New Model Reduces Binge Eating, Obesity in Veterans

A new model to treat binge eating disorders and loss of control eating was associated with decreased BMI and caloric intake for veterans in a recent clinical trial published in JAMA Network Open.

The Controlling Hunger and Regulating Eating (CHARGE; NCT03678766) randomized clinical trial compared active comparator cognitive behavioral therapy (CBT) with regulation of cues combined with behavioral weight loss in veterans aged 18 to 65 years with binge eating disorder (BED) or sub-threshold BED and had a body mass index (BMI) of 25 to 45. The trial was conducted from march 2019 to April 2023 at the University of California,San Diego. BED is the consumption of large amounts of food within a short period while experiencing loss of control (LOC) eating. It is indeed also associated with overweight, obesity, and high-risk comorbidities.

The study aimed to address and suggest new solutions for the high rates of binge eating, overweight, and obesity amongst veterans. Symptoms of BED and obesity can be traced back to military habits, including cycles of eating quickly followed by periods of deprivation, thus increasing veterans’ risk of binge eating, BED, overweight, and obesity.

full-syndrome BED, measured by the Eating Disorder Examination (EDE), is diagnosed when an individual has had at least 12 objective binge eating episodes (OBEs) over the past 3 months.Sub-threshold binge eating, while less intense, constitutes at least 3 OBEs, at least 6 subjective binge eating episodes (SBEs) or LOC episodes, at least 2 OBEs and 2 SBEs, or at least 1 OBE and 4 SBEs over the past 3 months. Of the randomized 129 veterans in the trial, 49% were White, 33% were Hispanic, 5% were Black, 5% were Asian, and 9% identified as more than 1 race, other, or unknown race. A total of 39 (30%) participants had 12 or more OBEs in the past 3 months at the beginning of the trial.

The Behavioral Susceptibility Theory provides evidence to support that there are genetic traits responsible for obesity,often amplified by the current ‘obesogenic’ habitat-an increase in the availability of cheap,crave-inducing foods-highlighting 2 mechanisms: eating onset and offset. Eating onset is defined as food-driven responses induced by an individual’s sensitivity to environmental food cues like food ads and shelf placement in grocery stores. Eating offset is characterized by an individual’s sensitivity to internal fullness, often driven by satiety responses.

The clinical trial framed its model around the behavioral susceptibility theory and developed regulation of cues (ROC) to target both eating onset and onset responses.Researchers evaluated veterans randomized into the active comparator or CBT group and the ROC, ROC plus BWL, and BWL cohorts at mistreatment, post-treatment, and at a 6-month follow-up.

ROC and BWL Groups Outperform CBT Group

Both groups received weekly 90-minute, in-person sessions and had the same goal to engage.Okay,let’s break down how to use the principles highlighted in the provided text – specifically,the “Regulation of Cues” (ROC) plus “Behavioral Weight Loss” (BWL) approach – to build tolerance to food responsiveness,and contrast it with the Cognitive Behavioral Therapy (CBT) method described. I’ll also address the limitations of the study and offer a practical application plan.

Understanding the Core Difference: Top-Down vs. Bottom-Up

The key takeaway from the study is the difference in approach:

CBT (Cognitive Behavioral Therapy): Focuses on top-down control.This means changing thoughts and beliefs about food, weight, and body image. It addresses the why behind the eating behavior. The phases described (education, reducing binge frequency, addressing cognition, self-esteem/body image/problem-solving) all fall into this category. It aims to decrease the overevaluation of weight and shape.
ROC + BWL (Regulation of Cues + Behavioral Weight Loss): Targets both top-down and bottom-up processes. It doesn’t just change thoughts; it retrains how you respond to appetitive cues (sights, smells, tastes, even thoughts about food).This is the “bottom-up” component – directly influencing the physiological and behavioral responses to food stimuli. BWL adds practical strategies for weight management, reinforcing the behavioral changes.

How to Use ROC Principles to Build Tolerance to Food Responsiveness

Food responsiveness means having a strong physiological and psychological reaction to food cues, leading to urges to eat even when not physically hungry.Here’s how to apply ROC principles, based on the study’s findings:

1. Identify Your Appetitive Cues: This is the crucial first step. Keep a detailed food diary, but not just of what you eat. Record:

What triggered the urge to eat? (Specific food, smell, sight, time of day, emotion, place, thought)
How strong was the urge? (Scale of 1-10)
What did you do? (Ate, distracted yourself, etc.)
What was the outcome? (guilt,satisfaction,continued eating,etc.)
Example: “Saw a commercial for pizza (visual cue). Urge level: 8/10. Ate two slices. Felt guilty afterward.”

1. Cue Exposure (Gradual & Controlled): this is the core of the ROC approach. Gradually expose yourself to your identified cues without giving in to the urge to eat. Start with low-intensity cues and work your way up. This is about habituation – your brain learns that the cue doesn’t automatically lead to eating.

Example (Pizza):
Week 1: Look at pictures of pizza for a few seconds,several times a day.Practice deep breathing or mindfulness when the urge arises.
Week 2: Watch a short video of someone making pizza. Again,manage the urge with coping strategies.
Week 3: Drive past a pizza restaurant.
Week 4: Walk into a pizza restaurant, look at the menu, and leave without ordering.
Important: The goal isn’t to eliminate the urge, but to tolerate it without reacting. The urge will likely decrease over time.

Meal Planning: Reduce impulsive eating by planning meals and snacks in advance.
Portion control: use smaller plates and measure portions. Healthy Substitutions: Identify healthier alternatives to your trigger foods.
Regular Physical Activity: Exercise can definitely help manage stress and reduce cravings.

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