Binge eating can have many negative outcomes. People who engage in binge eating (BED) tend to have a higher body mass index (BMI) than those who do not, and are at increased risk for obesity, which can lead to a range of health problems. Treating BED has been shown to be very difficult, as a number of factors influence behavior in BED and ultimate treatment outcome. Two of the most common methods for treating BED are cognitive behavioral therapy (CBT) and the use of antidepressant medication, with or without CBT. Carlos M. Grilo of the Department of Psychiatry at Yale University’s School of Medicine in Connecticut wanted to compare treatment forms. In a recent study, Grilo assessed 108 clients prior to, during, and after treatment for BED using CBT alone, fluoxetine, or placebo.
Grilo found that several variables determined outcome in the sample of participants. First, the youngest participants saw the biggest improvements when they received fluoxetine only. But for those with low self-esteem, overvaluation of body context and negative affect, CBT proved more effective. In fact, overvaluation emerged as the most significant predictor of BED remission. Not only did the participants with high levels of body awareness and sensitivity toward their weight in relation to their image see bigger improvements in BED frequency, they also saw decreases in psychopathology related to BED and decreases in depression. Overvaluation also appeared to improve remission rates in individuals who received medication only.
“These findings suggest that, among patients with BED, overvaluation accounts prospectively for unique and meaningful variation in binge eating, eating disorder psychopathology, and depression treatment outcomes,” Grilo said. He added that the largest weight losses occurred in participants with negative affect, low self-esteem, and high levels of depression. These same individuals also had fewer episodes of binge-eating post-treatment when compared to those with more positive psychological states, especially those in the medication-only group. In sum, the findings from this study, although gathered from over a short period of time from a primarily white sample, give clues as to the varying factors that contribute to treatment outcome success in individuals with BED.
Grilo, Carlos M., Robin M. Masheb, and Ross D. Crosby. Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder. Journal of Consulting and Clinical Psychology 80.5 (2012): 897-906. Print.
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