The overall purpose of this research is to develop a behavioral treatment for binge eating disorder (BED) that addresses the problem of obesity, as well as the behavioral and psychological aspects of the disorder. While treating obesity among patients with BED has the potential to improve morbidity and mortality, among the many treatments shown to be efficacious for the behavioral and psychological aspects of the disorder, none produce clinically meaningful weight loss outcomes. The proposed study seeks to build upon findings from the treatment outcome literature of BED that has found Cognitive-Behavioral Therapy (CBT) to be the best-established treatment to date, and efficacious for three of the four core domains (i.e., binge eating, attitudinal features of eating disorders, and psychological functioning), but not for weight loss. The primary aim of the proposed study is to investigate a novel dietary approach - lowering dietary energy density - for producing weight loss in obese patients with BED while maintaining the substantial improvements found with CBT. Lowering energy density allows individuals to eat a satisfying amount of food while reducing overall energy intake and maximizing satiety. Secondary aims include the exploration of associations between dietary changes and weight loss. The proposed study involves a randomized study to test the relative efficacy of two treatment conditions: 1) Cognitive-Behavioral Therapy plus General Nutrition counseling (CBT+GN; nutritional counseling NOT related to lowering energy density or weight loss), and 2) Cognitive-Behavioral Therapy plus Low Energy Density diet counseling (CBT+LED). Fifty obese patients with BED will be randomly assigned to the two treatment conditions. The two treatments will be delivered over six months, and will be matched for quantity of nutritional information provided and therapist contact dedicated to nutrition. Thus, each treatment session will include 40 minutes of CBT and 20 minutes of nutritional counseling (GN or LED). Assessments will occur at baseline, during treatment (2- and 4-months), and at post-treatment (6-months) and six-month follow-up. Successful outcomes will include clinically meaningful weight loss (i.e., at least 5% of baseline body weight); outcomes related to BED (i.e., binge eating, attitudinal features of eating disorders, and psychological functioning); outcomes related to energy density (i.e., data analyzed from 24-hour Dietary Recall Interviews including energy density, caloric intake, fat intake, and fruit and vegetable consumption; and hunger); and improved health status (i.e., lipids and blood pressure). Binge eating disorder (BED) is a significant clinical problem commonly associated with obesity. While research has identified effective treatments to reduce binge eating, these treatments fail to produce weight loss. The proposed study has the potential to address the problem of obesity by examining the efficacy of a low energy density dietary approach for weight loss in patients with BED, a special subgroup of the obese population. ? ? ? ? ? ? ?
