The objective of this research is to address the dual problems of overweight/obesity and binge eating among Veterans. Obesity is a leading cause of preventable death and one of the most serious public health problems faced by our nation. Binge eating is a common problem found amongst overweight/obese individuals that poses additional risk for psychiatric and medical comorbidity. Of great concern for the Veterans Health Administration (VHA) is that Veterans are disproportionately affected by obesity; 77 percent of Veterans seeking healthcare through the VHA are classified as overweight/obese compared to 68 percent of the general population. Also of concern is that binge eating is a highly prevalent problem among Veterans. Over 78 percent of Veterans seeking weight loss treatment through the VHA experience some binge eating, and almost half experience recurrent binge eating, defined as engaging in binge eating at least once per week. Evidence suggests that individuals who report recurrent binge eating have significant clinical impairment or distress despite not meeting full diagnostic criteria for Binge Eating Disorder (BED). In clinical trials it is unequivocal that cognitive-behavioral therapy (CBT) is the best-established treatment for BED, and that guided self-help CBT (gshCBT) is the preferred first-line approach. While CBT produces robust and lasting effects for binge eating and mental health, the effect on weight loss has been shown to be minimal at best. Our previous work, and the work of others, has demonstrated better weight outcomes, but worse binge eating and mental health outcomes, for patients with BED who receive weight loss treatment compared to CBT. To capitalize on the best of both treatments, we have recently completed an NIH-funded efficacy trial that combined manualized behavioral weight loss treatment with CBT in a sample of overweight/obese non-Veterans with clinical BED. Findings demonstrated that when CBT is combined with behavioral weight loss treatment that the benefits on binge eating are not compromised by the weight loss intervention, and that there are additional and significant improvements in weight and metabolic outcomes. The proposed study will address binge eating in Veterans, a population that has been overlooked with regard to this problem. Additionally, this effectiveness trial will extend the predominately efficacy treatment literature by leveraging the existing program for weight management within the VHA, and treating patients with both clinical and subclinical BED. Overweight/obese Veterans with at least recurrent binge eating, who are recruited through orientation sessions for the VHA weight management program, MOVE!, will be eligible to participate. Participants will be randomized to receive MOVE! (treatment- as-usual) or MOVE!+gshCBT. Given the VHA strategic plan to address the needs of women Veterans, we will also oversample for women. Major outcome assessments will be performed by an independent evaluator at the end of gshCBT treatment (3 months) and at 6- and 12-months following treatments (9 and 15 months after randomization). Comprehensive evaluations will assess binge eating, mental health, weight loss, and associated outcomes. The repeated assessments will allow for examination of potential predictors, moderators and correlates of treatment outcomes. This study will provide important information about the effectiveness and durability of treatment approaches for overweight/obese Veterans with binge eating, and inform the next phase of research to bring this type of intervention closer to ready for implementation.

Public Health Relevance

Obesity is a leading cause of preventable death and one of the most serious public health problems faced by our nation. Of great concern for the Veterans Health Administration (VHA) is that Veterans are disproportionately affected by obesity and have poor response to weight loss treatment. Also critical to the VHA is that binge eating, a problem strongly associated with psychiatric and medical illness, is also highly prevalent among Veterans. Over three-quarters of overweight or obese Veterans who seek weight loss treatment engage in binge eating behavior, and as a result, will have suboptimal weight loss outcome. To date there are no treatments that have been established in the VHA to address binge eating. The current project aims to leverage the VHA's national weight management program, MOVE!, by combining it with cognitive- behavioral therapy (CBT), the best-established treatment for binge eating. We anticipate that the combined treatment will reduce binge eating, improve mental health, and enhance weight loss response.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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HSR-2 Determinants of Patient Response to Care (HSR2)
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VA Connecticut Healthcare System
West Haven
United States
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