Bio


Dr. Adler is passionate about the intersection between behavioral health and technology to increase access to care. She is currently an attending Psychologist in the Eating Disorder and Weight Control Clinic and specializes in both research and clinical care for patients with disordered eating behaviors. Dr. Adler is the Author of The DBT Solution for Binge and Emotional Eating, which was originally written and tested for her doctoral dissertation. Dr. Adler currently teaches and supervises students and post-doctoral fellows in evidence based treatments.

Clinical Focus


  • Psychology

Academic Appointments


  • Clinical Assistant Professor, Psychiatry and Behavioral Sciences

Professional Education


  • Professional Education:PGSP-Stanford PsyD Consortium (2010) CA
  • Fellowship:Stanford University School of Medicine (2013) CA
  • Internship:VA San Diego Health Care System (2010) CA

Current Research and Scholarly Interests


I am interested in the design and delivery of clinical care using, data and technology. I have focused on disordered eating behaviors and obesity.

Clinical Trials


  • FDA Approved Medication to Reduce Binge Eating and/or Purging Not Recruiting

    This study will demonstrate the efficacy of Qsymia versus placebo in treating bulimia nervosa and binge eating disorder.

    Stanford is currently not accepting patients for this trial. For more information, please contact Debra L Safer, MD, 650-723-7928.

    View full details

All Publications


  • Correlates of Dietary Adherence and Maladaptive Eating Patterns Following Roux-en-Y Bariatric Surgery OBESITY SURGERY Adler, S., Fowler, N., Robinson, A., Salcido, L., Darcy, A., Toyama, H., Safer, D. 2018; 28 (4): 1130–35

    Abstract

    Self-reported poor dietary adherence following bariatric surgery is associated with less successful weight loss outcomes. Poor dietary adherence is a global construct lacking specificity regarding its underlying, clinically targetable, maladaptive eating behaviors.Comprehensive online survey data were obtained from a sample of 274 adults who underwent Roux-en-Y surgery in the prior 1-12 years. Correlations between dietary adherence and six eating-related behaviors were calculated, with the frequency of each behavior reported on a 7-point scale. Linear regression modeling was applied.All six maladaptive eating behaviors were highly correlated with dietary adherence (Pearson's r > 0.5): grazing (r = - 0.565), mindless eating (r = - 0.572), loss of control eating (r = - 0.517), eating "more than is best" after dinner (r = - 0.518), eating foods off of one's plan (r = - 0.557), and "when I eat something off-plan, I feel like I have blown it and I give up and eat more" (r = - 0.574). The estimated regression coefficients in the linear model was statistically significant, [F(5, 261) = 60.006, p < 0.001] and accounted for approximately 54% of the variance of global dietary adherence (R 2 = 0.535, adjusted R 2 = 0.526).Six maladaptive eating behaviors accounted for a highly significant portion of post-Roux-en-Y patients' poor self- reported dietary adherence. Prospective studies are needed to investigate the relationship between targetable maladaptive eating behaviors and bariatric surgery outcomes.

    View details for DOI 10.1007/s11695-017-2987-9

    View details for Web of Science ID 000429032600034

    View details for PubMedID 29076007

  • Study protocol and rationale for a randomized double-blinded crossover trial of phentermine-topiramate ER versus placebo to treat binge eating disorder and bulimia nervosa. Contemporary clinical trials Dalai, S. S., Adler, S., Najarian, T., Safer, D. L. 2018; 64: 173–78

    Abstract

    Bulimia nervosa (BN) and binge eating disorder (BED) are associated with severe psychological and medical consequences. Current therapies are limited, leaving up to 50% of patients symptomatic despite treatment, underscoring the need for additional treatment options. Qsymia, an FDA-approved medication for obesity, combines phentermine and topiramate ER. Topiramate has demonstrated efficacy for both BED and BN, but limited tolerability. Phentermine is FDA-approved for weight loss. A rationale for combined phentermine/topiramate for BED and BN is improved tolerability and efficacy. While a prior case series exploring Qsymia for BED showed promise, randomized studies are needed to evaluate Qsymia's safety and efficacy when re-purposed in eating disorders. We present a study protocol for a Phase I/IIa single-center, prospective, double-blinded, randomized, crossover trial examining safety and preliminary efficacy of Qsymia for BED and BN.Adults with BED (n=15) or BN (n=15) are randomized 1:1 to receive 12weeks Qsymia (phentermine/topiramate ER, 3.75mg/23mg-15mg/92mg) or placebo, followed by 2-weeks washout and 12-weeks crossover, where those on Qsymia receive placebo and vice versa. Subsequently participants receive 8weeks follow-up off study medications. The primary outcome is the number of binge days/week measured by EDE. Secondary outcomes include average number of binge episodes, percentage abstinence from binge eating, and changes in weight/vitals, eating psychopathology, and mood.To our knowledge this is the first randomized, double-blind protocol investigating the safety and efficacy of phentermine/topiramate in BED and BN. We highlight the background and rationale for this study, including the advantages of a crossover design.Clinicaltrials.gov identifier NCT02553824 registered on 9/17/2015. https://clinicaltrials.gov/ct2/show/NCT02553824.

    View details for DOI 10.1016/j.cct.2017.10.007

    View details for PubMedID 29038069

  • Early Adherence Targeted Therapy (EATT) for Postbariatric Maladaptive Eating Behaviors COGNITIVE AND BEHAVIORAL PRACTICE Robinson, A. H., Adler, S., Darcy, A. M., Osipov, L., Safer, D. L. 2016; 23 (4): 548-560
  • What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year? SURGERY FOR OBESITY AND RELATED DISEASES Robinson, A. H., Adler, S., Stevens, H. B., Darcy, A. M., Morton, J. M., Safer, D. L. 2014; 10 (4): 697-704
  • How smartphone applications may be implemented in the treatment of eating disorders: case reports and case series data Advances in Eating Disorders: Theory, Research and Practice Darcy, A., Adler, S., Miner, A., Lock, J. 2014
  • Group dialectical behavior therapy adapted for obese emotional eaters; a pilot study NUTRICION HOSPITALARIA Roosen, M. A., Safer, D., Adler, S., Cebolla, A., van Strien, T. 2012; 27 (4): 1141-1147

    Abstract

    Dialectical Behavior Therapy (DBT) has been shown to effectively target binge eating disorder (BED). This study pilots the effectiveness of group DBT for obese "emotional eaters" to reduce eating psychopathology and achieve weight maintenance. Thirty-five obese male and female emotional eaters receiving 20 group psychotherapy sessions of DBT adapted for emotional eating were assessed at end-of-treatment and 6 month follow-up for reductions in eating psychopathology and weight maintenance. DBT resulted in significant reductions in emotional eating and other markers of eating psychopathology at the end-of-treatment that were maintained at follow-up. The drop-out rate was very low, with only 1 participant dropping from treatment. Thirty-three (94%) of the sample provided data at every assessment point. Of these, 80% achieved either weight reduction or weight maintenance after treatment and throughout the follow-up period. The effect size for weight reduction was small. This pilot study demonstrates group DBT targeting emotional eating in the obese to be a highly acceptable and effective intervention for reducing eating related psychopathology at both at end-of-treatment and during follow-up. The ability of DBT to limit the upward trajectory of weight gain in obese patients with high degrees of emotional eating suggests that DBT may also help limit the increase or even prevent onset of obesity related morbidity in these patients.

    View details for DOI 10.3305/nh.2012.27.4.5843

    View details for Web of Science ID 000307042300025

    View details for PubMedID 23165554

  • A Prospective Assessment of Psychosocial Factors Among Bariatric Versus Non-bariatric Surgery Candidates OBESITY SURGERY Rutledge, T., Adler, S., Friedman, R. 2011; 21 (10): 1570-1579

    Abstract

    Psychological factors are considered potential contraindicators to bariatric surgery, but inconsistently predict surgical outcomes. We examined biomedical and psychosocial predictors of future bariatric candidacy in a population of veterans enrolling in a multidisciplinary weight management program.Ninety-five obese veterans meeting bariatric surgery eligibility criteria participating in a weight control intake class from 2007 to 2008 completed the MOVE!23 questionnaire to assess biomedical, psychiatric, social, and eating behavior factors. Twenty-five patients from this cohort completed or obtained approval for bariatric surgery during the next 2 years of follow-up.Patients progressing to bariatric candidacy over follow-up differed from non-bariatric patients in multiple areas, including reporting significantly lower rates of depression (28% versus 48.7%, respectively; p = 0.04) and smoking (4% versus 16%; p = 0.05), better self-rated health (e.g., 28% versus 10.7% rating themselves as in excellent or very good health), and averaged 50% fewer cardiovascular risk factors (p = 0.01). Bariatric patients also rated themselves as significantly faster eaters (p = .03) and as having higher rates of obsessive compulsive disorder (OCD; 28% versus 7%; p = 0.04). Depression and OCD status predicted patients going on to bariatric candidacy independent of body mass index (BMI), biomedical status, and demographic factors.Our results suggest that many of the commonly cited psychosocial contraindicators to bariatric surgery are already lower in patients considered for surgery relative to BMI equivalent treatment-seeking peers not approved for surgery. These differences may help explain inconsistent relationships between psychosocial factors and bariatric surgery outcomes.

    View details for DOI 10.1007/s11695-010-0287-8

    View details for Web of Science ID 000295175700014

    View details for PubMedID 20872090