Background

Addictive-like eating (e.g., “food addiction;” FA) behaviors are associated with obesity and binge-eating disorder (BED). Research has suggested that the presence of these addictive-like eating behaviors may signal a more disturbed subgroup of patients with BED. Emerging findings regarding the prognostic significance of addictive-like eating on obesity outcomes have been mixed and remain unknown for patients with BED. This study examined the predictive significance of two forms of additive-eating—FA and food craving—on weight-loss outcomes in patients with BED in a RCT in primary-care.

Methods

104 patients in primary care with co-existing BED/obesity (mean BMI 39), participating in a RCT testing self-help (shCBT) and obesity medication (sibutramine; Med) alone and in combination (balanced 2X2 factorial design), were randomly assigned to a 4-month treatment. Assessments independently performed throughout- and post-treatment included measured weights; patients completed the Yale Food Addiction Scale and Food Craving Inventory. Linear mixed models including random intercept and slope effects tested: (1) time-by-baseline food cravings on percent weight-loss (2) time-by-baseline FA on percent weight-loss; 3-way interactions including (3) time x shCBT x food craving; and (4) time x Med x food craving.

Results

Food cravings moderated the effect of time on percent weight-loss (p = .02). Further, individuals with high baseline levels of food cravings who did not receive shCBT lost less weight than those receiving shCBT, while those with low baseline levels of food cravings lost similar amounts of weight regardless of shCBT assignment (p = .02). There was not a significant time x Med x food cravings effect (p = .85). FA did not predict or moderate percent weight-loss outcomes.

Conclusions

More frequent food cravings at baseline, but not FA, attenuated subsequent weight loss. Self-help CBT appeared significantly more effective in producing weight loss for those with higher levels of food cravings.