Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
J Consult Clin Psychol. 2011 Oct;79(5):675-85. doi: 10.1037/a0025049.
Cognitive-behavioral therapy (CBT) is the best established treatment for binge-eating disorder (BED) but does not produce weight loss. The efficacy of behavioral weight loss (BWL) in obese patients with BED is uncertain. This study compared CBT, BWL, and a sequential approach in which CBT is delivered first, followed by BWL (CBT + BWL).
125 obese patients with BED were randomly assigned to 1 of the 3 manualized treatments delivered in groups. Independent assessments were performed posttreatment and at 6- and 12-month follow-ups.
At 12-month follow-up, intent-to-treat binge-eating remission rates were 51% (CBT), 36% (BWL), and 40% (CBT + BWL), and mean percent BMI losses were -0.9, -2.1, and 1.5, respectively. Mixed-models analyses revealed that CBT produced significantly greater reductions in binge eating than BWL through 12-month follow-up and that BWL produced significantly greater percent BMI loss during treatment. The overall significant percent BMI loss in CBT + BWL was attributable to the significant effects during the BWL component. Binge-eating remission at major assessment points was associated significantly with greater percent BMI loss cross-sectionally and prospectively (i.e., at subsequent follow-ups).
CBT was superior to BWL for producing reductions in binge eating through 12-month follow-up, while BWL produced statistically greater, albeit modest, weight losses during treatment. Results do not support the utility of the sequential approach of providing BWL following CBT. Remission from binge eating was associated with significantly greater percent BMI loss. Findings support BWL as an alternative treatment option to CBT for BED.
认知行为疗法（CBT）是治疗暴食症（BED）的最佳方法，但不能减轻体重。对于患有 BED 的肥胖患者，行为体重减轻（BWL）的疗效尚不确定。本研究比较了 CBT、BWL 以及先进行 CBT 后进行 BWL（CBT+BWL）的序贯方法。
125 名患有 BED 的肥胖患者被随机分配到 3 种手动治疗组中的 1 种。在治疗后、6 个月和 12 个月的随访中进行独立评估。
在 12 个月的随访中，意向性治疗暴食缓解率分别为 51%（CBT）、36%（BWL）和 40%（CBT+BWL），平均 BMI 损失百分比分别为-0.9、-2.1 和 1.5。混合模型分析显示，CBT 在 12 个月的随访中显著减少了暴食，而 BWL 在治疗期间显著减轻了 BMI。CBT+BWL 的总体显著 BMI 损失归因于 BWL 成分的显著效果。在主要评估点的暴食缓解与横断和前瞻性（即在随后的随访中）的更大 BMI 损失百分比显著相关。
CBT 在 12 个月的随访中对减少暴食的效果优于 BWL，而 BWL 在治疗期间则产生了统计学上更大的、但适度的体重减轻。结果不支持在 CBT 之后提供 BWL 的序贯方法的实用性。暴食缓解与更大的 BMI 损失百分比显著相关。这些发现支持将 BWL 作为治疗 BED 的替代治疗选择。
