An important problem with obese patients suffering from binge eating disorders (BED) is to treat their dysfunctional eating patterns while initiating a weight loss. We propose to assess a cognitive-behavioral therapy combined with a nutritional and a physical activity program. Our purpose is to verify that the addition of a nutritional and a physical program leads to a significant weight loss and enables psychological improvement. The patients (n=61) participated in a 12 weekly sessions group treatment of either a purely cognitive-behavioral therapy, or a cognitive-behavioral therapy associated to a nutritional approach mainly focused on fat restriction, or to a cognitive-behavioral therapy combined with a nutritional and a physical activity approach. The mean weight loss is significant (p<0.01) after the association of the cognitive-behavioral therapy and the nutritional education, but is even more significant (p<0.001) after the combination of a cognitive-behavioral therapy with a nutritional education and a physical activity program. Depression scores decrease in the three approaches, anxiety (p<0.05) results improve only in the combined nutritional, physical activity and cognitive-behavioral approach. Eating disorders improved significantly in all three approaches even if improvements in subscales seem more important in the combined approach. Finally, exercise seems to be a positive addition to the nutritional cognitive-behavioral therapy since it decreases negative mood, improves eating disorders and leads to an effective body weight loss.

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Dans l'obésité, les dimensions physiopathologiques et somatiques de la maladie sont étroitement tissées avec l'histoire de vie et les comportements intimes de l'individu. Cette complexité amène les soignants à questionner leur façon de concevoir l'éducation thérapeutique du patient et à développper de nouvelles modalités d'apprentissage, mettant en jeu les dimensions cognitives mais aussi émotionnelles et sensorielles de la personne

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