Effect of Behavioral Weight Management Interventions on Symptoms of Binge-Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis.

Abstract

Many individuals with obesity meet criteria for an eating disorder such as binge-eating disorder (BED) or bulimia nervosa (BN). However, the impact of behaviorally based weight management interventions such as behavioral weight loss (BWL) on eating disorder symptoms for individuals diagnosed with BED or BN is unclear, with one possibility being that encouraging intentional weight loss could exacerbate symptoms of these disorders. Thus, the purpose of this systematic review and meta-analysis was to evaluate the impact of behavioral weight management interventions on eating disorder symptoms among individuals diagnosed with BED or BN. Electronic database searches yielded 22 experimental groups across 11 trials that met inclusion criteria (890 participants). All trials reported that on average, baseline eating disorder symptoms decreased after weight management interventions at posttreatment. Random-effects meta-analyses revealed no significant difference between weight management interventions and comparison groups in posttreatment changes to binge-eating frequency (M_D = 0.59, 95% CI [-0.86, 1.86]), global eating disorder symptom severity (M_D = 0.03, 95% CI [-0.15, 0.21]), or pooled eating disorder symptom outcomes (g = 0.04, 95% CI [-0.20, 0.29]). Posttreatment symptom decreases were greater when weight management interventions were compared with no-treatment (vs. active) control groups, and outcomes were also moderated by the type of weight management intervention used. These findings, though limited by the small number of trials, heterogeneity in study design and outcome measures, and sparse long-term outcome data, suggest that behavioral weight management interventions may be an effective treatment modality for individuals diagnosed with full-threshold BED or BN.