World Health Organization 2013 Mental Health Survey found binge-eating disorder (BED) was prevalent, associated strongly with obesity and significantly with heightened psychiatric/medical comorbidities, including hypertension and other CVD risk factors, even after adjusting for other disorders. This controlled treatment study tested the effectiveness of stepped-care treatment to behavioral-weight-loss (BWL) and is the first to report outcomes for hypertension and other CVD risk-factors for obese BED patients.Design and method:
In this IRB-approved study, 191 patients (mean-age 48) with co-morbid BED/obesity (mean-BMI 39) were randomly assigned to six-months manualized protocols of BWL (N = 39) or stepped-care involving added anti-obesity medication and/or specialized cognitive-behavioral therapy (N = 152). Independent assessments were performed at baseline, during-treatment, post-treatment, and 12-months after completing treatment.Results:
Intent-to-Treat analyses of binge-eating remission rates revealed BWL and stepped-care did not differ (74% vs 64%). Mixed-models revealed significant weight-loss, BWL and stepped-care did not differ overall, but within stepped-care, medication was significantly superior to placebo overall and among initial responders on BWL and non-responders switched to CBT. Mixed-models revealed overall significant decreases in waist-circumference. Mixed models analyses targeting the subgroup of patients with Metabolic Syndrome (N = 66) revealed significant reductions in blood pressure and heart rate but no between-treatment differences.Conclusions:
BWL and stepped-care produced significant improvements in binge-eating and in hypertension and other CVD risk-factors in obese patients with BED. Anti-obesity medication enhanced outcomes in some CVD-risk factors (obesity, waist-circumference). Among the subgroup with Metabolic Syndrome, significant improvements in blood pressure and heart were observed through 12-month post-treatment follow-ups.