Eating Disorders Program (PROATA), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Major Maragliano 241, São Paulo, SP, 04017-030, Brazil.
School of Medicine, Translational Health Research Institute, Western Sydney University, 1797 Locked Bag Avenue, Sydney, 2751, Australia.
Eat Weight Disord. 2021 Feb;26(1):249-262. doi: 10.1007/s40519-020-00846-2. Epub 2020 Jan 25.
The association between binge eating and obesity is increasing. Treatments for disorders of recurrent binge eating comorbid with obesity reduce eating disorder (ED) symptoms, but not weight. This study investigated the efficacy and safety of introducing a weight loss intervention to the treatment of people with disorders of recurrent binge eating and a high body mass index (BMI).
A single-blind randomized controlled trial selected adults with binge eating disorder or bulimia nervosa and BMI ≥ 27 to < 40 kg/m. The primary outcome was sustained weight loss at 12-month follow-up. Secondary outcomes included ED symptoms. Mixed effects models analyses were conducted using multiple imputed datasets in the presence of missing data.
Ninety-eight participants were randomized to the Health Approach to Weight Management and Food in Eating Disorders (HAPIFED) or to the Cognitive Behavioural Therapy-Enhanced (CBT-E). No between-group differences were found for percentage of participants achieving weight loss or secondary outcomes, except for reduction of purging behaviour, which was greater with HAPIFED (p = 0.016). Binge remission rates specifically at 12-month follow-up favoured HAPIFED (34.0% vs 16.7%; p = 0.049). Overall, significant improvements in the reduction of ED symptoms were seen in both groups and these were sustained at the 12-month follow-up.
HAPIFED was not superior to CBT-E in promoting clinically significant weight loss and was not significantly different in reducing most ED symptoms. No harm was observed with HAPIFED, in that no worsening of ED symptoms was observed. Further studies should test approaches that target both the management of ED symptoms and the high BMI.
Level I, randomized controlled trial TRIAL REGISTRATION: US National Institutes of Health clinical trial registration number NCT02464345, date of registration 1 June 2015.
暴食与肥胖之间的关联正在增加。针对与肥胖共病的反复发作性暴食障碍的治疗方法可减轻进食障碍（ED）症状，但不能减轻体重。本研究旨在调查将体重减轻干预引入反复发作性暴食和高体重指数（BMI）人群的治疗中的疗效和安全性。
一项单盲随机对照试验，选取符合暴食障碍或神经性贪食症标准且 BMI≥27<40kg/m²的成年人。主要结局为 12 个月随访时的持续减重。次要结局包括 ED 症状。在存在缺失数据的情况下，使用多重插补数据集进行混合效应模型分析。
98 名参与者被随机分配至健康饮食体重管理和进食障碍饮食（HAPIFED）组或认知行为治疗增强（CBT-E）组。两组之间在达到减重或次要结局的参与者比例方面无差异，除了 HAPIFED 组的清除行为减少更显著（p=0.016）。HAPIFED 组在 12 个月随访时的暴食缓解率（34.0% vs 16.7%；p=0.049）更高。总体而言，两组的 ED 症状均有显著改善，且在 12 个月随访时仍持续存在。
HAPIFED 在促进临床显著减重方面并不优于 CBT-E，且在减轻大多数 ED 症状方面也没有显著差异。HAPIFED 没有造成伤害，因为 ED 症状没有恶化。进一步的研究应测试针对 ED 症状管理和高 BMI 的治疗方法。
一级，随机对照试验。
NCT02464345，注册日期：2015 年 6 月 1 日。
