None listed
Conditions
Brief summary
Binge eating is the defining feature of binge eating disorder (BED). What distinguishes BED from bulimia nervosa is the absence of purging after the binge (by self-induced vomiting, starving or extreme exercise). Binges are recurrent episodes of uncontrolled overeating, they involve eating rapidly, leaving the individual feeling uncomfortably full, embarrassed, disgusted and guilty. They are distressing and debilitating experiences. Specialist eating disorder services are less likely to recognise or prioritise BED. In the Sydney Local Health District, there is no formal treatment program available. It affects more men than the other eating disorders, those who are older and those with overweight or obesity. Consequently, health professionals, including eating disorder staff, are less familiar with BED and may lack confidence in how to treat it. Compounding this, there is a reluctance of those with BED to seek treatment. Some also have obesity and a past history of failing to manage their overweight (and their binge eating) can act as a barrier to engaging with treatment. In the newly revised NICE guidance for eating disorders, the recommended first line of treatment for adults with BED is a guided self-help program. The guide in guided self-help is what distinguishes ‘guided’ self-help from ‘pure’ self-help. The guide is central to engagement and adherence. Guides help a participant work around a self-help resource, facilitate engagement, motivate and help review participants’ progress. Guides are supportive, faciliatory and provide continuity through the program. Guides are typically qualified health/well-being professionals (such as dietitians and nurses) with an interest in working psychologically. They need no specialist expertise in eating disorders. As yet, there has been no evaluation of whether offering a group based program to reduce binge eating before participants start a weight management program at the Metabolism & Obesity Service will better help them to lose weight. This study aims to investigate this.
Interventions
Guided self-help
Participants who screen positive for binge eating symptomology will be sent a patient information sheet inviting them to take part in the guided self-help group program to address binge eating. Those who decline this invitation and those who screen negative for binge eating symptomology will be offered appointments for the group weight management clinics (usual care).
We will utilise ‘Working to Overcome Eating Difficulties’. This is the name of the manual. It was designed spe
Guided self-help Participants who screen positive for binge eating symptomology will be sent a patient information sheet inviting them to take part in the guided self-help group program to address binge eating. Those who decline this invitation and those who screen negative for binge eating symptomology will be offered appointments for the group weight management clinics (usual care). We will utilise ‘Working to Overcome Eating Difficulties’. This is the name of the manual. It was designed specifically for this study. The authors of the manual are Dr Suzanne Heywood-Everett, Prof Andrew Hill and Ms Ursula Philpot from the University of Leeds. A printed hardcopy of the manual which includes a food diary as part of its content is provided to each participant. The program consists of seven 1 hour long group Zoom sessions, spread over 12 weeks. The first four sessions occur weekly, the next two fortnightly and the last session is 4 weeks later. Group numbers are between six and eight participants. Attendance is recorded at each session. The strategy used to monitor adherence is the name of the participant is recorded. The seven guide-facilitated group sessions reflect the seven sections in the manual. It starts with an introductory session that familiarises the participant with the program and establishes engagement. The following sessions address the following: eating disorders and this treatment approach; physical and psychological health; food and health, and unwanted behaviours; thoughts; learning to feel good about yourself and planning for the future. The program is participant-led and the content based on the principles of cognitive behavioural therapy. Participants are requested to read and complete multiple exercises/tasks in the relevant sections prior to each session. The amount of time spent is up to the participant. It is anticipated to take no more than 1 hour to complete. Their guide (a dietitian) reviews the completions with the participants, discusses these, and helps troubleshoot any difficulties encountered in completing each section. Participants then begin a weight loss program at the Metabolism & Obesity Service. The Metabolism & Obesity Service offers a lifestyle intervention program with a focus on diet, activity and lifestyle modification. This is a six 1 hour long group Zoom program that is conducted over 8 weeks. The first four sessions occur weekly, the next two fortnightly. These commence no longer than 1 month after the completion of the guided self-help program. They can wait and commence the next Metabolism & Obesity Service lifestyle intervention program if they choose to. This will mean waiting up to 3 months. The Metabolism & Obesity Service provides patient centred care. We are flexible and understanding to patients needs. Attendance is recorded at each session. The strategy used to monitor adherence is the name of the participant is recorded. The program is presented by nursing and allied health therapists at the Metabolism & Obesity Service. They present upon the following topics: diet modifications for weight loss, lifestyle modifications for weight loss and activity. The activity content of the program is also presented via Zoom. Activity suggestions are presented on PowerPoint slides. It includes understanding the importance of exercise, the benefits of exercise, the role of exercise in weight loss and management, energy expenditure, types of exercise, exercise apparel, exertion scales, warming up and cooling down, apps and exercise to do at home. After the group program, each patient is seen individually or in a group setting run by a therapist (dietitian, physiotherapist or nurse). This occurs around 3 months after starting the Metabolism & Obesity Service lifestyle intervention program. This means 12 weeks after they start the Metabolism & Obesity Service lifestyle intervention program. The Metabolism & Obesity Service takes patient centred care approach. Individual appointments are therefore at the discretion of the patient. The duration of individual appointments is dependent upon the clinical needs of the patient. Typically, the duration is 20 minutes to 1 hour. Patients are then followed up monthly for 2 years as or clinically appropriate.
Sponsors
Royal Price Alfred Hospital
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participant inclusion criteria are: aged greater or equal to 18 years and a body mass index greater or equal to 30 kg/m2. Participant inclusion criteria for the guided self-help group are: aged greater or equal to 18 years and a body mass index greater or equal to 30 kg/m2 and a positive screen for binge eating symptomology. The questionnaire used to confirm a positive screen is the Binge Eating Disorder Screener (BEDS-7). It is a 7-item measure designed to screen for binge eating disorder.
Exclusion criteria
Exclusions are: concurrent treatment for eating or weight problems; previous bariatric surgery; pregnancy; severe current psychiatric or medical conditions that would preclude full participation in the treatment (e.g. major depression, psychosis); insufficient English language skills to engage with the guided self-help program.
Outcome results
None listed