Binge-Eating Treatment Found Cost-Effective

[Guest guest]

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 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.

*Primary source: *Journal of Consulting and Clinical Psychology

Source reference:

Streigel- 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.

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--

Ortiz, MS, RD

" My husband said he needed more space. So I locked him outside. "

" Cause of obesity, heart disease and cancer: Look at the end of your fork "