title: Cognitive-behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: a randomized controlled trial.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA. carlos.grilo@yale.edu
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Grilo
authors.forename: Robin M
authors.initials: RM
authors.lastname: Masheb
authors.forename: G Terence
authors.initials: GT
authors.lastname: Wilson
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
authors.forename: Marney A
authors.initials: MA
authors.lastname: White
mesh_terms: D000328:Adult; D056912:Binge-Eating Disorder / Q000523:psychology / Q000628:therapy*; D015992:Body Mass Index; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*