Binge-Eating Treatment Found Cost-Effective

A intervention that combined cognitive behavioral therapy and guided self-help was effective and cost-saving for patients with disorders that involve binge eating, a randomized trial showed.

The intervention plus usual care allowed more patients to remain free of binge-eating episodes at one year than usual care alone (64.2% versus 44.6%, P<0.041), according to Lynn DeBar, PhD, of the Kaiser Permanente Center for Health Research in Portland, Ore., and colleagues.

The number needed to treat was 5, they reported in the April issue of the Journal of Consulting and Clinical Psychology.

A separate paper by their group found that the intervention was more cost-effective than usual care (mean cost per patient $3,670.63 versus $4,098.02), despite the additional cost of the behavioral therapy, because the participants used fewer healthcare services overall than those in the usual-care group.

Thus, DeBar and her colleagues concluded, cognitive behavioral therapy accompanied by guided self-help "is a viable first-line treatment option for the majority of patients with recurrent binge eating who do not meet diagnostic criteria for bulimia nervosa or anorexia nervosa."

In an interview, DeBar said the intervention would likely be delivered not by MDs, but by ancillary staff in a primary care setting.

"We really think that this is likely suitable for health educators, for nutritionists to deliver, and other kinds of master's-level trained health professionals that may be in a primary care setting."

Previous studies have shown cognitive behavioral therapy to be effective for treating eating disorders with binge eating as a core symptom, but it is little used in clinical practice, possibly because of the training needed and the intensity and cost of the approach.

DeBar and her colleagues evaluated a method for increasing the use of the technique at a single health maintenance organization.

Of 123 patients with bulimia nervosa, binge-eating disorder, or recurrent binge eating in the absence of either of those two disorders, 59 were assigned to the combined cognitive behavioral therapy-guided, self-help intervention. The rest received usual care, which involved using any available services at the HMO, as they wished.

The intervention was delivered in eight sessions over a 12-week period by master's-level therapists with a background in cognitive behavioral therapy for depression, but not for eating disorders. The first session lasted one hour, with the rest lasting 20 to 25 minutes.

Participants in the intervention were instructed to read and follow instructions in Overcoming Binge Eating by Christopher Fairburn, DM, of the University of Oxford, with assistance from the therapist. The book describes a self-help program using self-monitoring, self-control strategies, and problem solving.