Die Adipositas geht im Erwachsenenalter oft mit psychischer Komorbidität einher, die den Gewichtsreduktionserfolg beeinflussen und eine Behandlung indizieren kann, die von Standardprogrammen der multimodalen Adipositasverhaltenstherapie (AVT) nicht abgedeckt wird. Dieser Artikel diskutiert am Beispiel der häufig komorbiden Binge-Eating-Störung (BES) aktuelle Forschungsergebnisse zu Ätiologie und Intervention bei Komorbidität mit dem Ziel, Implikationen für die weitere Forschung und Behandlung abzuleiten. Weil die Kognitive Verhaltenstherapie (KVT), die am besten belegte Therapieform für Erwachsene mit BES, der AVT bei der Reduktion der Essstörungssymptomatik überlegen war, bei der Gewichtsreduktion nur tendenziell und ausschließlich kurzfristig unterlegen, sollte sich die weitere Interventionsentwicklung auf graduelle Anpassungen der KVT zur Verbesserung der Gewichtsreduktion bei Patienten mit Adipositas und BED konzentrieren. Hierfür kommen mit dem Ziel einer geringfügigen Gewichtsreduktion einzelne adaptierte AVT-Interventionen in Betracht, während sich gleichzeitige oder sequentielle Kombinationen dieser beiden Therapieformen nicht eindeutig bewährt haben. Interventionen, die auf aktuellen Forschungsergebnissen für die Komorbidität beider Störungsbilder fußen, könnten individualisiert einbezogen werden, um die Wirksamkeit für Essstörungssymptomatik und Körpergewicht zu erhöhen. Neue digitale Behandlungsmodalitäten könnten den Transfer in den Lebensalltag und die Nachhaltigkeit der Effekte fördern. Diese Modifikationen hin zu einer adaptiven KVT für Erwachsene mit Adipositas und BES, basierend auf einem patientengerechten Therapierationale, bedürfen der Absicherung durch weitere experimentelle Therapieforschung. / Obesity often co-occurs with mental comorbidity in adults, likely impacting weight loss success and indicating treatment that is not covered by standard behavioral weight loss (BWL) treatment. Using the example of binge-eating disorder (BED) as a frequent comorbid condition, this article discusses current research on etiology and intervention in case of comorbidity, in order to derive implications for research and treatment. Cognitive-behavioral therapy (CBT), the most well-established treatment for adults with BED, was more efficacious than BWL in improving binge-eating symptomatology in patients with obesity and BED, while tending to show lower weight loss effects in the short term only. Therefore, further intervention development should focus on gradual adaptations of CBT for improving weight loss. These interventions could be adapted from BWL and aim at a slight weight loss. Parallel or sequential combinations of these treatments have not consistently demonstrated improved treatment effects. Interventions based on current research could be included on an individual basis, in order to enhance efficacy for eating disorder symptomatology and body weight. New digital treatment modalities could support the transfer into daily life and boost the long-term maintenance of therapeutic gains. These modifications regarding adaptive CBT for adults with obesity and BED should be based on an individual treatment rationale and require further research in an experimental therapeutics framework.

Die Binge-Eating-Störung (BES), als eigenständige Essstörung erstmals im Diagnostischen und Statistischen Manual psychischer Störungen DSM-5 definiert, ist durch wiederkehrende Essanfälle ohne gewichtskompensatorische Verhaltensweisen gekennzeichnet. Die breitere Definition in der avisierten International Classification of Diseases ICD-11 wird zu Veränderungen in Präsentation und Prävalenz dieser Störung führen. Die BES tritt vor dem Hintergrund einer komplexen, multifaktoriellen Ätiologie auf und geht mit einer erhöhten Essstörungs- und allgemeinen Psychopathologie, psychischen und körperlichen Komorbidität einschließlich Adipositas und verringertem Funktionsniveau einher. Trotz dieser Beeinträchtigungen wird die BES häufig weder diagnostiziert noch behandelt. Evidenzbasierte Therapien für die BES umfassen die Psychotherapie, wobei die Kognitive Verhaltenstherapie das etablierteste Verfahren darstellt, und die strukturierte Selbsthilfebehandlung. Andere Therapien wie die Pharmakotherapie, behaviorale Gewichtsreduktionstherapie und Kombinationstherapien erhielten in den aktuellen evidenzbasierten S3-Essstörungsleitlinien einen geringeren Empfehlungsgrad für spezielle Indikationen.

Objective: Analysis of short- and long-term effects of rapid response across three different treatments for binge-eating disorder (BED). Method: In a randomized clinical study comparing interpersonal psychotherapy (IPT), cognitive-behavioral guided self-help (CBTgsh), and behavioral weight loss (BWL) treatment in 205 adults meeting DSM-IV criteria for BED, the predictive value of rapid response, defined as ≥ 70% reduction in binge-eating by week four, was determined for remission from binge-eating and global eating disorder psychopathology at posttreatment, 6-, 12-, 18-, and 24-month follow-up. Results: Rapid responders in CBTgsh, but not in IPT or BWL, showed significantly greater rates of remission from binge-eating than non-rapid responders, which was sustained over the long term. Rapid and non-rapid responders in IPT and rapid responders in CBTgsh showed a greater remission from binge-eating than non-rapid responders in CBTgsh and BWL. Rapid responders in CBTgsh showed greater remission from binge-eating than rapid responders in BWL. Although rapid responders in all treatments had lower global eating disorder psychopathology than non-rapid responders in the short term, rapid responders in CBTgsh and IPT were more improved than those in BWL and non-rapid responders in each treatment. Rapid responders in BWL did not differ from non-rapid responders in CBTgsh and IPT. Conclusions: Rapid response is a treatment-specific positive prognostic indicator of sustained remission from binge-eating in CBTgsh. Regarding an evidence-based stepped care model, IPT, equally efficacious for rapid and non-rapid responders, could be investigated as a second-line treatment in case of non-rapid response to first-line CBTgsh.

Objectives: Binge-eating disorder (BED) is characterized by recurrent binge eating episodes, associated eating disorder and general psychopathology, and commonly occurs in obese individuals. Explicit self-esteem and explicit weight bias have been linked to BED, while little is known about implicit cognitive processes such as implicit self-esteem and implicit weight bias. Methods: Obese participants with BED and an individually matched obese only group (OB) and normal weight control group (CG; each N = 26) were recruited from the community to examine group differences and associations in explicit and implicit self-esteem and weight bias, as well as the impact of implicit cognitive processes on global eating disorder psychopathology. Implicit cognitive processes were assessed using the Implicit Association Test. Results: Significantly lower explicit self-esteem, as well as higher exposure to explicit weight bias, compared to CG and OB was found in the BED group. All groups showed positive implicit self-esteem, however, it was significantly lower in BED when compared to CG. BED and CG demonstrated equally high implicit weight bias whereas OB did not. Explicit and implicit measures were not significantly correlated. Global eating disorder psychopathology was predicted by explicit and implicit self-esteem. Conclusions: The results of the present study add to the importance of implicit self-esteem and implicit weight bias beyond explicit measures in BED, while both were previously shown to be associated with onset and maintenance of BED. In conclusion, implicit cognitive processes should be focused on in interventions for BED to investigate their impact on psychological treatments.

Objective: Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating and is associated with eating disorder and general psychopathology and overweight/obesity. Deficits in cognitive and emotional functioning for eating disorders or obesity have been reported. However, a systematic review on cognitive and emotional functioning for individuals with BED is lacking. Method: A systematic literature search was conducted across three databases (Medline, PubMed, and PsycINFO). Overall, n = 57 studies were included in the present review. Results: Regarding cognitive functioning, individuals with BED consistently demonstrated higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues), whereas cognitive functioning in the context of neutral stimuli appeared to be less affected. Thus, results suggest disorder-related rather than general difficulties in cognitive functioning in BED. With respect to emotional functioning, individuals with BED reported difficulties similar to individuals with other eating disorders, with a tendency to show less severe difficulties in some domains. In addition, individuals with BED reported greater emotional deficits when compared to obese and normal-weight controls. Findings suggest general difficulties in emotional functioning in BED. Thus far, however, investigations of emotional functioning in disorder-relevant situations are lacking. Discussion: Overall, the cross-sectional findings indicate BED to be associated with difficulties in cognitive and emotional functioning. Future research should determine the nature of these difficulties, in regards to general and disorder-related stimuli, and consider interactions of both domains to foster the development and improvement of appropriate interventions in BED.

Objectives: Binge-eating disorder (BED) is characterized by recurrent binge eating episodes, associated eating disorder and general psychopathology, and commonly occurs in obese individuals. Explicit self-esteem and explicit weight bias have been linked to BED, while little is known about implicit cognitive processes such as implicit self-esteem and implicit weight bias. Methods: Obese participants with BED and an individually matched obese only group (OB) and normal weight control group (CG; each N = 26) were recruited from the community to examine group differences and associations in explicit and implicit self-esteem and weight bias, as well as the impact of implicit cognitive processes on global eating disorder psychopathology. Implicit cognitive processes were assessed using the Implicit Association Test. Results: Significantly lower explicit self-esteem, as well as higher exposure to explicit weight bias, compared to CG and OB was found in the BED group. All groups showed positive implicit self-esteem, however, it was significantly lower in BED when compared to CG. BED and CG demonstrated equally high implicit weight bias whereas OB did not. Explicit and implicit measures were not significantly correlated. Global eating disorder psychopathology was predicted by explicit and implicit self-esteem. Conclusions: The results of the present study add to the importance of implicit self-esteem and implicit weight bias beyond explicit measures in BED, while both were previously shown to be associated with onset and maintenance of BED. In conclusion, implicit cognitive processes should be focused on in interventions for BED to investigate their impact on psychological treatments.

While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.

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