Remote vs Face-to-face Interventions for Bulimia Nervosa and Binge-eating Disorder: a Systematic Review and Meta-analysis

Remote delivery of interventions (e.g., online sessions, telephone sessions, e-mails, SMS, applications) facilitate access to health care and might be an efficacious alternative to face to face treatments for bulimia nervosa (BN) and binge-eating disorder (BED). Telehealth has evolved rapidly in recent years, facilitating access to health care, as it seems to be more accessible among different groups of the population. In the light of the COVID-19 pandemic, we decided to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared remote versus face-to-face interventions for the treatment of BN and BED. We searched EMBASE, PubMed, CENTRAL, ClinicalTrials.gov, and WHO ICTRP and reference lists of relevant articles up to April, 2023. The primary outcomes were remission (defined as abstinence from binge/bulimic episodes for at least 2 weeks) and frequency of binge episodes. We also analyzed frequency of purging episodes, response, mean values of eating disorder psychopathology, depression, anxiety, and quality of life rating scales as well as drop-out rates and adverse effects. Six RCTs were identified with a total of 698 participants. Face-to-face interventions were found more effective than remote interventions in terms of remission (RR = 0.69, 95% CI 0.53 to 0.89, P = 0.004, 4 RCTs, N = 526), but the result was mainly driven by one study. No important differences were found in the remaining outcomes; nevertheless, most comparisons were underpowered. Few adverse effects were reported. Remote interventions demonstrated comparable efficacy to face-to-face interventions in treating BN and BED, providing effective and acceptable healthcare to patients who would otherwise go untreated. Nonetheless, to arrive at more definitive and secure conclusions, it is imperative that additional randomized controlled trials and robust real-world effectiveness studies, preferably with appropriate comparison groups, are conducted.