Cognitive and behavioral approaches to reduce binge eating and excess weight in adolescents

About This Grant

PROJECT SUMMARY/ ABSTRACT Binge-eating disorder is the most prevalent and costly formal eating disorder, but has the lowest rate (<4%) of receiving eating disorder treatment. Binge eating often begins in adolescence and is strongly associated with obesity, physical and mental health impairment, and psychological distress. Yet, there are virtually no established treatments, and no clear standard of care, for adolescents with binge eating. Evidence-based treatments exist for adults, including psychological treatments (e.g., CBT-BED) and lifestyle behavioral obesity intervention (LBOI), but efficacy for adolescents remains largely unknown. LBOI is an effective treatment for adolescent obesity, but has only been tested post-hoc for binge eating. There is an urgent need for research identify and establish the efficacy of developmentally-appropriate interventions for adolescents with binge eating to improve adolescents’ health and quality of life. To address this pressing public health knowledge gap, CARE2 will test Cognitive and behavioral Approaches to Reduce binge Eating and Excess weight in adolescents. We will conduct a randomized controlled trial (RCT) in which participants are randomized to Psychological Treatment (CBT-BED), LBOI, or Active Control. We developed, refined, and tested adolescent-specific CBT-BED. Our pilot work showed that adolescent-specific CBT-BED was feasible, was more acceptable than nutrition education, and reduced binge eating. However, there has not been a definitive study that used an active control to establish efficacy, and patient characteristics that may be predictors and moderators of outcomes are not known. Further, CBT-BED has not been compared to LBOI, which shows promise for binge eating as well as weight. In the proposed study, we will compare both CBT-BED and LBOI to each other and to an Active Control. Active Control is daily self-monitoring (emotions, eating, exercise) on an “app”, mimicking real-world self-help, followed by treatment choice. After the delay, adolescents choose CBT-BED or LBOI and receive their treatment from a clinician (non-researcher). As such, the Active Control is both a control during the acute efficacy trial and an exploratory hybrid efficacy-effectiveness arm, in line with the NIH Stage Model of Psychotherapy Intervention Research. The specific aims of the CARE2 study are to 1) test whether CBT-BED and LBOI reduce binge eating and prevent excess weight gain, 2) test whether CBT-BED and LBOI reduce global eating disorder severity and improve quality of life, 3) explore durability of outcomes and patient characteristics that may moderate outcomes, and 4) explore adolescent treatment choice and effects on adherence and outcomes. Adolescents will be assessed at baseline, at end of treatment (6 months), and 6- and 12-months post-treatment. All visits occur via telehealth, allowing for national recruitment and pragmatic participation for families. Successful completion of CARE2 has the potential to improve health and reduce suffering during adolescence and improve lifelong health for adolescents with binge eating and excess weight.