1
|
Grilo CM. Treatment of Eating Disorders: Current Status, Challenges, and Future Directions. Annu Rev Clin Psychol 2024; 20:97-123. [PMID: 38211625 DOI: 10.1146/annurev-clinpsy-080822-043256] [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] [Indexed: 01/13/2024]
Abstract
Specific psychological treatments have demonstrated efficacy and represent the first-line approaches recommended for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Unfortunately, many patients, particularly those with anorexia nervosa, do not derive sufficient benefit from existing treatments, and better or alternative treatments for eating disorders are needed. Less progress has been made in developing pharmacologic options for eating disorders. No medications approved for anorexia nervosa exist, and only one each exists for bulimia nervosa and for binge-eating disorder; available data indicate that most patients fail to benefit from available medications. Longer and combined treatments have generally not enhanced outcomes. This review presents emerging findings from more complex and clinically relevant adaptive treatment designs, as they offer some clinical guidance and may serve as models for future enhanced treatment research.
Collapse
Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry and Department of Psychology, Yale University, New Haven, Connecticut, USA;
| |
Collapse
|
2
|
Long C, Williams AO, McGovern AM, Jacobsen CM, Hargens LM, Duval S, Jaff MR. Diversity in randomized clinical trials for peripheral artery disease: a systematic review. Int J Equity Health 2024; 23:29. [PMID: 38350973 PMCID: PMC10865563 DOI: 10.1186/s12939-024-02104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Significant race and sex disparities exist in the prevalence, diagnosis, and outcomes of peripheral artery disease (PAD). However, clinical trials evaluating treatments for PAD often lack representative patient populations. This systematic review aims to summarize the demographic representation and enrollment strategies in clinical trials of lower-extremity endovascular interventions for PAD. METHODS Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched multiple sources (Medline, EMBASE, Cochrane, Clinicaltrials.gov, WHO clinical trial registry) for randomized controlled trials (RCTs), RCT protocols, and peer-reviewed journal publications of RCTs conducted between January 2012 and December 2022. Descriptive analysis was used to summarize trial characteristics, publication or study protocol characteristics, and the reporting of demographic characteristics. Meta-regression was used to explore associations between demographic characteristics and certain trial characteristics. RESULTS A total of 2,374 records were identified. Of these, 59 met the inclusion criteria, consisting of 35 trials, 14 publications, and 10 protocols. Information regarding demographic representation was frequently missing. While all 14 trial publications reported age and sex, only 4 reported race/ethnicity, and none reported socioeconomic or marital status. Additionally, only 4 publications reported clinical outcomes by demographic characteristics. Meta-regression analysis revealed that 6% more women were enrolled in non-European trials (36%) than in European trials (30%). CONCLUSIONS The findings of this review highlight potential issues that may compromise the reliability and external validity of study findings in lower-extremity PAD RCTs when applied to the real-world population. Addressing these issues is crucial to enhance the generalizability and impact of clinical trial results in the field of PAD, ultimately leading to improved clinical outcomes for patients in underrepresented populations. REGISTRATION The systematic review methodology was published in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022378304).
Collapse
Affiliation(s)
- Chandler Long
- Duke Vascular and Endovascular Surgery, Duke University Medical Center, Duke University, Durham, NC, 27707, USA
| | - Abimbola O Williams
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA.
| | - Alysha M McGovern
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
| | - Caroline M Jacobsen
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
| | - Liesl M Hargens
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
| | - Sue Duval
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Michael R Jaff
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
- Peripheral Interventions, Boston Scientific, Maple Grove, MN, 55133, USA
| |
Collapse
|
3
|
Maguen S, Batten A, Siegel SE, Huggins J, Snow JL, Fenn LM, Dick AM, Zenteno C, West AC, Masheb RM. Validation of the EDDS-5 self-report survey against the SCID-5 diagnostic interview in US veterans. Eat Behav 2024; 52:101846. [PMID: 38335645 DOI: 10.1016/j.eatbeh.2024.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
The aim of our study was to validate the Eating Disorder Diagnostic Scale (EDDS-5) updated for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with a diverse veteran population against a clinician-administered interview based on the Structured Clinical Interview for DSM-5 (SCID-5). Our sample included 343 veterans, 18-75 years, recruited April 2019 to December 2022 who completed the EDDS-5 as well as other eating disorder and mental health measures. A subsample of these veterans received clinical interviews (n = 166), which were used to validate the EDDS-5. We found that despite multiple proposed modifications, the EDDS-5 performed poorly at correctly identifying diverse veterans who were diagnosed as having eating disorders through clinician-administered interviews. The sensitivity was very low, indicating that using the EDDS-5 did not identify many true positives and may also over diagnose those without true eating disorders. The EDDS-5 may not be the best for screening or diagnostic purposes among diverse samples like veterans.
Collapse
Affiliation(s)
- Shira Maguen
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA.
| | - Adam Batten
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA
| | - Sarah E Siegel
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA
| | - Joy Huggins
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA
| | | | | | | | | | | | - Robin M Masheb
- VA Connecticut Healthcare System, USA; Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
4
|
Goode RW, Bardone-Cone A, Wilhoit-Reeves S, Williams L, Malian H, Coan D, Noem T, Tate DF. Creating an appetite awareness and lifestyle modification intervention for Black women at risk for binge eating disorder: A pilot open trial. Clin Obes 2023; 13:e12613. [PMID: 37501401 DOI: 10.1111/cob.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/26/2023] [Accepted: 07/09/2023] [Indexed: 07/29/2023]
Abstract
Despite the availability of evidence-based interventions to improve binge eating, Black women have some of the lowest rates of access to care for eating disorders. Innovation is needed to offer accessible and culturally relevant treatment options. To this end, using an open trial design, we investigated the feasibility and acceptability of a group-based, appetite awareness training (AAT) + lifestyle modification (LM) programme in Black women at risk for BED in a primary care setting. Participants (n = 20) were Black women recruited from a family medicine centre affiliated with a local public university, and who reported at least two binge eating episodes in the last 28 days. Participants completed a 16-session AAT + LM programme over 4 months. Key outcomes were objective binge eating (assessed by the EDE and the EDE-Q), body dissatisfaction, and weight change, all assessed at baseline, four (post-treatment) and 6 months (2-month follow-up). Ninety-five percent of participants completed assessments at post-treatment and attended nearly 60% of intervention sessions. Among completers (n = 19), body dissatisfaction and objective binge eating decreased from baseline to post-treatment and this decrease was maintained at the 2-month follow-up. In exit interviews, participants reported programme satisfaction. Providing training in appetite awareness combined with lifestyle modification principles may be useful in the treatment of body dissatisfaction and binge eating among Black women.
Collapse
Affiliation(s)
- Rachel W Goode
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA
| | - Anna Bardone-Cone
- Department of Psychology and Neuroscience, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephanie Wilhoit-Reeves
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lesley Williams
- Mayo Clinic Department of Family Medicine, Scottsdale, Arizona, USA
| | - Hannah Malian
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danielle Coan
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Taylor Noem
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Deborah F Tate
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
5
|
Grilo CM, Lydecker JA, Gueorguieva R. Naltrexone plus bupropion combination medication maintenance treatment for binge-eating disorder following successful acute treatments: randomized double-blind placebo-controlled trial. Psychol Med 2023; 53:7775-7784. [PMID: 37366017 PMCID: PMC10751383 DOI: 10.1017/s0033291723001800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Certain treatments have demonstrated acute efficacy for binge-eating disorder (BED) but there is a dearth of controlled research examining pharmacotherapies as maintenance treatments for responders to initial interventions. This gap in the literature is particularly critical for pharmacotherapy for BED which is associated with relapse following discontinuation. The current study tested the efficacy of naltrexone/bupropion maintenance treatment amongst responders to acute treatments for BED. METHODS Prospective randomized double-blind placebo-controlled single-site trial, conducted August 2017-December 2021, tested naltrexone/bupropion as maintenance treatment for responders to acute treatments with naltrexone/bupropion and/or behavioral weight-loss therapy for BED with comorbid obesity. Sixty-six patients (84.8% women, mean age 46.9, mean BMI 34.9 kg/m2) who responded to acute treatments were re-randomized to placebo (N = 34) or naltrexone/bupropion (N = 32) for 16 weeks; 86.3% completed posttreatment assessments. Mixed models and generalized estimating equations comparing maintenance treatments (naltrexone/bupropion v. placebo) included main and interactive effects of acute treatments. RESULTS Intention-to-treat binge-eating remission rates following maintenance treatments were 50.0% (N = 17/34) for placebo and 68.8% (N = 22/32) for naltrexone/bupropion. Placebo following response to acute treatment with naltrexone/bupropion was associated with significantly decreased probability of binge-eating remission, increased binge-eating frequency, and no weight loss. Naltrexone/bupropion following response to acute treatment with naltrexone/bupropion was associated with good maintenance of binge-eating remission, low binge-eating frequency, and significant additional weight loss. CONCLUSIONS Adult patients with BED with co-occurring obesity who have good responses to acute treatment with naltrexone/bupropion should be offered maintenance treatment with naltrexone/bupropion.
Collapse
Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Janet A. Lydecker
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
6
|
Lim J, White J, Withington T, Catania S, Wilson D, Knight P, Rees B, Middeldorp C, Krishnamoorthy G. Family-based treatment takes longer for adolescents with mental health comorbidities: findings from a community mental health service. Eat Disord 2023; 31:588-609. [PMID: 37066723 DOI: 10.1080/10640266.2023.2201995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Children and adolescents diagnosed with an eating disorder often meet the diagnosis of another mental health disorder. In addition to eating disorders, individuals with comorbid disorders have higher suicide rates and more severe and chronic eating disorder symptoms. The present research aimed to investigate the influence of comorbid conditions on the treatment outcomes of children and adolescents that attended a public community mental health service. It was hypothesised that the patients with comorbidities would have a more extended treatment duration, slower rates of weight restoration, more hospital admissions for medical compromise, and poorer functioning than those without comorbidities. Data from 78 past patients at the Eating Disorder Program in Queensland, Australia, were analysed. Patients with comorbidities demonstrated similar recovery rates to those without comorbidities. However, those with comorbid conditions had longer episodes of treatment. The study's results support using Family Based Treatment for patients with and without comorbidities. The implications of the findings for public mental health services and directions for future research are discussed.
Collapse
Affiliation(s)
- Jacqueline Lim
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Jacinda White
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
| | - Tania Withington
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
- Child Health Research Center, University of Queensland, South Brisbane, Australia
| | - Salvatore Catania
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
| | - Daniel Wilson
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
- Child Health Research Center, University of Queensland, South Brisbane, Australia
| | - Penny Knight
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
| | | | - Christel Middeldorp
- Child Health Research Center, University of Queensland, South Brisbane, Australia
| | - Govind Krishnamoorthy
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| |
Collapse
|
7
|
Stice E, Yokum S. Elevated reward, emotion, and memory region response to thin models predicts eating disorder symptom persistence: A prospective functional magnetic resonance imaging study. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:716-724. [PMID: 37486363 PMCID: PMC10372719 DOI: 10.1037/abn0000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Because few studies have identified biological factors that predict the persistence of eating pathology, we tested the hypotheses that elevated responsivity of brain regions implicated in reward valuation to thin models and high-calorie binge foods would predict the persistence of eating pathology. We analyzed data from 146 women (Mage = 21.87 ± 3.81) with threshold or subthreshold anorexia nervosa, bulimia nervosa, binge eating disorder, or purging disorder who completed functional magnetic resonance imaging scans assessing neural response to thin models and binge foods at baseline, were randomized to two eating disorder treatments or a waitlist control condition and completed diagnostic interviews that assessed change in symptoms over 2.5-month follow-up. Elevated activation in regions associated with memory (parahippocampal gyrus r = .38; hippocampus r = .25) and with reward valuation and emotional salience (amygdala r = .35) in response to thin versus average-weight models predicted future persistence of an eating disorder symptom composite (all analyses controlled for treatment condition). Neural response to high-calorie binge foods did not predict the persistence of eating disorder symptoms. There was no evidence that either treatment moderated the relation of baseline neural responsivity to thin models to future persistence of eating disorder symptoms, though power for these post hoc analyses was limited. Results suggest that overvaluation of the thin ideal increases the risk for the persistence of eating disorder symptoms but provided no support for the hypothesis that overvaluation of high-calorie foods would predict symptom persistence. Results imply that treatments should seek to reduce the overvaluation of the thin ideal. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Eric Stice
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | | |
Collapse
|
8
|
Melisse B, Berg EVD, Jonge MD, Blankers M, Furth EV, Dekker J, Beurs ED. Efficacy of Web-Based, Guided Self-help Cognitive Behavioral Therapy-Enhanced for Binge Eating Disorder: Randomized Controlled Trial. J Med Internet Res 2023; 25:e40472. [PMID: 37126386 PMCID: PMC10186189 DOI: 10.2196/40472] [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] [Received: 06/22/2022] [Revised: 11/07/2022] [Accepted: 03/08/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Owing to the gap between treatment supply and demand, there are long waiting periods for patients with binge eating disorder, and there is an urgent need to increase their access to specialized treatment. Guided self-help cognitive behavioral therapy-enhanced (CBT-E) may have great advantages for patients if its efficacy can be established. OBJECTIVE The aim of this study was to examine the efficacy of guided self-help CBT-E compared with that of a delayed-treatment control condition. METHODS A single-blind 2-arm randomized controlled trial was designed to evaluate guided self-help CBT-E according to an intention-to-treat analysis. A total of 180 patients were randomly assigned to guided self-help CBT-E (n=90, 50%) or the delayed-treatment control condition (n=90, 50%) for which guided self-help CBT-E was provided after the initial 12-week delay. The primary outcome was reduction in binges. The secondary outcome was full recovery at the end of treatment, as measured using the Eating Disorder Examination during the last 4 weeks of treatment. A linear mixed model analysis was performed to compare treatment outcomes at the end of treatment. A second linear mixed model analysis was performed to measure between- and within-group effects for up to 24 weeks of follow-up. The Eating Disorder Examination-Questionnaire and clinical impairment assessment were conducted before and after treatment and during follow-up. In addition, dropout rates were assessed in both conditions. RESULTS During the last 4 weeks of treatment, objective binges reduced from an average of 19 (SD 16) to 3 (SD 5) binges, and 40% (36/90) showed full recovery in the guided self-help CBT-E group. Between-group effect size (Cohen d) was 1.0 for objective binges. At follow-up, after both groups received treatment, there was no longer a difference between the groups. Of the 180 participants, 142 (78.9%) completed treatment. The overall treatment dropout appeared to be associated with gender, level of education, and number of objective binges at baseline but not with treatment condition. CONCLUSIONS This is the first study to investigate the efficacy of guided self-help CBT-E. Guided self-help CBT-E appeared to be an efficacious treatment. This study's findings underscore the international guidelines recommending this type of treatment for binge eating disorder. TRIAL REGISTRATION Netherlands Trial Registry (NTR) NL7994; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7994. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-020-02604-1.
Collapse
Affiliation(s)
- Bernou Melisse
- Novarum Center for Eating Disorders, Amstelveen, Netherlands
- Section Clinical Psychology, Leiden University, Leiden, Netherlands
| | | | - Margo de Jonge
- Novarum Center for Eating Disorders, Amstelveen, Netherlands
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Amsterdam, Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
- Department of Psychiatry, Location AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eric van Furth
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Edwin de Beurs
- Section Clinical Psychology, Leiden University, Leiden, Netherlands
- Research Department, Arkin Mental Health Institute, Amsterdam, Netherlands
| |
Collapse
|
9
|
Forrest LN, Ivezaj V, Grilo CM. Machine learning v. traditional regression models predicting treatment outcomes for binge-eating disorder from a randomized controlled trial. Psychol Med 2023; 53:2777-2788. [PMID: 34819195 PMCID: PMC9130342 DOI: 10.1017/s0033291721004748] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/13/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND While effective treatments exist for binge-eating disorder (BED), prediction of treatment outcomes has proven difficult, and few reliable predictors have been identified. Machine learning is a promising method for improving the accuracy of difficult-to-predict outcomes. We compared the accuracy of traditional and machine-learning approaches for predicting BED treatment outcomes. METHODS Participants were 191 adults with BED in a randomized controlled trial testing 6-month behavioral and stepped-care treatments. Outcomes, determined by independent assessors, were binge-eating (% reduction, abstinence), eating-disorder psychopathology, and weight loss (% loss, ⩾5% loss). Predictors included treatment condition, demographic information, and baseline clinical characteristics. Traditional models were logistic/linear regressions. Machine-learning models were elastic net regressions and random forests. Predictive accuracy was indicated by the area under receiver operator characteristic curve (AUC), root mean square error (RMSE), and R2. Confidence intervals were used to compare accuracy across models. RESULTS Across outcomes, AUC ranged from very poor to fair (0.49-0.73) for logistic regressions, elastic nets, and random forests, with few significant differences across model types. RMSE was significantly lower for elastic nets and random forests v. linear regressions but R2 values were low (0.01-0.23). CONCLUSIONS Different analytic approaches revealed some predictors of key treatment outcomes, but accuracy was limited. Machine-learning models with unbiased resampling methods provided a minimal advantage over traditional models in predictive accuracy for treatment outcomes.
Collapse
Affiliation(s)
- Lauren N. Forrest
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
10
|
Forrest LN, Franko DL, Thompson-Brenner H, Grilo CM. Examining changes in binge-eating disorder network centrality and structure in patients treated with cognitive-behavioral therapy versus interpersonal psychotherapy. Int J Eat Disord 2023; 56:944-955. [PMID: 36565241 PMCID: PMC10159900 DOI: 10.1002/eat.23883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE A sizeable minority of patients with binge-eating disorder (BED) do not fully respond to evidence-based treatments. Evidence to guide refinements of treatments is needed. Conceptualizing BED as arising from a network of symptom-to-symptom interactions allows for identification of the most strongly connected symptoms, which could inform intervention targets. This study estimated networks of BED features at pretreatment and posttreatment to assess whether cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) differentially impacted the interrelationships of BED symptoms/features. METHODS Participants were 392 adults (83% women, 88% white) with BED who received CBT (n = 236) or IPT (n = 156) and assessed at pretreatment and posttreatment. Networks were estimated across timepoints and treatments. Expected influence (EI) was calculated; symptoms with the highest EI have the most strong and frequent associations with other symptoms. We also assessed whether the symptoms with the highest and lowest EI predicted posttreatment remission indicators. RESULTS In the CBT and IPT networks, shape concern, weight concern, and eating concern had the highest EI at pretreatment and posttreatment. EI significantly increased from pretreatment to posttreatment for some symptoms in CBT but did not change for any symptoms in IPT. Shape concern significantly and positively predicted BED remission indicators in CBT and IPT. CONCLUSIONS CBT and IPT similarly impacted interrelations among BED features. Pretreatment EI predicted posttreatment remission indicators, indicating that pretreatment centrality could signal meaningful intervention targets. Clinical implications and avenues for future research are discussed including how personalized network analysis may advance the understanding of the clinical utility of centrality. PUBLIC SIGNIFICANCE Cognitive behavioral therapy and interpersonal therapy for binge-eating disorder, which are two leading evidence-based treatments for binge-eating disorder that are quite different in their models and approaches, similarly impacted interrelations among binge-eating disorder symptoms. In addition, the most strongly interconnected symptom predicted indicators of remission. Studying the interrelations among symptoms may provide new insight on how treatments impact symptom relationships and inform intervention targets.
Collapse
Affiliation(s)
- Lauren N. Forrest
- Penn State College of Medicine, Department of Psychiatry & Behavioral Health, Hershey, PA
| | - Debra L. Franko
- Department of Applied Psychology, Northeastern University, Boston, MA
| | | | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
11
|
Kambanis PE, Bottera AR, Mancuso CJ, Spoor SP, Anderson LM, Burke NL, Eddy KT, Forbush KT, Keith JF, Lavender JM, Mensinger JL, Mujica C, Nagata JM, Perez M, De Young KP. Eating Disorder Examination-Questionnaire and Clinical Impairment Assessment norms for intersectional identities using an MTurk sample. Int J Eat Disord 2022; 55:1690-1707. [PMID: 36054425 PMCID: PMC10263063 DOI: 10.1002/eat.23799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There are limited data to guide the interpretation of scores on measures of eating-disorder psychopathology among underrepresented individuals. We aimed to provide norms for the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) across racial/ethnic, gender, and sexual identities, and sexual orientations and their intersections by recruiting a diverse sample of Amazon MTurk workers (MTurkers; N = 1782). METHOD We created a comprehensive, quantitative assessment of racial/ethnic identification, gender identification, sex assigned at birth, current sexual identification, and sexual orientation called the Demographic Assessment of Racial, Sexual, and Gender Identities (DARSGI). We calculated normative data for each demographic category response option. RESULTS Our sample was comprised of 68% underrepresented racial/ethnic identities, 42% underrepresented gender identities, 13% underrepresented sexes, and 49% underrepresented sexual orientations. We reported means and standard deviations for each demographic category response option and, where possible, mean estimates by percentile across intersectional groups. EDE-Q Global Score for a subset of identities and intersections in the current study were higher than previously reported norms for those identities/intersections. DISCUSSION This is the most thorough reporting of norms for the EDE-Q and CIA among racial/ethnic, sexual, and gender identities, and sexual orientations and the first reporting on multiple intersections, filling some of the gaps for commonly used measures of eating-disorder psychopathology. These norms may be used to contextualize eating-disorder psychopathology reported by underrepresented individuals. The data from the current study may help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups. PUBLIC SIGNIFICANCE We provide the most thorough reporting on racial/ethnic, sexual, and gender identities, and sexual orientations for the Eating Disorder Examination - Questionnaire and Clinical Impairment Assessment, and the first reporting on intersections, which fills some of the gaps for commonly used measures of eating-disorder psychopathology. These norms help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups.
Collapse
Affiliation(s)
| | | | | | | | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN
| | | | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Jill F. Keith
- Department of Family and Consumer Sciences, Human Nutrition and Food/Dietetics, University of Wyoming, Laramie, WY
| | - Jason M. Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD
- The Metis Foundation, San Antonio, TX
| | - Janell L. Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, Ft. Lauderdale, FL
| | - Christin Mujica
- Department of Psychology, University of Arkansas, Fayetteville, AK
| | - Jason M. Nagata
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Marisol Perez
- Department of Psychology, Arizona State University, Tempe, AZ
| | | |
Collapse
|
12
|
Goode RW, Webster CK, Gwira RE. A Review of Binge-Eating Disorder in Black Women: Treatment Recommendations and Implications for Healthcare Providers. Curr Psychiatry Rep 2022; 24:757-766. [PMID: 36370263 PMCID: PMC9789195 DOI: 10.1007/s11920-022-01383-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW We review relevant factors and barriers to care for binge-eating disorder (BED) in Black women. We examine evidence for the treatment of BED and provide recommendations to improve cultural relevance for assessing and treating BED in Black women. RECENT FINDINGS BED is the most common eating disorder among Black women. Moreover, evidence supports alternative factors that contribute to the onset of BED in Black women, including stress, trauma, and food insecurity. Furthermore, though there are evidence-based treatments for BED, disparities persist in access to care and treatment retention. Recommendations for increasing the cultural relevance of assessments and treatments are provided. Gaps in the literature remain on the use of evidence-based treatments for BED among Black women. As such, healthcare providers should include Black women as co-collaborators in their care and seek out training and consultation to aid in providing culturally affirming treatment.
Collapse
Affiliation(s)
- Rachel W Goode
- School of Social Work and Department of Psychiatry, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB #3550, Chapel Hill, NC, 27599, USA.
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA.
| | | | - Rebecca E Gwira
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, GA, USA
| |
Collapse
|
13
|
Goode RW, Malian H, Samuel-Hodge C, Noem T, Coan D, Takgbajouah M, Bahena L, Bulik CM. The impact of COVID-19 on Black women who binge-eat: a qualitative study. Eat Weight Disord 2022; 27:3399-3407. [PMID: 36059023 PMCID: PMC9441135 DOI: 10.1007/s40519-022-01472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/21/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although studies have traced the impact of COVID-19 on those with eating disorders, little is known about the specific impact of the pandemic on Black American women who report disordered eating behaviors and are at risk for eating disorders. Thus, the purpose of this study is to investigate the impact of COVID-19 on Black women who binge-eat. METHODS We recruited a purposive sample during the first wave of COVID-19 from the southeastern United States. Participants identified as Black women, reported binge-eating episodes in the last 28 days, and agreed to participate in a semi-structured interview. Prior to the interview, participants were administered a socio-demographic survey and the Eating Disorder Examination-Questionnaire. Interviews were transcribed verbatim and analyzed independently using qualitative content analysis and open coding to identify relevant codes and themes. RESULTS On average, participants (N = 20) were 43.05 ± 16.2 years of age and reported 5.6 ± 5.7 binge-eating episodes in the last 28 days. We identified six themes to describe participants' experiences managing their eating behavior during COVID-19: (1) food as a coping strategy; (2) lack of control around food; (3) increased time in a triggering environment (e.g., being at home with an easy availability of food); (4) lack of structure and routine; (5) challenges with limited food availability; and (6) positive impact of the pandemic. CONCLUSION In this study, Black women reported challenges managing their eating behavior during COVID-19. Results could inform the development and tailoring of treatments for Black women reporting disordered eating behaviors. LEVEL OF EVIDENCE Level V, qualitative interviews.
Collapse
Affiliation(s)
- Rachel W Goode
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hannah Malian
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carmen Samuel-Hodge
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Taylor Noem
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Danielle Coan
- School of Social Work, North Carolina State University, Raleigh, NC, USA
| | | | - Lisette Bahena
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cynthia M Bulik
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
14
|
Schmidt R, Hilbert A. Predictors of Symptom Trajectories After Cognitive-Behavioral Therapy in Adolescents With an Age-Adapted Diagnosis of Binge-Eating Disorder. Behav Ther 2022; 53:137-149. [PMID: 35027155 DOI: 10.1016/j.beth.2021.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/29/2022]
Abstract
Although evidence demonstrated efficacy of cognitive-behavioral therapy (CBT) in adolescents with binge-eating disorder (BED), treatment response is heterogeneous. This study uniquely examined baseline predictors of symptom trajectories in N = 73 adolescents (12-20 years) with an age-adapted diagnosis of BED (i.e., based on objective and subjective binge-eating episodes). Based on evidence from adult BED, dietary restraint, overvaluation of weight/shape, and depressive symptoms were used to predict changes in abstinence from binge eating and eating disorder psychopathology after 4 months of individual, face-to-face CBT using growth models. Longitudinal trajectories of abstinence from objective and subjective binge eating and global eating disorder psychopathology assessed via the Eating Disorder Examination were modeled for five time points (pre- and posttreatment, 6-, 12-, and 24-month follow-up). Beyond significant, positive effects for time, no significant predictors for abstinence from binge eating emerged. In addition to significant decreases in eating disorder psychopathology over time, higher pretreatment dietary restraint and overvaluation of weight/shape significantly predicted greater decreases in eating disorder psychopathology over time. Consistent with research in adult BED, adolescents with higher than lower eating disorder-specific psychopathology especially benefit from CBT indicating that restrained eating and overvaluation of weight/shape may be BED-specific prognostic characteristic across developmental stages. Future predictor studies with an additional focus on potential age-specific predictors, such as family factors, and within-treatment processes may be critical in further evaluating treatment-related symptom trajectories in adolescent BED.
Collapse
Affiliation(s)
- Ricarda Schmidt
- University of Leipzig Medical Center, Behavioral Medicine Research Unit.
| | - Anja Hilbert
- University of Leipzig Medical Center, Behavioral Medicine Research Unit
| |
Collapse
|
15
|
Grilo CM, Thompson-Brenner H, Shingleton RM, Thompson DR, Franko DL. Clinical moderators and predictors of cognitive-behavioral therapy by guided-self-help versus therapist-led for binge-eating disorder: Analysis of aggregated clinical trials. Int J Eat Disord 2021; 54:1875-1880. [PMID: 34472114 PMCID: PMC8492524 DOI: 10.1002/eat.23601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/06/2021] [Accepted: 08/24/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT)-therapist-led (CBTth) and guided-self-help (CBTgsh)-has efficacy for binge-eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods. METHOD Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treatments for BED in the U.S. Predictors and moderators of outcomes (treatment completion and binge-eating remission) were examined in N = 457 participants who received either CBTgsh (N = 164) or CBTth (N = 293). RESULTS Analyses, adjusting for demographic/clinical variables, indicated CBTth was significantly superior to CBTgsh for treatment completion (odds ratio [OR] = 20.0) and remission (OR = 14.6). For remission, analyses revealed significant predictors (age, treatment length, Weight Concern), a moderator (weight concern [OR = 5.13]), and a significant interaction between CBT-type and treatment length (OR = 2.66). For CBTgsh, longer treatment was associated with less remission, whereas for CBTth, longer treatment was associated with greater remission. For CBTgsh, 44.1% with low weight concern versus 56.3% with high weight concern achieved remission whereas for CBTth, 43.5% with high weight concern and 61.0% with low weight concern achieved remission. DISCUSSION Analyses of aggregated RCT BED data, adjusting for demographic/clinical characteristics, indicated superiority (large effect-sizes) in treatment outcomes of CBTth over CBTgsh and that Weight Concern moderated outcomes.
Collapse
Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | | | | | | | - Debra L. Franko
- Department of Applied Psychology, Northeastern University, Boston, MA
| |
Collapse
|
16
|
Haynos AF, Wang SB, Lipson S, Peterson CB, Mitchell JE, Halmi KA, Agras WS, Crow SJ. Machine learning enhances prediction of illness course: a longitudinal study in eating disorders. Psychol Med 2021; 51:1392-1402. [PMID: 32108564 PMCID: PMC7483262 DOI: 10.1017/s0033291720000227] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psychiatric disorders, including eating disorders (EDs), have clinical outcomes that range widely in severity and chronicity. The ability to predict such outcomes is extremely limited. Machine-learning (ML) approaches that model complexity may optimize the prediction of multifaceted psychiatric behaviors. However, the investigations of many psychiatric concerns have not capitalized on ML to improve prognosis. This study conducted the first comparison of an ML approach (elastic net regularized logistic regression) to traditional regression to longitudinally predict ED outcomes. METHODS Females with heterogeneous ED diagnoses completed demographic and psychiatric assessments at baseline (n = 415) and Year 1 (n = 320) and 2 (n = 277) follow-ups. Elastic net and traditional logistic regression models comprising the same baseline variables were compared in ability to longitudinally predict ED diagnosis, binge eating, compensatory behavior, and underweight BMI at Years 1 and 2. RESULTS Elastic net models had higher accuracy for all outcomes at Years 1 and 2 [average Area Under the Receiving Operating Characteristics Curve (AUC) = 0.78] compared to logistic regression (average AUC = 0.67). Model performance did not deteriorate when the most important predictor was removed or an alternative ML algorithm (random forests) was applied. Baseline ED (e.g. diagnosis), psychiatric (e.g. hospitalization), and demographic (e.g. ethnicity) characteristics emerged as important predictors in exploratory predictor importance analyses. CONCLUSIONS ML algorithms can enhance the prediction of ED symptoms for 2 years and may identify important risk markers. The superior accuracy of ML for predicting complex outcomes suggests that these approaches may ultimately aid in advancing precision medicine for serious psychiatric disorders.
Collapse
Affiliation(s)
- Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Shirley B. Wang
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Sarah Lipson
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- The Emily Program, Minneapolis, MN, USA
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Katherine A. Halmi
- New York Presbyterian Hospital-Westchester Division, Weill Medical College of Cornell University, White Plains, NY, USA
| | - W. Stewart Agras
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott J. Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- The Emily Program, Minneapolis, MN, USA
| |
Collapse
|
17
|
Goode RW, Cowell MM, Mazzeo SE, Cooper-Lewter C, Forte A, Olayia OI, Bulik CM. Binge eating and binge-eating disorder in Black women: A systematic review. Int J Eat Disord 2020; 53:491-507. [PMID: 31922293 PMCID: PMC8010989 DOI: 10.1002/eat.23217] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Although several effective behavioral treatments for binge-eating disorder (BED) exist, there are racial disparities in treatment access, with African-Americans and/or Black individuals having some of the lowest rates of access to care. Little is known about the experience and treatment of binge eating (BE) and BED among Black women. METHOD This systematic review, conducted according to PRISMA guidelines, synthesizes information related to BE and BED in Black women. RESULTS A total of N = 38 studies met our eligibility criteria. We did not identify any systematic risk of bias across studies. The majority of included studies used cross-sectional survey methodology, and relied on interview (EDE) and self-report measures (particularly the Binge Eating Scale, BES) for the assessment of BE. Outcomes were inconsistently measured across trials, and there are limited data on the results of evidence-based treatments for BE/BED in Black women. DISCUSSION Although Black women have similar or higher rates of BE than White women, most research on BE and BED has focused on White women, with Black individuals underrepresented in clinical trials. Future research should examine evidence-based treatments to prevent and treat BED in this population. OBJETIVO Aunque existen varios tratamientos conductuales que son efectivos para el Trastorno de Atracones (BED, por sus siglas en inglés), existen disparidades raciales en el acceso a tratamiento, con individuos Afroamericanos y/o personas de color teniendo algunas de las tasas más bajas de acceso al cuidado de la salud. Se sabe muy poco acerca de la experiencia y tratamiento del comer en atracones (BE, por sus siglas en inglés) y BED entre mujeres afroamericanas y/o de color. MÉTODO: Esta revisión sistemática, realizada bajo lineamientos de las guías PRISMA, sintetiza información relacionada con BE y BED en mujeres afroamericanas y/o de color. RESULTADOS Un total de N = 38 estudios cumplieron con nuestros criterios de elegibilidad. No identificamos ningún riesgo sistemático de sesgo entre los estudios. La mayoría de los estudios incluidos utilizaron una metodología de encuesta transversal y se basaron en la entrevista (EDE) y las medidas de autoinforme (en particular, la Binge Eating Scale, BES) para la evaluación de BE. Los resultados se midieron de manera inconsistente entre los ensayos, y hay datos limitados sobre los resultados de los tratamientos basados en la evidencia para BE/BED en mujeres afroamericanas y/o de color. DISCUSIÓN: Aunque las mujeres afroamericanas y/o de color tienen tasas similares o más altas de BE que las mujeres blancas, la mayoría de las investigaciones sobre BE y BED se han centrado en las mujeres blancas, con individuos afroamericanos y/o de color subrepresentados en ensayos clínicos. La investigación futura debería examinar los tratamientos basados en la evidencia para prevenir y tratar el BED en esta población.
Collapse
Affiliation(s)
- Rachel W Goode
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mariah M Cowell
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Courtney Cooper-Lewter
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexandria Forte
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Oona-Ifé Olayia
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
18
|
Four main barriers to weight loss maintenance? A quantitative analysis of difficulties experienced by obese patients after successful weight reduction. Eur J Clin Nutr 2020; 74:1192-1200. [PMID: 32001814 DOI: 10.1038/s41430-020-0559-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Weight maintenance remains to be a challenge for patients in a reduced obese state and it has been recommended to provide them more individualized support. For this purpose it is crucial to understand the barriers patients are experiencing after weight loss. Many have been identified by qualitative studies. We evaluated if a quantitative assessment of patient perspective during weight maintenance can help identify major barriers that refer to actual regain. METHODS Follow-up data were analyzed from patients attempting weight maintenances after successful completion of a nonsurgical weight loss and lifestyle intervention for morbid obesity. The data were acquired at mandatory follow-up assessments and included rating of 26 probable difficulties. A principal component analysis was carried out to explore whether these difficulties could be grouped into meaningful factors. Associations with socio-demographics, follow-up time, and weight changes were evaluated. RESULTS Data from 88 out of 102 patients were available (baseline BMI 49.5 ± 7.4 kg/m2; 12-month weight loss 24.3 ± 9.6%; follow-up time 1.48 ± 0.6 years). Four solid factors, composed of 21 items and explaining 56% of the variance were extracted and interpreted as 'Hedonic Hunger', 'Mental Distress', 'Binge Eating', and 'Demoralization'. Weight regain (12.4 ± 12%) was correlated with each factor, most closely with 'Mental Distress' (r = 0.38). When controlling for age and follow-up time, 'Binge Eating' was the most important predictor (adj. R2 = 0.297). CONCLUSIONS A quantitative assessment of patient perspective during the first years after weight loss can help identify valid barriers to weight loss maintenance.
Collapse
|
19
|
Lydecker JA, Gueorguieva R, Masheb R, White MA, Grilo CM. Examining sex as a predictor and moderator of treatment outcomes for binge-eating disorder: Analysis of aggregated randomized controlled trials. Int J Eat Disord 2020; 53:20-30. [PMID: 31497876 PMCID: PMC6983351 DOI: 10.1002/eat.23167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/02/2019] [Accepted: 08/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study examined whether sex predicted and/or moderated treatment outcomes among men and women who participated in binge-eating disorder (BED) randomized controlled trials (RCTs). METHOD Data were aggregated from RCTs performed at one medical center. RCTs tested cognitive-behavioral therapy, behavioral weight loss, multimodal treatment, and/or control conditions. Participants were 660 adults, both men (n = 170) and women (n = 490), with Diagnostic and Statistical Manual-fourth edition (DSM-IV)-defined BED. Doctoral-level research-clinicians assessed participants using structured interviews and established self-report measures of eating-disorder psychopathology and depression, and measured height and weight. Assessments occurred at baseline, throughout treatment, and at post-treatment. RESULTS Sex was not a significant moderator of any treatment outcomes. Mixed models revealed sex had a main effect: men had lower eating-disorder psychopathology and lost more weight than women over the course of treatment. DISCUSSION Both epidemiological and RCT studies report disparities in treatment-seeking between men and women with BED. Despite this, men have comparable or better treatment outcomes compared with women, including significantly greater weight loss. Thus, disseminating evidence-based BED treatments is promising for both men and women. Additional research is necessary, however, to understand treatment effects-including other predictors and moderators of outcomes-across diverse providers, treatment settings, and patient groups.
Collapse
Affiliation(s)
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Robin Masheb
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,PRIME HSR&D Center of Innovation (COIN), VA Connecticut Healthcare System, West Haven, CT
| | - Marney A. White
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,Department of Psychology, Yale University, New Haven, CT
| |
Collapse
|
20
|
Lydecker JA, Gueorguieva R, Masheb R, White MA, Grilo CM. Examining race as a predictor and moderator of treatment outcomes for binge-eating disorder: Analysis of aggregated randomized controlled trials. J Consult Clin Psychol 2019; 87:530-540. [PMID: 31008634 PMCID: PMC6589831 DOI: 10.1037/ccp0000404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine whether race predicted or moderated response to treatments for binge-eating disorder (BED). METHOD Participants were 592 adults (n = 113 Black; n = 479 White) with DSM-IV-defined BED who participated in randomized controlled trials (RCTs) at 1 medical center. Data were aggregated from RCTs for BED testing cognitive-behavioral therapy, behavioral weight loss, multimodal treatment, and/or control conditions. Participants had weight and height measured and were assessed using established interviews and self-report measures at baseline, throughout treatment, and post treatment. RESULTS Race did not significantly moderate treatment outcomes. Mixed models revealed a main effect of race: Black participants had fewer binge-eating episodes and lower depression than White participants across time points. Race also had a main effect in generalized estimating equations with a significantly greater proportion of Black participants achieving binge-eating remission than White participants. Race did not predict percent weight loss, but a significantly lower proportion of Black participants attained 5% weight loss than White participants. Race did not significantly predict global eating-disorder severity. CONCLUSION Despite disparities in treatment-seeking reported in epidemiological and RCT studies, Black individuals appear to have comparable or better treatment outcomes in BED treatment research compared with White individuals, except they were less likely to attain 5% weight loss at post treatment. This suggests that disseminating evidence-based treatments for BED among diverse populations holds promise and treatments may not require further adaptation prior to dissemination. Implementation research is needed to test treatment effectiveness across diverse providers, settings, and patient groups to improve understanding of potential predictors and moderators. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
- Division of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Robin Masheb
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
- PRIME HSR&D Center of Innovation (COIN), VA Connecticut Healthcare System, West Haven, CT
| | - Marney A. White
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
- Department of Psychology, Yale University, New Haven, CT
| |
Collapse
|
21
|
Hayes NA, Welty LJ, Slesinger N, Washburn JJ. Moderators of treatment outcomes in a partial hospitalization and intensive outpatient program for eating disorders. Eat Disord 2019; 27:305-320. [PMID: 30204570 DOI: 10.1080/10640266.2018.1512302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Eating disorders cause a number of severely impairing symptoms that may require more intensive intervention that is available through outpatient therapy services. The PHP/IOP level of care may be an effective mode of treatment in these cases, but few studies have examined overall outcomes or treatment moderators for this level of care. Using a large sample from a PHP/IOP specifically designed for the treatment of eating disorders, the current study examines a variety of symptoms (eating disorder severity, quality of life, depression, etc.) from admission to discharge, as well as potential moderators of treatment, including demographic and clinical factors. Overall, the PHP/IOP level of care was found to improve treatment outcomes. Age, race, gender, and depression were found to moderate the change in quality of life and functional impairment. Additionally, patients diagnosed with anorexia nervosa had significantly lowered quality of life and greater eating disorder symptomatology than all other diagnoses. The results of this study can help to inform clinical practice and help guide in treatment decisions at the partial hospitalization level of care.
Collapse
Affiliation(s)
- Nicole A Hayes
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Leah J Welty
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,b Department of Preventative Medicine, Division of Biostatistics , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Noel Slesinger
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Jason J Washburn
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,c Center for Evidence-Based Practice , AMITA Health Behavioral Medicine, Hoffman Estates , IL , USA
| |
Collapse
|
22
|
Polo AJ, Makol BA, Castro AS, Colón-Quintana N, Wagstaff AE, Guo S. Diversity in randomized clinical trials of depression: A 36-year review. Clin Psychol Rev 2019; 67:22-35. [DOI: 10.1016/j.cpr.2018.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
|
23
|
Borgès Da Silva V, Borgès Da Silva R, Prud'homme A, Campan P, Azorin JM, Belzeaux R. Association between binge eating disorder and psychiatric comorbidity profiles in patients with obesity seeking bariatric surgery. Compr Psychiatry 2018; 87:79-83. [PMID: 30253268 DOI: 10.1016/j.comppsych.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Eating disorders could be an important factor in the development of obesity, but psychiatric comorbidities are very heterogeneous in patients with obesity. Moreover, relationship between binge eating disorder and other psychiatric comorbidities is not clear. Our objective was to identify psychiatric comorbidity profiles of bariatric surgery candidates and to analyze the association between these profiles and binge-eating disorder. METHODS Our sample consisted of bariatric surgery candidates (n = 92) with mean Body Mass Index at 41.3 ± 0.6 kg/m2. To construct profiles, we classified patients according to their psychiatric comorbidities using cluster analysis techniques. We used logistic regression modelling to analyze associations between the presence of binge-eating disorder and the psychiatric comorbidity profiles. RESULTS We identified four profiles of psychiatric phenotypes. One of these profiles was not associated with any psychiatric disorder. Binge eating disorder was significantly associated with two profiles (p < 0.05): a profile with bipolar and obsessive-compulsive disorder (OR = 7.7 [1.7; 35.1]), and a profile with bipolar and panic disorder (OR = 20.7 [3.1; 137.5]). CONCLUSIONS Our multidimensional approach identified certain profiles specifically associated with binge-eating disorder in patients with obesity seeking bariatric surgery. These results may lead to a better understanding of the relationship between obesity and psychiatric disorders.
Collapse
Affiliation(s)
- Virginie Borgès Da Silva
- Centre Hospitalier Édouard Toulouse, Assistance publique des hôpitaux de Marseille, Marseille, France.
| | - Roxane Borgès Da Silva
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, P.O. Box 6128, Downtown Station Montréal, H3C3J7 Québec, Canada; University of Montreal Public Health Research Institute, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C3J7, Canada; Center for Interuniversity Research and Analysis of Organizations, 1130 Rue Sherbrooke O #1400, Montréal, Québec H3A 2M8, Canada.
| | - Alexandre Prud'homme
- University of Montreal Public Health Research Institute, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C3J7, Canada; Center for Interuniversity Research and Analysis of Organizations, 1130 Rue Sherbrooke O #1400, Montréal, Québec H3A 2M8, Canada.
| | - Pierre Campan
- Hôpital de La Conception, Assistance publique des hôpitaux de Marseille, Marseille, France.
| | - Jean Michel Azorin
- Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique des hôpitaux de Marseille, 270 Boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - Raoul Belzeaux
- Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique des hôpitaux de Marseille, 270 Boulevard de Sainte-Marguerite, 13009 Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université; Fondation FondaMental, Créteil, France.
| |
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW Eating disorders are recognized to occur across ethnic and racial groups. The aim of the present review was to examine recent advances in the understanding of the development, presentation, and intervention approaches specific to eating disorders among ethnic and racial minority groups. RECENT FINDINGS An increasing number of measures have been found to be useful tools for assessing eating disorder risk and symptoms among ethnic and racial minority populations. In addition, further evidence has emerged supporting the relationship between higher levels of eating disorder symptoms and acculturation stress, as well as investment in appearance ideals. In contrast, the relationship between ethnic identity and eating disorder symptoms is less consistent, although several studies suggest that positive ethnic identity may be protective. Finally, increasing efforts have been made to develop and implement culturally sensitive interventions by tailoring evidence-supported treatments. Our understanding of and capacity to treat eating disorders among ethnic and racial minority groups continues to improve. However, further research is needed, particularly among neglected groups, such a smaller ethnic and racial groups, males, and intersecting minority statuses.
Collapse
|
25
|
Lydecker JA, Grilo CM. Comparing men and women with binge-eating disorder and co-morbid obesity. Int J Eat Disord 2018; 51:411-417. [PMID: 29493793 PMCID: PMC5980708 DOI: 10.1002/eat.22847] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/11/2018] [Accepted: 02/06/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study examined differences in clinical presentation of men and women with binge-eating disorder (BED) who participated in treatment research at a medical-school based program. METHOD Participants were 682 adults (n = 182 men, n = 500 women) with DSM-IV-defined BED. Doctoral-level research clinicians assessed eating-disorder psychopathology, including BED diagnosis, using the Structured Clinical Interview for DSM-IV Disorders (SCID) and Eating Disorder Examination (EDE) interview. Research clinicians measured height and weight and participants completed a battery of established self-report measures. RESULTS Men had significantly higher body mass index (BMI) than women; women had significantly higher eating-disorder psychopathology (EDE scales and global score) and depression than men. Differences in eating-disorder psychopathology and depression remained higher for women than men after adjusting for race/ethnicity and BMI. Frequency of binge-eating episodes, subjective binge-eating episodes, and overeating episodes did not differ significantly by sex. Women had younger ages of onset for dieting and binge-eating behaviors than men but ages of onset for obesity and BED did not significantly differ between men and women. DISCUSSION There are some sex differences in clinical presentation and age-of-onset timeline of adults with BED. Men and women develop obesity and BED (at diagnostic threshold) around the same age but women begin dieting and binge-eating behaviors earlier than men. At presentation for treatment for BED, men and women did not differ in binge-eating frequency and although men and women differed significantly on BMI and eating-disorder psychopathology, the magnitude of these differences was quite modest.
Collapse
Affiliation(s)
| | - Carlos M. Grilo
- Yale School of Medicine, New Haven, CT, 06519,Yale University, New Haven, CT, 06511
| |
Collapse
|
26
|
Goode RW, Kalarchian MA, Craighead L, Conroy MB, Wallace J, Eack SM, Burke LE. The feasibility of a binge eating intervention in Black women with obesity. Eat Behav 2018; 29:83-90. [PMID: 29549863 PMCID: PMC5935580 DOI: 10.1016/j.eatbeh.2018.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/20/2018] [Accepted: 03/08/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION U.S. Black women have the highest rates of obesity and report frequent binge eating behaviors. To our knowledge, no intervention research has aimed to treat binge eating specifically among Black women. The purpose of this study was to investigate the feasibility and preliminary effect of Appetite Awareness Treatment (AAT), an 8-week cognitive-behavioral binge eating intervention, among Black women with obesity, and who report binge eating. METHODS Participants (N = 31), had a mean (±SD) age of 48.8 ± 12.8 years, a body mass index of 33.7 ± 3.9 kg/m2, and reported at least one binge eating episode monthly over the last three months. Using a randomized controlled trial design, Black women were randomized to AAT or a wait-list control group (WAIT) group. We examined recruitment, attendance, retention, and adherence. Linear mixed models explored preliminary differences between the AAT and WAIT on the primary outcome variables of binge eating and eating self-efficacy measured at baseline and 8-weeks. RESULTS Approximately one-third of screened participants were eligible and did enroll. Participants completed 55% of homework assignments, and attended 59% of intervention sessions. Retention to AAT was 87.5%. Compared to participants in the WAIT group, AAT participants had greater decreases in binge eating scores and greater improvements in eating self-efficacy scores at the end of Week 8. CONCLUSION Results suggest that AAT is feasible among Black women with binge eating behaviors, with evidence of preliminary efficacy, providing a rationale for a trial of AAT in a larger sample of Black women.
Collapse
Affiliation(s)
- Rachel W. Goode
- Schools of Social Work and Nursing, 2117 Cathedral of Learning, Pittsburgh, PA 15260 University of Pittsburgh,School of Social Work, University of North Carolina at Chapel Hill; 325 Pittsboro Street; CB #3550; Chapel Hill, NC 27599-3550
| | - Melissa A. Kalarchian
- School of Nursing, Duquesne University; Fisher Hall, 600 Forbes Avenue, Pittsburgh, PA 15282
| | - Linda Craighead
- Department of Psychology, Emory University; 201 Dowman Drive; Atlanta, GA 30322
| | - Molly B. Conroy
- Division of General Internal Medicine, University of Utah, 30 N 1900E.; Room 9R218; Salt Lake City, Utah 84132
| | - John Wallace
- Schools of Social Work and Nursing, 2117 Cathedral of Learning, Pittsburgh, PA 15260 University of Pittsburgh
| | - Shaun M. Eack
- Schools of Social Work and Nursing, 2117 Cathedral of Learning, Pittsburgh, PA 15260 University of Pittsburgh
| | - Lora E. Burke
- Schools of Social Work and Nursing, 2117 Cathedral of Learning, Pittsburgh, PA 15260 University of Pittsburgh
| |
Collapse
|
27
|
Song MK, Ward SE, Lin FC, Hamilton JB, Hanson LC, Hladik GA, Fine JP. Racial Differences in Outcomes of an Advance Care Planning Intervention for Dialysis Patients and Their Surrogates. J Palliat Med 2016; 19:134-42. [PMID: 26840848 DOI: 10.1089/jpm.2015.0232] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND African Americans' beliefs about end-of-life care may differ from those of whites, but racial differences in advance care planning (ACP) outcomes are unknown. OBJECTIVE The aim of this study was to compare the efficacy of an ACP intervention on preparation for end-of-life decision making and post-bereavement outcomes for African Americans and whites on dialysis. METHOD A secondary analysis of data from a randomized trial comparing an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) with usual care was conducted. There were 420 participants, 210 patient-surrogate dyads (67.4% African Americans), recruited from 20 dialysis centers in North Carolina. The outcomes of preparation for end-of-life decision making included dyad congruence on goals of care, surrogate decision-making confidence, a composite of the two, and patient decisional conflict assessed at 2, 6, and 12 months post-intervention. Surrogate bereavement outcomes included anxiety, depression, and post-traumatic distress symptoms assessed at 2 weeks, and at 3 and 6 months after the patient's death. RESULTS SPIRIT was superior to usual care in improving dyad congruence (odds ration [OR] = 2.31, p = 0.018), surrogate decision-making confidence (β = 0.18, p = 0.021), and the composite (OR = 2.19, p = 0.028) 2 months post-intervention, but only for African Americans. SPIRIT reduced patient decisional conflict at 6 months for whites and at 12 months for African Americans. Finally, SPIRIT was superior to usual care in reducing surrogates' bereavement depressive symptoms for African Americans but not for whites (β = -3.49, p = 0.003). CONCLUSION SPIRIT was effective in improving preparation for end-of-life decision-making and post-bereavement outcomes in African Americans.
Collapse
Affiliation(s)
- Mi-Kyung Song
- 1 Nell Hodgson School of Nursing, Emory University , Atlanta, Georgia
| | - Sandra E Ward
- 2 School of Nursing, University of Wisconsin-Madison , Madison, Wisconsin
| | - Feng-Chang Lin
- 3 School of Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Jill B Hamilton
- 4 School of Nursing, Johns Hopkins University , Baltimore, Maryland
| | - Laura C Hanson
- 5 School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | | | - Jason P Fine
- 3 School of Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| |
Collapse
|
28
|
Vroling MS, Wiersma FE, Lammers MW, Noorthoorn EO. Predicting Dropout from Intensive Outpatient Cognitive Behavioural Therapy for Binge Eating Disorder Using Pre-treatment Characteristics: A Naturalistic Study. EUROPEAN EATING DISORDERS REVIEW 2016; 24:494-502. [PMID: 27594180 DOI: 10.1002/erv.2474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dropout rates in binge eating disorder (BED) treatment are high (17-30%), and predictors of dropout are unknown. METHOD Participants were 376 patients following an intensive outpatient cognitive behavioural therapy programme for BED, 82 of whom (21.8%) dropped out of treatment. An exploratory logistic regression was performed using eating disorder variables, general psychopathology, personality and demographics to identify predictors of dropout. RESULTS Binge eating pathology, preoccupations with eating, shape and weight, social adjustment, agreeableness, and social embedding appeared to be significant predictors of dropout. Also, education showed an association to dropout. DISCUSSION This is one of the first studies investigating pre-treatment predictors for dropout in BED treatment. The total explained variance of the prediction model was low, yet the model correctly classified 80.6% of cases, which is comparable to other dropout studies in eating disorders. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
Collapse
Affiliation(s)
- Maartje S Vroling
- GGNet Amarum, Expert Centre for Eating Disorders, Zutphen/Nijmegen, the Netherlands. .,NijCare, Radboud University Nijmegen, Nijmegen, the Netherlands. .,Department of Clinical Psychology, Radboud University Nijmegen, Behavioral Science Institute, Nijmegen, the Netherlands.
| | - Femke E Wiersma
- GGNet Amarum, Expert Centre for Eating Disorders, Zutphen/Nijmegen, the Netherlands.,Department of Personality Disorders, Pro Persona Mental Health Care, Arnhem, the Netherlands
| | - Mirjam W Lammers
- GGNet Amarum, Expert Centre for Eating Disorders, Zutphen/Nijmegen, the Netherlands.,Department of Clinical Psychology, Radboud University Nijmegen, Behavioral Science Institute, Nijmegen, the Netherlands
| | - Eric O Noorthoorn
- GGNet, Training Centre for Psychiatrists Warnsveld, Warnsveld, the Netherlands.,Dutch Information Centre for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands
| |
Collapse
|
29
|
Saunders JF, Frazier LD, Nichols-Lopez KA. Self-esteem, diet self-efficacy, body mass index, and eating disorders: modeling effects in an ethnically diverse sample. Eat Weight Disord 2016; 21:459-468. [PMID: 26703131 DOI: 10.1007/s40519-015-0244-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/07/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Disordered eating patterns, particularly binge eating, are prevalent in Hispanic samples, yet the biopsychosocial risk factors remain understudied in minority populations. The relationship between diet self-efficacy and bulimic symptoms has been established in non-Hispanic white samples but not yet in Hispanics. This study sought to identify the direct role of diet self-efficacy on eating disorder risk and symptomology in a multicultural Hispanic sample, and to investigate the potential indirect relations among diet self-efficacy, self-esteem, body mass index (BMI), and eating disorder risk and symptomology in Hispanics and non-Hispanic whites. METHODS The present study surveyed 1339 college students from diverse ethnic backgrounds. Participants completed four standardized scales to assess acculturation, diet self-efficacy, global self-esteem, and eating disorder symptomology and risk. Self-reported height and weight were used for BMI calculations, and the data were analyzed in a robust maximum-likelihood structural equation modeling (SEM) framework. RESULTS The findings highlighted diet self-efficacy as a predictor of eating disorder risk and symptomology. Diet self-efficacy partially explained the covariation between self-esteem and eating disorder risk and symptomology, and between BMI and eating disorder risk and symptomology for the entire sample. CONCLUSION Diet self-efficacy emerged as an important construct to consider in developing eating disorder prevention and treatment models.
Collapse
Affiliation(s)
- Jessica F Saunders
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Leslie D Frazier
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
| | - Kristin A Nichols-Lopez
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| |
Collapse
|
30
|
Lee-Winn AE, Reinblatt SP, Mojtabai R, Mendelson T. Gender and racial/ethnic differences in binge eating symptoms in a nationally representative sample of adolescents in the United States. Eat Behav 2016; 22:27-33. [PMID: 27085166 PMCID: PMC4983227 DOI: 10.1016/j.eatbeh.2016.03.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Binge eating disorder (BED) is the most prevalent eating disorder in the U.S. adolescent population. Both BED and subthreshold binge eating disorder (SBED) are associated with physical and mental health problems. Gender and racial/ethnic differences in prevalence of binge eating in a nationally representative sample of adolescents have been reported but have not yet been assessed in relation to individual symptoms of binge eating. We examined gender and racial/ethnic differences in endorsement of eight binge eating symptoms in a nationally representative sample of U.S. adolescents. METHODS We used data from the National Comorbidity Survey-Adolescent Supplement (NCS-A; 2001-2004), a nationally representative cross-sectional study of adolescents aged 13 to 18years (n=9336). We compared binge eating symptoms across gender and racial/ethnic groups using multivariable regression models. RESULTS Females endorsed more binge eating symptoms than males associated with loss of control ('eat when not hungry') (adjusted prevalence ratio [aPR]=1.18, 95% confidence interval [CI]=1.02, 1.37, p=0.024) and distress (e.g., 'afraid of weight gain while binge eating' [aPR]=3.29, CI=2.43, 4.47, p<0.001). Racial/ethnic minorities displayed different patterns of binge eating symptoms than non-Hispanic Whites. Hispanics reported being more 'afraid of weight gain while binge eating' (aPR=2.05, CI=1.25, 3.37, p=0.006) than non-Hispanic Blacks. DISCUSSION Our findings suggest significant gender and racial/ethnic differences in binge eating symptom presentation. Future work should explore reasons for these gender and racial/ethnic differences and consider these differences when determining how best to prevent and treat binge eating in adolescents.
Collapse
Affiliation(s)
- Angela E Lee-Winn
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Shauna P Reinblatt
- The Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, 550 North Broadway, Baltimore, MD 21205, USA.
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
| |
Collapse
|
31
|
Lee-Winn AE, Townsend L, Reinblatt SP, Mendelson T. Associations of neuroticism-impulsivity and coping with binge eating in a nationally representative sample of adolescents in the United States. Eat Behav 2016; 22:133-140. [PMID: 27289518 PMCID: PMC4983245 DOI: 10.1016/j.eatbeh.2016.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/09/2016] [Accepted: 06/01/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Binge eating behavior is a public health concern due to its negative physical and mental health consequences. Little is known about the interplay of personality traits, coping styles, and binge eating in the general adolescent population. We examined the associations among the combination of neuroticism and impulsivity (NI), maladaptive coping styles (poor problem solving, distraction, and escape-avoidance), and lifetime prevalence of binge eating in a nationally representative sample of U.S. adolescents. We also explored coping as a moderator of the NI-lifetime binge eating association and gender as a moderator of the NI-coping associations and coping-lifetime binge eating associations. METHODS We used data from the National Comorbidity Survey: Adolescent Supplement (NCS-A: 2001-2004), a cross-sectional nationally representative study of adolescents aged 13 to 18years (n=10,028). We studied the associations of NI and coping with lifetime binge eating using multivariate regression models. RESULTS High NI was significantly associated with all three coping styles, especially escape-avoidance (β=3.96, confidence interval [CI]=3.62, 4.29, p<0.001). Gender was a significant moderator of the NI-distraction coping association (β=-0.68, CI=-1.33, -0.03, p=0.041), indicating a stronger association in males (β=1.20, CI=0.81, 1.58, p<0.001) than females (β=0.53, CI=0.02, 1.03, p=0.042). Lifetime prevalence of binge eating was 1.13 times higher with increased escape-avoidance coping (CI=1.10, 1.18, p<0.001). DISCUSSION Our findings indicate significant associations among high NI, increased escape-avoidance coping, and higher lifetime prevalence of binge eating in adolescents. Findings of our study have potential to inform development of interventions that target modification of maladaptive personality traits and coping styles to reduce problematic eating.
Collapse
Affiliation(s)
- Angela E. Lee-Winn
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Baltimore, MD 21205, USA
| | - Lisa Townsend
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Baltimore, MD 21205, USA.
| | - Shauna P. Reinblatt
- The Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, 550 North Broadway, Room 206D, Baltimore, MD 21205 USA
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Baltimore, MD 21205, USA.
| |
Collapse
|
32
|
Cooper Z, Allen E, Bailey-Straebler S, Basden S, Murphy R, O'Connor ME, Fairburn CG. Predictors and moderators of response to enhanced cognitive behaviour therapy and interpersonal psychotherapy for the treatment of eating disorders. Behav Res Ther 2016; 84:9-13. [PMID: 27423373 PMCID: PMC4988513 DOI: 10.1016/j.brat.2016.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 05/18/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
Abstract
Consistent predictors, and more especially moderators, of response to psychological treatments for eating disorders have not been identified. The present exploratory study examined predictors and moderators of outcome in adult patients who took part in a randomised clinical trial comparing two leading treatments for these disorders, enhanced cognitive behavioural therapy (CBT-E) and interpersonal psychotherapy (IPT). Four potentially important findings emerged. Firstly, patients with a longer duration of disorder were less likely to benefit from either treatment. Second, across the two treatments the presence, at baseline, of higher levels of over-evaluation of the importance of shape predicted a less good treatment outcome. Third DSM-IV diagnosis did not predict treatment outcome. Fourth, with the exception of patients with baseline low self-esteem who achieved a better outcome with CBT-E, it was generally not possible to identify a subgroup of patients who would differentially benefit from one or other treatment.
Collapse
Affiliation(s)
- Zafra Cooper
- Oxford University, Department of Psychiatry, UK.
| | - Elizabeth Allen
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, UK
| | | | | | | | | | | |
Collapse
|
33
|
Manasse SM, Espel HM, Schumacher LM, Kerrigan SG, Zhang F, Forman EM, Juarascio AS. Does impulsivity predict outcome in treatment for binge eating disorder? A multimodal investigation. Appetite 2016; 105:172-9. [PMID: 27230611 DOI: 10.1016/j.appet.2016.05.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 01/20/2023]
Abstract
Multiple dimensions of impulsivity (e.g., affect-driven impulsivity, impulsive inhibition - both general and food-specific, and impulsive decision-making) are associated with binge eating pathology cross-sectionally, yet the literature on whether impulsivity predicts treatment outcome is limited. The present pilot study explored impulsivity-related predictors of 20-week outcome in a small open trial (n = 17) of a novel treatment for binge eating disorder. Overall, dimensions of impulsivity related to emotions (i.e., negative urgency) and food cues emerged as predictors of treatment outcomes (i.e., binge eating frequency and global eating pathology as measured by the Eating Disorders Examination), while more general measures of impulsivity were statistically unrelated to global eating pathology or binge frequency. Specifically, those with higher levels of negative urgency at baseline experienced slower and less pronounced benefit from treatment, and those with higher food-specific impulsivity had more severe global eating pathology at baseline that was consistent at post-treatment and follow-up. These preliminary findings suggest that patients high in negative urgency and with poor response inhibition to food cues may benefit from augmentation of existing treatments to achieve optimal outcomes. Future research will benefit from replication with a larger sample, parsing out the role of different dimensions of impulsivity in treatment outcome for eating disorders, and identifying how treatment can be improved to accommodate higher levels of baseline impulsivity.
Collapse
Affiliation(s)
| | - Hallie M Espel
- Drexel University, Department of Psychology, Philadelphia, PA, USA
| | | | | | - Fengqing Zhang
- Drexel University, Department of Psychology, Philadelphia, PA, USA
| | - Evan M Forman
- Drexel University, Department of Psychology, Philadelphia, PA, USA
| | | |
Collapse
|
34
|
Lee-Winn AE, Townsend L, Reinblatt SP, Mendelson T. Associations of Neuroticism and Impulsivity with Binge Eating in a Nationally Representative Sample of Adolescents in the United States. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016; 90:66-72. [PMID: 26705374 DOI: 10.1016/j.paid.2015.10.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Binge eating behavior is a public health concern with serious physical and mental health consequences. Certain personality traits have been found to contribute to the development of eating disorders in clinical samples of youth, but little is known about associations between personality traits and binge eating in the general adolescent population. We examined the associations of neuroticism and impulsivity-both independently and in combination-with lifetime prevalence of binge eating, using nationally representative, cross-sectional data from the National Comorbidity Survey: Adolescent Supplement (n=437). Neuroticism and impulsivity were each significantly associated with lifetime prevalence of binge eating (adjusted prevalence ratio [aPR]=1.11, confidence interval [CI]=1.07, 1.15, p<0.001; aPR=1.06, CI=1.04, 1.09, p<0.001, respectively). The combination of high neuroticism and high impulsivity was associated with higher lifetime binge eating than the combination of low neuroticism and low impulsivity (aPR=3.72, CI=2.45, 5.65, p<0.001), and this association was stronger for female than male adolescents (females: aPR=5.37, CI=3.24, 8.91, p<0.001 vs. males: aPR=2.45, CI=1.43, 4.22, p=0.002). Our findings have implications for informing theories of etiology and interventions to target binge eating behaviors.
Collapse
Affiliation(s)
- Angela E Lee-Winn
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Room 782 Baltimore, MD 21205, USA
| | - Lisa Townsend
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Room 898 Baltimore, MD 21205, USA,
| | - Shauna P Reinblatt
- The Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, 5300 Alpha Commons Drive 4th Floor Baltimore, MD 21224 USA,
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Room 853 Baltimore, MD 21205, USA,
| |
Collapse
|
35
|
Lydecker JA, Grilo CM. Different yet similar: Examining race and ethnicity in treatment-seeking adults with binge eating disorder. J Consult Clin Psychol 2015; 84:88-94. [PMID: 26348841 DOI: 10.1037/ccp0000048] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study examined racial/ethnic differences in demographic variables and the clinical presentation of treatment-seeking adults with binge eating disorder (BED) who participated in treatment research at a medical school-based program. METHOD Participants were 775 (n = 195 men, n = 560 women) treatment-seeking adults with DSM-IV-defined BED who self-identified as Black (n = 121), Hispanic (n = 54), or White (n = 580). Doctoral-level research clinicians assessed participants for BED and for eating disorder psychopathology using the Structured Clinical Interview for DSM-IV Disorders and the Eating Disorder Examination (EDE) interview, and measured height and weight. Participants also completed established self-report measures. RESULTS Black participants had a greater proportion of women than White participants and White participants had higher education than Black and Hispanic participants. Black participants had higher body mass index (BMI) and reported more frequent binge eating episodes than White participants but eating-disorder psychopathology (EDE scales and Global Severity) did not significantly differ across racial/ethnic groups. Black participants had lower levels of depression than Hispanic and White participants. These differences in clinical presentation remained unchanged after adjusting for age, education, sex, and BMI. White participants had younger ages of onset for dieting, binge eating, and obesity, but not BED, than Black and Hispanic participants. CONCLUSION There are some racial/ethnic differences in the developmental trajectories and clinical presentation of treatment-seeking adults with BED that remain unchanged after adjusting for demographic differences. Black participants presented for treatment with higher BMI and binge eating frequency than White participants and with lower depression than White and Hispanic groups, but associated eating disorder psychopathology levels were similar across racial/ethnic groups.
Collapse
|
36
|
Acceptance and Commitment Therapy for Women Diagnosed With Binge Eating Disorder: A Case-Series Study. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
37
|
Mama SK, Schembre SM, O'Connor DP, Kaplan CD, Bode S, Lee RE. Effectiveness of lifestyle interventions to reduce binge eating symptoms in African American and Hispanic women. Appetite 2015; 95:269-74. [PMID: 26188275 DOI: 10.1016/j.appet.2015.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 07/09/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Lifestyle interventions that promote physical activity and healthy dietary habits may reduce binge eating symptoms and be more feasible and sustainable among ethnic minority women, who are less likely to seek clinical treatment for eating disorders. The purpose of this study was to investigate (1) whether participating in a lifestyle intervention is a feasible way to decrease binge eating symptoms (BES) and (2) whether changes in BES differed by intervention (physical activity vs. dietary habits) and binge eating status at baseline (binger eater vs. non-binge eater) in African American and Hispanic women. METHOD Health Is Power (HIP) was a longitudinal randomized controlled trial to promote physical activity and improve dietary habits. Women (N = 180) who completed anthropometric measures and questionnaires assessing fruit and vegetable and dietary fat intake, BES and demographics at baseline and post-intervention six months later were included in the current study. RESULTS Over one-fourth (27.8%) of participants were categorized as binge-eaters. Repeated measures ANOVA demonstrated significant two- and three-way interactions. Decreases in BES over time were greater in binge eaters than in non-binge eaters (F(1,164) = 33.253, p < .001), and women classified as binge eaters who participated in the physical activity intervention reported greater decreases in BES than non-binge eaters in the dietary habits intervention (F(1,157) = 5.170, p = .024). DISCUSSION Findings suggest behavioral interventions to increase physical activity may lead to reductions in BES among ethnic minority women and ultimately reduce the prevalence of binge eating disorder and health disparities in this population.
Collapse
Affiliation(s)
- Scherezade K Mama
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1440, Houston, TX 77030-3906, USA; Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman St., Garrison Gym Rm 104, Houston, TX 77204-6015, USA.
| | - Susan M Schembre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1330, Houston, TX 77030, USA.
| | - Daniel P O'Connor
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman St., Garrison Gym Rm 104, Houston, TX 77204-6015, USA.
| | - Charles D Kaplan
- Hamovitch Center for Science in the Human Services, School of Social Work, University of Southern California, 669 W. 34th Street, Montgomery Ross Fisher Building, Los Angeles, CA 90089-0411, USA.
| | - Sharon Bode
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman St., Garrison Gym Rm 104, Houston, TX 77204-6015, USA.
| | - Rebecca E Lee
- College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd,St., Phoenix, AZ 85004, USA.
| |
Collapse
|
38
|
Abstract
INTRODUCTION Binge eating disorder (BED), a formal eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is characterized by recurrent binge eating, marked distress about binge eating, and the absence of extreme weight compensatory behaviors. BED is more prevalent than other eating disorders, with broader distribution across age, sex and ethnic/racial groups, and is associated strongly with obesity and heightened risk for psychiatric/medical comorbidities. AREAS COVERED This article provides an overview of pharmacotherapy for BED with a focus on Phase III randomized controlled trials (RCTs). The search with minimal methodological inclusion requirements yielded 22 RCTs investigating several different medication classes; most were pharmacotherapy-only trials with 8 trials testing combination approaches with psychological-behavioral methods. EXPERT OPINION The evidence base regarding pharmacotherapy for BED remains limited, although this year the FDA approved the first medication (i.e., lisdexamfetamine dimesylate; LDX) specifically for moderate-to-severe BED. Data from RCTs suggest certain medications are superior to placebos for reducing binge eating over the short term; almost no data exist regarding longer-term effects of pharmacotherapy for BED. Except for topiramate, which significantly reduces both binge eating and weight, tested medications yield minimal weight loss and LDX is not indicated for weight loss. Psychological-behavioral and combination approaches with certain medications yield superior outcomes to pharmacotherapy-only acutely and over longer-term follow-up.
Collapse
Affiliation(s)
- Deborah L Reas
- Oslo University Hospital, Regional Department for Eating Disorders, Division of Mental Health and Addiction , Oslo , Norway +43 664 1880 910;
| | | |
Collapse
|
39
|
Lammers MW, Vroling MS, Ouwens MA, Engels RCME, van Strien T. Predictors of outcome for cognitive behaviour therapy in binge eating disorder. EUROPEAN EATING DISORDERS REVIEW 2015; 23:219-28. [PMID: 25802175 DOI: 10.1002/erv.2356] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/04/2015] [Accepted: 02/22/2015] [Indexed: 12/12/2022]
Abstract
The aim of this naturalistic study was to identify pretreatment predictors of response to cognitive behaviour therapy in treatment-seeking patients with binge eating disorder (BED; N = 304). Furthermore, we examined end-of-treatment factors that predict treatment outcome 6 months later (N = 190). We assessed eating disorder psychopathology, general psychopathology, personality characteristics and demographic variables using self-report questionnaires. Treatment outcome was measured using the bulimia subscale of the Eating Disorder Inventory 1. Predictors were determined using hierarchical linear regression analyses. Several variables significantly predicted outcome, four of which were found to be both baseline predictors of treatment outcome and end-of-treatment predictors of follow-up: Higher levels of drive for thinness, higher levels of interoceptive awareness, lower levels of binge eating pathology and, in women, lower levels of body dissatisfaction predicted better outcome in the short and longer term. Based on these results, several suggestions are made to improve treatment outcome for BED patients.
Collapse
Affiliation(s)
- Mirjam W Lammers
- Amarum, Expertise Centre for Eating Disorders, GGNet Network for Mental Health Care, The Netherlands
| | | | | | | | | |
Collapse
|
40
|
Shingleton RM, Thompson-Brenner H, Thompson DR, Pratt EM, Franko DL. Gender differences in clinical trials of binge eating disorder: An analysis of aggregated data. J Consult Clin Psychol 2015; 83:382-6. [PMID: 25730521 DOI: 10.1037/a0038849] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of the study was to examine gender differences in baseline and outcome variables in clinical trials for binge eating disorder (BED). METHOD Data from 11 randomized controlled psychosocial treatment studies were aggregated (N = 1,325: 208 male, 1,117 female). Baseline and outcome symptoms were assessed via the interview and questionnaire versions of the Eating Disorder Examination (EDE). Multilevel analyses were conducted investigating gender differences at baseline and posttreatment, defined as EDE scores, objective binge episode (OBE) reduction, and OBE remission at termination. RESULTS Few males from low socioeconomic status or minority groups participated in the outcome studies. Males reported significantly lower EDE global, shape, weight, and eating concerns at baseline. No main effects of gender were found in treatment outcome scores when controlling for baseline differences; however, baseline EDE global score (which showed gender differences at baseline) and OBEs directly predicted outcome for both males and females. A significant interaction between gender, treatment length, and shape/weight concerns indicated that males with lower shape/weight concerns achieved OBE remission in shorter treatments, whereas men with high shape/weight concerns and women with either high or low shape/weight concerns were more likely to achieve OBE remission in treatments of longer duration. CONCLUSIONS These results suggest BED treatment studies must improve their recruitment of men and appeal to men with lower shape/weight concerns. Additionally, longer term treatments, although more efficacious for women and men with more severe shape/weight concerns, may not be necessary for men with low shape/weight concerns. (PsycINFO Database Record
Collapse
Affiliation(s)
| | | | | | | | - Debra L Franko
- Department of Counseling and Applied Educational Psychology, Northeastern University
| |
Collapse
|
41
|
Grilo CM, Masheb RM, White MA, Gueorguieva R, Barnes RD, Walsh BT, McKenzie KC, Genao I, Garcia R. Treatment of binge eating disorder in racially and ethnically diverse obese patients in primary care: randomized placebo-controlled clinical trial of self-help and medication. Behav Res Ther 2014; 58:1-9. [PMID: 24857821 DOI: 10.1016/j.brat.2014.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/30/2022]
Abstract
The objective was to determine whether treatments with demonstrated efficacy for binge eating disorder (BED) in specialist treatment centers can be delivered effectively in primary care settings to racially/ethnically diverse obese patients with BED. This study compared the effectiveness of self-help cognitive-behavioral therapy (shCBT) and an anti-obesity medication (sibutramine), alone and in combination, and it is only the second placebo-controlled trial of any medication for BED to evaluate longer-term effects after treatment discontinuation. 104 obese patients with BED (73% female, 55% non-white) were randomly assigned to one of four 16-week treatments (balanced 2-by-2 factorial design): sibutramine (N = 26), placebo (N = 27), shCBT + sibutramine (N = 26), or shCBT + placebo (N = 25). Medications were administered in double-blind fashion. Independent assessments were performed monthly throughout treatment, post-treatment, and at 6- and 12-month follow-ups (16 months after randomization). Mixed-models analyses revealed significant time and medication-by-time interaction effects for percent weight loss, with sibutramine but not placebo associated with significant change over time. Percent weight loss differed significantly between sibutramine and placebo by the third month of treatment and at post-treatment. After the medication was discontinued at post-treatment, weight re-gain occurred in sibutramine groups and percent weight loss no longer differed among the four treatments at 6- and 12-month follow-ups. For binge-eating, mixed-models revealed significant time and shCBT-by-time interaction effects: shCBT had significantly lower binge-eating frequency at 6-month follow-up but the treatments did not differ significantly at any other time point. Demographic factors did not significantly predict or moderate clinical outcomes. Our findings suggest that pure self-help CBT and sibutramine did not show long-term effectiveness relative to placebo for treating BED in racially/ethnically diverse obese patients in primary care. Overall, the treatments differed little with respect to binge-eating and associated outcomes. Sibutramine was associated with significantly greater acute weight loss than placebo and the observed weight-regain following discontinuation of medication suggests that anti-obesity medications need to be continued for weight loss maintenance. Demographic factors did not predict/moderate clinical outcomes in this diverse patient group.
Collapse
Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, United States.
| | - Robin M Masheb
- Department of Psychiatry, Yale University School of Medicine, United States
| | - Marney A White
- Department of Psychiatry, Yale University School of Medicine, United States
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale University School of Public Health, United States
| | - Rachel D Barnes
- Department of Psychiatry, Yale University School of Medicine, United States
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University School of Medicine, United States
| | - Katherine C McKenzie
- Department of General Internal Medicine, Yale University School of Medicine, United States
| | - Inginia Genao
- Department of General Internal Medicine, Yale University School of Medicine, United States
| | - Rina Garcia
- Department of General Internal Medicine, Yale University School of Medicine, United States
| |
Collapse
|
42
|
Reyes-Rodríguez ML, Bulik CM, Hamer RM, Baucom DH. Promoviendo una Alimentación Saludable (PAS) design and methods: engaging Latino families in eating disorder treatment. Contemp Clin Trials 2013; 35:52-61. [PMID: 23376815 PMCID: PMC3640683 DOI: 10.1016/j.cct.2013.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/18/2013] [Accepted: 01/27/2013] [Indexed: 11/21/2022]
Abstract
The use of culturally sensitive intervention could improve mental health care for the eating disorder (ED) treatment in the Latino population. The aim of this report is to describe the rationale, design, and methods of the ongoing study entitled "Engaging Latino families in eating disorders treatment." The primary aim of the study is to compare (a) the combined effect of individual cognitive behavioral therapy for bulimia nervosa (CBT-BN) that has been previously adapted for the Latino population plus Family Enhanced (FE) modules, with (b) the standard adapted individual CBT-BN in a proof-of-principle study with 40 Latina adults with eating disorders and one relative or significant other per patient. We hypothesize that 1) the feasibility, acceptability, and adherence of participants in CBT-BN+FE will be superior to individual CBT-BN only; 2) relatives in CBT-BN+FE will report greater treatment satisfaction, greater reduction in family conflict, and greater decreases in caregiver burden than relatives in the individual CBT-BN only condition; and 3) patients who participate in CBT-BN+FE will show trends towards greater decreases in ED symptoms compared with patients in CBT-BN only; although power will be limited to detect this difference. However, we predict that they will show greater retention in treatment, greater treatment satisfaction, and greater decreases in family conflict than patients in CBT-BN only. The completion of this investigation will yield important information regarding the acceptability and feasibility of a culturally sensitive evidence-based treatment model for Latinos with eating disorders.
Collapse
Affiliation(s)
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
- Department of Nutrition, University of North Carolina, Chapel Hill, NC
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Donald H. Baucom
- Department of Psychology, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
43
|
Shingleton RM, Richards LK, Thompson-Brenner H. Using technology within the treatment of eating disorders: a clinical practice review. ACTA ACUST UNITED AC 2013; 50:576-82. [PMID: 23527906 DOI: 10.1037/a0031815] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The focus of this clinical practice review is to provide clinicians a framework for incorporating technology into the treatment of eating disorders (EDs). We detailed studies that were published within the past 11 years (2002-2012) and that included at least 10 participants. Our primary aims were to describe how technology has been used to enhance the delivery of ED treatment as well as report the effectiveness of these technology-based interventions. We also provided clinical applications and considerations for clinicians who wish to use technology within their own practice. We found that a range of technologies (e.g., televideo, e-mail, CD-ROM, Internet, text message) have been used as a means to either deliver or enhance treatment at various levels of care (e.g., therapy, guided self-help, treatment adjunct). The majority of the studies were based on cognitive-behavioral principles and included samples diagnosed with bulimia nervosa (BN), binge eating disorder (BED), or subclinical levels of BN or BED. Most researchers reported positive results, with a few caveats such as technology-based interventions may not be optimal for individuals with more severe pathology, and some individuals described wanting more personal interaction. The overarching finding was that technology may be successfully integrated within ED treatment and may offer new ways to extend ED interventions to individuals who may not otherwise have access to specialty ED care.
Collapse
Affiliation(s)
- Rebecca M Shingleton
- Psychology Department, Center for Anxiety and Related Disorders (CARD) at Boston University
| | | | | |
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|