The long-term aims of this research are to discover the most effective treatment approach for bulimia nervosa, to understand the mechanisms underlying effective treatment, and to identify aspects of psychopathology relevant to these aims. In this renewal proposal the focus of research shifts to overweight individuals who binge eat but do not purge. This syndrome, referred to as bulimia in this proposal, can be regarded as part of the same syndrome as bulimia nervosa and appears to respond to the same treatment approaches. However, individuals with bulimia are predisposed to obesity and thus suffer the health and mental health complications associated with obesity. Moreover, there is evidence that bulimics fare less well in obesity treatment programs, losing less weight, dropping out of treatment more frequently, and maintaining weight loss less well than the obese non-binge eater. Two major questions are posed in this proposal. First, would cognitive-behavioral treatment of binge eating prior to a weight loss program enhance reduction of binge eating, weight loss and maintenance of those losses, and dropout from treatment. Second, would the addition of medication (desipramine hydrochloride) in the weight loss phase of treatment result in superior maintenance of improvement in binge eating, fostering superior weight loss. Two hundred forty overweight women who binge eat will be allocated at random to the following additive design: behavior therapy for weight loss; cognitive-behavioral treatment for binge eating followed by behavior therapy for weight loss; and cognitive-behavioral treatment for binge eating, followed by desipramine plus behavior therapy for weight loss. An enhanced weight control program for the overweight binge eater would result in diminution of the health and mental health problems associated with obesity and binge eating, thus lowering the cost of health care services to these individuals.
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