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For obese binge eaters, good news and bad news

January 4, 2010 |  2:35 pm

Binge eaters who get a specialized form of talk therapy aimed at reducing their bingeing behavior are more likely than those who participate in a weight-loss program to shed their eating disorder two years after treatment, a new study finds. But among binge eaters who are obese, no treatments led to long-term weight loss.

Those findings are the newest evidence that binge eating--a pattern of frequent out-of-control consumption accompanied by guilt and shame and often contributing to obesity--may yield to therapies tailored to treating the disorder. But it also suggests that obesity--which affects most binge eaters--is tougher to treat, and will likely not go away even if the bingeing behavior is extinguished. The study, published in the Archives of General Psychiatry, comes as the American Psychiatric Assn. ponders whether binge eating should be recognized as an eating disorder distinct from bulimia and anorexia when the psychiatric community releases its updated diagnostic manual in 2013.

The study pitted three kinds of treatment--interpersonal therapy, a form of cognitive behavioral therapy described as "guided self-help," and a behavioral weight-loss program--against each other for 24 weeks. Immediately following the interventions and a year later, all three appeared to have roughly equal success in reducing the central--psychological--symptoms of binge eating disorder. The behavioral weight-loss program, however, resulted in greater weight loss at the earliest assessment period.

A year later, all three treatments still looked to have had similar rates of success in alleviating binge-eating symptoms. But by the two-year post-treatment mark, the two forms of talk therapy appeared far superior to the behavioral weight-loss program in maintaining a remission of binge-eating symptoms. Meanwhile, those in the behavioral weight-loss group steadily gained back the weight they had lost during the program; in the end, the number of subjects in all three intervention groups who had lost 5% of their body weight and kept it off showed statistically little difference: 21% of those in interpersonal therapy, 23% of those in cognitive behavioral therapy and 27% of those that had been in the behavioral weight-loss program were able to maintain a 5% weight loss. 

The study, led by Rutgers University psychologist G. Terence Wilson, underscores that, in treating binge eating disorder, treating the symptom--obesity--probably doesn't pay in the long run. And it's not effective either.

Think you may have a binge-eating problem? A good place to start is here, but also see our recent report on the subject, as well the fledgling support and advocacy organization for Binge Eating Disorder, here. Many people report they have had great success with Overeaters Anonymous, a 12-step program that views overeating as a form of addiction. To get the take of one of the nation's best-regarded binge-eating programs, check out the eating disorders program at Duke University.

-- Melissa Healy

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