Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder.
OBJECTIVE
Although binge eating disorder is a common and distressing concomitant of obesity, it has not yet been established whether affected individuals presenting to behavioral weight control programs should receive specialized treatments to supplement standard treatment. This study was designed to examine the added benefit of two adjunctive interventions, individual cognitive behavioral therapy (CBT) and fluoxetine, offered in the context of group behavioral weight control treatment.


METHODS
One hundred sixteen overweight/obese women and men with binge eating disorder were all assigned to receive a 16-session group behavioral weight control treatment over 20 weeks. Simultaneously, subjects were randomly assigned to receive CBT+fluoxetine, CBT+placebo, fluoxetine, or placebo in a two-by-two factorial design. Outcome measures, assessed at the end of the 16-session acute treatment phase, included binge frequency, weight, and measures of eating-related and general psychopathology.


RESULTS
Overall, subjects showed substantial improvement in binge eating and both general and eating-related psychopathology, but little weight loss. Subjects who received individual CBT improved more in binge frequency than did those not receiving CBT (p<0.001), and binge abstinence was significantly more common in subjects receiving CBT vs. those who did not (62% vs. 33%, p<0.001). Fluoxetine treatment was associated with greater reduction in depressive symptoms (p<0.05). The 54 subjects who achieved binge abstinence improved more on all measures than the 62 subjects who did not. In particular, these subjects lost, on average, 6.2 kg compared with a gain of 0.7 kg among non-abstainers.


CONCLUSIONS
Adjunctive individual CBT results in significant additional binge reduction in obese binge eaters receiving standard behavioral weight control treatment.
New York State Psychiatric Institute, Unit 116, 1051 Riverside Drive, New York, NY 10032, USA. mjd5@columbia.edu
Michael J
MJ
Devlin
Juli A
JA
Goldfein
Eva
E
Petkova
Huiping
H
Jiang
Pamela S
PS
Raizman
Sara
S
Wolk
Laurel
L
Mayer
Janel
J
Carino
Dara
D
Bellace
Claudia
C
Kamenetz
Ilyse
I
Dobrow
B Timothy
BT
Walsh
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D002032:Bulimia / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010919:Placebos; D016896:Treatment Outcome; D015431:Weight Loss
D018687:Antidepressive Agents, Second-Generation; D010919:Placebos; D005473:Fluoxetine