Food Addiction Symptoms and Clinical Outcomes in Binge-Type Eating Disorders: A Randomized Clinical Trial of Cognitive Behavioral Therapy-Guided Self-Help in China.

OBJECTIVE

Food addiction (FA) is clinically relevant in binge-type eating disorders (EDs), yet its treatment relevance remains unclear in mainland China. This study examined (1) FA's associations with ED psychopathology and psychosocial functioning; (2) FA symptom changes following cognitive behavioral therapy-guided self-help (CBT-gsh); and (3) whether FA improvement was independently associated with changes in psychosocial functioning.

METHOD: In this assessor-blind randomized controlled trial, 87 adults with binge-type EDs were allocated to a 10-week asynchronous web-based CBT-gsh program or a waitlist control group. Assessments occurred at baseline, post-treatment, and 1-month follow-up. FA severity was the primary outcome; secondary outcomes included ED psychopathology, binge-eating frequency, psychosocial impairment, depression/anxiety, and body mass index (BMI). Linear mixed models and hierarchical regression were used to analyze the data.

RESULTS

At baseline, FA severity was positively associated with ED psychopathology and psychosocial impairment. All outcomes except BMI improved significantly in the intervention group (all ps < 0.001), with no changes in controls. At post-treatment, 20% of intervention participants achieved binge-eating abstinence versus 2.5% of controls, and fewer met moderate-to-severe FA criteria (Δn = -16) in the intervention group. FA reduction was independently associated with lower post-treatment psychosocial impairment (β = 0.49, p < 0.001), beyond baseline impairment and ED psychopathology changes.

DISCUSSION: This study provides the first evidence from mainland China that CBT-gsh was associated with FA reductions in binge-type EDs. These reductions were independently associated with better psychosocial functioning, underscoring FA as a complementary and clinically meaningful treatment target.