Case-Based Review

Binge-Eating Disorder: Prevalence, Predictors, and Management in the Primary Care Setting

Journal of Clinical Outcomes Management. 2015 November;22(11)

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CBTgsh also performed as well or better than individualized treatments in one study [133]. CBTgsh, IPT, and behavioral weight loss (BWL) were compared in a large study of 205 primarily white, obese or overweight individuals diagnosed with BED. The 3 treatments produced equivalent outcomes for binge eating at post-treatment, but BWL produced significantly greater weight loss. However, at 2-year follow-up, the CBTgsh and IPT groups had maintained treatment gains and were significantly superior to BWL in reductions in binge eating. The 3 groups were equivalent with regard to weight loss at the 2-year follow-up, and none reported clinically significant weight loss. Of note, as compared to the IPT and BWL groups, the CBTgsh group received 10 sessions as opposed to 20, received 25-minute sessions as opposed to 60-minute sessions, and were treated by providers with limited levels of experience as opposed to doctoral-level clinical psychologists.

To summarize, CBT is the most often studied type of self-help treatment. Both CBTsh and CBTgsh produced improvements in binge eating and associated psychopathology as compared to baseline and wait-list controls, and treatment gains were maintained at 6-month follow-up. Conclusions regarding the relative superiority of pure self-help or guided self-help are premature given the small number of studies and conflicting results.

In addition, limited information is available regarding moderators and predictors of guided self-help outcomes. Masheb and Grilo [163] performed a cluster analysis of the sample for the CBTgsh vs. BWLgsh described above [164] and identified 2 clinically significant subtypes: a dietary-negative affect subtype characterized by high restraint, low self-esteem, and depressive symptoms; and an overvaluation of weight and shape subtype. For both the CBTgsh and BWLgsh groups, the dietary-negative affect subtype experienced higher levels of binge eating frequency, and the overvaluation of weight and shape subtype experienced higher levels of ED-related psychopathology. Additionally, individuals receiving BWLgsh who experienced a rapid response to treatment reported lower BE frequency, greater weight loss, and higher restraint than participants without a rapid response [142]. In contrast, rapid response did not appear to affect outcomes for CBTgsh participants. Finally, the combination of low self-esteem and high ED-related psychopathology negatively affected BE remission rates for CBTgsh recipients [133].

Pharmacologic Treatment

Currently only one medication, lisdexamfetamine dimesylate, has been FDA-approved for the treatment of BED. Previously approved for treating both adults and children with attention-deficit hyperactivity disorder, lisdexamfetamine dimesylate is a central nervous system stimulant and has been found to significantly reduce number of binge days, with robust effect sizes [165]. Beyond this medication, the evidence for pharmacologic treatment of BED is limited. A recent review identified only 22 studies exploring the effects of pharmacologic treatment in a methodologically rigorous way (eg, double-blind placebo design) [4]. To date, a number of different medication classes have been evaluated, including antidepressants, anticonvulsants, stimulants, anti-obesity drugs, and others. Overall, there is some evidence that antidepressant and anticonvulsant agents are efficacious at reducing BE frequency [166,167] and sometimes effective regarding statistically significant weight loss [168,169]. However, the majority of results are generally disappointing, both with respect to reductions in binge eating and sustained weight loss [48,170,171]. In addition, there are serious limitations in the literature that must be considered, including the limited number of studies that address the high placebo response observed in clinical samples, limited follow-up windows, and inadequate multiplicitious confirmatory trials. Despite these limitations, the evidence base related to pharmacologic treatment is continuously evolving and represents an important future direction for the treatment of BED.