Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
Psychol Med. 2012 Apr;42(4):807-17. doi: 10.1017/S0033291711001875. Epub 2011 Sep 16.
We examined rapid response in obese patients with binge-eating disorder (BED) in a clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL).
Altogether, 90 participants were randomly assigned to CBT or BWL. Assessments were performed at baseline, throughout and post-treatment and at 6- and 12-month follow-ups. Rapid response, defined as 70% reduction in binge eating by week four, was determined by receiver operating characteristic curves and used to predict outcomes.
Rapid response characterized 57% of participants (67% of CBT, 47% of BWL) and was unrelated to most baseline variables. Rapid response predicted greater improvements across outcomes but had different prognostic significance and distinct time courses for CBT versus BWL. Patients receiving CBT did comparably well regardless of rapid response in terms of reduced binge eating and eating disorder psychopathology but did not achieve weight loss. Among patients receiving BWL, those without rapid response failed to improve further. However, those with rapid response were significantly more likely to achieve binge-eating remission (62% v. 13%) and greater reductions in binge-eating frequency, eating disorder psychopathology and weight loss.
Rapid response to treatment in BED has prognostic significance through 12-month follow-up, provides evidence for treatment specificity and has clinical implications for stepped-care treatment models for BED. Rapid responders who receive BWL benefit in terms of both binge eating and short-term weight loss. Collectively, these findings suggest that BWL might be a candidate for initial intervention in stepped-care models with an evaluation of progress after 1 month to identify non-rapid responders who could be advised to consider a switch to a specialized treatment.
我们在一项测试认知行为疗法（CBT）和行为体重管理（BWL）的临床试验中，研究了暴食障碍（BED）肥胖患者的快速应答。
共有 90 名参与者被随机分配到 CBT 或 BWL 组。在基线、治疗期间和治疗后以及 6 个月和 12 个月随访时进行评估。快速应答定义为第 4 周时暴食行为减少 70%，通过接收者操作特征曲线确定，并用于预测结局。
57%的参与者（CBT 组为 67%，BWL 组为 47%）表现出快速应答，与大多数基线变量无关。快速应答预测了更好的结果改善，但对 CBT 与 BWL 的预后意义和时间进程有不同的影响。接受 CBT 的患者无论快速应答与否，在减少暴食行为和饮食障碍心理病理学方面都表现良好，但没有达到体重减轻的效果。接受 BWL 的患者中，没有快速应答的患者无法进一步改善。然而，那些有快速应答的患者更有可能达到暴食障碍缓解（62%对 13%），并且暴食行为频率、饮食障碍心理病理学和体重减轻的程度更大。
BED 治疗中的快速应答具有预后意义，可跟踪到 12 个月随访，为治疗特异性提供了证据，并对 BED 的阶梯式治疗模型具有临床意义。接受 BWL 的快速应答者在暴食和短期体重减轻方面都能受益。总的来说，这些发现表明 BWL 可能是阶梯式治疗模型初始干预的候选方法，在 1 个月后评估进展，以识别非快速应答者，并建议他们考虑转向专门治疗。
