CAVEATS: Limited wait time leaves unanswered questions
One limitation of this study is the lack of a control group beyond the 8-week waiting period. Prior studies of CBT for bulimia that delayed therapy for those in the control groups for a longer duration have consistently shown that patients receiving CBT did significantly better than those in the control group.9 While a “no treatment” group would have made the results more robust in this case, it would not have been ethical to withhold treatment for the entire length of the study.
It is noteworthy, too, that this study only included patients with a BMI >17.5. Patients with a diagnosis of anorexia nervosa, who by definition have a lower BMI, will need other treatments, including hospitalization in some cases.
CHALLENGES TO IMPLEMENTATION: Identifying patients and therapists
The primary challenge is to determine which of your patients have eating disorders. When discussing diet, adding a simple question such as, “Are you happy with your current weight?” can help you identify those who meet the criteria for an eating disorder or are at high risk.3
Identifying local mental health providers who are trained to provide CBT for patients with eating disorders is another concern. Insurance coverage for this intensive treatment may also be a limiting factor in some cases.
Many studies support the use of fluoxetine for patients with bulimia, and combined treatment with SSRIs and CBT has been shown to be superior to either treatment alone.8,10,14 Consider starting the patient on an antidepressant while she (or he) awaits the start of CBT.
Acknowledgements
The PURLs Surveillance System is supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
PURLs methodology
This study was selected and evaluated using FPIN’s Priority Updates from the Research Literature (PURLs) Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at www.jfponline.com/purls.
