Non-judgmental intervention may help binge eaters overcome disorders

August 28, 2003

A brief non-judgmental interview and feedback session designed to enhance people's motivation to change their behavior added to a self-help program appears to be effective in treating some people with two common types of eating disorders -bulimia nervosa and binge eating disorder.

The finding comes from an as yet unpublished University of Washington doctoral dissertation and also suggests that the session, which uses a technique called motivational interviewing, may be a cost effective way of providing assistance to a population that is particularly resistant to treatment.

People with eating disorders are extremely difficult to treat and are "often ambivalent about seeking treatment," said UW psychology doctoral student Erin Dunn. "Most people with eating disorders don't seek treatment on their own. They are indecisive about change and generally seek help when prompted through family, friends or a physician."

Failure rates for treating eating disorders are high. Depending on the type of therapy used, only 30 to 50 percent of those treated for an eating disorder get better, and the percentages are lower for patients who completely cease the behaviors associated with their condition. In addition, the costs for treating an eating disorder are expensive, usually involving individualized and intensive therapy. Patient dropout rates also are high.

Dunn's research showed that 24 percent of people who received a motivational interview as part of a self-help program were abstinent from binge eating at the end of four months compared to nine percent who only received the self help program. People who received the interview cut the incidence of binge eating by 38 percent compared with those in the self-help group who reduced their frequency of binge eating by 25 percent.

More people who went through an interview were abstinent from purging than those who did not receive one, but the difference was not statistically significant. This was likely due to the small sample size, she said.

People who received the interview also experienced significant reductions, 15 percent on average, in negative thoughts about their weight, shape and eating behaviors. The negative thoughts of individuals in the self-help groups did not change.

Motivational interviewing is a style of therapy that is non-judgmental, empathetic, non-confrontational and "meets the client where they are at in a collaborative effort," according to Dunn. It has been found to be helpful in dealing with a variety of behaviors such as weight loss, adopting an exercise program, using sunscreen and substance abuse including alcohol, drug and tobacco use.

Millions of Americans are afflicted by eating disorders each year. Lifetime prevalence for bulimia runs between 1 and 4 percent of women and approximately 1 per cent for men. Between 2 and 5 percent of all adults are affected by binge eating disorder. Bulimia is characterized by binge eating at least twice a week for at least three months, followed by some form of purging such as vomiting or excessive exercising to prevent weight gain. Binge eating disorder is a syndrome whose definition has yet to be been finalized by the psychiatric community. It is marked by recurrent binge eating at least twice a week for six months without the purging behaviors found in bulimia.

In the UW study, the largest yet investigation using motivational interviewing to treat eating disorders, 90 college students who met the full or partial diagnosis for these two disorders were recruited. The subjects were predominantly female (88 percent) and white (60 percent) or Asian/Pacific Islander (29 percent). On average, participants were of normal weight, but 95 percent of them reported a desired weight that was less than their current weight. On average, they wished to weigh about 19 pounds less.

The participants were randomly assigned to one of two groups, self-help only or self-help plus motivational interview. All were given a battery of questionnaires that provided demographic data and assessed their eating and purging behaviors and probed their attitudes about these behaviors and their motivation to change.

After completing the assessment, people in the self-help group were given a description of the study and a copy of a standardized self-help manual, which they briefly reviewed with a research assistant. Those in the motivational interview group also were given a description of the study but then a research assistant discussed the participant's responses to the questionnaires for one hour.

These discussions covered such topics as the pros and cons of their eating and purging behaviors, how the eating disorder interfered with their life goals and options for changing their behavior. Following the discussion, participants were given the self-help manual. Participants in both groups were mailed follow-up surveys to fill out two and fourth months later. In addition, they were contacted for a short telephone interview at one and three months.

"One important thing this study showed was that just engaging in a conversation with someone who is empathetic can be helpful to a person with an eating disorder," said Dunn. "It can be a counselor or therapist, or probably even a good friend. They need someone they can have an open, non-judgmental conversation with who can ask them what they are getting out of their behavior and whether they feel that maybe it is time to think about ways to change.

"People in the study told us 'it was just nice to talk openly and out loud about what I am going through and not have someone tell me to change.'"

The motivational interview technique appears to be cost effective because the study utilized trained college undergraduates to conduct the sessions, Dunn said. Professionals who have at least a master's degree usually provide treatment for eating disorders. Additionally, the improved outcome on the part of the participants was comparable to that found in other published studies of more intensive, individualized treatment.
For more information, contact Dunn at or 206-313-0739.

University of Washington

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