Assessment, Preparation, and Medical Management

The assessment and preparation of the patient about to start cognitive behavior therapy (CBT) for binge-eating disorder (BED) has three main goals. The first is to assess the nature and severity of the eating-disorder psychopathology using a data-driven approach. Information should be gathered on current status (i.e., current body weight, height, waist circumference, eating behaviour; levels of physical activity, body image, and quality of life), weight and eating disorder history, any previous treatments for obesity and eating disorder (including unmanaged efforts to lose weight), weight goals and reasons for wanting to lose weight, barriers to weight loss, and personal and family medical histories. The second goal is to engage the patients in the treatment. To this end, the therapist should adopt an engaging style, educating patients on BED, clinical obesity, and CBT for BED, assessing their readiness to change, actively involving them in the decision to effect change, and to make the programme a priority. One session is usually devoted to assessment and preparation, at the end of which a decision has to be made on how best to proceed. With ambivalent patients, one additional assessment interview may be scheduled to make a further attempt to engage them in the decision to start the treatment. Non-medical therapists preparing patients for CBT for BED should always refer them to a physician for the assessment and management of physical complications associated with BED and clinical obesity.