Bulimia Nervosa, Binge Eating Disorder
Conditions
Keywords
BN, Binge, overconsumption of food, purging, purge
Brief summary
Eating disorders includes anorexia nervosa, bulimia nervosa, binge eating and other specified feeding or eating disorder (OSFED). Common to all is the intensively occupation to control food intake, body image and body weight. Most people with this kind of disorder don't reach for professional help, or there may be more than 4 years before they do. Cognitive behavior therapy is the foremost method of treatment of eating disorders, but up to 30-50% of the patients don't respond to this. The investigators find it important to identify science based alternatives of therapy, as this may reduce the health concern, and broaden the choice of therapy methods. A former study by Sundgot-Borgen et al in 2002, found guided physical activity to reduce symptoms of bulimia nervosa just as good as the traditional cognitive therapy. The primary objective of the project is to see whether the combination of physical exercise and dietary therapy is more effective in treating eating disorders, than cognitive therapy. Secondly, the investigators want to see whether there are any differences with regard to the individual satisfaction of treatment method, and to associated costs. Interviews with a sufficient number of participants from the PED-t arm to meet data saturation criteria, and all theraphists in the new treatment offer, will give uniqe insight to experiences with the treatment method and the delivery of treatment.
Detailed description
Subjects are recruited through primary doctors, social media and newspapers, and will be included continuously by screening interviews. There will be a randomization into two treatment groups (cognitive behavior, or physical activity and nutrition education) to be followed for 16 weeks. Each week includes one meeting of group therapy (90 minutes) and homework related to treatment, and for 4 weeks midway there will be two therapy meetings pr week (a total of 20 meetings). Post tests are planned at week 17, and at 6, 12, and 24 months after treatment. Participants reqruited during ongoing treatment groups are placed on a waitlist, serving as controls to the treatment groups.
Interventions
BEHAVIORALCognitive Behaviour Therapy
Following group-modified protocol for cognitive behavioral therapy, CBT, first described by Fairburn 2008, modified by Modum Bad, Norway.
BEHAVIORALPhysical Activity and Dietary Therapy
Guided physical activity and dietary therapy, to (re-)introduce a more healthy lifestyle and help stabilizing a healthy weight. A detailed manual will be published.
Sponsors
The Norwegian Women´s Public Health Association
University of Tromso
Norwegian School of Sport Sciences
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The one transferring results from lab's and questionaires to SPSS are blinded for group affiliation.
Intervention model description
Comparing treatment of cognitive behavioural therapy, with treatment of physical exercise and dietary therapy. All participants randomized to either of the two treatment offers. Waitlist serves as control group.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Women, * BMI 17,5-35, * Age of 18-40 years, * DSM-5 criteria of bulimia nervosa, * DSM-5 criteria of Binge eating disorder * Living nearby Norwegian School of Sports Sciences, NSSS, in Oslo (Norway)
Exclusion criteria
* Age \<18 and \>40 years * BMI \<17,5 and \>35 * Pregnancy * Competing/experienced athlete * Anorexia nervosa * Currently, or during the past 2 years, in active treatment with cognitive therapy * Other personality disturbances * Suicidality
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effectiveness of treatment, evaluated through the change in symptoms of eating disorder | Pre-test in week 0, Post-tests (week 17), and at 6, 12, and 24 months after intervention. | Change in ED-symptoms are evaluated through screening and surveys: EDE-questionaire (Episodes of binge eating, episodes of purging, concern for body weight and appearance)(Fairburn, 2008), Clinical Impairment Assessment (CIA) (Fairburn, 2008), Eating Disorder Inventory-3 (EDI) (Garner, 2004), Eating Disturbance Scale (EDS-5) (Rosenvinge et al., 2000), DSM-5 (APA, 2013) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Experiences of the treatment method for eating disorders | Post-test (week 17) | Interview on the experiences the patients have to the specified treatment method of eating disorders (arm of intervention), EPDEX (Clinton 2001) |
| Associated cost with treatment method | Pre-test | Calculation of the directly and indirectly cost related to treatment method |
| Associated cost With treatment method | Post-test (by 6th month post-treatment) | Calculation of the directly and indirectly cost related to treatment method |
| Expectations of treatment method for eating disorders | Pre-test | Interview on the expectations the patients have to the specified treatment method of eating disorders (arm of intervention) EPDEX (Clinton 2001) |
| Group climate | week 1-16 | coerciveness scale from Therapeutic Factor Inventory (Lese & MacNair-Semands, 2000). |
| Working AIliance | week 1-16 | Working AIliance Inventory (Horwath & Greenberg, 1989) |
| Change in eating disorder behavior and cognitions related to body figure and bodyweight | Week 1-16 during treatment | Evaluation after each therapy session on progress in reducing eating disordered behaviour (binging and purging) and on changes of cognitions on body figure and -weight |
| Global measurement of general psychopathology | Pre-treatment | Beck's Anxiety Inventory (BAI), Beck Depression Inventory (BDI), QoL (Diener), Utrecht Coping List, Resilience Scale for Adults, the outcome rating scale (ORS), the three-factor eating questionnaire (TFEQ), Binge eating Scale (BES), Cantril's Ladder, Exercise dependency test, compulsice exercise test |
Other
| Measure | Time frame | Description |
|---|---|---|
| Interview: What are the theraphists experiences of their contribution to the PED-t program | Post treatment | Qualitative approaches, such as in-depth interviews, will give additional insights into the therapists' perspectives and experiences on delivering a new treatment offer for eating disorder. Data are analyzed in four steps within the framework of systematic text condensation (Malterud 2012). |
| Change in muscular strength | Pretest (week 0), post-test (week 17) and at 6, 12 and 24 months after treatment | Status of 1 repetition maximum, 1RM, muscular strength in squats, bench press and seated row |
| Interview: What are the experiences of the participants who drop out of the PED-t program? | Post treatment | Data are analyzed in four steps within the framework of systematic text condensation (Malterud 2012). |
| Change in cardiovascular endurance | Pre-test in week 0, Post-tests ( week 17), and at 6, 12 and 24 months after intervention. | CPET: with the use of modified Balke Treadmill performance evaluation test, The Borg scale (Borg, 1982) |
| Change in bone mineral density | Pre-test in week 0, Post-test (week 17) and 6, 12, and 24 months post-treatment | DXA (Dual-energy X-ray absorptiometry) |
| Change in body weight and bodycomposition | Pre-test and post-test (week 17) and at 6,12,18 and 24 months post-treatment | DXA (dual-energy x-ray absorptiometry) (weekly weight registration will also be kept in each arm of treatment) |
| Change in nutritional status | Pre-test, in week 8 of treatment, post-test (week 17) and at 6,12,18 and 24 months post-treatment | Blood test to identify nutritional status of iron, folate, cholesterol and triglycerides, ApoA, ApoB and vitamin-D, folic acid |
| Change in hormonal status | Pre-test, week 8 of treatment, post-test (week 17) and at 6,12,18 and 24 months post-treatment | Blood test to evaluate hormonal status of estradiol, progesterone, CTX, P1nP, insulin, leptin, TSH, T3, T4, FSH, LH, cortisol |
| Change in dietary and nutritional intake | Pre-test, each 3rd week in treatment (a total of 5 interviews), post-test (week 17), and post-treatment (6,12, and 24 months post-treatment) | 24 hour recall interview: interview on the intake of food and beverage during the past 24 hours. |
| Change in physical activity level | Pre-test in week 0, Post-test (week 17) and 6, 12, and 24 months post-treatment | Wearing a GT3X-BT actigraph accelerometer for 7 consecutive days and making notes on daily activity in 30 minutes intervals |
| Interview: measure and explore patients experienced treatment satisfaction and outcome/benefits with PED-t. | Post treatment | Qualitative approaches, such as in-depth interviews, will give additional insights into ED-patients' perspectives, notably experiences and satisfaction with the treatment. A sufficient number of participants to meet data saturation criteria are qualitatively interviewed. Data are analyzed in four steps within the framework of systematic text condensation (Malterud 2012). |
Countries
Norway
Outcome results
None listed