The effect of exercise, cognitive therapy, and nutritional counseling in treating bulimia nervosa.

Objective: The aim of this treatment study on bulimia nervosa was (i) to examine the effect of physical exercise as an experimental treatment condition against the well-documented effect of cognitive-behavioral therapy (CBT), and (ii) to compare the effect of CBT versus the effect of nutritional advice as one single treatment component of CBT.

Method: Normal weight female bulimic patients aged 18-29 yr were randomly assigned to a physical exercise program (N = 15), CBT (N = 16), nutritional advice (N = 17), or a waiting list control group (N = 16). Seventeen healthy female control subjects were also included. Treatment effects were determined by the frequency of binge eating and purging, scores on the Eating Disorder Inventory subscales "Drive for thinness," "Bulimia," and "Body dissatisfaction" and by a clinical interview to measure symptom severity. Assessments were made before and after treatment and at 6- and 18-month follow-up after the end of treatment.

Results: Nutritional counseling did not prove more effective than CBT. Physical exercise appeared more effective than CBT in reducing pursuit of thinness; change in body composition; aerobic fitness; and frequency of bingeing, purging, and laxative abuse.

Conclusion: Physical exercise is important in the treatment of normal weight bulimic patients. Further studies should address possible additive effects of CBT and physical exercise.