A groundbreaking study from University of California San Diego researchers demonstrates that a novel therapeutic approach significantly outperforms standard treatment for binge eating disorder among veterans. The research, published in JAMA Network Open, found that "regulation of cues" therapy combined with behavioral weight loss (ROC+BWL) reduced patients' odds of binge eating by 20% compared to cognitive-behavioral therapy (CBT), with benefits sustained six months after treatment completion.
Addressing a Critical Need in Veteran Healthcare
Binge eating represents a substantial health challenge within the veteran population, affecting 65% of female and 45% of male veterans. This prevalence far exceeds civilian rates, attributed to military experiences including eating quickly and periods of food deprivation that increase vulnerability to disordered eating patterns.
"The study showed that our treatment could reduce binge eating more than standard therapy even after the six-month follow up," said Kerri Boutelle, Ph.D., professor of pediatrics at UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science and corresponding author. "This is encouraging for developing more effective and durable solutions for veterans struggling with disordered eating."
Revolutionary Therapeutic Approach
Unlike traditional CBT, which focuses on normalizing eating patterns and addressing maladaptive thoughts and behaviors, regulation of cues targets two specific appetitive traits: food responsiveness and satiety responsiveness. The therapy teaches patients to become more attuned to natural hunger and fullness signals while learning to distinguish between physical hunger and emotion-driven cravings.
The ROC approach helps individuals tolerate cravings and better recognize internal satiety signals, addressing a fundamental disconnect many people with eating disorders experience with their body's natural regulatory mechanisms.
Robust Clinical Evidence
The randomized controlled trial, conducted between March 2019 and April 2023, enrolled 129 veterans with an average Body Mass Index of 34 from the Veterans Affairs San Diego Healthcare System and the San Diego community. Participants were randomly assigned to receive either ROC+BWL or standard CBT through weekly 90-minute group sessions over five months.
Both groups were encouraged to complete at least 250 minutes of moderate or vigorous physical activity weekly. The ROC+BWL group additionally received behavioral weight loss components including calorie monitoring and physical activity goals to promote weight reduction.
Sustained Clinical Benefits
The study revealed compelling efficacy data across multiple timepoints. Veterans receiving ROC+BWL demonstrated a 20% lower risk of binge eating at mid-treatment, post-treatment, and at the six-month follow-up compared to those receiving CBT. The treatment also produced greater weight loss during the five-month intervention period, though weight differences were not sustained at follow-up.
"These findings suggest that targeting how individuals respond to food cues, rather than just focusing on eating behaviors or thoughts, may offer a more effective and lasting treatment for binge eating," Boutelle explained. "But more research is needed on the effects on weight."
Clinical Implications and Future Directions
The research addresses a significant limitation of current first-line treatment, as CBT typically does not result in meaningful or lasting weight loss despite its established efficacy for binge eating symptoms. The sustained benefits observed with ROC+BWL, particularly for veterans with diagnosed Binge Eating Disorder, suggest this approach may offer superior long-term outcomes.
The study was supported by the Assistant Secretary of Defense for Health Affairs through the Department of Defense Peer-Reviewed Medical Research Program and the UC San Diego Altman Clinical and Translational Research Institute, reflecting the military's investment in addressing this critical health issue among service members and veterans.
