Binge abstinence is associated with reduced energy intake after treatment in patients with binge eating disorder and obesity.

OBJECTIVE: Binge eating disorder (BED) is strongly associated with obesity and related medical and psychiatric morbidities. Cognitive behavioral therapy (CBT) has consistently been shown to reduce binge eating frequency and improve psychological functioning, as well as to produce abstinence rates of roughly 50%. This study examined the relationship between binge abstinence and dietary and psychological outcomes after CBT for BED. METHODS: Fifty adult patients with BED received 6-month treatments using a combination of CBT and dietary counseling. Trained interviewers conducted two 24-hour dietary recall interviews on randomly selected days at baseline and at 6 months. RESULTS: Participants had significant reductions in energy, macronutrient, and sugar intake and an increase in fruit intake. They reported significant reductions in BMI and binge eating frequency (from mean = 14.24 to mean = 1.90 binge eating episodes during the previous 28 days), as well as improvements in psychological functioning. Those who became binge abstinent reported eating roughly 400 fewer calories per day and experienced greater improvements in psychological functioning than those who did not. CONCLUSIONS: Findings from this study suggest that individuals who achieve complete cessation from binge eating have significantly improved dietary and psychological outcomes that could potentially improve weight status, compared with those who continue to binge eat post-treatment.

A randomized controlled trial for obesity and binge eating disorder: low-energy-density dietary counseling and cognitive-behavioral therapy.

The present study examined a dietary approach - lowering energy density - for producing weight loss in obese patients with binge eating disorder (BED) who also received cognitive-behavioral therapy (CBT) to address binge eating. Fifty consecutive participants were randomly assigned to either a six-month individual treatment of CBT plus a low-energy-density diet (CBT+ED) or CBT plus General Nutrition counseling not related to weight loss (CBT+GN). Assessments occurred at six- and twelve-months. Eighty-six percent of participants completed treatment, and of these, 30% achieved at least a 5% weight loss with rates of binge remission ranging from 55% to 75%. The two treatments did not differ significantly in weight loss or binge remission outcomes. Significant improvements were found for key dietary and metabolic outcomes, with CBT+ED producing significantly better dietary outcomes on energy density, and fruit and vegetable consumption, than CBT+GN. Reductions in energy density and weight loss were significantly associated providing evidence for the specificity of the treatment effect. These favorable outcomes, and that CBT+ED was significantly better at reducing energy density and increasing fruit and vegetable consumption compared to CBT+GN, suggest that low-energy-density dietary counseling has promise as an effective method for enhancing CBT for obese individuals with BED.

Plenary Lecture 1: Dietary strategies for the prevention and treatment of obesity.

Obesity is a rapidly-growing public health problem that is related in part to the foods available in the eating environment. Properties of foods such as portion size and energy density (kJ/g) have robust effects on energy intake; large portions of energy-dense foods promote excess consumption and this effect starts in early childhood. Studies show, however, that in both adults and children these food characteristics can also be used strategically to moderate energy intake, as well as to improve diet quality. Dietary energy density can be reduced by increasing intake of water-rich foods such as vegetables and fruits. Their high water content allows individuals to eat satisfying portions of food while decreasing energy intake. Filling up at the start of a meal with vegetables or fruit and increasing the proportion of vegetables in a main course have been found to control hunger and moderate energy intake. Data from several clinical trials have also demonstrated that reducing dietary energy density by the addition of water-rich foods is associated with substantial weight loss even though participants eat greater amounts of food. Population-based assessments indicate that beginning in childhood there is a relationship between consuming large portions of energy-dense foods and obesity. These data suggest that the promotion of diets that are reduced in energy density should be an important component of future efforts to both prevent and treat obesity.

Dietary energy density in the treatment of obesity: a year-long trial comparing 2 weight-loss diets.

BACKGROUND: Consuming foods low in energy density (kcal/g) decreases energy intake over several days, but the effectiveness of this strategy for weight loss has not been tested. OBJECTIVE: The effects on weight loss of 2 strategies for reducing the energy density of the diet were compared over 1 y. DESIGN: Obese women (n = 97) were randomly assigned to groups counseled either to reduce their fat intake (RF group) or to reduce their fat intake and increase their intake of water-rich foods, particularly fruit and vegetables (RF+FV group). No goals for energy or fat intake were assigned; the subjects were instructed to eat ad libitum amounts of food while following the principles of their diet. RESULTS: After 1 y, study completers (n = 71) in both groups had significant decreases in body weight (P < 0.0001). Subjects in the RF+FV group, however, had a significantly different pattern of weight loss (P = 0.002) than did subjects in the RF group. After 1 y, the RF+FV group lost 7.9 +/- 0.9 kg and the RF group lost 6.4 +/- 0.9 kg. Analysis of all randomly assigned subjects also showed a different pattern of weight loss between groups (P = 0.021). Diet records indicated that both groups had similar reductions in fat intake. The RF+FV group, however, had a lower dietary energy density than did the RF group (P = 0.019) as the result of consuming a greater weight of food (P = 0.025), especially fruit and vegetables (P = 0.037). The RF+FV group also reported less hunger (P = 0.003). CONCLUSION: Reducing dietary energy density, particularly by combining increased fruit and vegetable intakes with decreased fat intake, is an effective strategy for managing body weight while controlling hunger.