Let's Talk About Binge Eating! Meet UCSD CHEAR Director Dr. Kerri Boutelle

Hi everyone! I’m so excited to discuss innovative approaches to binge eating treatment that’s happening right here in San Diego! I’ve interviewed Dr. Kerri Boutelle, licensed clinical psychologist and Professor of Pediatrics, Family Medicine and Public Health, and Psychiatry at University of California San Diego (UCSD). She is the founder and director of the Center for Healthy Eating and Activity Research (CHEAR), and is affiliated with Rady Children’s Hospital. Dr. Boutelle is also the senior supervising psychologist at the UCSD Eating Disorder and Treatment Program. I went to a training at CHEAR by Dr. Boutelle, and I was impressed with how dedicated she is to eating disorder research and treatment. I also really appreciated CHEAR’s focus on binge eating recovery.

***Trigger warning***  This blog post interview does include the terms weight lossoverweight, and obesity in the context of explaining CHEAR’s integrative binge eating and weight loss treatment program.  I do believe that Dr. Boutelle does articulate how their approach is very different than “dieting” and absolutely does NOT advocate extreme behaviors that could trigger eating disorder symptoms. 

Why did you choose to become an eating disorder specialist in San Diego?

I have an undergraduate degree in Food Science and Nutrition, and worked for large food companies before returning to graduate school.  The interaction of eating disorders, nutrition and the brain have fascinated me since early in my career.  In graduate school, I specialized in eating disorders and obesity, and my first faculty job was at the University of Minnesota.  I was recruited from University of Minnesota to UCSD in 2007.  Who would ever pass up the opportunity to live in San Diego!

What kind of treatment do you provide at the UCSD CHEAR program in San Diego?

The UCSD CHEAR program provides treatment in the form of randomized treatment research studies as well as in our clinic.  We are lucky to be able to develop treatments for eating disorders and weight side by side with providing clinical services to the community.

Our clinical eating disorder program provides evidence-based treatment for children, adolescents, and adults with a wide variety of eating and weight-related disorders. These include including overeating, emotional eating, weight management, gastroenterology problems, picky eating, as well as eating disorders (e.g., anorexia nervosa, bulimia nervosa, avoidant/restrictive food intake disorder [ARFID], binge eating disorder [BED]). Treatment typically includes weekly (or as needed) individual or family therapy on an outpatient basis. We work closely with the UCSD Eating Disorder Treatment and Research program and refer if needed.  

At CHEAR, we are lucky enough to provide higher level services for BED and weight loss, including partial hospitalization and intensive outpatient programs.  These programs use our unique model, that incorporates current evidence-based treatments with novel interventions.  For example, I’ve developed a new model to treat binge eating called Regulation of Cues (ROC).  The ROC program is based on the concept that individuals are born with distinct appetitive traits, and for some people who have specific vulnerabilities, the current food environment has triggered binge eating and overeating.  The ROC program targets two specific components, developing the ability to listen to one’s appetite and resist food cues for overeating. Our data suggests that the ROC program leads to reductions in binge eating as well as weight loss.

CHEAR is locally and nationally known for our research on developing state of the art interventions for obesity, binge eating, and overeating for children, adolescents, and adults. We are excited about our new site in San Marcos for our research programs.

In 2017, 2600 individuals contacted CHEAR for services, almost 500 were consented for our research studies, and 97 individuals received services from our clinic.  We are analyzing the data from 2018, but I can tell you that the numbers have increased.

CHEAR seems to take an innovative approach to help people recover from binge eating AND lose weight, especially if that’s what’s medically recommended. Would you explain your rationale on the relationship among weight loss, binge eating, and treatment? 

In the field of eating disorders, until recently, there has been a unidirectional opinion about weight loss in eating disorder patients: “focusing on weight loss will worsen eating disorder symptoms.”  However, being overweight is associated with a number of significant medical and psychiatric comorbidities.  In general, behavioral weight loss programs recommend restricting dietary intake and increasing activity to create a negative energy balance.  Restriction and extreme levels of physical activity are also eating disorder symptoms, which could exacerbate eating disorder cognitions and behaviors.  But eating healthy and physical activity can be healthy as well, as long as thoughts and behaviors are not extreme.  

The challenge is to look at these cognitions and behaviors on a continuum.  Many patients who come to CHEAR for binge eating emphasize their desire to lose weight.  Our approach is to reduce binge eating and loss of control eating first, and to provide structure and support for healthy eating.  After binge eating is reduced, if weight loss is a priority, we provide support for lifestyle changes to help reduce weight and educate them on realistic goals and challenges with weight loss.  We do not encourage excessive restriction or extreme behaviors.  We support slow changes in behaviors that relate to modest weight loss with a focus on health, not a specific number.  Our novel treatments, including our Regulation of Cues (ROC) model, focus on concurrently addressing binge eating and weight loss, without promoting extreme cognitions or behaviors.

Furthermore, both eating disorder treatments, like cognitive behavioral therapy, and behavioral weight loss programs, are provided to individuals in a blanket fashion without consideration of individual differences.  The field is now beginning to recognize individual differences as a powerful tool that can promote precision medicine, or treatments that are tailored to the individual instead of the disorder.  Our program is developed to identify individual differences and target both binge eating and weight over time.

Besides eating disorders, what other co-occurring issues do you treat?

It is common for individuals with eating disorders to have co-morbid disorders. These include depression, anxiety (e.g., obsessive compulsive disorder, generalized anxiety disorder, etc.), PTSD, and autism spectrum disorders to name a few. Our treatment typically targets the eating disorder and any symptoms from co-morbid disorders that are related to the eating issue. We also are able to offer evidence-based treatment for mild to moderate symptoms of depression and anxiety. If an individual has severe symptoms or a co-morbid disorder that is best treated by a specialist (e.g., autism spectrum disorders), we work in conjunction with his/her outside provider to appropriately address the client’s needs. 

How long have you been working with eating disorders overall, and how long have you been in San Diego?

I have been working with eating disorder patients for 26 years, and I’ve been in San Diego since 2007.

Who are your favorite types of clients to work with?

That is a loaded question.  I enjoy working with eating disorder patients across the spectrum, as each disorder has unique aspects while also sharing commonalities with the other disorders. 

What do you wish people knew about getting treatment for eating disorders?

I wish the general public was more savvy about the current evidence-based treatments.  Individuals with eating disorders have distinct strengths and challenges that require specific treatments to increase chances for success.  Many of these evidence-based treatments require specific training.  Although many practitioners have seen some eating disorder patients, I would recommend interviewing potential therapists and asking specifically about training and competencies.

Would you describe the types of research you’re involved with at the UCSD CHEAR program in San Diego?

My research program specifically focuses on binge eating, overeating, and weight loss.  We have six large trials running right now, and a number of smaller trials.  My research focuses on translating evidence-based treatments to the community and developing novel treatments based on basic science and neuroscience.   I collaborate with a number of faculty at UCSD and SDSU who research anorexia and bulimia, as well as general eating behaviors.

You’ve also recently landed a large grant. Congratulations! Would you describe a little bit about it and how it would support the San Diego community?

This study, called CHARGE (Controlling Hunger and ReGulating Eating) will compare the current gold standard treatment for binge eating, cognitive behavioral therapy, with the new ROC treatment we developed, among Veterans with overweight or obesity.  The ROC program focuses on developing the ability to listen to one’s appetite and resist cues for overeating.  Our pilot data suggests that ROC can reduce both binge eating and weight.  If we are successful, this study will provide a more potent method for addressing both binge eating and weight for the military.

How can people learn more and contact you?

They can use contact forms on our website at chear.ucsd.edu, email us at chear@ucsd.edu, or call 1-855-UCSD-4-W8(1-855-827-3498) 

Share one fun fact about you.

I hiked the Annapurna trail alone for three weeks.

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Thanks so much for reading my blog!  Have a wonderful day. :)  

Marianne 

If you are struggling to find eating disorder treatment in San Diegogive me a call for your free 15-minute phone consultation at (858) 699-3754, and I will help you get where you need to be! 

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