But a first-of-a-kind study conducted by researchers at the Kaiser Permanente Center for Health Research, Wesleyan University and Rutgers University found that more than 63 percent of participants had stopped binging at the end of the program – compared to just over 28 percent of those who did not participate. The program lasted only 12 weeks, but most of the participants were still binge free a year later. A second study, also published in the April issue of the Journal of Consulting and Clinical Psychology, found that program participants saved money because they spent less on things like dietary supplements and weight loss programs.

“It is unusual to find a program like this that works well, and also saves the patient money. It’s a win-win for everyone,” said study author Frances Lynch, PhD, MSPH, a health economist at the Kaiser Permanente Center for Health Research. “This type of program is something that all health care systems should consider implementing.”

“People who binge eat more than other people do during a short period of time and they lose control of their eating during these episodes. Binge eating is often accompanied by depression, shame, weight gain, loss of self-esteem and it costs the healthcare system millions of extra dollars,” said the study’s principal investigator Ruth H. Striegel-Moore, PhD, a professor of psychology at Wesleyan University. “Our studies show that recurrent binge eating can be successfully treated with a brief, easily administered program, and that’s great news for patients and their providers.”

Binge eating has received a lot of media attention recently because the American Psychiatric Association is recommending that it be considered a separate, distinct eating disorder like bulimia and anorexia. This new diagnosis can be expected to focus more attention on binge eating and how best to treat it, according to the researchers. It also could influence the number of people diagnosed and how insurers will cover treatment.

This randomized controlled trial, conducted in 2004-2005, involved 123 members of the Kaiser Permanente health plan in Oregon and southwest Washington. More than 90 percent of them were women, and the average age was 37. To be included in the study, participants had to have at least one binge eating episode a week during the previous three months with no gaps of two or more weeks between episodes.

Half of the participants were enrolled in the intervention and asked to read the book “Overcoming Binge Eating” by Dr. Christopher Fairburn, a professor of psychiatry and expert on eating disorders. The book details scientific information about binge eating and then outlines a six-step self-help program using self-monitoring, self-control and problem-solving strategies. Participants in the study attended eight therapy sessions over the course of12 weeks in which counselors explained the rationale for cognitive behavioral therapy and helped participants apply the strategies in the book. The first session lasted one hour, and subsequent sessions were 20-25 minutes. The average cost of the intervention was $167 per patient.

All participants were mailed fliers detailing the health plan’s offerings for healthy living and eating and encouraged to contact their primary care physician to learn about more services.

By the end of the 12-week program 63.5 percent of participants had stopped binging, compared to 28.3 percent of those who did not participate. Six months later, 74.5 percent of program participants abstained from binging, compared to 44.1 percent in usual care. At one year, 64.2 percent of participants were binge free, compared to 44.6 percent of those in usual care.

Everyone in the trial was asked to provide extensive information about their binge eating episodes, how often they missed work or were less productive at work, and the amount they spent on health care, weight-loss programs and weight loss supplements. Researchers also examined expenditures on medications, doctor visits, and other health-related services.

The researchers then compared these costs between the two groups and found that average total costs were $447 less in the intervention group. This included an average savings of $149 for the participants, who spent less on weight loss programs, over-the-counter medications and supplements. Total costs for the intervention group were $3,670 per person per year, and costs for the control group were $4,098.

As expected, participants in the intervention group spent less on weight loss programs and over-the-counter medications and supplements.

“While program results are promising, we highly encourage anyone who has problems with binge eating to consult with their doctors to make sure this program is right for them,” said study co-author Lynn DeBar, PhD, clinical psychologist at the Kaiser Permanente Center for Health Research.

Study authors include: Lynn DeBar, John F. Dickerson, Frances Lynch and Nancy Perrin from the Kaiser Permanente Center for Health Research in Portland, Oregon; Ruth H. Striegel-Moore and Francine Rosselli from Wesleyan University; G. Terence Wilson from Rutgers, The State University of New Jersey; and Helena C. Kraemer from the Stanford University School of Medicine.

Source:
Emily Schwartz
GolinHarris International

Half of women fit into two other categories, the study says, and were found to be the least likely to be leaning toward fat. Both types of women in those groups are concerned about nutrition and like to eat healthy.

“The basic attitude that people have about food is related to the likelihood that they’re at risk for obesity and weight gain,” said researcher Dennis Degeneffe, a study co-author.

The study, which appears in the December issue of the journal Health Education & Behavior, placed 200 women into five groups based on their attitudes about food. The women had an average age of 46, were well-educated (two-thirds had a four-year degree or higher) and 86 percent were white.

The researchers then compared the groups of women by measurements such as percentage of body fat, waist size and body mass index (BMI).

Those deemed to be “concerned about nutrition” (determined to eat well) and “creative cooks” (focused on food for their families) scored the lowest in the weight categories. “Impulsive eaters” and “guilt-ridden dieters” scored the highest, with “busy cooking avoiders” in the middle.

“Women in the middle group tend to lead busy lifestyles and are often preoccupied with other activities and responsibilities, with eating generally taking a back seat,” said Degeneffe, a research fellow at the University of Minnesota’s Food Industry Center.

Cynthia Sass, a registered dietitian and author in New York City, said the categories defined in the study “truly parallel what I see with my clients and women I talk to regarding how food and nutrition fit into their lives.”

“I have found that women who have a big responsibility to take care of their families appear to do less well at taking care of themselves, food-wise,” she said. In some cases, she said, food helps them to feel rewarded and cope with their lives.

She urges them to focus on their own needs “because taking better care of themselves will help them have the physical and emotional wellness they need to continue taking care of their families.”

Treating these kinds of women can be tough, said Lona Sandon, an assistant professor at the University of Texas Southwestern and national spokesperson for the American Dietetic Association. “Health and nutrition may be important to them, but convenience often wins,” she said. “It is very challenging to come up with solutions to help these women lose weight if they are not willing or able to give up something else in their life.”

Health Education & Behavior, a peer-reviewed journal of the Society for Public Health Education (SOPHE), publishes research on critical health issues for professionals in the implementation and administration of public health information programs. For information, contact Laura Drouillard at (202) 408-9804.

Sudo, N, et al. Relationship between attitudes and indicators of obesity for midlife women. Health Education & Behavior 36(6), 2009.

Source: Health Behavior News Service

People with bulimia experience cycles of disordered eating behavior in which they overeat and then purge, often by self-induced vomiting or taking laxatives. Binge eating disorder includes bouts of overeating, but without purging, and researchers have linked it to obesity.

Eating disorders are most common in women, with bulimia affecting about 1 percent of women and binge eating disorder affecting 2 percent to 5 percent. Although bulimia rates appear stable, binge eating disorder increasingly is becoming common.

The review included 48 studies with 3,054 participants and strengthened earlier findings in favor of cognitive behavioral therapy. It found that 37 percent of people completely stopped binge eating when given CBT focused on binging while 3 percent of those assigned to a waiting list control group quit.

Other therapies were less successful than CBT, helping 22 percent of participants achieve abstinence from binging by the end of treatment. One approach called interpersonal therapy did achieve comparable results but took months longer to do so.

Lead author Phillipa Hay, M.D., is foundation chair of mental health at the University of West Sydney in Australia. “Cognitive behavioral therapy is really the treatment of choice,” she said. “It has far and away the best evidence. It hadn’t really been so definitively found in previous reviews.”

The review appears in the latest issue of The Cochrane Library, which is a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Cynthia Bulik, Ph.D., is director of the University of North Carolina Eating Disorders Program at Chapel Hill. Bulik, who had no connection with the review, said the key findings are that “bulimia nervosa is treatable; that some treatment is better than no treatment; that CBT is associated with the best outcome for bulimia nervosa.”

The original intent of CBT was to treat depression. A modified type of CBT in the studies focuses specifically on binge eating disorder symptoms. Nonetheless, participants also experienced significant improvements in mood.

“Many people have problems with depression secondary to binge eating disorders,” Hay said. “They often feel anxious and guilty because of their binging so if the eating disorder improves, the depression improves as well. We did look at the effects of CBT [for binge eating] on depression and it does help depression significantly just in itself.”

Weight, however, did not change with treatment. “None of these psychotherapies really affect people’s weight, which is good thing for people with bulimia who are normal weight but for those who are overweight or obese, they will need weight-loss therapies as well,” Hay said.

Cognitive behavioral treatment of bulimia or binge eating disorder typically involves 15 to 20 outpatient sessions with a therapist over a five-month period. CBT works by helping patients change the way they think about their behavior.

“CBT rests on the premise that unhealthy thoughts lie at both the roots of bulimia nervosa and in the maintenance of unhealthy eating behaviors,” Bulik said. “The goals of CBT are first to have the patient become his or her own detective and via self-monitoring start to understand their patterns of binge eating and purging and recognize and anticipate the cues (triggers) for their unhealthy behaviors.” Once these patterns and the thoughts that drive them are identified, they can be challenged and addressed.

Hay gave the example of someone who, after binging, skips lunch and breakfast the following day. That can easily produce another binge because the craving caused by intense hunger is harder to resist. The therapist would help the patient see that eating healthy meals after a binge would break the cycle, even though fasting might initially seem like a better solution.

The review also compared CBT done in conjunction with a therapist to self-help using books that teach its techniques and tactics. While guided CBT was more effective, there was not much research on self-help and Hay says the approach is “promising” and that it should receive further study. There has been more research on bulimia than binge-eating disorder so more data would help clarify the best approaches to the latter.

Other studies have found that antidepressants can help fight bulimia and binge eating. While this review did not compare medication to psychotherapy, Hay says clinicians should try CBT first because more people stick with it. “The dropout rate is quite significantly higher with drugs,” she says.

“Some treatment is better than none,” Bulik said. “If you can’t find a therapist [who practices CBT for binge eating], don’t throw in the towel find another kind of therapist, pick up a self-help book, do something because the outcome will be better than doing nothing at all.”

The Cochrane Library contains high quality health care information, including Systematic Reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions. The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.

Source: Health Behavior News Service