Application of "BOOCS" to the Management of Eating Disordered Patients with Binge Eating

Fujino et al have developed a new therapeutic theory for obesity, the Brain Oriented Obesity Control System or "BOOCS". They have reported that the majority of obese persons using this method have succeeded in reducing body weight with few rebound cases. This theory considers obesity to be caused by "brain fatigue", progressive brain dysfunction under the stress of every day life, and emphasizes that management should be focused more on how to reduce "brain fatigue" rather than adherence to demanding diet/exercise regimens. To reduce "brain fatigue", "tow principles and three rules" as follows are given as instructions to obese persons. "Two principles" : (1) Make as few prohibition as possible and deny your wants as little as possible. (2) Do something pleasant for yourself. "Three rules" : (1) Do not prohibit what you like, even if it is bad for your health. (2) Do not practice what you dislike, even if it is good for your health. (3) Do only what you like among things and matters good for your health. Assuming that the binge eating of eating disordered patients might also be caused by "brain fatigue", we have applied BOOCS to the management of these patients.We developed a self-care manual for eating disorder (ED) patients with binge eating incorporating the BOOCS principles, which includes 4 instructions : (1) Learn to feed contentment from your main meals. (2) Do not attempt to force yourself to quit binge eating immediately. (3) You will not become obese if you feel content and comfortable with your main meals. (4) Try reducing the frequency of weighing yourself. We enrolled 6 new ED outpatients with binge eating (2 anorexia nervosa, and 4 bulimia nervosa, according to DSM-IV) who met the following criteria : (1) those not so physically critical that they needed to be hospitalized, (2) those who had not been treated medically before. We gave a manual to each patient on her first visit, and then using it gave her individual-therapeutic sessions weekly or bi-weekly. As a result, 5 out of 6 patients showed a reduction of binge frequency within 1 week of the first visit, and all 6 patients had remission of binging within 5 to 17 weeks without any medication or hospitalization. Although all the ptients had problems of interpersonal relationship besides their eating problems, 3 solved them by them-selves as they were released by BOOCS from the battle against binging. Moreover, the other 3 patients who required psychotherapy to treat interpersonal problems reported that the "two principles" from BOOCS had been applicable to solving such problems beyond their eating problems.In this report, we briefly present the histories and clinical courses of 4 patients, and discuss the possible mechanism(s) of the success of BOOCS. In conclusion, we suggest that BOOCS is applicable to be management of eating disordered patients with binge eating.