Preoperative and post‐operative psychosocial interventions for bariatric surgery patients: A systematic review

Psychosocial interventions are increasingly being utilized to help patients prepare for, and adjust to changes following, bariatric surgery in order to optimize psychosocial adjustment and weight loss. The current systematic review examined the impact of preoperative and post‐operative psychosocial interventions with a behavioural and/or cognitive focus on weight, dietary behaviours, eating pathology, lifestyle behaviours, and psychological functioning. A PsycINFO and Medline search of publications was conducted in March 2019. Two authors assessed retrieved titles and abstracts to determine topic relevance and rated the quality of included studies using a validated checklist. Forty‐four articles (representing 36 studies) met the study inclusion criteria. The current evidence is strongest for the impact of psychosocial interventions, particularly cognitive behavioural therapy, on eating behaviours (eg, binge eating and emotional eating) and psychological functioning (eg, quality of life, depression, and anxiety). The evidence for the impact of psychosocial interventions on weight loss, dietary behaviours (eg, dietary intake), and lifestyle behaviours (eg, physical activity) is relatively weak and mixed. Psychosocial interventions can improve eating pathology and psychosocial functioning among bariatric patients, and the optimal time to initiate treatment appears to be early in the post‐operative period before significant problematic eating behaviours and weight regain occur.     

Improving Inhibitory Control Abilities (ImpulsE)—A Promising Approach to Treat Impulsive Eating?

Although there is preliminary evidence that inhibitory control training improves impulsive eating, less is known about the effects on eating behaviour and weight loss in clinical samples. Sixty‐nine treatment‐seeking adults with obesity (binge‐eating disorder 33.3%; other specific feeding and eating disorders 40.6%) were randomly blockwise allocated to ImpulsE, an intervention to improve inhibitory control and emotion regulation abilities or a guideline‐appropriate cognitive behavioural therapy (CBT)‐based treatment as usual. Self‐reported and performance‐based impulsivity, eating disorder pathology and BMI were compared at baseline (T1), post‐treatment (T2) and 1‐ or 3‐month follow‐up. ImpulsE led to better food‐specific inhibition performance (p = .004), but groups did not differ regarding improvements in global Eating Disorder Examination Questionnaire (EDE‐Q) score at T2. At 3‐month follow‐up, binge eaters benefited most from ImpulsE (p = .028) and completers of ImpulsE demonstrated a significantly greater weight reduction (p = .030). The current findings propose ImpulsE as a promising approach to treat obesity, illustrating acceptability and additional benefits for course of weight. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

A Randomised Controlled Comparison of Second‐Level Treatment Approaches for Treatment‐Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy

A question that arises from the literature on therapy is whether second‐level treatment is effective for patients with recurrent binge eating who fail first‐level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive‐behavioural treatment (CBT) programme benefit from additional CBT (A‐CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge‐related cues). We assessed the effectiveness of virtual reality‐CET as a second‐level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A‐CBT. The significant differences observed between the two groups at post‐treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality‐CET over A‐CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Does severe dietary energy restriction increase binge eating in overweight or obese individuals? A systematic review

Severe dietary energy restriction is often used for overweight or obese individuals to achieve rapid weight loss and related health improvements. However, the extent of putative adverse effects on eating behaviour is unknown. We thus systematically searched seven databases for studies that assessed binge eating before and after severe dietary energy restriction (low or very low energy diets) in overweight or obese individuals. Fifteen clinically supervised interventions from 10 publications (nine of which involved only women) were included. Among individuals with clinically relevant pre‐treatment binge eating disorder, severe dietary energy restriction significantly decreased binge eating in all four interventions involving this population, at least during the weight loss programme. In contrast, no consistent association between severe dietary energy restriction and the onset of bingeing was found in 11 interventions involving individuals without pre‐treatment binge eating disorder, with four such interventions showing significant increases, two showing no change, and five showing significant decreases in binge eating. We conclude that clinically supervised severe dietary energy restriction appears safe and beneficial for overweight or obese individuals with pre‐treatment binge eating disorder, and does not necessarily trigger binge eating in those without binge eating disorder.     

Therapist adherence and therapeutic alliance in individual cognitive‐behavioural therapy for adolescent binge‐eating disorder

To evaluate psychological treatments for adolescent binge‐eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic alliance and their associations in cognitive‐behavioural therapy (CBT) for adolescents with BED. In a randomised‐controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio‐taped CBT sessions from a sample of N = 64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between‐patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT.     

Mindfulness‐based interventions for obesity‐related eating behaviours: a literature review

Mindfulness‐based interventions (MBIs) targeting eating behaviours have gained popularity in recent years. A literature review was conducted to determine the effectiveness of MBIs for treating obesity‐related eating behaviours, such as binge eating, emotional eating and external eating. A search protocol was conducted using the online databases Google Scholar, PubMed, PsycINFO and Ovid Healthstar. Papers were required to meet the following criteria to be included in this review: (i) describe a MBI or the use of mindfulness exercises as part of an intervention; (ii) include at least one obesity‐related eating behaviour as an outcome; (iii) include quantitative outcomes; and (iv) be published in English in a peer‐reviewed journal. A total of N = 21 papers were included in this review. Interventions used a variety of approaches to implement mindfulness training, including combined mindfulness and cognitive behavioural therapies, mindfulness‐based stress reduction, acceptance‐based therapies, mindful eating programmes, and combinations of mindfulness exercises. Targeted eating behaviour outcomes included binge eating, emotional eating, external eating and dietary intake. Eighteen (86%) of the reviewed studies reported improvements in the targeted eating behaviours. Overall, the results of this first review on the topic support the efficacy of MBIs for changing obesity‐related eating behaviours, specifically binge eating, emotional eating and external eating.     

Rumination in Patients with Binge‐Eating Disorder and Obesity: Associations with Eating‐Disorder Psychopathology and Weight‐bias Internalization

Overvaluation of shape and weight in binge‐eating disorder (BED) is associated with greater eating‐disorder psychopathology and greater weight‐bias internalization, which are—in turn—associated with poorer mental and physical health. Little is known, however, about the significance of other cognitive processes, such as rumination, in BED. This study examined rumination and overvaluation of shape/weight with eating‐disorder psychopathology and weight‐bias internalization among 237 treatment‐seeking patients with BED and comorbid obesity. Hierarchical multiple regressions indicated that rumination was associated with eating‐disorder psychopathology and weight‐bias internalization above and beyond the influence of overvaluation of shape/weight. Findings suggest that, among patients with BED/obesity, rumination is an important cognitive process associated with severity of eating‐disorder psychopathology even after accounting for overvaluation of shape/weight. Patients with greater rumination might be more likely to dwell on weight‐based discrimination experiences and internalize these negative attitudes. Additional controlled examination could determine whether rumination represents another potential target for BED/obesity treatment. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Dieting and the development of eating disorders in overweight and obese adults

We reviewed articles evaluating the relations among dieting, weight loss treatment, weight cycling, eating disorders, and psychological functioning in overweight and obese adults. Moderate caloric (energy) restriction, in combination with behavioral weight loss treatment, does not seem to cause clinically significant binge eating in overweight adults without preexisting binge eating problems and might ameliorate binge eating, at least in the short term, in those reporting recurrent binge eating before treatment. Most studies of behavioral weight loss interventions report improvements in psychological status during weight loss. However, these improvements might return to baseline with weight regain. Weight cycling does not seem to be associated with clinically significant psychopathologic conditions, although results of cross-sectional studies show an association between weight cycling and binge eating, as well as poorer perceived health status. "Nondieting" approaches seem to lead to improvements in mood and self-esteem; however, weight loss is generally minimal. Concerns that dieting induces eating disorders or other psychological dysfunction in overweight and obese adults are generally not supported by empirical studies. Such concerns should not preclude attempts to reduce caloric intake and increase physical activity to achieve modest weight loss or prevent additional weight gain.     

Predictors,Moderators, and Mediators of Treatment Outcome Following Manualised Cognitive‐Behavioural Therapy for Eating Disorders: A Systematic Review

This systematic review synthesised the literature on predictors, moderators, and mediators of outcome following Fairburn's CBT for eating disorders. Sixty‐five articles were included. The relationship between individual variables and outcome was synthesised separately across diagnoses and treatment format. Early change was found to be a consistent mediator of better outcomes across all eating disorders. Moderators were mostly tested in binge eating disorder, and most moderators did not affect cognitive‐behavioural treatment outcome relative to other treatments. No consistent predictors emerged. Findings suggest that it is unclear how and for whom this treatment works. More research testing mediators and moderators is needed, and variables selected for analyses need to be empirically and theoretically driven. Future recommendations include the need for authors to (i) interpret the clinical and statistical significance of findings; (ii) use a consistent definition of outcome so that studies can be directly compared; and (iii) report null and statistically significant findings. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Subjective and Objective Binge Eating in Relation to Eating Disorder Symptomatology,Depressive Symptoms,and Self‐Esteem among Treatment‐Seeking Adolescents with Bulimia Nervosa

This study investigated the importance of the distinction between objective (OBE) and subjective binge eating (SBE) among 80 treatment‐seeking adolescents with bulimia nervosa. We explored relationships among OBEs, SBEs, eating disorder (ED) symptomatology, depression, and self‐esteem using two approaches. Group comparisons showed that OBE and SBE groups did not differ on ED symptoms or self‐esteem; however, the SBE group had significantly greater depression. Examining continuous variables, OBEs (not SBEs) accounted for significant unique variance in global ED pathology, vomiting, and self‐esteem. SBEs (not OBEs) accounted for significant unique variance in restraint and depression. Both OBEs and SBEs accounted for significant unique variance in eating concern; neither accounted for unique variance in weight/shape concern, laxative use, diuretic use, or driven exercise. Loss of control, rather than amount of food, may be most important in defining binge eating. Additionally, OBEs may indicate broader ED pathology, while SBEs may indicate restrictive/depressive symptomatology. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings

This study examined racial differences in eating‐disorder psychopathology, eating/weight‐related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating‐disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Cognitive‐behavioural,fluoxetine and combined treatment for bulimia nervosa: short‐ and long‐term results

This study examined the short‐ and long‐term effectiveness of cognitive‐behavioural group treatment (CBT), pharmacological treatment with fluoxetine and combined treatment in patients with DSM‐III‐R bulimia nervosa. Fifty‐three patients were randomly assigned to the three conditions. Outcome measures were frequency of bingeing and purging, attitudes toward weight and shape, depression and self‐concept. Patients were followed for 1 year post‐treatment. Thirty‐five patients completed treatment. Drop‐out rates were 42 per cent for CBT, 25 per cent for the fluoxetine and 33 per cent for the combined condition. All treatments led to significant improvements in eating disorder symptoms and in other psychological disturbances between pre‐ and post‐treatment, which could be maintained at 1‐year follow‐up. Abstinence rates for completers were highest for CBT at both post‐treatment and follow‐up. The short‐ and long‐term results of this study do not favour the combined treatment in comparison to CBT alone. Cultural differences in health systems as well as in the acceptance of treatments offered in a treatment trial are discussed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Role of Non‐suicidal Self‐Injury and Binge‐Eating/Purging Behaviours in the Caregiving Experience Among Mothers and Fathers of Adolescents with Eating Disorders

This study investigated the caregiving experiences of mothers and fathers of restrictive and binge‐eating/purging eating disordered (ED) inpatients with and without non‐suicidal self‐injury (NSSI). Sixty‐five mothers and 65 fathers completed the Experience of Caregiving Inventory. All inpatients completed the Self‐Injury Questionnaire—Treatment Related to assess NSSI and the Eating Disorder Evaluation Scale to assess eating disorder symptoms. Mothers reported significant more negative and more positive caregiving experiences compared with fathers. Mothers (but not fathers) of restrictive ED patients reported more positive caregiving experiences compared with mothers of binge‐eating/purging patients. The presence of NSSI in ED patients was associated with more negative caregiving experiences of both parents. Mothers and fathers of ED inpatients differ in caregiving experiences, and both binge‐eating behaviours and NSSI negatively affect their caregiving experience. Therefore, supportive interventions for parents of ED patients are necessary, especially of those patients who engage in NSSI. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

An examination of the interpersonal model of binge eating over the course of treatment

The current study examined the interpersonal model of binge eating, which posits that interpersonal problems lead to negative affect, which results in binge eating, over the course of two psychotherapy treatments (interpersonal psychotherapy and cognitive behavioural therapy) in 162 adults with binge‐eating disorder. A series of longitudinal simple mediation analyses preliminarily showed that treatment addresses the mechanisms of the interpersonal model of binge eating as theoretically proposed in predicting reductions in binge eating, the primary dependent variable, and the secondary dependent variables including global eating disorder psychopathology, shape concern, and weight concern, but not reductions in restraint or eating concern. Moderated mediation analyses did not fully support treatment differences, as changes in the mechanisms of the interpersonal model occurred in both treatments and suggest both treatments addressed negative affect and interpersonal precipitants of eating disorder symptomatology. Future research should replicate this study using variables that do not overlap in time to investigate causation of the model, and more generally, further examine theoretical treatment models and treatment mediators as this research could help improve efficacy of treatment for binge‐eating disorder.     

To Go or Not to Go: A Proof of Concept Study Testing Food‐Specific Inhibition Training for Women with Eating and Weight Disorders

Inefficient food‐specific inhibitory control is a potential mechanism that underlies binge eating in bulimia nervosa and binge eating disorder. Go/no‐go training tools have been developed to increase inhibitory control over eating impulses. Using a within‐subjects design, this study examined whether one session of food‐specific go/no‐go training, versus general inhibitory control training, modifies eating behaviour. The primary outcome measure was food consumption on a taste test following each training session. Women with bulimia nervosa and binge eating disorder had small non‐significant reductions in high‐calorie food consumption on the taste test following the food‐specific compared with the general training. There were no effects on eating disorder symptomatic behaviour (i.e. binge eating/purging) in the 24 h post‐training. The training task was found to be acceptable by the clinical groups. More research is needed with larger sample sizes to determine the effectiveness of this training approach for clinical populations. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Effect of self‐monitoring on binge eating: treatment response or ‘binge drift’?

The current study aimed to determine if subjective bulimic episodes (SBEs) and objective bulimic episodes (OBEs) have different reactive effects to self‐monitoring. Fourteen women with bulimia nervosa (57%) or binge eating disorder (43%) were diagnosed using the Eating Disorder Examination (EDE; version 12.0). During the 7‐days post‐interview, participants filled out daily self‐monitoring records indicating the food consumed and any episodes of loss of control over eating. These records were reviewed and coded for OBEs and SBEs using the EDE coding scheme. Paired samples t‐tests indicated that participants' average number of daily OBEs significantly decreased from baseline to the period of self‐monitoring (t = 2.41, p < 0.05, Cohen's d = 0.90), whereas there was a significant increase from baseline to self‐monitoring in their average number of SBEs (t = ?2.41, p < 0.05, Cohen's d = 0.86). Of the 12 participants who showed a decrease in OBEs, 75% showed a concurrent increase in SBEs. The data suggest that the reactivity of OBEs to minimal or brief interventions may in part be due to binge drift, or the reduction of OBEs at the expense of increasing SBEs. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Naturalistic outcomes for a day‐hospital programme in a mixed diagnostic sample of adolescents with eating disorders

Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day‐hospital programmes (DHPs), existing studies have included limited follow‐up, small samples, and a focus on restricting‐type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow‐up (n = 126; M_{follow up} = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow‐up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow‐up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow‐up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow‐up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.     

Psychological Factors Predict Eating Disorder Onset and Maintenance at 10‐year Follow‐up

The present study sought to identify psychological factors that predict onset and maintenance of eating disorders. Secondary analyses were conducted using data from an epidemiological study of health and eating behaviours in men and women (N = 1320; 72% female) to examine the prospective and independent influence of the Eating Disorder Inventory Perfectionism, Interpersonal Distrust, and Maturity Fears subscales in predicting the onset and maintenance of eating disorders at 10‐year follow‐up. Multivariate models indicated higher Perfectionism (p = .025), lower Interpersonal Distrust (p < .001), and higher Maturity Fears (p = .037) predicted increased risk for eating disorder onset at 10‐year follow‐up, but only Perfectionism (p = .004) predicted eating disorder maintenance. Differential prediction of eating disorder onset versus maintenance highlights potentially different psychological foci for prevention versus treatment efforts. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Binge eating disorder: a review

Binge eating disorder (BED) is a new proposed eating disorder in the DSM-IV. BED is not a formal diagnosis within the DSM-IV, but in day-to-day clinical practice the diagnosis seems to be generally accepted. People with the BED-syndrome have binge eating episodes as do subjects with bulimia nervosa, but unlike the latter they do not engage in compensatory behaviours. Although the diagnosis BED was created with the obese in mind, obesity is not a criterion. This paper gives an overview of its epidemiology, characteristics, aetiology, criteria, course and treatment. BED seems to be highly prevalent among subjects seeking weight loss treatment (1.3-30.1%). Studies with compared BED, BN and obesity indicated that individuals with BED exhibit levels of psychopathology that fall somewhere between the high levels reported by individuals with BN and the low levels reported by obese individuals. Characteristics of BED seemed to bear a closer resemblance to those of BN than of those of obesity.A review of RCT's showed that presently cognitive behavioural treatment is the treatment of choice but interpersonal psychotherapy, self-help and SSRI's seem effective. The first aim of treatment should be the cessation of binge eating. Treatment of weight loss may be offered to those who are able to abstain from binge eating.