Clinical Guidance: Upward Weight Trend in Bulimia Nervosa
Standard treatments for bulimia nervosa are for patients with normal weight, but Bulik et al. (CME, p. 1031) report that a growing proportion of patients are substantially overweight or obese. Weight-related medical problems require coordination with primary care and expanded treatment goals. Cognitive-behavioral therapy (CBT), the gold standard for bulimia nervosa, is fairly ineffective in reducing weight. Compatible strategies tested for binge-eating disorder include appetite awareness training, behavioral weight loss, and appetite-focused CBT. A combined approach may be essential to treatment adherence, as patients are seeking weight loss. Nonetheless, goals of therapy include setting realistic expectations and shifting the focus from weight to health. Therapy groups specifically for overweight bulimia nervosa patients help avoid negative body comparisons.