Group Psychosocial Therapy Shows Promise for Binge Eating

Individuals with obesity and binge eating disorder may benefit from a group psychosocial intervention called People need People (PnP), a pilot trial suggests.

The study led by Trine T. Eik-Nes, PhD, from the Norwegian University of Science and Technology (NTNU), in Trondheim, was published in Frontiers in Endocrinology.

"PnP is a treatment that we hope can be given for those who do not benefit from cognitive behavior therapy (CBT)," Eik-Nes told Medscape Medical News in an email.

"Our program uses stigma theory and [Bowlby's] attachment theory, which is not covered in CBT," she said. According to Bowlby's attachment theory, infants react to temporary separation from a parent (stress) in different ways; previous studies have linked eating disorders with insecure attachment.

Eik-Nes and senior author Kjersti Hognes Berg, a PhD candidate at NTNU, developed the 10-session intervention that consists of teaching patients "reasons for their overeating, followed by exercises and group discussions," Eik-Nes explained in a press release from the university.

The current study tested feasibility in 42 patients with obesity and binge eating disorder.

Decreasing Binging Episodes

The average number of binging episodes decreased from 15 to 14 based on pre- and post-intervention replies to the question, "Over the past 28 days how many times have you eaten what other people would regard as an unusually large amount of food (given the circumstances)?"

Based on questionnaire responses, the patients also experienced a significant improvement in their emotional issues, such as inner turmoil, anxiety, depression, and irritability, and they reported feeling far less restricted in their social activities.

"Our interdisciplinary approach worked well," Eik-Nes summarized. "Just the fact that everyone completed the study is a very good result."

"Assessments of [binge eating disorder] and delivery of this intervention may optimize selection of candidates and bariatric outcomes," the researchers note.

They are planning a multi-arm phase 2 study. "If the benefits of PnP can be reproduced, the consequence can be that patients can be treated effectively and cost-effectively, opening access to treatment for this group of patients," they speculate.

Focus on Understanding Binge Eating, Not on Diet and Exercise

People with obesity and binge eating disorder may have been bullied as children or had childhood trauma, negative thoughts about themselves, contempt for their bodies, problematic relationships with parents, or social difficulties, the researchers write.

They may have felt stigmatized, "coped" by binge eating, felt ashamed, and hid the illness from loved ones.

Binge eating disorder, the researchers explain, "is a psychiatric disorder that is characterized by recurrent episodes of binge eating, in the absence of compensatory behaviors and accompanied by a sense of loss of control."

Previous research suggests that 30% to 50% of people with a high degree of overeating who seek treatment for obesity have psychological challenges around loss of control (such as overeating that lasts a whole day).

The recommended treatment for obesity with binge eating disorder is cognitive behavioral therapy (CBT), or to a lesser extent, interpersonal therapy. CBT may only be partially effective.

Patients may benefit from second-generation antidepressants such as lisdexamfetamine and topiramate.

PnP was designed to address possible underlying emotional difficulties in individuals with binge eating disorders, such as alexithymia (inability to describe and/or recognize one's own emotions), shame, and/or attachment insecurity.

Binge eating episodes can be a response to internal stressors (eg, overvaluation of weight or shape) or external stressors (eg, weight stigma).

PnP aims to help the patient understand their stressors and learn not to respond by binge eating.

The pilot study enrolled 36 women and six men with obesity and binge eating disorder who were a mean age of 39 years and had a mean body mass index (BMI) of 42.4 kg/m².

Of these, six patients had had bariatric surgery and had a mean BMI of 33.4 kg/m².

In baseline questionnaires, participants reported high levels of grazing (constant snacking) and internalized shame, and 77% were quite a bit or extremely bothered by emotional problems. One third either overestimated or underestimated their body size.

The 10 sessions were conducted by two therapists. Each 3-hour session consisted of a teaching section, small-group learning activities and whole-group discussion, and eating lunch together.

The topics included poor body image, adverse childhood events, weight stigma, internalized weight bias, and challenges of interpersonal relationships.

PnP "is not body-weight-centric and aims to treat [binge eating disorder] to decrease [eating disorder] pathology and facilitate a healthier lifestyle," the researchers stress. There are no modules about diet or physical activity.

Despite the study's promising findings, "we can't say anything about the long-term effect of the treatment yet, " Eik-Nes cautioned. "We hope this study can lay the foundation for a larger project on morbid obesity and psychological disorders. Then we'd like to investigate change over time."

The authors have reported no relevant financial relationships.

Front Endocrinol. Published online November 21, 2021. Full Text

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