title: Self-help for binge eating disorder in primary care: a randomized controlled trial with ethnically and racially diverse obese patients.
abstract: OBJECTIVE
  The objective was to examine the effectiveness of a self-help treatment as a first line primary care intervention for binge eating disorder (BED) in obese patients. This study compared the effectiveness of a usual care plus self-help version of cognitive behavioral therapy (shCBT) to usual care (UC) only in ethnically/racially diverse obese patients with BED in primary care settings in an urban center.
  
  
  METHODS
  48 obese patients with BED were randomly assigned to either shCBT (N = 24) or UC (N = 24) for four months. Independent assessments were performed monthly throughout treatment and at post-treatment.
  
  
  RESULTS
  Binge-eating remission rates did not differ significantly between shCBT (25%) and UC (8.3%) at post-treatment. Mixed models of binge eating frequency determined using the Eating Disorder Examination (EDE) revealed significant decreases for both conditions but that shCBT and UC did not differ. Mixed models of binge eating frequency from repeated monthly EDE-questionnaire assessments revealed a significant treatment-by-time interaction indicating that shCBT had significant reductions whereas UC did not during the four-month treatments. Mixed models revealed no differences between groups on associated eating disorder psychopathology or depression. No weight loss was observed in either condition.
  
  
  CONCLUSIONS
  Our findings suggest that pure self-help CBT did not show effectiveness relative to usual care for treating BED in obese patients in primary care. Thus, self-help CBT may not have utility as a front-line intervention for BED for obese patients in primary care and future studies should test guided-self-help methods for delivering CBT in primary care generalist settings.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, USA. Electronic address: carlos.grilo@yale.edu.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Grilo
authors.forename: Marney A
authors.initials: MA
authors.lastname: White
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
authors.forename: Rachel D
authors.initials: RD
authors.lastname: Barnes
authors.forename: Robin M
authors.initials: RM
authors.lastname: Masheb
mesh_terms: D056912:Binge-Eating Disorder / Q000628:therapy*; D015992:Body Mass Index; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003863:Depression / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology*; D011320:Primary Health Care; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome
keywords: Binge eating; Eating disorders; Obesity; Primary care; Treatment