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Randomized Controlled Trial
. 2025 Aug:195:112169.
doi: 10.1016/j.jpsychores.2025.112169. Epub 2025 May 26.

Is there harm in behavioral lifestyle weight management for binge-eating disorder in patients with obesity: Findings from a randomized controlled trial

Carlos M Grilo  1 , Valentina Ivezaj  2 , Sydney Yurkow  2 , Janet A Lydecker  2
Affiliations
Randomized Controlled Trial

Is there harm in behavioral lifestyle weight management for binge-eating disorder in patients with obesity: Findings from a randomized controlled trial

Carlos M Grilo et al. J Psychosom Res. 2025 Aug.

Abstract

Objective: Trials of behavioral lifestyle weight management (BLWM) for binge-eating disorder (BED) with obesity have documented significant broad benefits. Heated debate has surfaced concerning whether BLWM interventions might exacerbate eating-disorder psychopathology and therefore be contraindicated for patients with BED. This secondary analysis of a randomized controlled trial (RCT) testing BLWM examined heterogeneity of outcomes to identify frequency of individuals who experienced increased symptoms.

Methods: Sixty-nine participants with BED with obesity in an RCT were assessed for binge-eating, eating-disorder psychopathology, and weight at baseline and posttreatment. Thirty-four were randomized to placebo and 35 to BLWM+placebo. Changes were examined at the individual level to identify cases of any increased features.

Results: At posttreatment, 3.7 % (N = 1) of participants in BLWM+placebo versus 17 % (N = 5) in placebo reported increased binge-eating frequency, and 7.4 % (N = 2) versus 18 % (N = 5) had increased eating-disorder psychopathology. Overall, a total of 7.4 % (N = 2) of participants who received BLWM+placebo had any increase on binge-eating and/or eating-disorder psychology (one participant increased both). Increased symptoms had mostly small magnitudes and did not differ significantly between interventions.

Conclusion: In this controlled trial for BED with obesity, the frequency of cases with any increased symptoms of binge eating and/or eating-disorder psychopathology was rare, most increases had small magnitudes, and rates did not differ significantly between BLWM+placebo versus placebo. While any worsening in even one individual is not an optimal outcome, these participant-level findings for patients with BED with obesity address concerns that BLWM exacerbates eating-disorder psychopathology and provide further clinical context regarding overall effectiveness of BLWM.

Clinicaltrials: govregistration:NCT03045341 (Behavioral and Pharmacologic Treatment of Binge Eating and Obesity: Acute Treatment).

Keywords: Adverse events; Behavior therapy; Binge eating; Eating disorders; Lifestyle modification; Obesity; Pharmacotherapy; Weight loss.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflicts of interest. Dr. Grilo reports broader interests, which did not influence this research, including royalties from Guilford Press and Taylor & Francis Publishers for academic books. Dr. Lydecker has received funding for other work from the National Eating Disorders Association.

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