Adherence as a predictor of dropout in internet-based guided self-help for adults with binge-eating disorder and overweight or obesity
Open accessAbstract
OBJECTIVE: Internet-based guided self-help (GSH-I) is an efficacious treatment for adults with binge-eating disorder (BED) and overweight or obesity. Although broadly accessible, high dropout from GSH-I has been reported. However, little is known about the factors explaining dropout from GSH-I, including patients' adherence to treatment. METHOD: Within a randomized trial on the treatment of BED, adherence to 4-month GSH-I was objectively assessed in N = 89 patients with BED and overweight or obesity. Objective adherence and subjective treatment evaluation were evaluated as predictors of dropout from GSH-I, defined as having accessed 5 or less of 11 modules. Cutoffs with optimal sensitivity and specificity were derived using Receiver Operating Characteristics curves analysis, and baseline sociodemographic and clinical correlates were determined. RESULTS: According to our definition, n = 22 (24.7%) patients were defined as dropouts. Results of the full logistic regression model accounted for 72% of the variance in dropout and all objective adherence parameters (i.e., number of messages exchanged, days with a completed food diary, and days spent per module), but not patients' subjective GSH-I evaluation significantly predicted dropout. Specifically, not completing the food diary in week 7 had maximized sensitivity and specificity in predicting dropout. Patients' body mass index was positively associated with the number of messages exchanged between patients and coaches. No other associations between baseline variables and objective adherence were found. DISCUSSION: Patients at risk for dropout from GSH-I can be reliably identified via monitoring of objective adherence and may be provided with additional interventions to prevent dropout.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
This aligns with evidence suggesting early dropout in ED-focused online programs might be predicted by baseline characteristics that reflect more complex mental health presentations, affirming the need for additional support for such individuals, e.g., face-to-face CBT.
“This aligns with evidence suggesting early dropout in ED-focused online programs might be predicted by baseline characteristics that reflect more complex mental health presentations (58), affirming the need for additional support for such individuals, e.g., face-to-face CBT (59).”
From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [59]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,588 · see citing works
Statistical Power Analysis for the Behavioral Sciences (2nd ed.).
Lachenbruch, P. A., & Cohen, J. (1989) · Journal of the American Statistical Association · doi:10.2307/2290095 · Cited by 37,385 · see citing works
The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014) · Psychological Science in the Public Interest · doi:10.1177/1529100614531398 · Cited by 1,642 · see citing works
Berg, K. C., Peterson, C. B., Frazier, P., & Crow, S. J. (2012) · International Journal of Eating Disorders · doi:10.1002/eat.20931 · Cited by 1,042 · see citing works
A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies
Donkin, L., Christensen, H., Naismith, S. L., Neal, B., Hickie, I. B., & Glozier, N. (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1772 · Cited by 876 · see citing works
Eating Disorder Examination-Questionnaire
Hilbert, A., Tuschen‐Caffier, B., Karwautz, A. F. K., Niederhofer, H., & Munsch, S. (2007) · Diagnostica · doi:10.1026/0012-1924.53.3.144 · Cited by 716 · see citing works
Self-citationVall, E., & Wade, T. D. (2015) · International Journal of Eating Disorders · doi:10.1002/eat.22411 · Cited by 553 · see citing works
What's under the ROC? An Introduction to Receiver Operating Characteristics Curves
Streiner, D. L., & Cairney, J. (2007) · The Canadian Journal of Psychiatry · doi:10.1177/070674370705200210 · Cited by 530 · see citing works
Perceived barriers and facilitators towards help‐seeking for eating disorders: A systematic review
Ali, K., Farrer, L. M., Fassnacht, D. B., Gulliver, A., Bauer, S., & Griffiths, K. M. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22598 · Cited by 427 · see citing works
Addressing critical gaps in the treatment of eating disorders
Kazdin, A. E., Fitzsimmons‐Craft, E. E., & Wilfley, D. E. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22670 · Cited by 389 · see citing works
Hay, P., Mitchison, D., Collado, A. E. L., González-Chica, D. A., Stocks, N., & Touyz, S. (2017) · Journal of Eating Disorders · doi:10.1186/s40337-017-0149-z · Cited by 325 · see citing works
Vall, E., & Wade, T. D. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22518 · Cited by 302 · see citing works
Binge-Eating Disorder in Adults
Brownley, K. A., Berkman, N. D., Peat, C. M., Lohr, K. N., Cullen, K., Bann, C., & Bulik, C. M. (2016) · Annals of Internal Medicine · doi:10.7326/m15-2455 · Cited by 285 · see citing works
Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder
Hilbert, A., Petroff, D., Herpertz, S., Pietrowsky, R., Tuschen-Caffier, B., Vocks, S., & Schmidt, R. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000358 · Cited by 283 · see citing works
Self-citationBeck-Depressions-Inventar Revision (BDI–II)
Wintjen, L., & Petermann, F. (2010) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747.a000033 · Cited by 201 · see citing works
Obesity with Comorbid Eating Disorders: Associated Health Risks and Treatment Approaches
Da Luz, F. Q., Hay, P., Touyz, S., & Sainsbury, A. (2018) · Nutrients · doi:10.3390/nu10070829 · Cited by 199 · see citing works
Carrard, I., Crépin, C., Rouget, P., Lam, T., Golay, A., & Van der Linden, M. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.05.004 · Cited by 176 · see citing works
Self-citationTurton, R., Bruidegom, K., Cardi, V., Hirsch, C. R., & Treasure, J. L. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.12.008 · Cited by 169 · see citing works
Treating eating disorders over the internet: A systematic review and future research directions
Aardoom, J. J., Dingemans, A. E., Spinhoven, P., & Van Furth, E. F. (2013) · International Journal of Eating Disorders · doi:10.1002/eat.22135 · Cited by 158 · see citing works
de Zwaan, M., Herpertz, S., Zipfel, S., Svaldi, J., Friederich, H.-C., Schmidt, F., Mayr, A., Lam, T., Schade-Brittinger, C., & Hilbert, A. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.2150 · Cited by 153 · see citing works
Self-citationReducing eating disorder symptoms and risk factors using the internet: A meta‐analytic review
Melioli, T., Bauer, S., Franko, D. L., Moessner, M., Ozer, F., Chabrol, H., & Rodgers, R. F. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22477 · Cited by 147 · see citing works
Harnessing the power of technology for the treatment and prevention of eating disorders
Bauer, S., & Moessner, M. (2013) · International Journal of Eating Disorders · doi:10.1002/eat.22109 · Cited by 128 · see citing works
Schlegl, S., Bürger, C., Schmidt, L., Herbst, N., & Voderholzer, U. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3554 · Cited by 123 · see citing works
Beintner, I., Jacobi, C., & Schmidt, U. H. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.01.003 · Cited by 118 · see citing works
Internet-based interventions for eating disorders in adults: a systematic review
Dölemeyer, R., Tietjen, A., Kersting, A., & Wagner, B. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-207 · Cited by 99 · see citing works
The association between adherence and outcome in an Internet intervention for depression
Fuhr, K., Schröder, J., Berger, T., Moritz, S., Meyer, B., Lutz, W., Hohagen, F., Hautzinger, M., & Klein, J. P. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.12.028 · Cited by 97 · see citing works
Epidemiology of binge eating disorder
Erskine, H. E., & Whiteford, H. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000449 · Cited by 93 · see citing works
ter Huurne, E. D., de Haan, H. A., Postel, M. G., van der Palen, J., VanDerNagel, J. E., & DeJong, C. A. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3946 · Cited by 78 · see citing works
E-Health Interventions for Eating Disorders: Emerging Findings, Issues, and Opportunities
Aardoom, J. J., Dingemans, A. E., & van Furth, E. F. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0673-6 · Cited by 78 · see citing works
Do adherence variables predict outcome in an online program for the prevention of eating disorders?
Manwaring, J. L., Bryson, S. W., Goldschmidt, A. B., Winzelberg, A. J., Luce, K. H., Cunning, D., Wilfley, D. E., & Taylor, C. B. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.2.341 · Cited by 73 · see citing works
Disseminating Evidence-Based Psychological Treatments for Eating Disorders
Cooper, Z., & Bailey-Straebler, S. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0551-7 · Cited by 71 · see citing works
Technology-enhanced monitoring in psychotherapy and e-mental health
Bauer, S., & Moessner, M. (2012) · Journal of Mental Health · doi:10.3109/09638237.2012.667886 · Cited by 54 · see citing works
Isabelle, C., Christelle, C., Patrick, R., Tony, L., Martial, V. D. L., & Alain, G. (2011) · Clinical Practice & Epidemiology in Mental Health · doi:10.2174/1745017901107010008 · Cited by 51 · see citing works
Watson, H. J., Levine, M. D., Zerwas, S. C., Hamer, R. M., Crosby, R. D., Sprecher, C. S., O'Brien, A., Zimmer, B., Hofmeier, S. M., Kordy, H., et al. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22644 · Cited by 50 · see citing works
de Zwaan, M., Herpertz, S., Zipfel, S., Tuschen‐Caffier, B., Friederich, H., Schmidt, F., Gefeller, O., Mayr, A. J., Lam, T., Schade‐Brittinger, C., et al. (2012) · Trials · doi:10.1186/1745-6215-13-220 · Cited by 47 · see citing works
Self-citationKönig, H., Bleibler, F., Friederich, H., Herpertz, S., Lam, T., Mayr, A. J., Schmidt, F., Svaldi, J., Zipfel, S., Brettschneider, C., et al. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22822 · Cited by 45 · see citing works
Self-citationWagner, G., Penelo, E., Nobis, G., Mayrhofer, A., Wanner, C., Schau, J., Spitzer, M., Gwinner, P., Trofaier, M., Imgart, H., et al. (2014) · European Eating Disorders Review · doi:10.1002/erv.2336 · Cited by 39 · see citing works
Maximizing the public health impact of eating disorder services: A simulation study
Moessner, M., & Bauer, S. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22792 · Cited by 28 · see citing works
An open trial of self‐help behaviours of clients with eating disorders in an online programme
Leung, S. F., Joyce, L. C. M., & Russell, J. D. (2012) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2012.05988.x · Cited by 19 · see citing works
Hilbert, A. 1., & Tuschen-Caffier, B. 1. (2016) · Cited by 18 · see citing works
Self-citationAssessment of eating disorders: interview or self-report questionnaire
Fairburn, C. G., & Beglin, S. J. (1994) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199412)16:4
Flagged first, then by citations
Research works printed but not linked: 1
- Fairburn, C. G., Cooper, Z. & O'Connor, M. E. (2014). Eating Disorder Examination (Edition 17.0D). Retrieved from https://www.credo- oxford.com/pdfs/EDE_17.0D.pdf
Cited by
Sorted by citations
Access to <scp>evidence‐based</scp> care for eating disorders during the <scp>COVID</scp> ‐19 crisis
Weissman, R. S., Bauer, S., & Thomas, J. J. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23279 · Cited by 143 · see citing works
Wyssen, A., Meyer, A. H., Messerli‐Bürgy, N., Forrer, F., Vanhulst, P., Lalanne, D., & Munsch, S. (2021) · European Eating Disorders Review · doi:10.1002/erv.2856 · Cited by 40 · see citing works
Davey, E., Allen, K. L., Bennett, S. D., Bryant‐Waugh, R., Clarke, T., Cooper, Z., Dixon‐Ward, K., Dudley, J., Eisler, I., Griffiths, J., et al. (2023) · European Eating Disorders Review · doi:10.1002/erv.2981 · Cited by 39 · see citing works
Effectiveness of a Web-Based Cognitive Behavioral Self-Help Intervention for Binge Eating Disorder
Pruessner, L., Timm, C., Barnow, S., Rubel, J. A., Lalk, C., & Hartmann, S. F. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.11127 · Cited by 39 · see citing works
Melisse, B., van den Berg, E. M., de Jonge, M., Blankers, M., van Furth, E. F., Dekker, J., & de Beurs, E. (2023) · Journal of Medical Internet Research · doi:10.2196/40472 · Cited by 35 · see citing works
Jensen, E. S., Linnet, J., Holmberg, T. T., Tarp, K., Nielsen, J. H., & Lichtenstein, M. B. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23384 · Cited by 20 · see citing works
Pape, M., Färber, T., Seiferth, C., Roth, T., Schroeder, S., Wolstein, J., Herpertz, S., & Steins‐Loeber, S. (2022) · JMIR Formative Research · doi:10.2196/38480 · Cited by 20 · see citing works
Self-citationArey, D. L., Sagi, A., & Blatt, A. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00855-3 · Cited by 17 · see citing works
Wu, M. S., Chen, S.-Y., Wickham, R. E., Leykin, Y., Varra, A. A., Chen, C., & Lungu, A. (2022) · Digital Health · doi:10.1177/20552076221133760 · Cited by 13 · see citing works
Exploring tailored virtual emotion regulation approaches for individuals with emotional eating
Dol, A., van Gemert-Pijnen, L., Schwartz, L. M., Velthuijsen, H., & Bode, C. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00856-2 · Cited by 9 · see citing works
Ran, M. O., Zuozhi, F. A. N. G., & Jiandong, F. A. N. G. (2022) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2023.00669 · Cited by 10 · see citing works
Rom, S., Miskovic‐Wheatley, J., Barakat, S., Aouad, P., Fuller‐Tyszkiewicz, M., & Maguire, S. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23803 · Cited by 8 · see citing works
Linnet, J., Jensen, E. S., Runge, E., Hansen, M. B., Hertz, S. P. T., Mathiasen, K., & Lichtenstein, M. B. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100538 · Cited by 8 · see citing works
Pruessner, L., Hartmann, S. F., Rubel, J. A., Lalk, C., Barnow, S., & Timm, C. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100514 · Cited by 8 · see citing works
Rom, S., Miskovic-Wheatley, J., Barakat, S., Aouad, P., Kim, M., Fuller-Tyszkiewicz, M., & Maguire, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1229261 · Cited by 7 · see citing works
Valdez-Aguilar, M., Arévalo, R. V., Aguilar, X. L., Martínez, A. O. R., Rosińska, M., & Díaz, J. M. M. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00809-9 · Cited by 6 · see citing works
Days between sessions predict attrition in text-based internet intervention of Binge Eating Disorder
Linnet, J., Hertz, S. P. T., Jensen, E. S., Runge, E., Tarp, K., Holmberg, T. T., Mathiasen, K., & Lichtenstein, M. B. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100607 · Cited by 4 · see citing works
eHealth treatments for compulsive overeating: A narrative review
Moghimi, E., Davis, C. A., & Rotondi, M. (2020) · Current Addiction Reports · doi:10.1007/s40429-020-00312-0 · Cited by 3 · see citing works
Lezo, A., Mascheroni, A., Troiano, E., Gandullia, P., Milano, W., Turchetto, M., Demontis, S., Cereda, E., Sara, B., & Corradi, E. (2025) · European Eating Disorders Review · doi:10.1002/erv.70042 · Cited by 3 · see citing works
Ran, M. O., Jiandong, F. A. N. G., & CHANG, B. (2023) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2023.01742 · Cited by 4 · see citing works
Self-Help Interventions for the Treatment of Binge Eating
Hilbert, A., & Puls, H. (2020) · Springer eBooks · doi:10.1007/978-3-030-43562-2_19 · Cited by 3 · see citing works
Self-citationvan Roessel, I. M. A. A., de Koning, M. J., Birk, M. V., Blom, J., Dekker, J., Feskens, E. J. M., de Graaf, J. P., Lü, Y., Lucassen, D. A., Pondaag, E., et al. (2025) · Obesity Pillars · doi:10.1016/j.obpill.2025.100177 · Cited by 2 · see citing works
Hayn, D., Falgenhauer, M., Czerny, S., Hoffmann, F., & Kästner, P. (2022) · Studies in health technology and informatics · doi:10.3233/shti220365
Çevrim İçi Ruh Sağlığı Hizmetlerini Yarıda Bırakma Sebepleri Üzerine Güncel Bir İnceleme
Sönmez, İ., & Yılmaz, T. (2023) · Kalem Uluslararasi Egitim ve Insan Bilimleri Dergisi · doi:10.23863/kalem.2023.254
Open Pilot Trial of a Coached Digital Program for Lower‐Income Adults With Eating Disorders
Accurso, E. C., Drury, C. R., Yu, K., Vendlinski, S. S., Pérez‐Flores, N. J., Howe, C. P., Wilfley, D. E., & Fitzsimmons‐Craft, E. E. (2025) · International Journal of Eating Disorders · doi:10.1002/eat.24459
kohpaei, S. T., Torkan, H., & Yosefi, Z. (2024) · Journal of Psychological Science · doi:10.61186/jps.23.142.185
Protocol for a pilot RCT investigating a weight loss navigation program for adults
Silverstein, H. A., Forman, E. M., Gilden, A. H., Hagerman, C. J., Milliron, B., Zhang, F., & Butryn, M. L. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.108163
Design, Implement, Sustain: Advancing Program‐Led Interventions for Binge Eating, a Narrative Review
Melisse, B., van Doornik, S. F. W., & Elburg, A. A. V. (2026) · European Eating Disorders Review · doi:10.1002/erv.70118
- Authors
- Puls, H., Schmidt, R., Herpertz, S., Zipfel, S., Tuschen‐Caffier, B., Friederich, H., Gerlach, F., Mayr, A., Lam, T., Schade‐Brittinger, C., de Zwaan, M., & Hilbert, A.
- Affiliations
- Leipzig University (DE)
- Ruhr University Bochum (DE)
- Universitätsklinikum Tübingen (DE)
- University of Freiburg (DE)
- University Hospital Heidelberg (DE)
- Medizinische Hochschule Hannover (DE)
- University of Bonn (DE)
- NetUnion (Switzerland) (CH)
- Philipps University of Marburg (DE)
- Department of Psychosomatic Medicine and Psychotherapy Hannover Medical School Hannover Germany
- Corresponding author
- Puls, Hans‐Christian
- ORCID
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2019-12-31
- Volume
- 53
- Issue
- 4
- Pages
- 555-563
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W2996855266
- Cited by
- 29
- References
- 43
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 10 · 2022: 7 · 2021: 1 · 2020: 4
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Eating Disorders (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- German Federal Ministry of Education and Research (01EO1501, 01GV0601, 01GV1002)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- binge eating disorder, obesity, overweight, treatment discontinuation, medication adherence, body mass index, student dropout prediction, digital mental health interventions
- MeSH terms
- Adult, Female, Humans, Male, Obesity, Patient Compliance, Self-Help Groups, Health Behavior, Treatment Outcome, Telemedicine, Internet, Overweight, Young Adult, Binge-Eating Disorder
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
