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.

项目摘要/摘要暴饮暴食障碍（床）是最普遍的饮食失调症，与大量相关精神病和医疗合并症。尽管肥胖不是卧床诊断标准的一部分 65％的患有床的人是肥胖的，超过四分之一的患者寻求肥胖治疗在床上。迄今为止，尽管有几种有效的减少暴饮暴食的治疗方法促进床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1）缺乏更改卡路里平衡的强调（通过饮食和体育锻炼）不鼓励严格的饮食约束，这可能会促进最终的重新暴饮暴食病理学的发生，2）旨在促进长期遵守饮食的有限策略和体育活动目标，以及3）标准行为减肥治疗（SBT）和认知行为疗法（CBT）解决床的关键维护因素（例如，食物奖励升高敏感性，体重和形状的高估，负面影响和困扰不耐症）。基于接受行为治疗（ABBT）可以为个人提供改善所需的心理工具负面影响，苦难不耐受以及体重和形状的高估和支持长期遵守尽管食物升高，但旨在增加体重的饮食和体育锻炼建议奖励灵敏度。我们现有的飞行员数据支持ABBT产生较高减肥的能力肥胖患者的结果和脆弱性的肥胖患者类似于观察到的结果在床上。 ABBT还显示出有效减少床上的暴饮暴食发作。我们的飞行员数据表明与SBT相比，ABBT可以为床患者产生优势的减肥结果。拟议项目的主要目标是评估ABBT与SBT相关的疗效床患者的体重减轻和减肥维持。第二个目标是测试假设在主动干预期间和治疗期间，两种治疗的作用机制减肥阶段。最后，我们旨在评估适度假设，表明优越性对于那些具有较高食物奖励敏感性的人，体重高估的人来说，ABBT的尤其明显和形状，负面影响和苦难不耐受。我们的目标致力于确定的长期目标改善减肥结果的更有效方法，使用证据来最大化有效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个超重和肥胖的患者，患有床至25个疗程的ABBT或SBT。所有参与者将遵循直到治疗后一年。基于实验室的行为评估，临床医生指导干预措施和自我报告措施将用于提供假设调节和中介的多方法评估途径，以及这些关联如何受到治疗的影响。