Using Virtual Reality to Combat Binge Eating Disorder and Obesity

Patients with binge eating disorder, or BED, may be helped by a technique that “unlocks” a negative body image using a form of virtual reality, according to Italian researchers. The virtual reality method is based upon the theory that individuals with BED and obesity may have a negative body image that they can’t change, even after successful weight loss. The old negative “tapes” continue to play, and the individual never breaks the cycle. Instead, dietary restraint or disinhibited eating behaviors usually follow once treatment ends.

Dr. Gian Luca Cesa and colleagues in Italy and Mexico tested an enhanced cognitive behavioral therapy (CBT) approach that included a virtual reality protocol (Med Internet Res. 2013 Jun 12; 15(6):e113). The researchers compared the results from exposure to virtual reality with standard CBT and inpatient multimodal treatment, measuring initial weight loss, weight loss maintenance, remission of BED, and improvement in body satisfaction among 90 obese (BMI greater than 40 kg/m²) BED patients. Forty patients were randomly assigned to one of the 3 treatment groups (virtual reality, standard CBT, and inpatient treatment).

All study participants remained in the hospital for 6 weeks, where they received medical, nutritional, physical, and psychological care. In particular, all maintained a low-calorie diet tailored to each patient’s needs, had weekly nutritional group sessions conducted by dietitians, and had individual and group psychological support, as well as physical training. Patients in the CBT group received 15 additional CBT sessions over 5 weeks.
Patients in the virtual-reality-enhanced CBT group received 15 additional sessions, including 5 weekly group sessions focused on concerns about body weight and shape and problematic eating and 10 biweekly virtual reality sessions. The authors used NeuroVR open-use software, which runs on standard Windows-based computers and provides 14 virtual environments the therapist can use during a 60-mintue session. The environments include home, supermarket, pub, restaurant, swimming pool, beach, and gymnasium and two body image comparison areas. Using the virtual reality experience, patients can practice both eating-emotional-relational management and general decision-making and problem-solving skills.

The Outcome

All patients were assessed at three time points: 1 week after the start of the inpatient program, during the last week, and by mail 1 year later. At each of these time points, the Italian versions of the Body Satisfaction scale, the Body Image Avoidance Questionnaire, and Contour Drawing Rating Scale were used. One year after the study, patients in all three treatment groups had significantly reduced their weight. This was expected because all underwent the same 6-week medically managed inpatient treatment. Binge eating episodes also decreased to zero among all. Significant weight increases and BMI changes were reported in the inpatient group, but not in the other treatment groups. Enhanced cognitive therapy was significantly more effective for improving or maintaining weight loss after treatment than was IP alone.

Although the virtual-reality treatment, compared with the standard CBT approach, was better able to prevent weight regain, this did not permanently halt binge eating. At a 1-year follow-up, the monthly number of binge eating episodes significantly increased in all 3 groups.