Evidence-Based Reviews

Binge eating disorder: Evidence-based treatments

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Alone or combined, pharmacotherapy and CBT can reduce binging, psychopathology



Binge eating is consumption of an unusually large amount of food coupled with a feeling of loss of control over eating. Binge eating disorder (BED) is characterized by recurrent episodes of binge eating without inappropriate compensatory behaviors (eg, self-induced vomiting, misuse of laxatives, diuretics, or other agents, excessive exercise).1 It is the most common eating disorder in the United States, with a lifetime prevalence of approximately 3.5% in women and 2% in men.2 The diagnosis falls within the DSM-IV-TR category of eating disorders not otherwise specified,1 but clinicians often view it as a distinct clinical phenomenon. In DSM-IV-TR, an individual would meet criteria for BED if he or she engages in regular binge eating behavior in the absence of recurrent compensatory behaviors ≥2 days per week over 6 months.1 Proposed changes for DSM-5 recognize a distinct BED diagnosis, reduce the frequency criterion to once per week and the duration criterion to the past 3 months, and shift the focus from binge days to binge episodes (Table 1).3

Table 1

Proposed DSM-5 criteria for binge eating disorder

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  2. The binge-eating episodes are associated with ≥3 of the following:
  3. Marked distress regarding binge eating is present
  4. The binge eating occurs, on average, at least once a week for 3 months
  5. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake disorder
Source:Reference 3

BED can occur in individuals of all body mass indices (BMI), but is common among individuals who are overweight or obese as well as those with depression or type 2 diabetes; BED can complicate treatment of these conditions.2,4,5 Primary treatment goals are:

  • abstinence from binge eating
  • improved psychological functioning
  • appropriate weight regulation in overweight patients.

We report on 3 approaches to BED treatment: medication only, behavioral intervention only, and medication plus behavioral intervention. This article provides insights about emerging changes in diagnostic criteria for BED as well as evidence-informed treatment options and recommendations.

The evidence base

We conducted a review of 23 BED studies: 7 medication only, 5 medication plus behavioral, and 11 behavioral only. We focused on studies conducted since September 2005 that included binge frequency, weight, and depression as primary outcomes (see Berkman et al6 for a review of BED treatment studies before 2005). The studies included 2,527 participants (2,216 women and 311 men). Although the sex distribution of BED in the general population tends to slightly favor women,2 the proportion of women presenting for treatment generally is considerably higher than that of men. In studies that reported on race and/or ethnicity, 1,639 participants were identified as white, 191 as African American, 25 as Hispanic, 2 as Asian, 1 as Native American, and 25 as “other.” Ages ranged from 18 to 77.

Several medications are effective

In placebo-controlled studies, a high-dose selective serotonin reuptake inhibitor (escitalopram7), 2 anticonvulsants (zonisamide8 and topiramate9), a selective norepinephrine reuptake inhibitor (atomoxetine10), and an appetite suppressant (sibutramine11) were associated with significant decreases in binge eating frequency, weight, and BMI in overweight/obese patients diagnosed with BED (Table 2). In an open-label trial, memantine—a N-methyl-D-aspartate receptor antagonist often used to treat symptoms of Alzheimer’s disease—was associated with a significant reduction in binge eating but no change in weight.12 Lamotrigine was not significantly different from placebo in reducing binge eating or weight, but showed promise in reducing metabolic parameters such as glucose and triglyceride levels commonly associated with obesity and type 2 diabetes.13 Because BED often is comorbid with obesity and type 2 diabetes, lamotrigine augmentation when treating obese individuals with BED warrants further investigation. As with any pharmacologic agent, carefully consider potential side effects and interactions with other drugs before prescribing medications for BED. Informing patients of potential side effects is crucial for patient safety and accuracy of the data collected in well-controlled treatment studies.

Table 2

Pharmacotherapy for binge eating disorder

Guerdjikova et al, 20087Escitalopram, 10 to 30 mg/d, vs placebo for 12 weeksEscitalopram was significantly better than placebo in reducing weight, BMI, and illness severity
McElroy et al, 20068Zonisamide, 100 to 600 mg/d, vs placebo for 16 weeksZonisamide was significantly better than placebo in reducing BE, weight, BMI, and various aspects of unhealthy eating behavior
McElroy et al, 20079Topiramate, 25 to 400 mg/d, vs placebo for 16 weeksTopiramate was significantly better than placebo in reducing BE, weight, BMI, and related psychological features of BE
McElroy et al, 200710Atomoxetine, 40 to 120 mg/d, vs placebo for 10 weeksAtomoxetine was significantly better than placebo in reducing BE, weight, BMI, and obsessive-compulsive features of BE, and in achieving remission
Wilfley et al, 200811Sibutramine, 15 mg/d, vs placebo for 24 weeksSibutramine was significantly better than placebo in reducing BE, weight, BMI, and related psychological features of BE
Brennan et al, 200812Open-label memantine, 5 to 20 mg/d, for 12 weeksMemantine was associated with decreased binge frequency and related psychological features of BE
Guerdjikova et al, 200913Lamotrigine, 50 to 400 mg/d, vs placebo for 16 weeksLamotrigine was not significantly different from placebo
BE: binge eating; BMI: body mass index


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