Is physical exercise and dietary therapy a feasible alternative to cognitive behavior therapy in treatment of eating disorders? A randomized controlled trial of two group therapies.

Therese Fostervold Mathisen,Jorunn Sundgot‐Borgen,Solfrid Bratland‐Sanda,Gunn Pettersen,Jan H Rosenvinge,Karianne Vrabel,Oddgeir Friborg

doi:10.1002/eat.23228

Abstract

ObjectiveTo compare effects of physical exercise and dietary therapy (PED‐t) to cognitive behavioral therapy (CBT) in treatment of bulimia nervosa (BN) and binge‐eating disorder (BED).MethodThe active sample (18–40 years of age) consisted of 76 women in the PED‐t condition and 73 in the CBT condition. Participants who chose not to initiate treatment immediately (n = 23) were put on a waiting list. Outcome measures were the eating disorder examination questionnaire (EDE‐Q), Clinical Impairment Assessment (CIA), Satisfaction with Life Scale (SWLS), Beck Depression Inventory (BDI), and numbers in remission at posttreatment, and at 6‐, 12‐, and 24‐months follow‐up.ResultsBoth treatment conditions produced medium to strong significant improvements on all outcomes with long‐term effect. The PED‐t produced a faster improvement in EDE‐Q and CIA, but these differences vanished at follow‐ups. Only PED‐t provided improvements in BDI, still with no between‐group difference. Totally, 30–50% of participants responded favorable to treatments, with no statistical between‐group difference.DiscussionBoth treatments shared a focus on normalizing eating patterns, correcting basic self‐regulatory processes and reducing idealized aesthetic evaluations of self‐worth. The results point to the PED‐t as an alternative to CBT for BN and BED, although results are limited due to compliance and dropout rates. Replications are needed by independent research groups as well as in more clinical settings.

Highlights

Sustained recovery from bulimia nervosa (BN) or binge-eating disorder (BED) requires that a treatment focuses on the overvaluation of controlling body weight and food intake, and the affective dysregulation represented by binge eating with or without purging (Fairburn et al, 1995)
We found support to our hypothesis, as the physical exercise and dietary therapy (PED-t) performed equal to cognitive behavioral therapy (CBT) in alleviating symptoms of BN, bingeeating disorder (BED), as well as in improving subjective well-being and psychosocial impairment
The effects of PED-t are overall on par with the well-established CBT for BN and BED

Summary

Introduction

Sustained recovery from bulimia nervosa (BN) or binge-eating disorder (BED) requires that a treatment focuses on the overvaluation of controlling body weight and food intake, and the affective dysregulation represented by binge eating with or without purging (Fairburn et al, 1995). Regular physical activity is found to alleviate symptoms of anxiety and depression (Fox, 1999; Rosenbaum, Tiedemann, Sherrington, Curtis, & Ward, 2014; Stubbs et al, 2018) Such effects may be explained both neurobiological, psychosocial, and behavioral changes (Ashdown-Franks et al, 2019; Lubans et al, 2016; Mullen & Hall, 2015). We argue that to combine dietary therapy with guided physical activity (physical exercise and dietary therapy, PED-t) may represent an effective, alternative treatment option for persons with BN and BED This combination has to our knowledge, never been tested against a well-established psychological treatment using a RCT design

Results

Discussion

Conclusion