Future interventions should consider patients’ views
Fear of gaining weight is one of the crucial factors that maintain some eating disorders, according to Dr. Rachael M. Butler and colleagues at the University of Louisville, KY, and Drexel University, Philadelphia (Eat Weight Disord. 2023. 28:29). While there is little research on the role of fear of weight gain during cognitive behavioral therapy (CBT-E), these researchers’ study provides some new data about dealing with this stubborn symptom.
Fear of weight gain may originate from an overvaluation of shape and weight—a core symptom across binge-spectrum eating disorders, according to the authors. They add that fear of weight gain may also underlie disordered eating behaviors through a cycle of avoidance, as is seen in anxiety disorders. Those with a fear of gaining weight tend to avoid those foods they think will lead to weight gain. Then, ritualized eating behaviors and body-checking follow.
The study group
Dr. Butler’s group recruited 63 adults with clinically significant binge-spectrum eating disorders. The participants (56 females, 7 males),were between 18 and 55 years of age, and had averaged one objective binge-eating episode per week over the past 12 weeks. Participants were excluded when 80% or more of the binge episodes included raw fruits and vegetables.
All participants received modified 12-session CBT-E sessions, and completed a 120-minute intake session; all other sessions were 60 minutes long. The participants were given homework involving self-monitoring, regular eating goals, and reducing shape-checking between sessions. They were also randomized to two groups, the first to complete a 10-minute computerized inhibitory control training and the second to a sham training daily for the first four weeks, then once weekly for the duration of treatment. Inhibitory control training aimed to increase inhibitory control toward food, using a “Go/No Go” task during which the participant viewed visual food or non-food cues and were instructed to reply as quickly as possible, except when a “No Go” signal (a blue circle) appeared, always paired with stimuli representing the participant’s self-reported binge foods. The sham condition contained the same stimuli and instructions, without “No Go” signals. This was meant to act as an attention control.
The Eating Disorders Examination was used to assess disordered eating over the past 3 months, and all tests were completed online on the participants’ home computers. Participants also completed the Goldfarb Fear of Fat Scale (GFFS), a 10-item measure used to measure fear of weight gain or “fatness” measured pre-treatment, mid-treatment, and post-treatment. Before each session, participants were asked to list how often they had binged or had LOC episodes over the past week. Body mass index (BMI, mg/kg2) was calculated using participants’ self-reported height (reported at baseline). Weight was recorded during in-person sessions.
GFFS scores decreased with treatment
There were several notable findings. Over the course of treatment, from session 1 to session 12, fear of weight gain decreased significantly. Participants with BN-spectrum illness started with higher GFFS scores and larger decreases in fear of weight gain. The diagnosis did not affect the change in GFFS scores over time, according to the authors. BMI and fear of weight gain were not associated during treatment, suggesting that changes in an individual’s weight do not correlate with fear of weight gain. Importantly, while fear of weight gain was reduced during treatment, it was still elevated at the end of treatment. One wonders if this might be an important warning of relapse.
The authors noted that to their knowledge this was the first study to examine fear of weight gain during CBT-E treatment for binge-eating spectrum disorders. They also reported that fear of weight gain is not directly targeted in CBT-E. Future studies exploring which components of CBT-E contribute to decreases in fear of weight gain could allow clinicians to emphasize certain parts of treatment for persons with strong fears of weight gain.