Randomized Controlled Trial Testing the Effectiveness of Adaptive “SMART” Stepped-Care Treatment for Adults with Binge-Eating Disorder Co-morbid with Obesity
Abstract
Objective: This RCT tested effectiveness of an adaptive “SMART” stepped-care approach to “standard” behavioral weight loss (BWL (Standard)) for patients with binge-eating disorder (BED) and obesity. Method: 191 patients with BED/obesity were randomly assigned to six-months BWL (Standard) (N=39) or Stepped-care (N=152). Within Stepped-care, patients started with BWL for one month; treatment-responders continued BWL while non-responders switched to CBT. All patients receiving Stepped-care were additionally randomized to weight-loss medication or placebo (double-blind) for the remaining five months. Independent assessments were performed reliably at baseline, throughout-treatment, and post-treatment. Results: ITT analyses of remission rates (zero binges/month) revealed BWL (Standard) and Stepped-care did not differ significantly overall (74.4% vs 66.5%); within Stepped-care, remission rates ranged 40.0%−83.3% with medication significantly superior to placebo (overall) and among non-responders switched to CBT. Mixed-models analyses of binge-eating frequency revealed significant time-effects but BWL (Standard) and Stepped-care did not differ overall; within Stepped-care, medication was significantly superior to placebo (overall) and among non-responders switched to CBT. Mixed models revealed significant weight loss but BWL (Standard) (5.1% weight-loss) and Stepped-care (5.8% weight-loss) did not differ overall; within Stepped-care (range 0.4%−8.8% BMI loss), medication was…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 191 participants or records.
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