This competing continuation application seeks funds to perform a randomized controlled trial comparing a stepped care approach to a standard behavioral weight loss treatment (BWL) for obese patients with binge eating disorder (BED). Although cognitive behavioral therapy (CBT) is currently the best-established treatment for BED, it does not produce weight loss in this obese patient group. BWL is a viable treatment option given its effectiveness, its wider availability, and need for less specialized training than CBT. In this study, subjects will be randomized to either stepped-care or to standard BWL for 6 months. In the stepped-care arm, following one month of BWL, patients are stratified by whether or not they show an early rapid response to BWL. In this application we provide findings from four controlled trials showing the robust predictive utility of rapid response for the purpose of subsequent treatment assignment. Rapid responders are then randomized to receive either the sibutramine or placebo in addition to continuing to receive BWL for another 5 months. Patients who do not show a rapid response to BWL are switched to guided self-help CBT (CBTgsh) and are randomized to also receive sibutramine or placebo for another 5 months. The BWL in both the stepped-care arm and standard treatment arm will be the same. BWL and CBTgsh will follow established manualized protocols. Medication conditions will be double-blind. Changes throughout the course of treatments will be evaluated, including an assessment at one month to ascertain early treatment response. Major outcome assessments will be performed by independent evaluators at the end of treatments (6 months) and at 6- and 12-months following treatments (12 and 18 months after randomization). Comprehensive evaluations will assess both binge eating and obesity and their associated outcomes and will examine the durability of the treatments. The repeated assessments will also allow for exploration of mediators and moderators of outcomes and estimates of cost-effectiveness. Public Health Relevance: This R01 is a randomized controlled trial comparing a stepped care approach to a standard behavioral weight loss treatment (BWL) for obese patients with binge eating disorder (BED). Subjects will be randomized to either stepped-care or to standard BWL for 6 months. Subjects will be followed up for 12 months after treatment. This study will provide important information about the effectiveness and durability of these treatment approaches for obese person with BED.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK049587-13
Application #
7840539
Study Section
Psychosocial Risk and Disease Prevention Study Section (PRDP)
Program Officer
Kuczmarski, Robert J
Project Start
1996-08-01
Project End
2013-05-30
Budget Start
2010-06-01
Budget End
2011-05-31
Support Year
13
Fiscal Year
2010
Total Cost
$639,773
Indirect Cost
Name
Yale University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
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Lydecker, Janet A; White, Marney A; Grilo, Carlos M (2017) Form and formulation: Examining the distinctiveness of body image constructs in treatment-seeking patients with binge-eating disorder. J Consult Clin Psychol 85:1095-1103
Masheb, Robin M; White, Marney A; Grilo, Carlos M (2016) Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder. Eur Eat Disord Rev 24:247-50
Lydecker, Janet A; White, Marney A; Grilo, Carlos M (2016) Black patients with binge-eating disorder: Comparison of different assessment methods. Psychol Assess 28:1319-1324
Roberto, Christina A; Galbraith, Katharine; Lydecker, Janet A et al. (2016) Preferred descriptions for loss of control while eating and weight among patients with binge eating disorder. Psychiatry Res 246:548-553
Lydecker, Janet A; Grilo, Carlos M (2016) Different yet similar: Examining race and ethnicity in treatment-seeking adults with binge eating disorder. J Consult Clin Psychol 84:88-94
Udo, Tomoko; White, Marney A; Barnes, Rachel D et al. (2016) Psychosocial and metabolic function by smoking status in individuals with binge eating disorder and obesity. Addict Behav 53:46-52
Udo, Tomoko; McKee, Sherry A; Grilo, Carlos M (2015) Factor structure and clinical utility of the Beck depression inventory in patients with binge eating disorder and obesity. Gen Hosp Psychiatry 37:120-5
Blomquist, Kerstin K; Grilo, Carlos M (2015) Family histories of anxiety in overweight men and women with binge eating disorder: A preliminary investigation. Compr Psychiatry 62:161-9

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