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Review
. 2020 Sep;53(9):1353-1376.
doi: 10.1002/eat.23297. Epub 2020 Jun 25.

Meta-analysis on the long-term effectiveness of psychological and medical treatments for binge-eating disorder

Anja Hilbert  1 , David Petroff  2 , Stephan Herpertz  2 , Reinhard Pietrowsky  3 , Brunna Tuschen-Caffier  4 , Silja Vocks  5 , Ricarda Schmidt  1
Affiliations
Review

Meta-analysis on the long-term effectiveness of psychological and medical treatments for binge-eating disorder

Anja Hilbert et al. Int J Eat Disord. 2020 Sep.

Abstract
in English, French

Objective: Long-term effectiveness is a critical aspect of the clinical utility of a treatment; however, a meta-analytic evaluation of psychological and medical treatments for binge-eating disorder (BED), including weight loss treatments, is outstanding. This meta-analysis sought to provide a comprehensive evaluation of the long-term effectiveness in diverse treatments for BED regarding a range of clinically relevant outcomes.

Method: Based on a systematic search up to February 2018, 114 published and unpublished randomized-controlled (RCTs), nonrandomized, and uncontrolled treatment studies, totaling 8,862 individuals with BED (DSM-IV, DSM-5), were identified and analyzed using within-group random-effect modeling.

Results: Effectiveness (regarding binge-eating episodes and abstinence, eating disorder and general psychopathology) up to 12 months following treatment was demonstrated for psychotherapy, structured self-help treatment, and combined treatment, while the results regarding body weight reduction were inconsistent. These results were confirmed in sensitivity analyses with RCTs on the most common treatments-cognitive-behavioral therapy and self-help treatment based on this approach. Follow-up intervals longer than 12 months were rarely reported, mostly supporting the long-term effectiveness of psychotherapy. Few follow-up data were available for pharmacotherapy, and behavioral and self-help weight loss treatment, while follow-up data were lacking for pharmacological and surgical weight loss treatment. Study quality varied widely.

Discussion: This comprehensive meta-analysis demonstrated the medium-term effectiveness of psychotherapy, structured self-help treatment, and combined treatment for patients with BED, and supported the long-term effectiveness of psychotherapy. The results were derived from uncontrolled comparisons over time. Further long-term high quality research on psychological and medical treatments for BED is required.

Objectivo: La efectividad a largo plazo es un aspecto crítico de la utilidad clínica de un tratamiento; sin embargo, una evaluación metaanalítica de los tratamientos psicológicos y médicos para el trastorno por atracón (TpA), incluidos los tratamientos para perder peso, es sobresaliente. Este metaanálisis buscó proporcionar una evaluación integral de la efectividad a largo plazo en diversos tratamientos para TpA con respecto a una gama de resultados clínicamente relevantes. MÉTODO: En base a una búsqueda sistemática hasta febrero de 2018, se identificaron 114 estudios controlados aleatorios (ECA), no aleatorizados y no controlados, publicados y no publicados, de tratamiento, con un total de 8,862 individuos con TpA (DSM-IV, DSM-5), fueron identificados y analizados utilizando modelos de efecto aleatorio dentro del grupo.

Resultados: Se demostró la efectividad para psicoterapia, tratamiento de autoayuda estructurado y tratamiento combinado (con respecto a los episodios de atracones y la abstinencia, el trastorno de la conducta alimentaria y la psicopatología general) hasta 12 meses después del tratamiento, mientras que los resultados con respecto a la reducción del peso corporal fueron inconsistentes. Estos resultados se confirmaron en análisis de sensibilidad con ECAs sobre los tratamientos más comunes - terapia cognitivo conductual y tratamiento de autoayuda basado en este enfoque. Los intervalos de seguimiento de más de 12 meses rara vez se reportaron, la mayoría apoyando la efectividad a largo plazo de la psicoterapia. Había pocos datos de seguimiento disponibles para farmacoterapia y tratamiento de pérdida de peso conductual y de autoayuda, mientras que faltaban datos de seguimiento para el tratamiento farmacológico y quirúrgico de pérdida de peso. La calidad del estudio varió ampliamente. DISCUSIÓN: Este metaanálisis integral demostró la efectividad a medio plazo de la psicoterapia, el tratamiento de autoayuda estructurado y el tratamiento combinado para pacientes con TpA, y apoyó la efectividad a largo plazo de la psicoterapia. Los resultados se derivaron de comparaciones no controladas a lo largo del tiempo. Se requiere más investigación a largo plazo de alta calidad sobre tratamientos psicológicos y médicos para TpA.

Keywords: binge-eating disorder; clinical trials; meta-analysis; nonrandomized-controlled trials; randomized-controlled trials; therapeutics.

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