A Randomized Comparison of Cognitive Behavioral Therapy and Behavioral Weight Loss Treatment for Overweight Individuals with Binge Eating Disorder Simone Munsch, PhD* Esther Biedert, PhD Andrea Meyer, PhD Tanja Michael, PhD Barbara Schlup, LicPhil Alex Tuch, BSc Juergen Margraf, PhD ABSTRACT Objectives: The aim of this study was to determine the efficacy of cognitive-behav- ioral therapy (CBT) and behavioral weight loss treatment (BWLT) for overweight patients with binge eating disorder (BED). Method: Eighty obese patients meeting criteria of BED according to DSM-IV-TR were randomly assigned to either CBT or BWLT consisting of 16 weekly treatments and 6 monthly follow-up sessions. Binge eating, general psychopathology, and body mass index (BMI) were assessed before, during, and after treatment, and at 12-month follow-up. Results: At posttreatment results fa- vored CBT as the more effective treat- ment. Analysis of the course of treat- ments pointed to a faster improvement of binge eating in CBT based on the num- ber of self-reported weekly binges, but faster reduction of BMI in BWLT. At 12- month follow-up, no substantial differen- ces between the two treatment condi- tions existed. Conclusion: CBT was somewhat more efficacious than BWLT in treating binge eating but this superior effect was barely maintained in the long term. Further research into cost effectiveness is needed to assess which treatment should be con- sidered the treatment of choice. V V C 2006 by Wiley Periodicals, Inc. Keywords: BED; randomized comparison; cognitive-behavioral therapy; behavioral weight loss treatment; long-term efficacy; end point analyses; course of treatment (Int J Eat Disord 2007; 40:102–113) Introduction The prevalence of binge eating disorder (BED), which is characterized by persistent overeating epi- sodes, feelings of loss of control, and marked dis- tress in the absence of regular compensatory behaviors (DSM-IV-TR), 1 is 0.7–3.3% in commu- nity-based studies and rises to 29.7% in weight con- trol samples (Munsch et al., Eur Eat Disord Rev,. Submitted for publication). 2–6 BED is often accom- panied by being overweight and represents a seri- ous threat to mental and physical health. 7 Research findings show that BED is responsive to a variety of procedurally and conceptually different group treatment approaches, with cognitive-behav- ioral therapy (CBT) being the best-established psy- chotherapy treatment. 8 Rates of abstinence from binge eating at the end of CBT range from 41 to 79% and generally remain improved over baseline levels until 12-month follow-up. 3,9–12 Interpersonal psycho- therapy (IPT) is a viable alternative for overweight patients with BED. 12 Further, behavioral weight loss treatment (BWLT) 9,13 and very low calorie diets (VLCD) are also effective in treating BED. 14,15 Studies directly comparing BWLTwith CBT show comparable effects on binge eating at posttreatment. 13,16,17 Guided self-help CBT approaches result in remis- sion rates of about 50% assessed by self-monitoring and according to the EDE-Q, 18 as mentioned by Carter and Fairburn and by Grilo and Masheb, 19,20 which is somewhat lower than reported abstinence rates achieved with individual administration of CBT. Guided self-help BWLT as investigated by Grilo and Masheb (2005) resulted in an abstinence rate of 18.4% assessed by self-monitoring and of 23.7% assessed by EDE-Q. 20 One might consider it advantageous to treat BED with BWLT, as this treatment does not require the same professional training as CBT and might thus be easier to disseminate to a greater population. However, it would be premature to conclude that BWLT is the treatment of choice, as several meth- odological considerations need to be kept in mind: Accepted 13 August 2006 *Correspondence to: Dr. Simone Munsch, at: Institute for Psychology, University of Basel, Missionsstrasse 62a, 4055 Basel, Switzerland. E-mail: simone.munsch@unibas.ch Institute of Psychology, University of Basel, Basel, Switzerland Published online 6 November 2006 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.20350 V V C 2006 Wiley Periodicals, Inc. 102 International Journal of Eating Disorders 40:2 102–113 2007—DOI 10.1002/eat TOPICAL SECTION ARTICLE