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Binge-eating disorder treatments

BED patients respond well to major forms of treatment

Unlike other eating disorders, such as anorexia nervosa and bulimia nervosa, BED is not associated with regular purging, fasting, or excessive exercise
Given the high levels of association among BED, obesity, and depression, future studies should determine whether certain treatments are better suited for particular subsets of patients

A systematic review by the RTI International-University of North Carolina (UNC) Evidence-based Practice Center (EPC),  published in the Annals of Internal Medicine, identified several effective options for treating patients with binge-eating disorder. The review reported strong support that therapist-led cognitive behavioural therapy (or CBT), lisdexamfetamine (brand name Vyvanse, a central nervous system stimulant), and second-generation antidepressants (as a class of drugs) help binge-eating disorder (BED), patients to reduce their frequency of binge eating and achieve abstinence.

The study also found more limited support for similar benefits with the anticonvulsant topiramate and from less therapist-intensive approaches to delivering CBT (partially therapist-led and guided self-help).

Binge-eating disorder is the most common eating disorder in America, affects 3 percent of adults in their lifetime. Recently recognized as a distinct eating disorder by the American Psychiatric Association, BED is characterized by recurrent psychologically distressing binge-eating episodes; during which individuals experience a lack of control and consume larger amounts of food than most people would under similar circumstances. Unlike other eating disorders, such as anorexia nervosa and bulimia nervosa, BED is not associated with regular purging, fasting, or excessive exercise.

Eating-related psychological symptoms, such as obsessions and compulsions, and susceptibility to hunger, also responded well to these treatments. Symptoms of depression were improved only through treatment with second-generation antidepressants. Lisdexamfetamine and topiramate were associated with reductions in weight.  Across medication trials, various negative side effects such as nervousness, sweating, and faster heart beat were commonly reported problems. Serious side effects from treatment were extremely low.

"Our review shows promising signs in today's medical evidence base for both psychological and medication interventions," said Dr Kim Brownley, associate professor at the UNC Center of Excellence for Eating Disorders and lead author on the paper. "Additional studies are needed for examining approaches to providing psychological treatments to patients who have limited access to BED-trained psychotherapists, treatments that combine psychological interventions and medications, and longer term outcomes of care." 

Given the high levels of association among BED, obesity, and depression, future studies should determine whether certain treatments are better suited for particular subsets of patients, the authors concluded.

"Despite the positive findings about successful options for BED patients, how well the results can be applied may be limited for some populations,” said Dr Nancy Berkman, senior research analyst at RTI and co-author of the paper. “Current research often did not include men; adults over 40 years of age; racial and ethnic minorities; individuals with various coexisting medical conditions; and those with higher levels of depression and anxiety. Also, although binge eating is implicated as a treatment-limiting factor in bariatric surgery patients, we found no treatment studies in this population."

In January 2015, lisdexamfetamine became the first medication approved by the US Food and Drug Administration for treating patients with BED. 

This stud was funded by the US Agency for Healthcare Research and Quality (AHRQ), the current review updates and extends the EPC's 2006 AHRQ review on eating disorders by examining 34 randomized controlled trials of treatment for BED.  This is nearly twice as many trials as in the earlier review.  The authors were also able to apply meta-analytic (statistical) techniques to measure more precisely the effectiveness of some of these interventions.

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