Reprinted from Eating Disorders Review
May/June 2010 Volume 21, Number 3
©2010 Gürze Books
A short-term intervention program for binge eating that combines cognitive behavioral therapy (CBT) and guided self-help can be effective and also cost-saving for patients with recurrent binge eating, according to the results of a recent study (J Consult Clin Psychol, April 2010, released before print).
Dr. Ruth Streigel-Moore and her colleagues conducted the study at the Kaiser-Permanente Medical Center, Portland, OR, and in southwest Washington State. Dr. Lynn DeBar of Kaiser-Permanente reported that this combined treatment approach allowed more patients to remain free of binge-eating episodes at one year follow-up than a group that received usual care alone, without the guided self-help (64.2% versus 44.6%, respectively). In addition, Dr. Debar noted that the combined therapy appears to be a viable first-line treatment option for most patients with recurrent binge-eating who do not meet the diagnostic criteria for bulimia nervosa (BN) or anorexia nervosa (AN).
The study group included 123 persons with recurrent binge eating in the absence of BN or binge-eating disorder (BED). Half were assigned to the combined CBT-therapy-guided self-help intervention and half received standard care, which involved using any available services at the HMO that they wished. Those in the intervention group could also use any of the center’s services.
The CBT-self-help intervention was delivered in eight sessions over 12 weeks by master’s level therapists with a background in use of CBT for depression, but not for eating disorders. The first session lasted 60 minutes, while the remainder ran for from 20 to 25 minutes each. Participants were instructed to read and follow instructions from the self-help book, Overcoming Binge Eating, by Christopher Fairburn, MD, of the University of Oxford, UK, with assistance from the therapist. The mean age of the participants was 37 years; 92% were female and 97 % were Caucasian. Mean body mass index (BMI) was 31.27 kg/m2.
Throughout the 12 weeks of the study, the use of medications and services to treat eating disorders, mental health problems, and other conditions at the HMO did not differ between the two groups.
After 12 weeks, 63.5% of participants had stopped binge-eating, compared to 28.3% of the control group. By six months, abstinence from binge-eating was greater in the intervention group than in the regular care group (74.5% versus 44.1%, respectively). By 12 months, the advantages for the intervention group were not as marked, but they were still greater than in the regular-care group, and 64% of the intervention participants were binge-free, compared to 45% in the comparison group. The individuals who had had the combined treatment also had better improvement in eating-related psychopathology, depression, and social adjustment than did the regular-care group.
Throughout the year, Dr. DeBar reported, patients who received the intervention had 25.2 more binge-free days than did the controls, resulting in a cost savings of $427 over the other group, when healthcare services, medications, intervention costs, and patient care costs were considered. Changes in weight were similar between the two groups, although those in the combined intervention group who stopped binge-eating lost weight and those who continued to binge-eat gained weight. Two limitations of the study were insufficient power for testing predictors or moderators of treatment outcome, as well as the homogeneity of the study participants,