Overvaluation of shape/weight at posttreatment predicts relapse at 12‐month follow‐up after successful behaviorally‐based treatment of binge‐eating disorder

Abstract

AbstractObjectiveTo test whether overvaluation of shape/weight at the end of treatment prospectively predicts relapse at 12‐month follow‐up in patients with binge‐eating disorder (BED).MethodParticipants were 129 patients with BED who achieved abstinence from binge eating after 6 months of behaviorally‐based weight‐loss treatments in a clinical trial. Independent assessments conducted at posttreatment and at 12‐month follow‐up included the Eating Disorder Examination interview, the Beck Depression Inventory, and weight measurements.ResultsOf the 129 participants who attained abstinence from binge‐eating at posttreatment, 46 (36%) were categorized with clinical overvaluation and 83 (64%) with subclinical overvaluation; 115 (89%) were re‐assessed at 12‐month follow‐up. Participants with overvaluation at posttreatment were significantly more likely than those without to relapse at 12‐months to non‐abstinence from binge eating (54% vs. 28%) and to diagnosis‐level binge‐eating frequency of once weekly or greater (31% vs. 13%). Overvaluation at posttreatment predicted significantly higher eating‐disorder psychopathology and depression scores at 12‐month follow‐up but were unrelated to weight and weight changes. Treatment groups did not have main or interaction effects; posttreatment overvaluation effects were observed regardless of treatment and of covarying for posttreatment value of dependent variables.ConclusionsOur findings suggest that overvaluation of shape/weight at the end of treatment predicts relapse and heightened eating‐disorder psychopathology and depression scores 1 year later in patients who achieved abstinence from binge eating with behaviorally‐based treatments.Overvaluation of shape/weight has significant clinical implications and warrants consideration as a diagnostic specifier for BED as it provides important prospective prognostic information.Public SignificanceAlthough effective treatments are available for binge‐eating disorder, relapse following successful treatments is not uncommon. Almost nothing is known about what predicts relapse following treatments for binge‐eating disorder. Our study found that overvaluation of shape/weight (i.e., body image concerns that overly impact self‐worth) at posttreatment prospectively predicted relapse and higher eating‐disorder psychopathology and depression 1 year later in patients who achieved binge‐eating abstinence with behaviorally based treatments.Clinicaltrials.gov registration: NCT00829283. (Treatment of obesity and binge eating: Behavioral weight loss vs. stepped care.)