The Efficacy of Psychological Therapies in Reducing Weight and Binge Eating in People with Bulimia Nervosa and Binge Eating Disorder Who Are Overweight or Obese—A Critical Synthesis and Meta-Analyses

Abstract

Recurrent binge eating episodes, the core feature of Bulimia Nervosa (BN) and Binge Eating Disorder (BED), are frequently comorbid with obesity. Psychological interventions, notably Cognitive Behavioural Therapy (CBT), are effective for binge eating reduction in BED or BN but less so for weight loss. Behavioural Weight Loss Therapy (BWLT) shows effectiveness for binge eating reduction and weight loss but the latter appears poorly sustained over time. Our aim was to review evidence for efficacy of psychological therapies for BN/BED associated with overweight or obesity in reducing binge frequency and weight. A systematic search for randomized controlled trials with adult samples who had BN or BED was conducted considering articles in English, French, Spanish and Portuguese with no restrictions for the timeline publication ending in March 2016. A quality appraisal of the trials and meta-analyses comparing BWLT to CBT were done. This review identified 2248 articles for screening and 19 published articles were selected. No trials of BN were identified. This review found CBT was favoured compared to BWLT with regard to short-term binge eating reduction. However, insufficient evidence was found for superiority for BWLT efficacy compared to CBT considering binge eating remission, reduction of binge eating frequency and weight loss. More research is needed to test the efficacy of psychological treatments for BED or BN with co-morbid overweight or obesity, including trials evaluating binge eating remission and weight loss in the long-term.

Emotion-Focused Cognitive Behavioral Therapy in Comorbid Obesity With Binge Eating Disorder: A Pilot Study of Feasibility and Long-Term Outcomes

“…However, recent data suggest that comorbid obesity and BED is increasing at a faster rate than obesity alone (Darby et al, 2009;da Luz et al, 2017). Moreover, weight loss has proven to be significantly greater in patients with obesity who achieved and sustained binge remission in the long-term (Palavras et al, 2017). These findings suggest that these two problems, which are often studied and treated separately, should be addressed together.…”

“…In spite of this, psychological therapies have mostly been borrowed by general obesity management (Amianto et al, 2015) and do not explore the relationship between these two conditions. Effective integrated approaches to obesity and BED that relieve the dysfunction due to overeating while enhancing appropriate weight loss are required (Palavras et al, 2017).…”

“…To date, Cognitive Behavioral Therapy (CBT) is recognized as the best established treatment for obesity (for review see Brennan et al, 2014;Castelnuovo et al, 2017;Jacob et al, 2018) and obesity coupled with BED (for review see Duchesne et al, 2007;Palavras et al, 2017). In regard to emotional eating, the efficacy of CBT has been revealed to be superior to other interventions [cf.…”

Rates of abstinence following psychological or behavioral treatments for binge‐eating disorder: Meta‐analysis

“…Several meta‐analyses examining the efficacy of psychological treatments for BED on abstinence have been published (Linardon, Fairburn, et al, ; Linardon, Wade, de la Piedad Garcia, & Brennan, ; Palavras, Hay, & Claudino, ; Peat et al, ; Vocks et al, ). With the exception of Vocks et al (), these meta‐analyses examined between‐groups differences.…”

Precision psychiatry—What it means for eating disorders?

“…Precision medicine has the potential to revolutionise psychiatry, offering a range of exciting opportunities for optimising the prevention, diagnosis, and treatment of mental disorders. It is therefore time for us to move away from a "one size fits all" approach whereby we use evidence about the average effect of a treatment to tailored, individual treatment using an in-depth characterisation of the individual (Brockmeyer, Friederich, & Schmidt, 2018;Nazar et al, 2016;Palavras, Hay, Filho, & Claudino, 2017;Peat et al, 2017). Elements of a clinical signature for disease may include signs, symptoms, outcome trajectory, and biomarkers such as genome (Stein & Smoller, 2018), connectome (Riva-Posse et al, 2018), inflammasome ("Big data meets mechanism," 2015) and cognitive/emotional traits (Cotter & Barnett, 2018).…”