Strong evidence for CBT, medications in treating binge-eating disorder, review finds
Physicians in practice may not know what to make of this newly defined disorder, which may be challenging to detect because of the shame that is often involved, according to an editorial.
Therapist-guided cognitive behavioral therapy (CBT), lisdexamfetamine, and second-generation antidepressants are the most effective treatments for adults diagnosed with binge-eating disorder, according to a recent meta-analysis and systematic review.
These treatments reduce the frequency of binge eating, increase the likelihood of achieving abstinence from binge eating, and improve other eating-related psychological outcomes, researchers found. Results were published online June 28 by Annals of Internal Medicine.
Patients with binge-eating disorder have psychologically distressing episodes of out-of-control eating that are recurrent (≥1 per week for 3 months) and brief (≤2 hours). As the most common eating disorder, the condition affects about 3% of U.S. adults in their lifetimes.
Researchers found 34 trials with low or medium risk of bias: 9 waitlist-controlled psychological/behavioral trials and 25 placebo-controlled trials that compared only medication (n=19) or a combination of a behavioral and pharmacologic intervention (n=6). Participants had a diagnosis of binge-eating disorder and were mostly female (≥77%), white, and overweight or obese, with a mean age range of 36 to 47 years. Trial sizes ranged from 24 to 394 randomly assigned participants, with treatment lasting from 6 weeks to 6 months.
More participants achieved abstinence from binge eating with therapist-led CBT versus waitlist (58.8% vs. 11.2%; risk ratio (RR), 4.95 [95% CI, 3.06 to 8.00]). Lisdexamfetamine and second-generation antidepressants also achieved favorable results versus placebo (40.2% vs. 14.9%; RR, 2.61 [95% CI, 2.04 to 3.33]) and (39.9% vs. 23.6%; RR, 1.67 [95% CI, 1.24 to 2.26]), respectively.
Partially therapist-led CBT, guided self-help CBT, and topiramate increased binge-eating abstinence and reduced binge-eating frequency, while therapist-led CBT and structured self-help CBT reduced binge-eating frequency, according to qualitative synthesis. Lisdexamfetamine and second-generation antidepressants also decreased binge-eating frequency and total eating-related obsessions and compulsions.
The psychological studies did not report harms, but 20 of 25 placebo-controlled trials reported medication side effects, most of which have been documented in patients without binge-eating disorder. Of note, lisdexamfetamine (approved by the FDA in 2015 as the first and only drug for binge-eating disorder) led to more insomnia and general sleep disturbances, headaches, gastrointestinal upsets, and sympathetic nervous system arousal compared to placebo. It also may decrease appetite.
Limitations of the analysis include a paucity of post-treatment follow-up, exclusion of individuals receiving psychotropic medications, a potential lack of generalizability given the characteristics of the study participants, and methodological limitations within the trials.
The review raises questions for physicians in practice, who may not know what to make of this newly defined disorder, which may be challenging to detect because of the shame that is often involved, according to an accompanying editorial. “Greater than expected weight dissatisfaction, large weight fluctuations, and depressive symptoms in individuals of any size all should raise the practitioner's index of suspicion,” the editorialist wrote.
Until comparative effectiveness and long-term studies are conducted on treatments for binge-eating disorder, physicians must base treatment decisions on availability, costs, adverse effects, patient preference, individual goals, and patient-specific factors (e.g., comorbid depression), the editorialist wrote.