This application seeks funds to conduct a study of cognitive behavioral and behavioral weight loss treatments for obese patients with binge eating disorder (BED). The proposed study builds directly upon the findings of the initial project that examined the efficacy of fluoxetine treatment and cognitive behavioral therapy (CBT) and the relative efficacy of the treatments alone and in combination for patients with BED (balanced 2 x 2 factorial design). CBT produced significant and clinically meaningful improvements in the behavioral (binge eating), cognitive (attitudinal features of eating disorders), and associated psychological (depression) features of BED, but not for the physical problem of obesity. In the 2 x 2 factorial design: (1) CBT was superior to treatment without CBT, treatment with fluoxetine was not superior to treatment without fluoxetine, and no interaction between treatments occurred; (2) Specific comparisons among specifc treatments revealed that fluoxetine was not superior to placebo, CBT + Placebo and CBT + Fluoxetine were similar, and CBT + Placebo and CBT + Fluoxetine were superior to Fluoxetine-only and Placebo-only. Findings suggest that CBT has efficacy for the behavioral, cognitive, associated psychological features of BED. The strong association between BED and obesity, and the major health risks associated with obesity highlight the need for developing interventions that also reduce weight. It remains uncertain whether behavioral weight loss (BWL) has efficacy for producing weight loss in BED or for reducing binge eating and its associated features. The proposed study involves a comparison of three treatment conditions: (1) CBT; (2) BWL, and (3) a sequential (two-part) treatment consisting of CBT followed by BWL. Assessments will occur at baseline, bimonthly during treatment, and 6-and 12-months post-treatment. The primary specific aim is to test the relative efficacy of CBT, BWL, and a sequential treatment consisting of CBT followed by BWL. Secondary aims are to (1) explore predictors and processes of change during the acute treatment and follow-up period, and (2) examine whether (a) BWL ("dieting") after the CBT produces weight loss, and (b) weight regain (if it occurs following BWL) is accompanied/followed by reoccurrence of binge eating, attitudinal features of eating disorders, psychological distress, or psychiatric disturbances.
NIH ExPorter
NIH ExPorter