Improving Weight Loss Outcomes for Binge Eating Disorder

项目概要/摘要 暴饮暴食症（BED）是最普遍的饮食失调，与大量的 精神和医学并发症。虽然肥胖不是BED诊断标准的一部分，但超过 65%的BED患者肥胖，超过四分之一的患者寻求肥胖治疗。 床的存在。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， 促进患有BED的患者的临床上显著的体重减轻仍然是一个挑战。我们认为， 现有的治疗方法与1）缺乏对改变卡路里平衡的强调（通过 饮食和体育活动），而不鼓励严格的饮食限制，这可能会促进最终的重新- 暴饮暴食病理的发生，2）旨在促进长期坚持饮食的有限策略 和身体活动目标，以及3）标准行为减肥治疗（SBT）和 认知行为疗法（CBT），以解决BED的关键维持因素（例如食物奖励增加 敏感性，高估体重和形状，负面影响和痛苦的不容忍）。基于验收 行为治疗（ABBT）可以为个人提供必要的心理工具，以改善 负面影响，痛苦的不容忍，以及对体重和形状的高估，并支持长期坚持 饮食和身体活动的建议，旨在产生减肥，尽管提高食物 奖励敏感性我们现有的试验数据支持ABBT产生上级减肥的能力 肥胖患者和脆弱性与观察到的结果相似的肥胖患者的结局 在床上ABBT也被证明可以有效地减少床上的暴饮暴食事件。我们的试点数据 表明ABBT可以产生上级的体重减轻结果与SBT相比，床患者。 拟议项目的主要目标是评估ABBT相对于SBT的功效， BED患者的体重减轻和体重减轻维持。第二个目标是测试假设的 两种治疗的作用机制，无论是在积极干预和治疗后 减肥维持阶段。最后，我们的目标是评估适度假设，说明优越性 对于那些食物奖励敏感度较高、体重高估的人来说，ABBT的作用尤其明显。 和形状，负面影响，和痛苦的容忍度。我们的目标是实现更长期的目标， 更有效的方法来改善减肥的结果，使用证据，以最大限度地提高有效的 干预措施的组成部分，并将患者与治疗类型相匹配。因此，我们将随机分配 130例超重和肥胖患者，接受25次ABBT或SBT治疗。所有参与者将被跟踪 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，以及自我评估。 报告措施将被用来提供一个多方法评估假设的调节和调解 途径，以及这些关联如何受到治疗的影响。

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.