Patient expectations of a new treatment for eating disorders combining guided physical exercise and dietary therapy: an interview study of women participating in a randomised controlled trial at the Norwegian School of Sport Sciences.

BMJ open. 2019;9(4):e025344
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Bulimia nervosa (BN) and binge eating disorder (BED) are two types of eating disorders characterised by binging episodes where excessive energy is consumed. Unlike BED, BN is also characterised by compensatory behaviours such as purging, excessive exercise and/or laxative use. It is estimated that only two-thirds of people with these eating disorders seek treatment despite the impact they can have on their physical and psychological functioning. Patient expectations of treatments have been previously shown to impact on treatment outcomes. This study was part of a randomised controlled trial (RCT) and explored patient expectations of a new treatment programme on guided exercise and diet therapy using qualitative methods (semi-structured interviews n = 10). Those interviewed expected to increase their knowledge of nutrition and physical exercise (e.g. reduce their fear of food), experience less physical and mental symptoms associated with their eating disorder (e.g. less negative body image) and expected their therapist to be competent and to take care of them. These expectations are important to treatment compliance. This study suggests it is important to identify and discuss patient expectations about treatment before they start to manage their expectations (e.g. the speed they may recover). The authors also suggest it may be important to manage expectations throughout the treatment to adjust their goals or strategies to help meet them.

Abstract

OBJECTIVES To study the expectations women with bulimia nervosa (BN) or binge eating disorder (BED) had to a new treatment programme based on guided physical exercise and dietary therapy. DESIGN AND PARTICIPANTS Semistructured interviews were conducted with six women with BN and four women with BED following a group-based therapy programme. Transcribed interviews were analysed using a text-condensing analytic approach. RESULTS The analysis resulted in three main categories, that is, expectations about (1) increased knowledge, (2) symptom changes and (3) therapeutic expertise. The women expected that learning more about nutrition and physical exercise would give them more energy, less fear of food, physical and mental symptoms and a negative body focus. They also expected therapists to be professional and competent, and able to take care of them. CONCLUSION The overall high and positive treatment expectation can, to some extent, reflect enthusiasm about a new and innovative approach to treatment. However, the results also reflect generic and highly adequate outcome expectations, which for the purpose of effectiveness should be incorporated into all treatment efforts at least for patients with eating disorders. TRIAL REGISTRATION NUMBER NCT02079935; Results.

Lifestyle medicine

Fundamental Clinical Imbalances : Neurological
Patient Centred Factors : Mediators/Eating disorder
Environmental Inputs : Psychosocial influences
Personal Lifestyle Factors : Psychological
Functional Laboratory Testing : Not applicable

Methodological quality

Allocation concealment : Not applicable

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