New study results published online in the American Journal of Psychiatry suggest that a binge eating treatment strategy combining cognitive behavioral therapy (CBT), telemedicine consultations and Noom’s self-monitoring app could be effective in reducing symptoms compared to standard care.
Announced back in in 2015, the investigation — conducted by researchers from Mount Sinai, Kaiser Permanente and Noom — evaluated 225 Kaiser Permanente Northwest patients diagnosed with binge eating disorder or bulimia nervosa over a 52-week window, among the first 12 weeks of which the intervention was delivered.
“The purpose of this study was to evaluate the robustness of the intervention when delivered by non-specialist health coaches in a community health care system via telemedicine,”Dr. Thomas D. Hildebrandt, lead author and the chief of the Center of Excellence in Eating and Weight Disorders at The Mount Sinai Hospital (as well as a Noom advisory board member and equity owner), said in a statement from the health system. “We were encouraged by the results that showed that this intervention is effective and can be scaled outside of specialty clinical programs.”
Compared to those receiving standard care (n = 111), patients in the intervention group (n = 114) reported significantly fewer days in which they experienced objective binge-eating episodes (β = -0.66) at 52 weeks.
This group also logged higher remission rates than the controls (56.75 versus 30%), “suggesting that the effects of the intervention continued to facilitate changes within the follow-up period that were not observed among those who received standard care,” Hildebrandt said. Reclassifying all missing reports as treatment failures also yielded a similar remission rate ratio (33.3% versus 10.8%).
Further, the researchers noted similar remission rate improvements in regard to patients’ compensatory behaviors such as vomiting, laxative use or excessive exercise; various eating disorder symptoms; and clinical impairment. No significant difference in quality of life was observed at the end of the follow-up period.
HOW IT WAS DONE
Between April 2016 and March 2017, researchers enrolled Kaiser Permanente Northwest members aged 18 to 55 years. Those eligible were mailed a study brochure that referred to an online questionnaire, with those indicating loss-of-control eating at least once per month screened over the phone to determine whether they met the study criteria for objective binge episodes.
The intervention consisted of telephone coaching sessions with a Kaiser Permanente Northeast-employed health coach, once per week until week four, and then biweekly until week 12. Alongside these the researchers provided a CBT-guided self-help book and the Noom Monitor smartphone app, a customizeable self-monitoring system that lets users log their meals and behaviors. The participants were provided with instructions on how to use this app, while their coaches could monitor their progress through a provider dashboard.
Of note, standard care at Kaiser Permanente Northwest did not consist of any services specific to binge-eating disorder, but “unrestricted access to clinical resources within the health plan.”
Researchers assessed the patients at baseline, and at weeks four, eight, 12, 26 and 52 using several questionnaire assessments of primary and secondary outcomes of interest.
THE LARGER TREND
A handful of studies and pilots have looked at the ways in which digital behavioral health tools and telemedicine can promote healthier lifestyles. A 2018 study in the Journal of Telemedicine and Telcare, for instance, found weekly telemedicine sessions to significantly assist obese patients trying to lose weight. Another in the Journal of Internal Medicine highlighted described similar benefits from a hybrid CBT counseling and online behavior change support system.
Noom, for its part, made headlines in May of last year with the announcement of a $58 million fundraise to support Noom Weight Loss Coach, its current signature product.
“Scaling and implementing empirically supported interventions have become an important priority across mental health conditions and our study shows that CBT-[guided self-help] via telemedicine is effective and scalable as an intervention for binge eating disorders,” Hildebrandt said.