(PS8-A2) Fear of Weight Gain During Cognitive Behavioral Therapy for Binge-spectrum Eating Disorders

Background: Theory supports the conceptualization of eating disorders (EDs) using an anxiety-based model, and fear of weight gain may play a central role in maintaining EDs. Despite this, research on the role of fear of weight gain during cognitive behavioral therapy (CBT-E) for binge-spectrum EDs is sparse. Specifically, it is not clear whether CBT-E adequately targets fear of weight gain. Additionally, little research exists on the temporal relationship between fear of weight gain and disordered eating behaviors such binge eating.

Method: The current study examined changes in fear of weight gain during 12 sessions of CBT-E for binge-spectrum EDs. Additionally, we investigated whether fear of weight gain predicted binge eating or weight change during treatment. Participants (N = 43) were adults of any gender recruited as part of a larger trial. Participants were administered diagnostic assessments using the Eating Disorder Examination and completed the Goldfarb Fear of Fat Scale (GFFS) at pre-, mid-, and posttreatment. Brief surveys, including a 4-item version of the GFFS were completed before each therapy session.

Results: Multilevel models (MLM) were employed due to the nested nature of our longitudinal data. Fear of weight gain decreased across treatment (i.e., session-by-session, and pre-, mid-, posttreatment). This effect was moderated by diagnosis, such that those with bulimia nervosa (BN) spectrum EDs reported higher fear of weight gain at baseline and experienced a larger decrease in fear of weight gain across treatment than those with binge eating disorder. Those reporting higher fear of weight gain at a given session experienced more frequent binge episodes the following week. Fear of weight gain was not associated with session-by-session changes in BMI (all p’s > .05).

Conclusions: CBT-E appears to implicitly target fear of weight gain during treatment of binge-spectrum EDs likely through regularizing eating patterns, reducing compensatory behaviors, and breaking dietary rules Despite this, fear of weight gain remained somewhat high at posttreatment, especially for those with BN-spectrum EDs. Future interventions should consider directly targeting fear of weight gain as it appears to be a maintaining factor for binge episodes.