Journal of Consulting and Clinical Psychology 1997, Vol. 65, No. 2, 343-347 Copyright 1997 by the American Psychological Association 0022-006X/$3.00 One-Year Follow-Up of Cognitive-Behavioral Therapy for Obese Individuals With Binge Eating Disorder W. Stewart Agras Department of Psychiatry Christy F. Telch Department of Psychiatry Bruce Arnow Department of Psychiatry Kathleen Eldredge Department of Psychiatry Margaret Marnell Department of Psychiatry This research was supported by Grant MH38637 from the National Institute of Mental Health. Correspondence may be addressed to W Stewart Agras, Department of Psychiatry,School of Medicine, Stanford University,401 Quarry Road,Palo Alto,California,94305-5542, Received: April 23, 1996 Revised: August 19, 1996 Accepted: August 27, 1996 ABSTRACT The results of a 1-year posttreatment follow-up of 93 obese women diagnosed as having binge eating disorder (BED) and treated with group cognitive-behavioral therapy (CBT) followed by weight loss treatment are described. The group as a whole maintained both reductions in binge eating and abstinence rates fairly well. However, they regained the weight lost during treatment. Those who stopped binge eating during CBT maintained a weight loss of 4.0 kg over the follow-up period. In contrast, those who continued to binge gained 3.6 kg. Twenty-six percent of those abstinent after CBT met criteria for BED at follow-up and had gained weight, whereas the remaining 74% had lost weight. Stopping binge eating appears critical to sustained weight loss in BED. Binge eating disorder (BED) poses a complex clinical problem because the disordered eating is usually combined with overweight and often with frank obesity ( Bruce & Agras, 1992 ; Marcus, Wing, & Lamparski, 1985 ; Telch, Agras, & Rossiter, 1988 ). Hence, the syndrome is accompanied by the medical complications of obesity and the comorbid psychopathology associated with the eating disorder. ( Marcus et al., 1990 ; Yanovski, Nelson, Dubbert, & Spitzer, 1993 ). Treatment outcome, therefore, must focus at a minimum on the binge eating characterizing this disorder, on weight changes, and preferably also changes in comorbid psychopathology. Similar to bulimia nervosa, antidepressant medication ( McCann & Agras, 1990 ) cognitive-behavioral therapy (CBT; Agras, Rossiter, et al., 1992 ; Telch, Agras, Rossiter, Wilfley, & Kenardy, 1990 ; Wilfley et al., 1993 ), and interpersonal therapy (IPT; Wilfley et al., 1993 ) are all effective in the treatment of BED. Antidepressant medication is superior to placebo in reducing binge eating but does not add to the effectiveness of CBT in reducing binge eating ( Agras, Telch, Arnow, Eldredge, Wilfley, et al., 1994 ). However, antidepressant medication may enhance weight loss beyond the effects of CBT. Page 1 of 711/4/2000http://spider.apa.org/ftdocs/ccp/1997/april/ccp652343.htmlTo date, only one study has reported follow-up results for the treatment of BED with CBT at 1-year posttreatment ( Wilfley et al., 1993 ). This study found some relapse in the frequency of binge eating and small weight gains over the follow-up period. However, more recent studies suggest that patients who stop binge eating stabilize their weight during treatment, whereas those who continue to binge eat usually gain weight ( Agras, Telch, Arnow, Eldredge, Wilfley, et al., 1994 ; Smith, Marcus, & Kaye, 1992 ). Hence, it is important in a follow-up study to distinguish between those who stop binge eating and those who do not, because weight stabilization if continued posttreatment would be an important benefit. In the present study, the results of a 1-year posttreatment follow-up of patients with BED treated with group CBT followed by weight loss treatment is reported. These patients participated in three controlled studies investigating various aspects of CBT ( Agras, Telch, Arnow, Eldredge, Henderson, & Marnell, 1995 ; Agras, Telch, Arnow, Eldredge, Wilfley, et al., 1994; Eldredge et al., in press). Method Participants Ninety-three women meeting diagnostic criteria for BED formed the cohort for the present study. Their mean age was 46.0 years ( SD = 10.2). All but 2% had completed high school, 26% had graduated from college, whereas 35% had completed a graduate degree. Ninety-two percent of the sample were Caucasian, 3% Hispanic, and 3% African Americans. The mean age of onset of overweight was 17.0 years ( SD = 11.8), followed by the onset of binge eating at 19.7 years ( SD = 11.3). The mean rate of binge eating before treatment was 4.2 days/week ( SD = 1.6), average weight was 101.0 kg ( SD = 20.2), and the mean body mass index was 36.7 kg/M 2 ( SD = 6.6), indicating a moderate to severely obese group of individuals. Design and Treatment The participants in this study had completed 30 sessions of group treatment over a 36-week period in one of three controlled studies as noted above and were then followed for an additional 52 weeks. Details of the recruitment, exclusion factors, and treatment are provided in the three previous publications. Briefly, the treatments were manualized and each therapy group was conducted by two experienced PhD-level psychologists. Both the CBT and weight loss groups were of 90-min duration, with 8-10 patients in each group. Treatment consisted of 12 weekly group sessions of CBT for binge eating followed by 18 group weight loss sessions extending over 24 weeks. CBT was aimed first at instituting a regular pattern of three meals and two snacks (i.e., decreasing the intervals between eating episodes), then at decreasing avoidance of feared foods and coping with the precipitants of binge episodes, and finally at relapse prevention. Weight loss treatment was based on the LEARN Program for Weight Control ( Brownell, 1985 ), with some modifications for this patient population (e.g., stressing gradual weight loss with caloric restriction achieved largely by reductions in fat intake). Assessments For the purpose of this study, participants were assessed after completion of 12 weeks of CBT and at the end of 36 weeks of treatment. They then attended follow-up assessments at Weeks 52, 70, and 88. Primary measures The two primary measures were the frequency of binge eating and weight. Binge eating was assessed Page 2 of 711/4/2000http://spider.apa.org/ftdocs/ccp/1997/april/ccp652343.htmlover a 2-week interval from detailed self-monitoring records. We chose to use the number of days in which the participant reported one
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