Matched treatment of obesity in overweight patients. A randomised controlled trial.
(pilot is non-randomised treatment-control study. This ABR application pertains to the pilot study)

Dieting, treatment of choice for counteracting weight gain and obesity, has
become controversial. At its best it is ineffective. At its worst it is
damaging to health, as it may contribute to binge eating problems. Obesity is a
major risk factor in the development of hypertension, cardiovascular disease
and type 2 diabetes. At present 8% of the adult North American population is
suffering from type 2 diabetes and the majority of these patients are obese.
Since obesity is increasing world-wide, type 2 diabetes is becoming the
pandemic disease of 21st century . Reduction of body weight either by diet or
bariatric surgery has substantial positive effects on glycemic control and the
development of diabetes. In practice however, consults with a dietician lead
only in very few cases to long term loss of body weight. On the basis of a
review of studies of long-term outcomes of calorie-restricting diets it was
recently concluded that dieting does not lead to lasting weight loss. A similar
finding was recently obtained with Dutch patients with newly diagnosed Type-2
diabetes. In spite of their high motivation for weight loss as this would
positively affect their diabetes mellitus and their anti-diabetic medication,
about half of them weighted even more at the 4-year follow up than they did at
diagnosis .

The present project aims at giving obese patients new opportunities to loose
body weight by enabling care providers to match treatments to patients by using
an evidence based matching procedure with the Dutch Eating Behaviour
Questionnaire (DEBQ). The DEBQ assesses the degree of emotional eating (eating
in response to negative emotions), external eating (eating in response to
external food cues such as sight and smell of food) and restrained eating
(eating less than desired to maintain or lose weight). A distinction can be
made between patients with low and patients with high tendency toward emotional
eating with/without external eating. It is possible to determine the patients
with potentially good responses to weight loss diets, the potentially
successful dieters (low emotional and external eaters) and to determine those
for which diets for reason of low interoceptive awareness and hypofunctionality
of dopamine related reward circuits are contra-indicated, the unsuccessful
dieters (high emotional and external eaters). Treatment target for the
potentially successful dieters is weight loss by means of diet and the
treatment target for unsuccessful dieters is improvement of interoceptive
awareness and enhancement of emotion regulation abilities as well as decease of
overeating and binge eating problems by means of Dialectical Behaviour Therapy
(DBT) and regulation of eating behaviour by means of (cognitive)behaviour
therapy.
The ultimate aim of this project is to investigate the effects of these
different treatments of obesity in overweight and obese patients on weight
reduction and emotion regululation on long term using a randomised control
design taking account of DEBQ-scores with pre-test, and post tests (6(T1) and
12 (T2) months and 4-years (T4)). The immediate aim is a pilot study on a
treatment and control group (treatment as usual) in the outpatient clinic for
eating disorders of the GGZ Oostbrabant with pretest and posttests (T1, T2,
T3).

In a pilot study a treatment group will be compared with a control group
(treatment as usual) in an eating disorder clinic (day treatment setiing) with
a pre-test en posttests((T1 (pre-test); T2 (6 months); T3 ( 12 months)).

An emotion regulation therapy for people with eating binges vs treatment as
usual.

The completion of questionnaires at three moments takes one hour a time.
The intervention consists of 20 groupsessions (two hours pers session) and a
maximum of six sessions (45 minutes) with a trained dietician for the control
group.