Unit for Psychotherapy Research/ Unit for Eating Disorders at Psychotherapy Centre Stolpegaard
The National Institute of Public Health, University of Southern Denmark
Funded by satspuljemidler
Experiences and outcomes in treatment of binge eating disorder (BED)
& obesity. A mixed methods study
Meyer, L., Waaddegaard, M., Tjørnhøj Thomsen, T., Lau, M.
BACKGROUND
6 months
Binge eating disorder (BED) is a common and
severe eating disorder characterised by
recurrent episodes of binge eating in the
absence of regular compensatory behaviour.
Approximately 2/3 becomes overweight or
obese (1). As in other eating disorders, Body
Image Disturbance (BID) is a central factor in
BED (2), where it is associated with illness
severity and prognosis. Whereas treatment is
found effective in reducing binge eating
behaviour, it is less effective in reducing BID
and rarely leads to weight loss (3).
A purpose of this study is to explore effective
and meaningful ways of working with body
and weight issues in patients with BED and
obesity. The study investigates outcomes and
patient experiences in a new two-phased
treatment
programme
introduced
at
Stolpegaard Psychotherapy Centre where
phase 1 is systemic and narrative group
psychotherapy followed by a phase 2 that is
either weight loss or well-being treatment.
AIMS
The study aims to:
1. examine measurable changes following
the two treatment phases.
2. explore patient experiences of change.
3. examine characteristics of patients who
choose and benefit from weight loss or
well-being treatment.
PREEDE-Intw
BMI
SCL-90
IIP
SDS
WHO-5
PHASE 1
(1-2 months)
POST-
EDE-Intw
BMI
Systemic & narrative SCL-90
PSYCHOTHERAPY
IIP
SDS
WHO-5
FIELDOBSERVATIONS
PREEDE-Intw
BMI
SCL-90
IIP
SDS
WHO-5
PHASE 2
WEIGHT LOSS
WELL-BEING
FIELDOBSERVATIONS
INDEPTH
INTWS
FACT –DSM-5 Diagnostic criteria for
BED include recurrent episodes of binge
eating characterized by eating a large
amount of food within a short period of
time, accompanied by a sense of loss of
control and followed by marked distress.
Contrary to bulimia, the is no regular
compensatory behavior.
6 months
POSTEDE-Intw
BMI
SCL-90
IIP
SDS
WHO-5
FACT – In Denmark, an estimated
50.000 people are affected by BED. This
is more than Anorexia and Bulimia
together. Approximately 8% of people
with obesity and 25% of people in weight
loss treatment have BED.
INDEPTH
INTWS
Figure 1. Design: Mixed methods
DESIGN & METHODS
The study uses a mixed methods
design. The quantitative data are
gathered pre- and post-interventions
in a naturalistic single group design
using Eating Disorder Examination
interviews, self-report questionnaires,
and Body Mass Index (BMI). This is
supplemented with an embedded
qualitative data generation using field
observations and in-depth interviews
with patients (n=15). 105 patients
have been included during the period
of Nov. 2013 to Nov. 2015.
Field observations and interviews run
from Nov. 2015 to May 2016.
PARTICIPANTS
Adult
patients
at
Stolpegard
Psychotherapy Centre meeting DSMIV diagnostic criteria for Binge Eating
Disorder. BMI > 27.
Figure 2. Flow: Included patients Nov. 2013-Nov.2015
ANALYSES
RESULTS
Interviews will be analysed using
systemic
and
narrative
theory.
Qualitative and quantitative data will
be integrated in an iterative process,
Data are merged to produce detailed
understandings of patient needs and
changes both in and following
treatment.
Phase 1: Preliminary statistical analyses
of quantitative data indicate a decrease in
binge eating behaviour and a stable
weight following Phase 1. Interviews
mirror this stability, and patients describe
it as a liberation from the BED. According
to both quantitative and qualitative data
body and weight issues persist.
Phase 2: Statistical analysis is premature.
Field observations and interviews show a
variety of processes of change in relation
to body and weight. In the Well-Being
group patients express experiences of
reconnecting with their bodies, thus
bringing about change via acceptance and
appreciation of their bodies.
In the Weight Loss group patients are
balancing, how they can make small
changes in their eating and movement so
as to induce a modest weight loss without
leaning into the strict rules and regulations
of the eating disorder.
How can we effectively and meaningfully address body & weight issues in treatment
of patients with BED and obesity?
PERSPECTIVE
Patients’ experiences of a Weight Loss group and a Well-Being group
”…I have given up on the idea of loosing 20 kg in this treatment but I am slowly working to change my life style. I feel like I’m in a good place with myself,
and that’s worth something isn’t it. If there are too many rules and things I can’t do, it starts off the eating disorder and all the critical things it says about
me. I still want to lose weight, I just want to do it without hating myself.
(Woman from a Weight Loss group)
”My body is my friend more than my enemy. My body talks to me and tells me what I need. For instance, if I’m tired or my knee hurts. I’ve noticed all
that it does for me. I’m also aware of my senses, and I’m grateful to be able to see, hear and smell. And for tasting food. Before, my body was just a
rack that carried me around.
(Woman from a Well-Being group)
References 1) Hudson, J.I., Hiripi, E., Harrison, G.P., & Kessler, (2011) The prevalence and Correlates of eating disorders ion the national comorbidity survey replication, BIOL PSYCHIATRY, 61 2) Grilo, C.M. 2013), Int. J Eat Disord 208-211 3) Hay, P. 2013 A systematic review of evidence for psychological treatments in eating disorders: 2005-2012, Int. J Eat Disord. 46: 462-469
This study combines frequently used
quantitative measures of eating disorder
psychopathology and weight with patients’
experiences of recovery and change. This
combination may shed light on the
experienced
meaning
of
measurable
changes. Additionally, knowledge about
change processes may provide insights into
which treatment options need to be made
available
to
patients
in
order
to
accommodate different treatment needs.