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NATIONAL HARBOR, Maryland -- Cognitive behavioral therapy helped four patients scheduled for bariatric surgery who engaged in binge eating to moderate their food intake, researchers reported here.

Tested in a rural setting, the pilot intervention led to more restrained eating, on average, as measured with the Dutch Eating Behavior Questionnaire (30.50 pre-treatment versus 34.00 post-treatment, P<0.05), according to lead author Sara Assar, PsyD, of West Virginia University, and colleagues.

Using the same questionnaire, there was also a trend toward reducing external eating among the small cohort (33.50 versus 31.00), in the study presented at the .

By improving patients' eating habits prior to undergoing bariatric surgery, researchers hope to improve the procedures' outcomes.

There were also trends toward improvement for disinhibition (10.75 versus 9.75) and hunger (7.00 versus 4.75) measured on a Three Factor Eating Questionnaire, in addition to improved cognitive restraint (10.25 versus 16.75) -- none of which reached statistical significance but which were nevertheless characterized as clinically relevant.

A trend toward reduced moderate binge eating was also reported after bariatric surgery, measured on the Binge Eating Scale (21.00 versus 16.25).

"No study to date has specifically examined outcomes of CBT treatment for pre-surgical bariatric patients in rural populations," Assar discussed during an oral presentation of the findings. "The program was adapted based on previous treatment interventions and culturally-sensitive modules, that were sensitive to rural concerns."

The study pooled four patients from rural West Virginia prior to undergoing bariatric surgery who were screened for disordered eating and met criteria for binge eating The patients enrolled in the pilot intervention program, which consisted of four one-hour long group cognitive behavioral treatment sessions. Exclusion criteria included psychosis, suicidal ideations, as well as mood disorders.

Assar and colleagues tailored previous interventions for binge eating to their rural population, which faces unique challenges including limited access to treatment and to healthy foods.

The Binge Eating Scale was a self-reported, 16-item survey to rate the severity of binge eating. A total of 51-items are included on the self-reported Three Factor Eating Questionnaire -- 21 items relating to cognitive restraint of eating rated on a scale ranging from 0 to 21, 16 items on disinhibition rated 0 to 16, and 14 items assessed hunger rated 0 to 14. The Dutch Eating Behavior Questionnaire measured 33 items using a 5-point scale to measured factors that trigger episodes of binge eating, rating levels of emotional eating, external eating, and restrained eating.

Participants also rated the amount of binge eating and emotional eating episodes at baseline through the third week of the study.

During the first session of the intervention, the participants discussed the goals of treatment, along with an understanding on what binge eating is. The group was given materials to improve self-monitoring of eating, as well as coping strategies for dealing with challenges in a rural area. The second session included a discussion of the consequences of binge eating after surgery are, and ways to improve rural stress, impulsivity, and mood enhancement via relaxation techniques. Understanding triggers, consequences, and controlling one's thoughts was the basis for the third session, followed by self-compassion teachings and reflection at the final session.

The group is still ongoing, Assar said, noting that future research will of course require a larger sample.

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