Objective
Cognitive‐behavioral therapy (CBT) is efficacious for a range of eating disorder presentations, yet premature dropout is one factor that might limit CBTs effectiveness. Improved ...understanding of dropout from CBT for eating disorders is important. This meta‐analysis aimed to study dropout from CBT for eating disorders in randomized controlled trials (RCTs), by (a) identifying the types of dropout definitions applied, (b) providing estimates of dropout, (c) comparing dropout rates from CBT to non‐CBT interventions for eating disorders, and (d) testing moderators of dropout.
Method
RCTs of CBT for eating disorders that reported rates of dropout were searched. Ninety‐nine RCTs (131 CBT conditions) were included.
Results
Dropout definitions varied widely across studies. The overall dropout estimate was 24% (95% CI = 22–27%). Diagnostic type, type of dropout definition, baseline symptom severity, study quality, and sample age did not moderate this estimate. Dropout was highest among studies that delivered internet‐based CBT and was lowest in studies that delivered transdiagnostic enhanced CBT. There was some evidence that longer treatment protocols were associated with lower dropout. No significant differences in dropout rates were observed between CBT and non‐CBT interventions for all eating disorder subtypes.
Conclusion
Present study dropout estimates are hampered by the use of disparate dropout definitions applied. This meta‐analysis highlights the urgency for RCTs to utilize a standardized dropout definition and to report as much information on patient dropout as possible, so that strategies designed to minimize dropout can be developed, and factors predictive of CBT dropout can be more easily identified.
Resumen
Objetivo
La terapia cognitivo conductual (TCC) es eficaz para una variedad de presentaciones de trastornos de la conducta alimentaria (TCA), sin embargo el abandono prematuro es un factor que puede limitar la eficacia de las TCC. Un mejor entendimiento de la deserción prematura de TCC para TCA es muy importante. Este meta‐análisis tuvo como objetivo estudiar el abandono de TCC para TCA en ensayos controlados aleatorios (ECAs), mediante (a) la identificación de tipos de definiciones de abandono aplicadas, (b) la provisión de estimaciones de deserción, (c) la comparación de las tasas de abandono entre intervenciones de TCC y no TCC para TCA, y (d) evaluación de moderadores para abandono.
Método
Se realizaron búsquedas en los ECA de TCC para los trastornos de la conducta alimentaria (TCA) que informaron tasas de abandono. Noventa y nueve ECAs (131 con TCC) fueron incluidos.
Resultados
Las definiciones de abandono variaron ampliamente entre los estudios. La estimación general de abandono fue de 24% (95% CI = 22–27%). El tipo de diagnóstico, tipo de definición de abandono, severidad de los síntomas basales, calidad del estudio o la edad de la muestra no moderaron este estimado. El abandono fue mayor entre los estudios que dieron TCC por internet y fue más baja en los estudios que dieron TCC mejorada transdiagnóstica. Hubo algo de evidencia que los protocolos de tratamiento más largos estuvieron asociados con menores abandonos. No hubo diferencias significativas en los rangos de abandono observados entre las intervenciones TCC y no TCC para todos los subtipos de TCA.
Conclusión: Las estimaciones de abandono del estudio actual se ven obstaculizadas por el uso de definiciones dispares de abandono aplicadas. Este meta‐análisis resalta la urgencia de que los ECA utilicen una definición de abandono estandarizado y notifiquen la mayor cantidad posible de información sobre el abandono del paciente, de modo que puedan desarrollarse estrategias diseñadas para minimizar el abandono y los factores predictivos del abandono del TCC puedan identificarse más fácilmente.
Objective: This meta-analysis examined the efficacy of cognitive-behavioral therapy (CBT) for eating disorders. Method: Randomized controlled trials of CBT were searched. Seventy-nine trials were ...included. Results: Therapist-led CBT was more efficacious than inactive (wait-lists) and active (any psychotherapy) comparisons in individuals with bulimia nervosa and binge eating disorder. Therapist-led CBT was most efficacious when manualized CBT-BN or its enhanced version was delivered. No significant differences were observed between therapist-led CBT for bulimia nervosa and binge eating disorder and antidepressants at posttreatment. CBT was also directly compared to other specific psychological interventions, and therapist-led CBT resulted in greater reductions in behavioral and cognitive symptoms than interpersonal psychotherapy at posttreatment. At follow-up, CBT outperformed interpersonal psychotherapy only on cognitive symptoms. CBT for binge eating disorder also resulted in greater reductions in behavioral symptoms than behavioral weight loss interventions. There was no evidence that CBT was more efficacious than behavior therapy or nonspecific supportive therapies. Conclusions: CBT is efficacious for eating disorders. Although CBT was equally efficacious to certain psychological treatments, the fact that CBT outperformed all active psychological comparisons and interpersonal psychotherapy specifically, offers some support for the specificity of psychological treatments for eating disorders. Conclusions from this study are hampered by the fact that many trials were of poor quality. Higher quality RCTs are essential.
What is the public health significance of this article?
This meta-analysis demonstrates that CBT is an efficacious psychological treatment for individuals with eating disorders. CBT produces large and long lasting improvements in core behavioral and cognitive symptoms of eating disorders.
Summary
Objective
The aim of this study was to evaluate the impact of mindfulness‐based interventions on psychological and physical health outcomes in adults who are overweight or obese.
Methods
We ...searched 14 electronic databases for randomized controlled trials and prospective cohort studies that met eligibility criteria. Comprehensive Meta‐analysis software was used to compute the effect size estimate Hedge's g.
Results
Fifteen studies measuring post‐treatment outcomes of mindfulness‐based interventions in 560 individuals were identified. The average weight loss was 4.2 kg. Overall effects were large for improving eating behaviours (g = 1.08), medium for depression (g = 0.64), anxiety (g = 0.62) and eating attitudes (g = 0.57) and small for body mass index (BMI; g = 0.47) and metacognition (g = 0.38) outcomes. Therapeutic effects for BMI (g = 0.43), anxiety (g = 0.53), eating attitudes (g = 0.48) and eating behaviours (g = 0.53) remained significant when examining results from higher quality randomized control trials alone. There was no efficacy advantage for studies exceeding the median dose of 12 h of face‐to‐face intervention. Studies utilizing an Acceptance and Commitment Therapy approach provided the only significant effect for improving BMI (g = 0.66), while mindfulness approaches produced great variation from small to large (g = 0.30–1.68) effects across a range of psychological health and eating‐related constructs. Finally, the limited longitudinal data suggested maintenance of BMI (g = 0.85) and eating attitudes (g = 0.75) gains at follow‐up were only detectable in lower quality prospective cohort studies.
Conclusions
Mindfulness‐based interventions may be both physically and psychologically beneficial for adults who are overweight or obese, but further high‐quality research examining the mechanisms of action are encouraged.
Individuals with type 2 diabetes (T2D) require a long-term dietary strategy for blood glucose management and may benefit from time-restricted eating (TRE, where the duration between the first and ...last energy intake is restricted to 8-10 h/day). We aimed to determine the feasibility of TRE for individuals with T2D. Participants with T2D (HbA1c >6.5 to <9%, eating window >12 h/day) were recruited to a pre-post, non-randomised intervention consisting of a 2-week Habitual period to establish baseline dietary intake, followed by a 4-weeks TRE intervention during which they were instructed to limit all eating occasions to between 10:00 and 19:00 h on as many days of each week as possible. Recruitment, retention, acceptability, and safety were recorded throughout the study as indicators of feasibility. Dietary intake, glycaemic control, psychological well-being, acceptability, cognitive outcomes, and physiological measures were explored as secondary outcomes. From 594 interested persons, and 27 eligible individuals, 24 participants enrolled and 19 participants (mean ± SD; age: 50 ± 9 years, BMI: 34 ± 5 kg/m
, HbA1c: 7.6 ± 1.1%) completed the 6-week study. Overall daily dietary intake did not change between Habitual (~8400 kJ/d; 35% carbohydrate, 20% protein, 41% fat, 1% alcohol) and TRE periods (~8500 kJ/d; 35% carbohydrate, 19% protein, 42% fat, 1% alcohol). Compliance to the 9 h TRE period was 72 ± 24% of 28 days (i.e., ~5 days/week), with varied adherence (range: 4-100%). Comparisons of adherent vs. non-adherent TRE days showed that adherence to the 9-h TRE window reduced daily energy intake through lower absolute carbohydrate and alcohol intakes. Overall, TRE did not significantly improve measures of glycaemic control (HbA1c -0.2 ± 0.4%;
= 0.053) or reduce body mass. TRE did not impair or improve psychological well-being, with variable effects on cognitive function. Participants described hunger, daily stressors, and emotions as the main barriers to adherence. We demonstrate that 4-weeks of TRE is feasible and achievable for these individuals with T2D to adhere to for at least 5 days/week. The degree of adherence to TRE strongly influenced daily energy intake. Future trials may benefit from supporting participants to incorporate TRE in regular daily life and to overcome barriers to adherence.
Objective
Depressive symptoms are an important risk factor and consequence of binge eating and purging behavior in bulimia nervosa (BN). Although psychotherapy is effective in reducing symptoms of BN ...in the short‐ and long‐term, it is unclear whether psychotherapy for BN is also effective in reducing depressive symptoms. This meta‐analysis examined the efficacy of psychotherapy for BN on depressive symptoms in the short‐ and long‐term.
Method
Randomized controlled trials (RCTs) on BN that assessed depressive symptoms as an outcome were identified. Twenty‐six RCTs were included.
Results
Psychotherapy was more efficacious at reducing symptoms of depression at post‐treatment (g = 0.47) than wait‐lists. This effect was strongest when studies delivered therapist‐led, rather than guided self‐help, treatment. No significant differences were observed between psychotherapy and antidepressants. There was no significant post‐treatment difference between CBT and other active psychological comparisons at reducing symptoms of depression. However, when only therapist‐led CBT was analyzed, therapist‐led CBT was significantly more efficacious (g = 0.25) than active comparisons at reducing depressive symptoms. The magnitude of the improvement in depressive symptoms was predicted by the magnitude of the improvement in BN symptoms.
Discussion
These findings suggest that psychotherapy is effective for reducing depressive symptoms in BN in the short‐term. Whether these effects are sustained in the long‐term is yet to be determined, as too few studies conducted follow‐up assessments. Moreover, findings demonstrate that, in addition to being the front‐running treatment for BN symptoms, CBT might also be the most effective psychotherapy for improving the symptoms of depression that commonly co‐occur in BN.
Resumen
Objetivo: Los síntomas depresivos son un importante factor de riesgo y consecuencia de las conductas de atracón y purga en la bulimia nervosa (BN). Aunque la psicoterapia es efectiva en reducir los síntomas de BN en el corto y largo plazo, no está claro si la psicoterapia para BN también es efectiva en reducir los síntomas depresivos. Este meta‐análisis examinó la eficacia de la psicoterapia para BN en síntomas depresivos en el corto y largo plazo. Método: Se identificaron Ensayos Controlados Aleatorizados (ECAs) sobre BN que evaluaron síntomas depresivos como resultado. Se incluyeron 26 ECAs. Resultados: La psicoterapia fue más eficaz en reducir síntomas de depresión en el post‐tratamiento (g = 0.47) que en las listas de espera. Este efecto fue mayor en los estudios en que el tratamiento fue dirigido por un terapeuta en lugar de tratamiento de autoayuda. No se encontraron diferencias significativas entre la psicoterapia y los antidepresivos. No hubo diferencia significativa post‐tratamiento en reducir los síntomas de depresión entre la Terapia Cognitivo Conductual (TCC) y otras comparaciones psicológicas activas. Sin embargo, cuando sólo se analizó la TCC dirigida por un terapeuta, la TCC dirigida por un terapeuta fue significativamente más eficaz en reducir los síntomas de depresión (g = 0.25) que las comparaciones activas. La magnitud de la mejoría en síntomas depresivos se predijo por la magnitud de la mejoría en los síntomas de BN. Discusión: Estos hallazgos sugieren que la psicoterapia es efectiva para reducir los síntomas depresivos en la BN en el corto plazo. Si estos efectos son sostenidos en el largo plazo aún debe ser determinado, ya que muy pocos estudios llevaron a cabo evaluaciones de seguimiento. Además, los hallazgos demuestran que, además de ser el tratamiento de primera línea para la BN, la TCC podría ser también la psicoterapia más efectiva para mejorar los síntomas de depresión que comúnmente acompañan a la BN.
Objective
While evidence regarding associations between weight stigma and biopsychosocial outcomes is accumulating, outcomes are considered in isolation. Thus, little is known about their complex ...relationships. This article extends existing work by systematically reviewing the biopsychosocial consequences of stigma in adults with overweight/obesity.
Methods
Articles were identified through Medline, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases. Independent extraction of articles was conducted using predefined data fields, including data on biopsychosocial correlates in each study.
Results
Twenty‐three studies published from 2001 and addressing correlates of stigma in adults with overweight/obesity (body mass index ≥25 kg m−2; 18‐65 years) were identified. Numerous biopsychosocial correlates of weight stigma were studied, particularly in treatment‐seeking individuals. Available research shows that weight stigma is consistently associated with medication non‐adherence, mental health, anxiety, perceived stress, antisocial behavior, substance use, coping strategies, and social support. Biopsychosocial correlates were not considered in combination in research. Psychological correlates were well documented in comparison to biological and social correlates for each weight stigma type. There were some indications that associations are stronger once stigma is internalized.
Conclusions
While there is evidence for biopsychosocial correlates of weight stigma, these are not considered in combination in research; thus their inter‐relationships are unknown. Conclusions from the review are limited by this and the small number of studies, types of designs, and variables considered.
Bariatric surgery is often pursued to improve quality of life (QOL). This paper systematically reviews the literature examining QOL following bariatric surgery. Fifteen controlled trials examined ...changes in QOL in obese (BMI > 30) adults (18–65 years) following bariatric surgery; seven compared bariatric surgery to non-surgical interventions and six compared different types of bariatric surgery. Bariatric surgery resulted in greater improvements in QOL than other obesity treatments. Significant differences in QOL improvements were found between different types of bariatric surgery. QOL improvements were more likely to occur within the first 2 years following surgery, with greater improvements in physical QOL than mental QOL. Bariatric surgery improves QOL. Future research is needed to investigate changes in QOL in different domains in the short- and long-term following bariatric surgery.
Introduction The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently ...under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population. Aim The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations. Methods The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience. Recommendations Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed. Conclusions This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field. Keywords: Guideline, Atypical anorexia nervosa, Bulimia nervosa, Binge-eating disorder, Other specified feeding or eating disorder, Obesity
Objective To evaluate a commercially available, structured short-term weight management program designed for adolescents with obesity delivered by nonhealth professionals. Study design A multisite ...parallel-group randomized controlled trial was conducted to evaluate a commercial 12-week lifestyle behavioral program in commercial weight management centers in Australia. Eligible participants (13-17 years, body mass index (BMI) z score ≥1.282 with no presenting morbidities) were randomized (n = 88) to intervention or wait-list, and the program was delivered by consultants at participating weight management centers. The primary outcome was change in BMI z score. Secondary outcomes included the psychometric variables quality of life, body-esteem, and self-esteem. Data was analyzed according to intention-to-treat principles. Results Of 74 participants who consented to enter the study, 66 provided baseline anthropometric data and 12-week data were available for 55 individuals (74%). A significantly greater decrease in BMI z score in the intervention group (n = 32) was observed when compared with the wait-list control group, mean difference (MD) = −0.27 kg/m2 ; 95% CI, −0.37,−0.17; P < .001). Participants allocated to receive the lifestyle intervention reported a greater improvement in body esteem (MD = 1.7, 95% CI, 0.3, 3.1; P = .02) and quality of life (MD = 5.9, 95% CI, 0.9, 10.9; P = .02) compared with the wait-list control group. Conclusions A structured lifestyle intervention delivered by a commercial provider in an adolescent population can result in clinically relevant weight loss and improvements in psychosocial outcomes in the short term. Further research is required to evaluate long-term outcomes. Trial registration International Clinical Trials Registry: ISRCTN13602313.
Postpartum women are at higher risk of depression compared to the general population. Despite the mental health benefits an active lifestyle can provide, postpartum women engage in low physical ...activity and high screen time. Very little research has investigated the social ecological (i.e. individual, social and physical environmental) influences on physical activity and screen time amongst postpartum women, particularly amongst those with depressive symptoms. Therefore, this study sought to examine the influences on physical activity and screen time amongst postpartum women with heightened depressive symptoms.
20 mothers (3-9 months postpartum) participating in the Mums on the Move pilot randomised controlled trial who reported being insufficiently active and experiencing heightened depressive symptoms participated in semi-structured telephone interviews exploring their perceptions of the key influences on their physical activity and screen time across various levels of the social ecological model. Strategies for promoting physical activity and reducing screen time were explored with participants. Thematic analyses were undertaken to construct key themes from the qualitative data.
Findings showed that postpartum women with depressive symptoms reported individual (i.e. sleep quality, being housebound, single income), social (i.e. childcare, social support from partner and friends) and physical environmental (i.e. weather, safety in the local neighbourhood) influences on physical activity. Postpartum women reported individual (i.e. screen use out of habit and addiction, enjoyment) and social (i.e. positive role modelling, social isolation) influences on screen-time, but no key themes targeting the physical environmental influences were identified for screen time. Strategies suggested by women to increase physical activity included mother's physical activity groups, home-based physical activity programs and awareness-raising. Strategies to reduce screen time included the use of screen time tracker apps, increasing social connections and awareness-raising.
Amongst postpartum women with heightened depressive symptoms, influences on physical activity encompassed all constructs of the social ecological model. However, screen time was only perceived to be influenced by individual and social factors. Intervention strategies targeting predominantly individual and social factors may be particularly important for this high-risk group. These findings could assist in developing targeted physical activity and screen time interventions for this cohort.
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