A intervention that combined cognitive behavioral therapy and guided self-help was effective and cost-saving for patients with disorders that involve binge eating, a randomized trial showed.

The intervention plus usual care allowed more patients to remain free of binge-eating episodes at one year than usual care alone (64.2% versus 44.6%, P<0.041), according to Lynn DeBar, PhD, of the Kaiser Permanente Center for Health Research in Portland, Ore., and colleagues.

The number needed to treat was 5, they reported in the April issue of the Journal of Consulting and Clinical Psychology.

A separate paper by their group found that the intervention was more cost-effective than usual care (mean cost per patient $3,670.63 versus $4,098.02), despite the additional cost of the behavioral therapy, because the participants used fewer healthcare services overall than those in the usual-care group.

Thus, DeBar and her colleagues concluded, cognitive behavioral therapy accompanied by guided self-help “is a viable first-line treatment option for the majority of patients with recurrent binge eating who do not meet diagnostic criteria for bulimia nervosa or anorexia nervosa.”

In an interview, DeBar said the intervention would likely be delivered not by MDs, but by ancillary staff in a primary care setting.

“We really think that this is likely suitable for health educators, for nutritionists to deliver, and other kinds of master’s-level trained health professionals that may be in a primary care setting.”

Previous studies have shown cognitive behavioral therapy to be effective for treating eating disorders with binge eating as a core symptom, but it is little used in clinical practice, possibly because of the training needed and the intensity and cost of the approach.

DeBar and her colleagues evaluated a method for increasing the use of the technique at a single health maintenance organization.

Of 123 patients with bulimia nervosa, binge-eating disorder, or recurrent binge eating in the absence of either of those two disorders, 59 were assigned to the combined cognitive behavioral therapy-guided, self-help intervention. The rest received usual care, which involved using any available services at the HMO, as they wished.

The intervention was delivered in eight sessions over a 12-week period by master’s-level therapists with a background in cognitive behavioral therapy for depression, but not for eating disorders. The first session lasted one hour, with the rest lasting 20 to 25 minutes.

Participants in the intervention were instructed to read and follow instructions in Overcoming Binge Eating by Christopher Fairburn, DM, of the University of Oxford, with assistance from the therapist. The book describes a self-help program using self-monitoring, self-control strategies, and problem solving.

Overall, the mean age of the participants was 37. Some 92% were female, and 97% were white. The mean body mass index was 31.27 kg/m2.

Individuals in both groups were mailed a flyer detailing all available services at the HMO and were allowed to use any services throughout the study. They were also encouraged to speak with their primary care physician about appropriate services.

Throughout the 12-week intervention period, the use of medications and services to treat eating disorders, mental health problems, and other conditions at the HMO did not differ between the two groups.

By six months, abstinence from binge eating was greater in the intervention group (74.5% versus 44.1%, P<0.001). The number needed to treat was 3.

By 12 months, the advantage for the intervention group was attenuated but still significant.

Regarding the apparent narrowing benefit over time, DeBar said, "It may be that some kind of a short booster session with a health coach may be a really good way to help people sustain those [benefits]."

The individuals who had received the combined treatment also showed greater improvements in eating-related psychopathology, depression, and social adjustment (P<0.038 for all).

There was no significant difference between the two groups in weight change, although a post hoc analysis showed that those who stopped binge eating lost weight, and those who continued to binge eat gained weight.

"It really does suggest … that this [intervention] prevents people from gaining additional weight. So it really might be quite significant in terms of the overweight and obesity problems in the country," DeBar said.

Through one year, patients who received the intervention had 25.2 more binge-free days than the controls, resulting in $427 less in total societal costs, when healthcare services, medications, intervention costs, and patient costs were considered.

That equated to an incremental cost-effectiveness ratio of $26,847 per quality-adjusted life year. Values less than $40,000 are considered cost-effective.

The "findings support cognitive behavioral therapy-guided self-help dissemination for recurrent binge-eating treatment," DeBar and her colleagues wrote.

They noted some limitations of the study, including insufficient power for testing predictors or moderators of treatment outcome, as well as the homogeneity of the participants.

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Primary source: Journal of Consulting and Clinical Psychology
Source reference: Streigel-Moore R, et al “Cognitive behavioral guided self-help for the treatment of recurrent binge eating” J Consult Clin Psychol 2010; DOI: 10.1037/a0018915.

Additional source: Journal of Consulting and Clinical Psychology
Source reference:
Lynch F, et al “Cost-effectiveness of guided self-help treatment for recurrent binge eating” J Consult Clin Psychol 2010; DOI: 10.1037/a0018982.

By Todd Neale, Staff Writer, MedPage Today
Published: April 01, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner