TOPLINE:

A 12‑week web‑based, guided self‑help program offered comparable benefits for binge eating disorder (BED) as 20weeks of standard cognitive-behavior therapy-enhanced (CBT‑E), despite its shorter duration and lower level of therapist involvement, a new noninferiority study showed.

METHODOLOGY:

• Researchers conducted a noninferiority randomized clinical trial between November 2021 and October 2024 at a specialized eating disorder center in Netherlands.
• Among nearly 200 adults (mean age, 38 years; 86% women; mean BMI, 34) with a diagnosis of BED or other specified feeding or eating disorder subtype, about half were randomly assigned to receive web‑based, guided self‑help program and the other half to treatment as usual.
• The web-based, guided self‑help program consisted of 12 weeks of treatment with brief weekly 20‑minute videoconferencing check‑ins; treatment as usual was comprised of 20 weeks of standard CBT‑E delivered in 50‑minute sessions.
• The primary outcome was the number of objective binge eating episodes at the end of treatment and at the 20 weeks post-treatment. Secondary outcomes included binge-free days, eating disorder pathology, full remission, dropout rates, body shape dissatisfaction, BMI, clinical impairment, and therapeutic alliance — as measured with the Working Alliance Inventory.

TAKEAWAY:

• Web-based, guided self-help program was noninferior to treatment as usual in reduction of binge eating episodes at the end of treatment (contrast estimate [CE], -0.8; P = .1) and at 20 weeks (CE, -0.6; P = .2).
• The treatment as usual group had a stronger therapeutic alliance at the end of treatment (CE, -5.99; P = .01) and better clinical impairment outcomes at 20 weeks (CE, 1.7; P = .01).
• BMI remained stable in the web-based, self-help group but increased in the treatment as usual group, with significant group differences at the end of treatment (CE, -1.3; P < .001) and at 20 weeks (CE, -1.8; P = .003). No between-group differences were observed in binge‑free days, disorder pathology, body dissatisfaction, remission rates, or dropout rates.
• Per-protocol analysis confirmed noninferiority at the end of treatment (CE, -0.9; P = .09) and at the 20-week follow-up (CE, -0.6; P = .18), although noninferiority was not maintained at 40 weeks.

IN PRACTICE:

“Based on the positive findings from this study, future work should examine the source of guidance in the guided self-help program,” the investigators wrote.

“Understanding the comparative differences in who administers guidance, including nonspecialized healthcare workers and experts by experience, will provide more evidence for the accessibility and scalability of treatment,” they added.

SOURCE:

This study was led by Ella van Beers, Novarum Centre for Eating Disorders and Obesity, Amstelveen, Netherlands. It was published online on October 10 in JAMA Network Open.

LIMITATIONS:

This study was limited by the exploratory nature of its secondary analysis design, incomplete interview data at the 40‑week follow‑up, the absence of a closed post‑treatment period, and modest attrition or missing data despite imputation. It was conducted in a single specialized eating disorder center with a predominantly female, Netherlands‑born sample, which limited the generalizability to other settings and populations.

DISCLOSURES:

The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.