Page 14 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

14 Chapter 1
In a 2011 Australian CBT-E effectiveness study, the proportion of patients in remission resembled the percentage found in the Fairburn 2009 study (Fairburn et al., 2009; Byrne et al. 2011). The main difference with the Fairburn efficacy study was the drop-out rate, which was substantially higher in the Australian trial (40% versus 22.1%) (Byrne et al., 2011).
In 2013, Fairburn et al. presented findings of their CBT-E Underweight study for anorexia nervosa patients with a BMI between 15 and 17.5. For the 64% of patients completing treatment, there was a substantial increase in BMI (mean 2.77 kg/m2, SD 1.81). Healthy weight was reached by 62% of patients who completed treatment. A 2013 CBT-E inpatient study by Dalle Grave et al., including severely underweight patients, found 86.1% of completers achieved body mass index ≥ 18.5. Six months after discharge, during which the majority of patients received outpatient treatment, 38.8% of adult patients still had a healthy weight (Dalle Grave et al., 2013).
Over the last five years, particularly for normal weight adult patients with bulimia nervosa, binge eating disorder and atypical eating disorders, the evidence base of cognitive behavioral therapy-enhanced as leading approach has broadened (Waller, 2016; Hilbert, Hoek, & Schmidt, 2017; De Jong, Schoorl, & Hoek, 2018). In the systematic review of De Jong et al. posttreatment remission rates for normal weight eating disorders were found ranging from 22 % to 68%; the found wide range was partly explained by differences in samples and in used outcome measures (De Jong, Schoorl, & Hoek, 2018).
A review published in 2016, including three studies apart from the Oxford group, suggests that CBT-E Underweight does moderately well, with approximately 30% of patients with anorexia nervosa entering treatment recover by end of outpatient therapy (Waller, 2016).
Eating disorders and obesity
Obesity is defined as abnormal or excessive fat accumulation that may impair health. Its fundamental cause is an energy imbalance between the consumption and expenditure of calories (World Health Organization, 2020). Worldwide, the prev- alence of obesity has nearly tripled since 1975, with 13% of adults (11% men,15% women) being obese, i.e. having a body mass index (BMI: kg/m2) of 30 or higher (World Health Organization, 2020). The prevalence of morbid obesity (BMI ≥ 40) worldwide, is estimated at 0.64% in men and 1.6% in women (NCD Risk Factor Collaboration, 2016).
Besides the associated serious physical health risks, being (morbidly) obese also