Cognitive and Behavioral Approaches to Reduce Binge Eating and Excess Weight in Adolescents (Online)

Binge eating is the most prevalent eating disorder but has the lowest rate (<4%) of receiving eating disorder treatment. Binge eating often begins in adolescence and is related to obesity, physical and mental health problems, and psychological distress. Yet, there are virtually no established treatments, and no clear standard of care, for adolescents with binge eating. Evidence-based treatments exist for adults, including psychological treatments (e.g., CBT-BED) and lifestyle behavioral obesity intervention (LBOI), but how well these treatments work for adolescents remains largely unknown. LBOI is an effective treatment for adolescent obesity, but has only been tested as additional outcomes (not the initial goal) for binge eating. There is an urgent need for research to establish the efficacy of interventions for adolescents with binge eating to improve adolescents' health and quality of life. This study will conduct a randomized controlled trial (RCT) in which adolescents are randomized to Psychological Treatment (cognitive behavioral therapy for binge eating, or CBT-BED), Behavioral Treatment (lifestyle health behavioral treatment for obesity, or LBOI), or Active Control. In this study, we will compare both CBT-BED and LBOI to each other and to an Active Control. Active Control is daily self-monitoring (emotions, eating, exercise) on an "app", mimicking real-world self-help, followed by choice of CBT-BED or LBOI.

• Cognitive-Behavioral Therapy for Adolescent Binge Eating (Behavioral), also known as CBT-BED: Cognitive-behavioral therapy for binge-eating disorder (CBT-BED) for adolescents with binge eating and overweight or obesity, delivered remotely by telehealth. Sessions target cognitive and emotional drivers of binge eating through coping skills, problem-solving triggers, cognitive restructuring, and executive-function skill training; parent sessions focus on communication and support.
• Lifestyle Behavioral Obesity Intervention (Behavioral), also known as LBOI, Intensive Health Behavior Lifestyle Treatment, Behavioral Obesity Treatment, Behavioral Weight Loss: Lifestyle behavioral obesity intervention (LBOI) for adolescents with binge eating and overweight or obesity, delivered remotely by telehealth. Sessions provide nutrition and physical-activity prescriptions to create a modest calorie deficit and sustainable lifestyle habits and problem-solve nonadherence; parent sessions focus on the home food environment.
• Active Control (Other), also known as Self-monitoring: Self-monitoring eating, emotions, and exercise daily in a digital "app" that is similar to real-world self-help.

Primary outcomes

• Binge Eating Episode Frequency [End of treatment (6 months)]: Eating episodes will be assessed by the Eating Disorder Examination
• Weight (e.g., Percent Loss) [End of treatment (6 months)]: Percent BMI change

Secondary outcomes

• Eating Disorder Severity [End of treatment (6 months)]: Global eating-disorder psychopathology will be assessed by the Eating Disorder Examination.
• Weight-related Quality of Life score [End of treatment (6 months)]: Weight-related quality of life will be assessed by questionnaire.

Sex: All, ages: 12 Years to 17 Years

Inclusion Criteria:

1. Be in the age range ≥12 years old and ≤17 years old;
2. Have a BMI that places them above the 85th percentile based on their age and sex;
3. Report 4 episodes of binge eating (feeling a loss of control while eating) per month for the past 3 months;
4. Be available for participation in the study for 18 months.

Exclusion Criteria:

1. Have a medical or psychiatric condition that would require a higher level of care, such as hospitalization or intensive outpatient care (e.g., neurological disorder, psychotic disorders, suicidality);
2. Have a medical or psychiatric condition that would prohibit them from engaging in behavioral treatment or moderate physical activity (e.g., cardiovascular problems);
3. Have uncontrolled medical condition(s) (e.g., uncontrolled diabetes or hypertension);
4. Be pregnant or breastfeeding;
5. Be taking medication(s) or participating in treatment(s) that could influence weight or appetite;
6. Have begun taking hormonal contraceptives less than 3 months prior, as this can be related to weight changes;
7. Have a developmental or cognitive disorder that would interfere with engaging in cognitive treatment;
8. Have a concurrent feeding/eating disorder (e.g., bulimia nervosa); or
9. Be participating in another clinical research study.

NIH grants: R01DK146817