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Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications

Published online by Cambridge University Press:  16 September 2011

C. M. Grilo ,
M. A. White ,
G. T. Wilson ,
R. Gueorguieva  and
R. M. Masheb
C. M. Grilo*
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
M. A. White
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
G. T. Wilson
Affiliation:
Graduate School of Applied and Professional Psychology, Rutgers – The State University of New Jersey, Piscataway, NJ, USA
R. Gueorguieva
Affiliation:
Division of Biostatistics, Yale School of Public Health, New Haven, CT, USA
R. M. Masheb
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
*
*Address for correspondence: Dr C. M. Grilo, Yale University School of Medicine, 301 Cedar Street (2nd Floor), New Haven, CT 06519, USA. (Email: [email protected])
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Abstract

Background

We examined rapid response in obese patients with binge-eating disorder (BED) in a clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL).

Method

Altogether, 90 participants were randomly assigned to CBT or BWL. Assessments were performed at baseline, throughout and post-treatment and at 6- and 12-month follow-ups. Rapid response, defined as ⩾70% reduction in binge eating by week four, was determined by receiver operating characteristic curves and used to predict outcomes.

Results

Rapid response characterized 57% of participants (67% of CBT, 47% of BWL) and was unrelated to most baseline variables. Rapid response predicted greater improvements across outcomes but had different prognostic significance and distinct time courses for CBT versus BWL. Patients receiving CBT did comparably well regardless of rapid response in terms of reduced binge eating and eating disorder psychopathology but did not achieve weight loss. Among patients receiving BWL, those without rapid response failed to improve further. However, those with rapid response were significantly more likely to achieve binge-eating remission (62% v. 13%) and greater reductions in binge-eating frequency, eating disorder psychopathology and weight loss.

Conclusions

Rapid response to treatment in BED has prognostic significance through 12-month follow-up, provides evidence for treatment specificity and has clinical implications for stepped-care treatment models for BED. Rapid responders who receive BWL benefit in terms of both binge eating and short-term weight loss. Collectively, these findings suggest that BWL might be a candidate for initial intervention in stepped-care models with an evaluation of progress after 1 month to identify non-rapid responders who could be advised to consider a switch to a specialized treatment.

Keywords

Binge eatingcognitive behavior therapyeating disordersobesitytreatmentweight loss
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 4 , April 2012 , pp. 807 - 817
Copyright
Copyright © Cambridge University Press 2011

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