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Am Fam Physician. 2010;82(5):534

Background: Several psychological treatments have shown promise in treating binge eating disorder. Interpersonal psychotherapy can effectively treat binge eating and associated psychopathology, but requires specialized training. Behavioral weight loss treatment and guided self-help based on cognitive behavior therapy can be implemented by a wider range of health professionals than interpersonal psychotherapy and have been shown to have short-term benefits against binge eating disorder. However, their long-term effectiveness is unknown. Wilson and colleagues compared short- and long-term treatment results for binge eating disorder using specialized therapies.

The Study: A total of 205 adults who met the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria for binge eating disorder were randomly assigned to receive 19 sessions of interpersonal psychotherapy, 20 sessions of behavioral weight loss treatment, or 10 sessions of cognitive behavior therapy. All participants had an initial body mass index (BMI) between 27 and 45 kg per m2 (i.e., overweight or obese). Participants were reassessed after the treatment phase, and then followed for 24 months to assess binge eating habits and weight. Exclusion criteria included uncontrolled psychiatric conditions (e.g., psychosis), substance abuse, current participation in a structured weight loss program, pregnancy, or use of medications that would affect weight.

Results: The interpersonal psychotherapy group had significantly less attrition than the other groups (7 versus 28 percent for behavioral weight loss treatment and 30 percent for cognitive behavior therapy). All three methods initially yielded similar binge eating disorder remission rates of approximately 64 percent, but after two years patients using cognitive behavior therapy or interpersonal psychotherapy were more likely to remain in remission than those using behavioral weight loss treatment (see accompanying table). Similar proportions of patients in each group maintained a 5 percent or greater body weight reduction after two years (21 percent for interpersonal psychotherapy, 23 percent for cognitive behavior therapy, and 27 percent for behavioral weight loss treatment).

InterventionOdds ratios
Interpersonal psychotherapy vs. behavioral weight loss treatment2.6
Guided self-help based on cognitive behavior therapy vs. behavioral weight loss treatment2.3
Interpersonal psychotherapy vs. guided self-help based on cognitive behavior therapy1.2

Conclusion: The authors conclude that interpersonal psychotherapy and cognitive behavior therapy are more effective than behavioral weight loss treatment in reducing binge eating behaviors after two years, with no difference in BMI noted among the groups. Cognitive behavior therapy should be considered a first-line treatment for most patients with binge eating disorder. Interpersonal psychotherapy should still be considered the treatment of choice for those who are more likely to benefit from more structured management (e.g., low self-esteem and a high level of specific eating disorder psychopathology).

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