Improving Weight Loss Outcomes for Binge Eating Disorder

项目摘要/摘要 暴饮暴食障碍(Bed)是最普遍的饮食障碍，与大量 精神疾病和医学上的共病。尽管肥胖不是床上的诊断标准的一部分，但超过 65%的卧床者患有肥胖症，超过四分之一的肥胖症患者寻求治疗 带床的礼物。到目前为止，虽然有几种有效的治疗方法可以减少暴饮暴食， 在有床的患者中促进临床显著的体重减轻仍然是一个挑战。我们相信失败的原因 现有的治疗方法与1)缺乏对改变卡路里平衡的重视(通过两者 饮食和体力活动)，而不鼓励严格的饮食限制，这可能会促进最终的 暴食病理的发生，2)旨在促进长期坚持饮食的有限策略 和体力活动目标，以及3)标准行为减肥治疗(SBT)和 认知行为疗法(CBT)，以解决床上的关键维持因素(例如，提高食物奖励 敏感性、对重量和形状的高估、负面影响和对痛苦的不容忍)。以接受为基础 行为治疗(ABBT)可以为个人提供必要的心理工具，以改善 消极的情绪，痛苦的不耐性，以及对体重和体型的高估，并支持长期坚持 符合饮食和体力活动的建议，即使食物含量升高，也能减肥 奖励敏感度。我们现有的试验数据支持ABBTS产生卓越减肥效果的能力 一般肥胖患者和易损性与观察结果相似的肥胖患者的结果 在床上。ABBT也被证明可以有效地减少床上暴饮暴食的次数。我们的试点数据 提示与SBT相比，ABBT对卧床患者的减肥效果更好。 拟议项目的主要目标是评估ABBT相对于SBT的功效，以促进 减肥和减肥维持性患者卧床。第二个目标是测试假设 两种治疗方法在积极干预和治疗后的作用机制 减肥维持期。最后，我们的目标是评估适度假设，表明 对于那些食物奖励敏感度较高、体重过高的人，ABBT的影响尤其明显 以及形体、消极情绪和对痛苦的不容忍。我们的目标是实现更长远的目标，即确定 更有效的方法来改善减肥效果，使用证据来最大化有效 干预措施的组成部分，以及将患者与治疗类型相匹配。因此，我们将随机分配 130名超重和肥胖患者卧床至25次ABBT或SBT。所有参与者都将被跟踪 直到治疗后一年。基于实验室的行为评估、临床医生指导的干预和自我 报告措施将被用来提供对假设的调解和调解的多方法评估 途径，以及治疗如何影响这些联系。

PROJECT SUMMARY/ABSTRACT Binge eating disorder (BED) is the most prevalent eating disorder and is associated with substantial psychiatric and medical comorbidity. Although obesity is not part of the diagnostic criteria for BED, more than 65% of individuals with BED are obese, and more than a quarter of patients seeking treatment for obesity present with BED. To date, although there exist several effective treatments for reducing binge eating, facilitating clinically significant weight loss in patients with BED remains a challenge. We believe the failure of existing treatment approaches is related to 1) a lack of emphasize on altering the calorie balance (through both diet and physical activity) without encouraging strict dietary restraint that could promote an eventual re- occurrence of binge eating pathology, 2) limited strategies designed to promote long-term adherence to dietary and physical activity goals, and 3) the failure of both standard behavioral weight loss treatments (SBT) and cognitive behavioral therapy (CBT) to address key maintenance factors for BED (e.g. elevated food reward sensitivity, overvaluation of weight and shape, negative affect and distress intolerance). Acceptance-based behavioral treatment (ABBT) can provide individuals with the psychological tools necessary to improve negative affect, distress intolerance, and overvaluation of weight and shape and support long-term adherence to the dietary and physical activity recommendations designed to produce weight loss despite elevated food reward sensitivity. Our existing pilot data support the ability of ABBTs to produce superior weight loss outcomes both for obese patients at large and for obese patients with vulnerabilities similar to those observed in BED. ABBTs have also been shown to effectively reduce binge eating episodes in BED. Our pilot data suggests that ABBT could produce superior weight loss outcomes for patients with BED compared to SBT. The primary goal of the proposed project is to evaluate the efficacy of ABBT in relation to SBT for facilitating weight loss and weight loss maintenance in patients with BED. A secondary goal is to test hypothesized mechanisms of action of the two treatments, both during active intervention and during the post-treatment weight loss maintenance phase. Lastly, we aim to evaluate moderation hypotheses stating that the superiority of ABBT will be especially pronounced for those with higher food reward sensitivity, overvaluation of weight and shape, negative affect, and distress intolerance. Our aims work towards longer-range goals of identifying more effective methods for improving weight loss outcomes, using evidence to maximize the effective components of interventions, and matching patients to treatment type. Accordingly, we will randomly assign 130 overweight and obese patients with BED to 25 sessions of ABBT or SBT. All participants will be followed until one year post-treatment. Lab-based behavioral assessments, clinician guided interventions, and self- report measures will be used to provide a multi-method assessment of hypothesized moderating and mediating pathways, and how these associations are affected by treatment.