Binge Eating Disorder. ACTA ACUST UNITED AC 2012; 13:1077-88. [PMID: 15976151 DOI: 10.1038/oby.2005.126] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although binge eating disorder is a common and distressing concomitant of obesity, it has not yet been established whether affected individuals presenting to behavioral weight control programs should receive specialized treatments to supplement standard treatment. This study was designed to examine the added benefit of two adjunctive interventions, individual cognitive behavioral therapy (CBT) and fluoxetine, offered in the context of group behavioral weight control treatment. RESEARCH METHODS AND PROCEDURES One hundred sixteen overweight/obese women and men with binge eating disorder were all assigned to receive a 16-session group behavioral weight control treatment over 20 weeks. Simultaneously, subjects were randomly assigned to receive CBT+fluoxetine, CBT+placebo, fluoxetine, or placebo in a two-by-two factorial design. Outcome measures, assessed at the end of the 16-session acute treatment phase, included binge frequency, weight, and measures of eating-related and general psychopathology. RESULTS Overall, subjects showed substantial improvement in binge eating and both general and eating-related psychopathology, but little weight loss. Subjects who received individual CBT improved more in binge frequency than did those not receiving CBT (p<0.001), and binge abstinence was significantly more common in subjects receiving CBT vs. those who did not (62% vs. 33%, p<0.001). Fluoxetine treatment was associated with greater reduction in depressive symptoms (p<0.05). The 54 subjects who achieved binge abstinence improved more on all measures than the 62 subjects who did not. In particular, these subjects lost, on average, 6.2 kg compared with a gain of 0.7 kg among non-abstainers. DISCUSSION Adjunctive individual CBT results in significant additional binge reduction in obese binge eaters receiving standard behavioral weight control treatment.
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Affiliation(s)
- Michael J Devlin
- New York State Psychiatric Institute, Unit 116, 1051 Riverside Drive, New York, NY 10032, USA.
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Abstract
Binge eating disorder (BED) is the most prevalent eating disorder in adults, and individuals with BED report greater general and specific psychopathology than non-eating disordered individuals. The current paper reviews research on psychological treatments for BED, including the rationale and empirical support for cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), dialectical behavior therapy (DBT), behavioral weight loss (BWL), and other treatments warranting further study. Research supports the effectiveness of CBT and IPT for the treatment of BED, particularly for those with higher eating disorder and general psychopathology. Guided self-help CBT has shown efficacy for BED without additional pathology. DBT has shown some promise as a treatment for BED, but requires further study to determine its long-term efficacy. Predictors and moderators of treatment response, such as weight and shape concerns, are highlighted and a stepped-care model proposed. Future directions include expanding the adoption of efficacious treatments in clinical practice, testing adapted treatments in diverse samples (e.g., minorities and youth), improving treatment outcomes for nonresponders, and developing efficient and cost-effective stepped-care models.
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Affiliation(s)
- Juliette M. Iacovino
- Department of Psychology, Washington University in St. Louis, Campus Box 1125, One Brookings Drive, St. Louis, MO 63130, USA,
| | - Dana M. Gredysa
- Department of Psychology, Washington University in St. Louis, Campus Box 1125, One Brookings Drive, St. Louis, MO 63130, USA
| | - Myra Altman
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660S Euclid, St. Louis, MO 63110, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660S Euclid, St. Louis, MO 63110, USA
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Carrard I, Linden MV, Golay A. Comparison of Obese and Nonobese Individuals with Binge Eating Disorder: Delicate Boundary Between Binge Eating Disorder and Non-Purging Bulimia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2012; 20:350-4. [DOI: 10.1002/erv.2174] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Isabelle Carrard
- Therapeutic Education Service for Chronic Diseases; University Hospitals of Geneva; Geneva; Switzerland
| | - Martial Van Linden
- Cognitive Psychopathology and Neuropsychology Unit; University of Geneva; Geneva; Switzerland
| | - Alain Golay
- Therapeutic Education Service for Chronic Diseases; University Hospitals of Geneva; Geneva; Switzerland
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Grilo CM, Masheb RM, Wilson GT, Gueorguieva R, White MA. Cognitive-behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: a randomized controlled trial. J Consult Clin Psychol 2012; 79:675-85. [PMID: 21859185 DOI: 10.1037/a0025049] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE 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). METHOD 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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22
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Weineland S, Arvidsson D, Kakoulidis TP, Dahl J. Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT. Obes Res Clin Pract 2012; 6:e1-e90. [DOI: 10.1016/j.orcp.2011.04.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/08/2011] [Accepted: 04/15/2011] [Indexed: 10/18/2022]
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Barnes RD, Blomquist KK, Grilo CM. Exploring pretreatment weight trajectories in obese patients with binge eating disorder. Compr Psychiatry 2011; 52:312-8. [PMID: 21497226 PMCID: PMC3522185 DOI: 10.1016/j.comppsych.2010.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 06/21/2010] [Accepted: 06/25/2010] [Indexed: 10/19/2022] Open
Abstract
Treatments for obese patients with binge eating disorder (BED) typically report modest weight losses despite substantial reductions in binge eating. Although the limited weight losses represent a limitation of existing treatments, an improved understanding of weight trajectories before treatment may provide a valuable context for interpreting such findings. The current study examined the weight trajectories of obese patients in the year before enrollment in primary care treatment for BED. Participants were a consecutive series of 68 obese patients with BED recruited from primary care centers. Doctoral-level clinicians administered structured clinical interviews to assess participants' weight history and eating behaviors. Participants also completed a self-report measure assessing eating and weight. Overall, participants reported a mean weight gain of 9.5 lb in the past year, although this overall average comprised remarkable heterogeneity in patterns of weight changes, which ranged from losing 40 lb to gaining 62 lb. Most participants (65%) gained weight, averaging 22.5 lb. Weight gain was associated with more frequent binge eating episodes and overeating at various times. Most obese patients with BED who present to treatment in a primary care setting reported having gained substantial amounts of weight during the previous year. Such weight trajectory findings suggest that the modest amounts of weight losses typically reported by treatment studies for this specific patient group may be more positive than previously thought. Specifically, although the weight losses typically produced by treatments aimed at reducing binge eating seem modest, they could be reinterpreted as potentially positive outcomes given that the treatments might be interrupting the course of recent and large weight gains.
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Affiliation(s)
| | | | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine
,Department of Psychology, Yale University
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24
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Comparison of individual and group cognitive behavioral therapy for binge eating disorder. A randomized, three-year follow-up study. Appetite 2010; 55:656-65. [DOI: 10.1016/j.appet.2010.09.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 09/12/2010] [Accepted: 09/19/2010] [Indexed: 11/17/2022]
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Clyne C, Latner JD, Gleaves DH, Blampied NM. Treatment of emotional dysregulation in full syndrome and subthreshold binge eating disorder. Eat Disord 2010; 18:408-24. [PMID: 20865594 DOI: 10.1080/10640266.2010.511930] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The link between negative affect and binge eating in those with binge eating disorder (BED) has been well established. The present study examined the efficacy of a treatment for BED designed to increase recognition and regulation of negative emotion, replicating and extending a previous investigation (Clyne, C., & Blampied, N.M. [2004]. Training in emotion regulation as a treatment for binge eating: A preliminary study. Behaviour Change, 21, 269-281) by including a control group, a larger number of participants, and formal diagnoses rather than classifying binge eating symptomatology from self-report questionnaires. Twenty-three women diagnosed with subthreshold or full syndrome BED (using the Eating Disorders Examination) participated in a treatment program that focused on increasing emotional regulation skills. Each participant completed the Eating Disorders Examination Questionnaire, the Binge Eating Scale, the Emotional Eating Scale, and completed self-monitoring records of binge episodes. Binge abstinence rates following treatment (post-treatment and 1 year follow-up were 78% and 87% respectively) were comparable to other empirically supported treatments for BED. Other positive changes in eating and general pathology were observed. These effects were well-maintained up to 1 year later.
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Affiliation(s)
- Courtney Clyne
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
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26
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Carels RA, Wott CB, Young KM, Gumble A, Koball A, Oehlhof MW. Implicit, explicit, and internalized weight bias and psychosocial maladjustment among treatment-seeking adults. Eat Behav 2010; 11:180-5. [PMID: 20434066 DOI: 10.1016/j.eatbeh.2010.03.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 02/19/2010] [Accepted: 03/05/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Weight bias among weight loss treatment-seeking adults has been understudied. This investigation examined the 1) levels of implicit, explicit, and internalized weight bias among overweight/obese treatment-seeking adults, 2) association between weight bias and psychosocial maladjustment (binge eating, body image, depression), and 3) association between participation in weight loss treatment and changes in weight bias. METHODS Fifty-four overweight and obese individuals (BMI > or = 27) recruited for a weight loss intervention completed measures of depression, body image, binge eating, and implicit, explicit, and internalized weight bias. RESULTS Participants evidenced significant implicit, explicit, and internalized weight bias. Greater weight bias was associated with greater depression, poorer body image, and increased binge eating. Despite significant reductions in negative internalized and explicit weight bias following treatment, weight bias remained strong. CONCLUSIONS Weight bias among treatment-seeking adults is associated with greater psychological maladjustment and may interfere with their ability to achieve optimal health and well-being.
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Affiliation(s)
- R A Carels
- Bowling Green State University, Department of Psychology, Bowling Green, OH 43403, United States.
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Sim LA, McAlpine DE, Grothe KB, Himes SM, Cockerill RG, Clark MM. Identification and treatment of eating disorders in the primary care setting. Mayo Clin Proc 2010; 85:746-51. [PMID: 20605951 PMCID: PMC2912736 DOI: 10.4065/mcp.2010.0070] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Eating disorders, which are associated with a host of adverse medical morbidities, negative psychological sequelae, and considerable reductions in quality of life, should be diagnosed and treated promptly. However, primary care physicians may find it uniquely challenging to detect eating disorders in their early stages, before obvious physical problems arise and while psychological symptoms are subtle. Although psychological symptoms may dominate the presentation, the physician is an integral member of the treatment team and is in a unique role to diagnose and treat eating disorders. This clinical review surveys the eating disorders literature, identified by searching MEDLINE and PubMed for articles published from January 1, 1983, to September 30, 2009, using the following keywords: anorexia nervosa, bulimia nervosa, eating disorders, eating disorders NOS, binge eating, binge eating disorder, and night eating syndrome. This review also focuses on practical issues faced by primary care physicians in the management of these conditions and other issues central to the care of these complex patients with medical and psychiatric comorbid conditions.
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Affiliation(s)
- Leslie A Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
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28
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Evaluation of a functional treatment for binge eating associated with bulimia nervosa. Eat Weight Disord 2010; 15:e100-7. [PMID: 20571313 DOI: 10.1007/bf03325288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Binge-eating disorders (BED) are a common problem affecting up to 5 percent of the American population in any given 6-month period. Currently, the most widely accepted treatment is some variation of Cognitive Behavior Therapy, although the abstinence rates following this type of treatment are only around 50%. A recent study by Bosch et al. explored the effects of extinction with four women who engaged in binge-eating behavior associated with BED and bulimia nervosa (BN). The treatment was successful, with three of the four participants obtaining abstinence. To date, this has been the only study examining this procedure. The purpose of the current study was to further evaluate extinction of binge eating with four young women who met diagnostic criteria for BN. The results showed that the treatment decreased binge eating to zero for all four women, although one dropped out of the study shortly after beginning the intervention.
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Abstract
This Seminar adds to the previous Lancet Seminar about eating disorders, published in 2003, with an emphasis on the biological contributions to illness onset and maintenance. The diagnostic criteria are in the process of review, and the probable four new categories are: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. These categories will also be broader than they were previously, which will affect the population prevalence; the present lifetime prevalence of all eating disorders is about 5%. Eating disorders can be associated with profound and protracted physical and psychosocial morbidity. The causal factors underpinning eating disorders have been clarified by understanding about the central control of appetite. Cultural, social, and interpersonal elements can trigger onset, and changes in neural networks can sustain the illness. Overall, apart from studies reporting pharmacological treatments for binge eating disorder, advances in treatment for adults have been scarce, other than interest in new forms of treatment delivery.
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Affiliation(s)
- Janet Treasure
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, UK.
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Multivariate therapeutic approach to binge-eating disorder: combined nutritional, psychological and pharmacological treatment. Int Clin Psychopharmacol 2009; 24:312-7. [PMID: 19794312 DOI: 10.1097/yic.0b013e32832ac828] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Treatment for binge-eating disorder (BED) is directed towards either the physical or psychopathological impairments, and often does not cover all the alterations characterizing the disease. In 30 BED patients, we monitored the effects of three types of 6-month treatment, randomly assigned to one of the three treatment groups, each consisting of 10 patients. Group 1 received a 1700-kcal diet (21% proteins, 27% lipids, 52% carbohydrate), cognitive-behavioural therapy (CBT), sertraline (50-150 mg/day) and topiramate (25-150 mg/day); group 2 received the same diet, CBT, sertraline; and group 3 received nutritional counselling and CBT. Binge frequency and weight were assessed every month. The Eating Disorder Inventory-2, the Symptoms Check List-90-Revised (SCL-90-R) and the Personality Diagnostic Questionnaire-4-Revised (PDQ-4-R) were administered before and after treatment. Binge frequency and excessive weight decreased significantly only in group 1 patients, in whom improvement was noted in total Eating Disorder Inventory-2 scores and the subitems 'bulimia', 'drive for thinness', 'maturity fear', 'ascetism', in total SCL-90-R scores and in the subitem 'somatization', in PDQ-4-R subitems 'schizotypic personality' and 'dependent personality'. Group 2 patients improved on the SCL-90-R subitems 'depression' and 'interpersonal relationship' and in the PDQ-4-R 'schizoid personality'. Combination therapy seems to be the only fully effective treatment in BED patients.
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Masheb RM, Grilo CM. Examination of predictors and moderators for self-help treatments of binge-eating disorder. J Consult Clin Psychol 2009; 76:900-4. [PMID: 18837607 DOI: 10.1037/a0012917] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Predictors and moderators of outcomes were examined in 75 overweight patients with binge-eating disorder (BED) who participated in a randomized clinical trial of guided self-help treatments. Age variables, psychiatric and personality disorder comorbidity, and clinical characteristics were tested as predictors and moderators of treatment outcomes. Current age and age of BED onset did not predict outcomes. Key dimensional outcomes (binge frequency, eating psychopathology, and negative affect) were predominately predicted, but not moderated, by their respective pretreatment levels. Presence of personality disorders, particularly Cluster C, predicted both posttreatment negative affect and eating disorder psychopathology. Negative affect, but not major depressive disorder, predicted attrition, posttreatment negative affect, and eating disorder psychopathology. Despite the prognostic significance of these findings for dimensional outcomes, none of the variables tested were predictive of binge remission (i.e., a categorical outcome). No moderator effects were found. The present study found poorer prognosis for patients with negative affect and personality disorders, suggesting that treatment outcomes may be enhanced by attending to the cognitive and personality styles of these patients.
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Affiliation(s)
- Robin M Masheb
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520-8098, USA.
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Abstract
Resources that summarize research-supported treatments (RSTs) are useful tools in clinical decision making. These resources can be particularly helpful when clinicians are uncertain about which treatment direction to take, when treatment does not seem to be working, when clinicians need to justify their approach to others, and when clinicians do not have time to review recent research on a particular clinical issue. This article describes resources for finding short, user-friendly summaries of research-supported group treatments, briefly describes several research-supported group treatments that are not well described in existing resources, and recommends several ways in which these research summaries can be used to improve group practice.
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Affiliation(s)
- Jennifer Johnson
- Brown University Department of Psychiatry and Human Behavior, Providence, RI 02906, USA.
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Leahey TM, Crowther JH, Irwin SR. A Cognitive-Behavioral Mindfulness Group Therapy Intervention for the Treatment of Binge Eating in Bariatric Surgery Patients. COGNITIVE AND BEHAVIORAL PRACTICE 2008. [DOI: 10.1016/j.cbpra.2008.01.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE To examine discrete eating behaviours as predictors of body mass and psychological processes through which these behaviours might lead to increased body mass. METHOD Three hundred and twenty-nine undergraduate females filled out questionnaires on eating beyond satiety (EBS), snacking, night eating, and hunger as well as the process variables--eating expectancies and self-reported cue reactivity--in an online study. The eating behaviours were regressed on body mass index and mediation analyses were conducted for the process variables. RESULTS EBS was the strongest predictor of body mass when the other eating behaviours were controlled. The process variables did not mediate the relationship between EBS and body mass. DISCUSSION EBS may be a discrete variable on which to intervene to prevent and treat overweight and obesity. Further research is needed to elucidate the situational and affective antecedents of EBS.
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Affiliation(s)
- T Yanover
- Department of Psychology, University of South Florida, Tampa, FL 33620, USA.
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35
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Simmons KL. Improving stoma surgery outcomes:more patient choice, more psychosocial support. ACTA ACUST UNITED AC 2008. [DOI: 10.12968/gasn.2008.6.4.29383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Presnell K, Pells J, Stout A, Musante G. Sex differences in the relation of weight loss self-efficacy, binge eating, and depressive symptoms to weight loss success in a residential obesity treatment program. Eat Behav 2008; 9:170-80. [PMID: 18329595 DOI: 10.1016/j.eatbeh.2007.07.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 07/01/2007] [Accepted: 07/27/2007] [Indexed: 11/29/2022]
Abstract
The aim of the current study was to examine whether weight loss self-efficacy, binge eating, and depressive symptoms predicted weight loss during treatment, and whether gender moderates these associations with prospective data from 297 participants (223 women and 74 men) enrolled in a residential obesity treatment program. Men reported higher initial levels of self-efficacy than women, whereas women reported greater pre-treatment levels of binge eating and depressive symptoms. Higher pre-treatment levels of weight control self-efficacy, binge eating, and depressive symptoms predicted greater weight loss in men, but not in women. Results suggest that certain psychological and behavioral factors should be considered when implementing weight loss interventions, and indicate a need to consider gender differences in predictors of weight loss treatment. Future research should seek to identify predictors of weight loss among women.
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Affiliation(s)
- Katherine Presnell
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275, United States.
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Osberg TM, Poland D, Aguayo G, MacDougall S. The Irrational Food Beliefs Scale: development and validation. Eat Behav 2008; 9:25-40. [PMID: 18167321 DOI: 10.1016/j.eatbeh.2007.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 01/10/2007] [Accepted: 02/28/2007] [Indexed: 11/28/2022]
Abstract
This article reports the development and validation of a measure of Irrational Food Beliefs (IFB), defined as cognitively distorted and unhealthy attitudes and beliefs pertaining to food, which is proposed to be a factor that undermines success at weight loss and maintenance. Studies 1 and 2 demonstrated that the Irrational Food Beliefs Scale (IFBS) contains ecologically valid items and is comprised of two primary factors (irrational and rational food beliefs) whose items are internally consistent. Study 3 established that irrational subscale scores were positively associated with first semester weight gain in college freshmen. In Study 4, irrational food belief scores related predictably to measures of recent weight gain, poor weight loss maintenance, and bulimic symptoms in another college sample. In addition, IFB scores were not unduly influenced by test-taking response sets, and they were positively associated with depression and phobic anxiety and negatively correlated with self-esteem and need for cognition. Study 5 revealed strong positive associations between irrational food beliefs and bulimic symptoms, as well as number of previous diets in an obese community sample. The role irrational food beliefs may play in poor weight loss outcomes and maintenance is discussed.
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Affiliation(s)
- Timothy M Osberg
- Department of Psychology, DePaul Hall, Niagara University, NY 14109-2208, United States.
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Abstract
OBJECTIVE To revisit the merits and problems inherent in considering obesity, or some aspect of obesity, as a mental or behavioral disorder. METHOD The author suggests shifting the focus from the state of obesity to the process of nonhomeostatic overeating that results in obesity. Studies are reviewed that pertain to various models of nonnormative overeating including eating disorder models that stress the form of overeating, substance use disorder models focusing on its consequences, and affect regulation or stress response models focusing on its function. RESULTS Studies focusing on abnormal eating patterns, including binge eating and night eating suggest that such patterns may be related to the development of obesity. While the literature pertaining to substance use and other models of nonhomeostatic overeating is beginning to mount, current evidence is mostly preliminary and indirect. CONCLUSION An attempt to devise diagnostic criteria based on the above models raises multiple difficulties, since the phenomena central to each model are dimensional, common, and variably associated with distress or dysfunction. A detailed understanding of the neurobiological relationships among eating behavior, reward systems, and affect regulation systems will enable a more meaningful consideration of these models and will facilitate specific treatment for disorders of overeating.
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Affiliation(s)
- Michael J Devlin
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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39
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Dingemans AE, Spinhoven P, van Furth EF. Predictors and mediators of treatment outcome in patients with binge eating disorder. Behav Res Ther 2007; 45:2551-62. [PMID: 17643390 DOI: 10.1016/j.brat.2007.06.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 06/07/2007] [Accepted: 06/12/2007] [Indexed: 11/23/2022]
Abstract
A randomized controlled trial (N=52) was conducted comparing cognitive-behavioral therapy with a waiting list control group to identify mediators and predictors of treatment outcome. Reduction of weight concerns mediated abstinence of binge eating at post-treatment. Abstinence was marginally mediated by changes in eating and shape concerns, depressive symptoms and global severity of general psychopathology. Neither treatment outcome nor status at 1-year follow-up could be predicted by severity of eating disorder, comorbid psychopathology or maladaptive core beliefs at baseline or at post-treatment. The only predictor for abstinence at both post-treatment and 1-year follow-up was the coping style palliative reacting: higher scores predicted less favorable outcomes. Lower expression of emotions at post-treatment predicted more reduction of eating disorder psychopathology at follow-up. No other patient characteristics allowing treatment-patient matching could be identified.
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Affiliation(s)
- Alexandra E Dingemans
- Center for Eating Disorders Ursula, PO Box 422, 2260 AK Leidschendam, The Netherlands.
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40
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Abstract
Eating disorders have traditionally been considered afflictions of adolescents and young women. Recent evidence, however, suggests that eating disorders often occur across the life span. Although the incidence of these disorders among mid-life and older women appears to be on the rise, it is not clear if this reflects a true increase in prevalence, better recognition among clinicians, or both. This paper presents an overview of the etiology and treatment of eating disorders, with particular emphasis on developmental factors impacting older women. Recommendations for the treatment of eating disorders among older women are offered. An emerging clinical literature suggests various lines of research that are needed to explore the development and treatment of eating disorders in older women.
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Affiliation(s)
- Lynn Brandsma
- Dept. of Psychology, Chesnut Hill College, Philadelphia, PA 19118, USA.
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41
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Devlin MJ, Goldfein JA, Petkova E, Liu L, Walsh BT. Cognitive behavioral therapy and fluoxetine for binge eating disorder: two-year follow-up. Obesity (Silver Spring) 2007; 15:1702-9. [PMID: 17636088 DOI: 10.1038/oby.2007.203] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study assessed the long-term effects of group behavioral treatment plus individual cognitive behavioral therapy (CBT) and/or fluoxetine in binge eating disorder (BED) patients. RESEARCH METHODS AND PROCEDURES A total of 116 individuals were randomized to an initial five-month trial and were followed up over two years. Assessments, including binge frequency, weight, and self-report measures, were administered at pre-treatment, post-treatment, and approximately 6, 12, 18, and 24 months after initial treatment. RESULTS Across treatment groups, there was overall improvement over 29 months in binge frequency and in binge abstinence. The odds of binge abstinence 2 years post-treatment were 1.373 times the odds of binge abstinence immediately post-treatment. There was no significant change in weight over the two-year period. Subjects who received individual CBT evidenced lower binge frequency over the two-year follow-up period than patients who had not received individual CBT. Similarly, CBT was associated with increased rates of binge abstinence. There were no main effects of treatment assignment on weight over the two-year follow-up period. There was a significant advantage for fluoxetine assignment over the two-year follow-up period on depressive symptoms. DISCUSSION The major significance of the study rests in its examination of the long-term effects of standardized interventions for BED. Our findings provide support for the ideas that short-term treatment may confer long-term benefit and that not all treatments are equivalent in the benefits they confer.
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Affiliation(s)
- Michael J Devlin
- Eating Disorders Research Unit, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, Unit 116, 1051 Riverside Drive, New York, NY 10032, USA.
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42
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Blaine B, Rodman J. Responses to weight loss treatment among obese individuals with and without BED: a matched-study meta-analysis. Eat Weight Disord 2007; 12:54-60. [PMID: 17615489 DOI: 10.1007/bf03327579] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The moderating influence of binge eating status on obese individuals' responses to weight loss treatment was evaluated with a meta-analysis of 36 tests of weight loss treatment (n=792) that were matched to control key background variables. After controlling for pre-treatment weight, treatment produced more weight loss in samples of obese non-BED compared with obese BED participants. Weight loss treatment produced large posttreatment reductions in depression in both obese BED and non-BED samples. The results indicate that BED status moderated post-treatment weight loss among people in weight treatment programs. Obese BED (average weight loss=1.3 kg) samples lost negligible weight compared to obese non-BED (average weight loss=10.5 kg) samples. BED status did not moderate psychological responses to treatment: both BED and non-BED samples experienced large post-treatment reductions in depression. The clinical implications of these findings are discussed.
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Affiliation(s)
- B Blaine
- Psychology Department, St. John Fisher College, Rochester, NY 14618, USA.
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43
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Tanofsky-Kraff M, Wilfley DE, Young JF, Mufson L, Yanovski SZ, Glasofer DR, Salaita CG. Preventing excessive weight gain in adolescents: interpersonal psychotherapy for binge eating. Obesity (Silver Spring) 2007; 15:1345-55. [PMID: 17557971 PMCID: PMC1949388 DOI: 10.1038/oby.2007.162] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The most prevalent disordered eating pattern described in overweight youth is loss of control (LOC) eating, during which individuals experience an inability to control the type or amount of food they consume. LOC eating is associated cross-sectionally with greater adiposity in children and adolescents and seems to predispose youth to gain weight or body fat above that expected during normal growth, thus likely contributing to obesity in susceptible individuals. No prior studies have examined whether LOC eating can be decreased by interventions in children or adolescents without full-syndrome eating disorders or whether programs reducing LOC eating prevent inappropriate weight gain attributable to LOC eating. Interpersonal psychotherapy, a form of therapy that was designed to treat depression and has been adapted for the treatment of eating disorders, has shown efficacy in reducing binge eating episodes and inducing weight stabilization among adults diagnosed with binge eating disorder. In this paper, we propose a theoretical model of excessive weight gain in adolescents at high risk for adult obesity who engage in LOC eating and associated overeating patterns. A rationale is provided for interpersonal psychotherapy as an intervention to slow the trajectory of weight gain in at-risk youth, with the aim of preventing or ameliorating obesity in adulthood.
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Affiliation(s)
- Marian Tanofsky-Kraff
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, NIH, Bethesda, MD, USA.
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Lau DCW, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ 2007; 176:S1-13. [PMID: 17420481 PMCID: PMC1839777 DOI: 10.1503/cmaj.061409] [Citation(s) in RCA: 662] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- David C W Lau
- Department of Medicine, Julia McFarlane Diabetes Research Centre, Diabetes and Endocrine Research Group, University of Calgary, Calgary, Alta.
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45
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Blaine BE, Rodman J, Newman JM. Weight loss treatment and psychological well-being: a review and meta-analysis. J Health Psychol 2007; 12:66-82. [PMID: 17158841 DOI: 10.1177/1359105307071741] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Research suggests that weight loss treatment generally benefits psychological well-being but these effects have never been quantitatively reviewed. A meta-analysis of 117 weight loss treatment tests showed that weight loss treatment was associated with lowered depression and increased self-esteem. Treatment type moderated treatment effects on depression and self-esteem. Actual weight loss moderated treatment effects on self-esteem but not depression; only treatments that produced actual weight loss predicted increased self-esteem whereas improvements in depression were independent of weight loss. The clinical implications of the findings and the possible causal relationships among weight, depression and self-esteem are discussed.
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46
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Stahre L, Tärnell B, Håkanson CE, Hällström T. A randomized controlled trial of two weight-reducing short-term group treatment programs for obesity with an 18—month follow—up. Int J Behav Med 2007; 14:48-55. [PMID: 17511533 DOI: 10.1007/bf02999227] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We found in an earlier study that participants in a short-term treatment program for obesity showed a good weight reduction (10.4 kg) 18 months after treatment terminated. The program included elements from cognitive therapy (CT) and psychoeducation. In the present study the efficacy of a slight modification of the same treatment program (cognitive treatment group) was compared with a behavioral program that included moderate-intensity physical activity and behavioral techniques (the control treatment group) in a randomized controlled trial. The primary effect variable was weight change 18 months after the end of therapy. Both treatment programs lasted for 10 weeks (2 hr/week), and thereafter the participants were weighed periodically over an 18-month period. The participants were obese women employed outside the home. Twelve of the participants did not receive treatment after randomization. Eleven of these participants had been randomized to the cognitive program, whereas the remaining participant was randomized to the control program. The mean age for those that began the 2 programs was 48.5 years, and the mean body mass index (BMI) was 36.6. For those who completed the treatment programs and participated in the 18-month follow-up, the baseline BMI was 34.7. One participant in the cognitive treatment group (n=16) and 6 in the control program (n=26) dropped out during treatment. Both per-protocol and intention-to-treat analyses were performed on the data. Fifteen participants (94%) completed the cognitive program. Of these, 13 (87%) participated at the 18-month follow-up. Their mean weight loss at treatment completion was 8.6 kg(SD=2.9) and 18 months later 5.9 kg (SD=5.4). Twenty participants (77%) completed the control program. Of these, 16 (80%) participated in the 18-month follow-up. Their mean weight loss at the end of treatment was 0.7 kg (SD=1.2), and 18 months later they showed an increase in weight of 0.3 kg (SD=4.3) as compared with baseline weight. The weight differences between the 2 program groups were highly significant (p<.01-.001) at all posttreatment weighings. In the intention-to-treat analysis, all participants who started the cognitive treatment (n=16) or control program (n=26) were included. The last observation carried forward was used for those who dropped out from therapy or from follow-up. Eighteen months after the end of therapy, the mean weight loss was 5.5 kg (SD=5.5) in the cognitive group, whereas the control group evidenced a weight loss of 0.6 kg (SD=5.5). The weight change differences between the 2 groups were highly significant at all follow-up weighings (p<.001). The low drop-out rate during the treatment period demonstrates that the participants found the 2 programs acceptable. The long-term efficacy of the cognitive treatment program seems to be satisfactory. With its group format and short treatment duration, the cognitive program is attractive from a cost-effective standpoint.
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Affiliation(s)
- Lisbeth Stahre
- Karolinska Institutet, Department of Clinical Neuroscience, Section for Psychiatry, Huddinge, Stockholm, Sweden.
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47
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Munsch S, Biedert E, Meyer A, Michael T, Schlup B, Tuch A, Margraf J. A randomized comparison of cognitive behavioral therapy and behavioral weight loss treatment for overweight individuals with binge eating disorder. Int J Eat Disord 2007; 40:102-13. [PMID: 17089420 DOI: 10.1002/eat.20350] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine the efficacy of cognitive-behavioral therapy (CBT) and behavioral weight loss treatment (BWLT) for overweight patients with binge eating disorder (BED). METHOD Eighty obese patients meeting criteria of BED according to DSM-IV-TR were randomly assigned to either CBT or BWLT consisting of 16 weekly treatments and 6 monthly follow-up sessions. Binge eating, general psychopathology, and body mass index (BMI) were assessed before, during, and after treatment, and at 12-month follow-up. RESULTS At posttreatment results favored CBT as the more effective treatment. Analysis of the course of treatments pointed to a faster improvement of binge eating in CBT based on the number of self-reported weekly binges, but faster reduction of BMI in BWLT. At 12-month follow-up, no substantial differences between the two treatment conditions existed. CONCLUSION CBT was somewhat more efficacious than BWLT in treating binge eating but this superior effect was barely maintained in the long term. Further research into cost effectiveness is needed to assess which treatment should be considered the treatment of choice.
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Affiliation(s)
- Simone Munsch
- Institute of Psychology, University of Basel, Basel, Switzerland.
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48
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Khazaal Y, Fresard E, Rabia S, Chatton A, Rothen S, Pomini V, Grasset F, Borgeat F, Zullino D. Cognitive behavioural therapy for weight gain associated with antipsychotic drugs. Schizophr Res 2007; 91:169-77. [PMID: 17306507 DOI: 10.1016/j.schres.2006.12.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 12/22/2006] [Accepted: 12/23/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Overweight and obesity are common concerns in individuals with severe mental disorders. In particular, antipsychotic drugs (AP) frequently induce weight gain. This phenomenon lacks current management and no previous controlled studies seem to use cognitive therapy to modify eating and weight-related cognitions. Moreover, none of these studies considered binge eating or eating and weight-related cognitions as possible outcomes. AIM The main aim of this study is to assess the effectivity of cognitive and behavioural treatment (CBT) on eating and weight-related cognitions, binge eating symptomatology and weight loss in patients who reported weight gain during AP treatment. METHOD A randomized controlled study (12-week CBT vs. Brief Nutritional Education) was carried out on 61 patients treated with an antipsychotic drug who reported weight gain following treatment. Binge eating symptomatology, eating and weight-related cognitions, as well as weight and body mass index were assessed before treatment, at 12 weeks and at 24 weeks. RESULTS The CBT group showed some improvement with respect to binge eating symptomatology and weight-related cognitions, whereas the control group did not. Weight loss occurred more progressively and was greater in the CBT group at 24 weeks. CONCLUSION The proposed CBT treatment is particularly interesting for patients suffering from weight gain associated with antipsychotic treatment.
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Affiliation(s)
- Yasser Khazaal
- Department of Psychiatry, University Hospital of Vaud, Lausanne, Switzerland.
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49
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Shapiro JR, Reba-Harrelson L, Dymek-Valentine M, Woolson SL, Hamer RM, Bulik CM. Feasibility and acceptability of CD-ROM-based cognitive-behavioural treatment for binge-eating disorder. EUROPEAN EATING DISORDERS REVIEW 2007; 15:175-84. [PMID: 17676687 DOI: 10.1002/erv.787] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We compared preliminary feasibility and acceptability of CD-ROM-delivered CBT for overweight individuals with binge-eating disorder (BED) to 10 weekly group CBT sessions (Group) and to a waiting list control (WL). Attrition was numerically greater in the Group than the CD-ROM condition; although only Group differed significantly from WL in dropout rates. Those in the CD-ROM condition reported continued use of their CD-ROM after treatment. Also, the majority of WL participants elected to receive CD-ROM over Group treatment at the end of the waiting period. Preliminarily, no significant differences emerged across the active treatment groups on most outcome measures. However, there was a significantly greater decline in binge days in the two active groups relative to WL. CD-ROM appears to be an acceptable and at least initially preferred method of CBT delivery for overweight individuals with BED.
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Affiliation(s)
- Jennifer R Shapiro
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC 27599, USA.
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50
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Abstract
The authors examined rapid response among 108 patients with binge eating disorder (BED) who were randomly assigned to 1 of 4 16-week treatments: fluoxetine, placebo, cognitive-behavioral therapy (CBT) plus fluoxetine, or CBT plus placebo. Rapid response, defined as 65% or greater reduction in binge eating by the 4th treatment week, was determined by receiver operating characteristic curves. Rapid response characterized 44% of participants and was unrelated to participants' demographic or baseline characteristics. Participants with rapid response were more likely to achieve binge-eating remission, had greater improvements in eating-disorder psychopathology, and had greater weight loss than participants without rapid response. Rapid response had different prognostic significance and distinct time courses for CBT versus pharmacotherapy-only treatments. Rapid response has utility for predicting outcomes and provides evidence for specificity of treatment effects with BED.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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