Randomized controlled trial comparing smartphone assisted versus traditional guided self-help for adults with binge eating.

Tom Hildebrandt, Andreas Michaelides, Dianna Mackinnon, Rebecca Greif, Lynn DeBar, Robyn Sysko

Journal: The International journal of eating disorders 2018;50(11):1313-1322

PMID: 28960384

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Plain Language Summary

Mobile technology offers the potential for greater accessibility to patients, and a reduced treatment burden, which could increase adherence to self-help treatments. The aim of this randomised controlled study was to test the efficacy of a smartphone app – Noom Monitor - compared to traditional cognitive behaviour therapy in the management of binge eating episodes. The study recruited 66 adults who were randomized into two groups: cognitive-behaviour therapy through self-guided help or cognitive-behaviour therapy through self-guided help using Noom Monitor. Results show that patients receiving cognitive-behaviour therapy through self-guided help using Noom Monitor experienced a greater reduction in objective bulimic episodes and purging, and an increase in weekly meal and snack adherence. Authors conclude that smartphone apps can improve initial outcomes of cognitive-behaviour therapy through self-guided help and may offer a useful way to improve participant adherence among those who stay engaged in the treatment.

Abstract

OBJECTIVE

Guided self-help treatments based on cognitive-behavior therapy (CBT-GSH) are efficacious for binge eating. With limited availability of CBT-GSH in the community, mobile technology offers a means to increase use of these interventions. The purpose of this study was to test the initial efficacy of Noom Monitor, a smartphone application designed to facilitate CBT-GSH (CBT-GSH + Noom), on study retention, adherence, and eating disorder symptoms compared to traditional CBT-GSH.

METHOD

Sixty-six men and women with DSM-5 binge-eating disorder (BED) or bulimia nervosa (BN) were randomized to receive eight sessions of CBT-GSH + Noom (n = 33) or CBT-GSH (n = 33) over 12 weeks. Primary symptom outcomes were eating disorder examination objective bulimic episodes (OBEs), subjective bulimic episodes (SBEs), and compensatory behaviors. Assessments were collected at 0, 4, 8, 12, 24, and 36 weeks. Behavioral outcomes were modeled using zero-inflated negative-binomial latent growth curve models with intent-to-treat.

RESULTS

There was a significant effect of treatment on change in OBEs (β = -0.84, 95% CI = -1.49, -0.19) favoring CBT-GSH + Noom. Remission rates were not statistically different between treatments for OBEs (β = -0.73, 95% CI = -1.86, 3.27; CBT-GSH-Noom = 17/27, 63.0% vs. CBT-GSH 11/27, 40.7%, NNT = 4.5), but CBT-GSH-Noom participants reported greater meal and snack adherence and regular meal adherence mediated treatment effects on OBEs. The treatments did not differ at the 6-month follow-up.

DISCUSSION

Smartphone applications for the treatment binge eating appear to have advantages for adherence, a critical component of treatment dissemination.

Address: Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.; Noom, Inc., 229 W 28th Street, New York, 10001.; Kaiser Permanente Center for Health Research, 3325 N. Interstate Ave, Portland, Oregon, 97227.

DOI: 10.1002/eat.22781