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Improving Weight Loss Outcomes for Binge Eating Disorder

改善暴食症的减肥效果

基本信息

批准号：
9755423
负责人：
ADRIENNE SARAH JUARASCIO
金额：
$ 47.07万
依托单位：
DREXEL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9755423
关键词：
Address Adherence Affect Aftercare Behavior Behavior Therapy Behavior assessment Behavioral Binge Eating Binge eating disorder Body Weight decreased Calories Cognitive Therapy Comorbidity Data Diagnostic Diet Distress Drops Eating Disorders Equilibrium Failure Female Food Goals Hyperphagia Individual Intervention Interview Maintenance Measures Mediating Medical Methods Morbid Obesity Obesity Outcome Overweight Participant Pathway interactions Patient Self-Report Patient-Focused Outcomes Patients Phase Physical activity Prevalence Psychopathology Randomized Recommendation Rewards Shapes Specialist Testing United States Value of Life Weight Work base body dissatisfaction clinically significant design eating pathology effective therapy emotional eating experience flexibility follow-up improved intervention effect male negative affect obesity treatment peer programs psychologic reduced food intake restraint secondary outcome self esteem tool treatment program weight loss intervention weight loss program

项目摘要

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.

项目概要/摘要暴食症（BED）是最普遍的饮食失调症，与大量的饮食失调有关。精神和医学共病。尽管肥胖不是 BED 诊断标准的一部分，但超过 65% 的暴食症患者肥胖，超过四分之一的患者寻求肥胖治疗与 BED 一起出现。迄今为止，尽管有几种有效的治疗方法可以减少暴饮暴食，促进暴食症患者临床上显着的体重减轻仍然是一个挑战。我们相信失败现有的治疗方法与以下因素有关：1）缺乏对改变卡路里平衡的强调（通过饮食和体力活动），而不鼓励严格的饮食限制，这可能会促进最终的恢复暴食病理学的发生，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）解决暴食症的关键维持因素（例如提高食物奖励敏感性、对体重和体形的高估、负面情绪和痛苦不耐受）。基于验收行为治疗（ABBT）可以为个人提供改善所必需的心理工具负面情绪、痛苦不耐受以及对体重和体形的高估，并支持长期坚持尽管食物增加，但仍符合旨在实现减肥效果的饮食和身体活动建议奖励敏感性。我们现有的试点数据支持 ABBT 产生卓越减肥效果的能力对于一般肥胖患者和具有与观察到的相似脆弱性的肥胖患者的结果在床上。 ABBT 也被证明可以有效减少 BED 中的暴食事件。我们的试点数据表明与 SBT 相比，ABBT 可以为 BED 患者带来更好的减肥效果。拟议项目的主要目标是评估 ABBT 相对于 SBT 的功效，以促进 BED 患者的体重减轻和体重维持。第二个目标是测试假设两种治疗方法在主动干预期间和治疗后的作用机制减肥维持阶段。最后，我们的目标是评估适度假设，指出优越性对于那些对食物奖励敏感度较高、体重估价过高的人来说，ABBT 的影响尤其明显以及形状、负面影响和痛苦不容忍。我们的目标致力于实现更长远的目标更有效的方法来改善减肥效果，利用证据最大限度地提高减肥效果干预措施的组成部分，以及将患者与治疗类型相匹配。据此，我们将随机分配 130 名超重和肥胖的 BED 患者接受了 25 次 ABBT 或 SBT。所有参与者都将受到关注直到治疗后一年。基于实验室的行为评估、临床医生指导的干预措施以及自我评估报告措施将用于对假设的调节和调解提供多方法评估途径，以及这些关联如何受到治疗的影响。