体重管理与体重管理联合认知行为疗法对美国超重退伍军人暴饮暴食症的随机对照试验
Randomized Controlled Trial of Weight Management Versus Weight Management With Concurrent Cognitive-Behavioral Therapy for Binge-Eating Disorder in US Veterans With High Weight.
作者信息
Masheb Robin M, Buta Eugenia, Snow Jennifer L, Munro Lindsay F, Lawless Mark, Abel Erica A, McWain Nicole E, Marsh Alison, Cary Amanda, Grilo Carlos M, Raffa Susan D, Ruser Christopher B
机构信息
VA Connecticut Healthcare System, West Haven, Connecticut, USA.
Yale University School of Medicine, New Haven, Connecticut, USA.
出版信息
Int J Eat Disord. 2025 Sep;58(9):1777-1792. doi: 10.1002/eat.24476. Epub 2025 Jun 9.
OBJECTIVE
To determine the effectiveness of adding a brief psychological eating-disorder treatment (CBT) to weight management for addressing DSM-5 binge-eating disorder (BED) in US military Veterans with high weight.
METHOD
One hundred and nine Veterans, with DSM-5 BED, seeking weight management services were randomly assigned to VA's Weight Management Program (MOVE!), or MOVE! plus a brief, clinician-led cognitive-behavioral therapy (MOVE! + CBT). Primary (eating disorder psychopathology and binge eating), secondary (mental health, quality of life, and eating- and appearance-related), and exploratory (weight) outcomes were analyzed with mixed-effects models for four timepoints (baseline, 3-month [post-treatment], and 9- and 15-month follow-ups).
RESULTS
MOVE! + CBT reported significantly less overall eating disorder psychopathology compared to MOVE! at all post-randomization timepoints: difference at 3 months -0.18 (-0.3, -0.06, p = 0.003), 9 months -0.15 (-0.3, 0, p = 0.05), and 15 months -0.27 (-0.42, -0.12, p < 0.001). There were no differences between groups in binge-eating frequency. MOVE! + CBT remission rates were 28% at 3 months, 42% at 9 months, and 27% at 15 months. MOVE! remission rates were 22% at 3 months, 26% at 9 months, and 20% at 15 months. MOVE! + CBT was superior at post-treatment through 15 months on eating-, weight-, and shape-related (p's < 0.05), but few other, secondary outcomes. A 5% weight loss ranged from 26% to 38% for MOVE! + CBT, and 17% to 33% for MOVE!.
DISCUSSION
Weight management alone and with concurrent CBT resulted in significant improvements in BED. The addition of CBT enhanced some specific outcomes but not weight loss. Findings provide evidence-based clinical guidance and population-level impact for addressing BED in the context of high weight, especially among Veteran populations.
TRIAL REGISTRATION
Clinical Trial Registry Number: NCT03234881(Weight Loss Treatment for Veterans with Binge Eating).
目的
确定在体重管理中增加简短的心理饮食失调治疗（认知行为疗法）对解决美国超重退伍军人的《精神疾病诊断与统计手册》第5版暴食症（BED）的有效性。
方法
109名患有《精神疾病诊断与统计手册》第5版暴食症且寻求体重管理服务的退伍军人被随机分配到退伍军人事务部的体重管理计划（MOVE!），或MOVE!加上简短的、由临床医生主导的认知行为疗法（MOVE!+CBT）。主要结果（饮食失调精神病理学和暴饮暴食）、次要结果（心理健康、生活质量以及饮食和外貌相关）和探索性结果（体重）通过混合效应模型在四个时间点（基线、3个月[治疗后]、9个月和15个月随访）进行分析。
结果
与MOVE!相比，MOVE!+CBT在所有随机分组后的时间点报告的总体饮食失调精神病理学显著更少：3个月时差异为-0.18（-0.3，-0.06，p=0.003），9个月时为-0.15（-0.3，0，p=0.05），15个月时为-0.27（-0.42，-0.12，p<0.001）。两组在暴饮暴食频率上没有差异。MOVE!+CBT在3个月时的缓解率为28%，9个月时为42%，15个月时为27%。MOVE!在3个月时的缓解率为22%，9个月时为26%，15个月时为20%。MOVE!+CBT在治疗后至15个月期间在饮食、体重和体型相关方面更优（p<0.05），但在其他次要结果方面则不然。MOVE!+CBT的5%体重减轻率在26%至38%之间，MOVE!的体重减轻率在17%至33%之间。
讨论
单独的体重管理以及与认知行为疗法同时进行都使暴食症有显著改善。增加认知行为疗法增强了一些特定结果，但没有增强体重减轻效果。研究结果为在超重背景下解决暴食症，特别是在退伍军人人群中，提供了基于证据的临床指导和人群层面的影响。
试验注册
临床试验注册号：NCT03234881（暴食退伍军人的减肥治疗）
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