Binge eating disorder (BED) is characterized by recurrent episodes of binge eating and, subsequently, significant psychological distress (e.g., shame, guilt). Recently recognized by the American Psychiatric Association (APA) as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), BED is considered a significant public health problem independently and for its impact on obesity and diabetes. The related problem, loss-of-control (LOC) eating, describes recurrent binge-like eating behavior in individuals who cannot meet full criteria for BED such as post-bariatric surgery patients and children. LOC eating has detrimental psychological and physical health effects, including significant distress and symptoms of depression, as well as excess weight gain in children and suboptimal weight loss and weight regain in post-bariatric patients. Table 1 lists the diagnostic criteria for BED (as defined in the current DSM-5 and earlier, in the DSM, Fourth Edition [DSM-IV]) and frequently-used definitions of LOC eating.

Diagnostic and statistical manual of mental disorders, fifth edition

Significant progress has been achieved in the development and evaluation of evidence-based psychological treatments for eating disorders over the past 25 years. Cognitive behavioral therapy is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy for adolescents with anorexia nervosa. Important challenges remain. Even the most effective interventions for bulimia nervosa and binge-eating disorder fail to help a substantial number of patients. A priority must be the extension and adaptation of these treatments to a broader range of eating disorders (eating disorder not otherwise specified), to adolescents, who have been largely overlooked in clinical research, and to chronic, treatment-resistant cases of anorexia nervosa. The article highlights current conceptual and clinical innovations designed to improve on existing therapeutic efficacy. The problems of increasing the dissemination of evidence-based treatments that are unavailable in most clinical service settings are discussed.

/pdf/psychological-treatment-of-eating-disorders-392en648c3.pdf

Psychological treatment of eating disorders.

Is Cognitive-Behavioral Therapy More Effective Than Other Therapies? A Meta-Analytic Review

This meta-analysis of eating disorder prevention programs found that intervention effects ranged from an absence of any effects to reductions in current and future eating pathology Certain effects persisted as long as 2 years and were superior to minimal-intervention control conditions Larger effects occurred for selected (vs universal), interactive (vs didactic), and multisession (vs single session) programs; for programs offered solely to females and to participants over age 15; for programs without psychoeducational content; and for trials that used validated measures The results identify promising prevention programs and delineate sample, format, and design features that are associated with larger effects, but they suggest the need for improved methodological rigor and statistical modeling of trials and enhanced theoretical rationale for interventions

http://cedd.org.au/wordpress/wp-content/uploads/2014/09/Eating-Disorder-Prevention-Programs-A-Meta-Analytic-Review.pdf

Eating disorder prevention programs: A meta-analytic review.

This paper reviews the conceptual foundation of mindfulness-based eating awareness training (MB-EAT). It provides an overview of key therapeutic components as well as a brief review of current research. MB-EAT is a group intervention that was developed for treatment of binge eating disorder (BED) and related issues. BED is marked by emotional, behavioral and physiological disregulation in relation to food intake and self-identity. MB-EAT involves training in mindfulness meditation and guided mindfulness practices that are designed to address the core issues of BED: controlling responses to varying emotional states; making conscious food choices; developing an awareness of hunger and satiety cues; and cultivating self-acceptance. Evidence to date supports the value of MB-EAT in decreasing binge episodes, improving one's sense of self-control with regard to eating, and diminishing depressive symptoms.

Mindfulness-Based Eating Awareness Training for Treating Binge Eating Disorder: The Conceptual Foundation

Background: Cognitive-behavioral therapy (CBT) has documented efficacy for the treatment of bingeeating disorder (BED). Interpersonal psychotherapy (IPT) has been shown to reduce binge eating but its long-term impact and time course on other BEDrelated symptoms remain largely unknown. This study compares the effects of group CBT and group IPT across BED-related symptoms among overweight individuals with BED. Methods: One hundred sixty-two overweight patients meeting DSM-IV criteria for BED were randomly assigned to 20 weekly sessions of either group CBT or group IPT. Assessments of binge eating and associated eating disorder psychopathology, general psychological functioning, and weight occurred before treatment, at posttreatment, and at 4-month intervals up to 12 months following treatment. Results: Binge-eating recovery rates were equivalent for CBT and IPT at posttreatment (64 [79%] of 81 vs 59 [73%] of 81) and at 1-year follow-up (48 [59%] of 81 vs 50 [62%] of 81). Binge eating increased slightly through follow-up but remained significantly below pretreatment levels. Across treatments, patients had similar significant reductions in associated eating disorders and psychiatric symptoms and maintenance of gains through followup. Dietary restraint decreased more quickly in CBT but IPT had equivalent levels by later follow-ups. Patients’ relative weight decreased significantly but only slightly, with the greatest reduction among patients sustaining recovery from binge eating from posttreatment to 1-year follow-up. Conclusions: Group IPT is a viable alternative to group CBT for the treatment of overweight patients with BED. Although lacking a nonspecific control condition limits conclusions about treatment specificity, both treatments showed initial and long-term efficacy for the core and related symptoms of BED. Arch Gen Psychiatry. 2002;59:713-721

/pdf/a-randomized-comparison-of-group-cognitive-behavioral-40y4kbqw0s.pdf

A Randomized Comparison of Group Cognitive-Behavioral Therapy and Group Interpersonal Psychotherapy for the Treatment of Overweight Individuals With Binge-Eating Disorder

Developmentally relevant high-risk dietary situations (e.g., parties where tempting foods are available) may influence overweight youth's weight control, as they increase risk for overeating. Better self-efficacy for coping with these situations-which preadolescents may learn from their parents-could foster successful weight control. Overweight preadolescents (N = 204) ages 7-12 years (67% female), each with one parent, separately completed the Hypothetical High-Risk Situation Inventory (HHRSI) pre- and post-weight loss treatment. The HHRSI assesses temptation to overeat and confidence in refraining from overeating in response to four high-risk dietary scenarios. Participants generated coping strategies for each scenario. Coping strategies and confidence increased and temptation decreased from pre- to post-weight loss treatment. Parents' increase in confidence from pre- to post-treatment was associated with preadolescents' and parents' weight loss. Tailoring treatments to enhance parents' coping skills (e.g., building strategies, targeting high temptation/low confidence scenarios) may maximize preadolescents' weight control.

/pdf/preadolescents-and-parents-dietary-coping-efficacy-during-2m7sf1xpb6.pdf

R. Robinson Welch

Papers

A Randomized Comparison of Group Cognitive-Behavioral Therapy and Group Interpersonal Psychotherapy for the Treatment of Overweight Individuals With Binge-Eating Disorder

Preadolescents’ and Parents’ Dietary Coping Efficacy during Behavioral Family-Based Weight Control Treatment