From the Guidelines
To treat hyperphagia, a comprehensive treatment plan incorporating medical, psychiatric, psychological, and nutritional expertise is essential, and for patients with binge-eating disorder, eating disorder-focused cognitive-behavioral therapy or interpersonal therapy is recommended 1. When managing hyperphagia, it's crucial to address both the physical and psychological aspects of the condition.
- Establishing regular eating patterns with three balanced meals and planned snacks can help prevent extreme hunger that leads to overeating.
- Keeping a food journal to track what, when, and why you eat can help identify emotional or situational triggers.
- Practicing mindful eating by eating slowly, without distractions, and stopping when you feel satisfied rather than completely full is also beneficial.
- Portion control is essential, using smaller plates, measuring servings, and following the plate method (half vegetables, quarter protein, quarter carbohydrates).
- Staying hydrated with water throughout the day can help as thirst is often mistaken for hunger. For emotional eating, developing alternative coping strategies like walking, deep breathing, or calling a friend can be helpful. In some cases, professional help may be necessary, considering working with a registered dietitian for personalized nutrition guidance or a therapist specializing in eating behaviors if overeating stems from psychological factors. For clinical cases of binge eating disorder, medications like lisdexamfetamine or certain SSRIs may be prescribed under medical supervision, as recommended by the American Psychiatric Association 1. It's also important to be aware of the increased risk of intestinal necrosis after binge-eating in individuals with Prader-Willi Syndrome, as they may have a high pain tolerance that can mask symptoms and delay treatment 1.
From the FDA Drug Label
2.4 Dosage for Treatment of Moderate to Severe BED in Adults The recommended starting dosage in adults is 30 mg once daily to be titrated in increments of 20 mg at approximately weekly intervals to achieve the recommended target dose of 50 mg to 70 mg once daily.
Discontinue lisdexamfetamine dimesylate capsules if binge eating does not improve.
Lisdexamfetamine dimesylate capsules are a treatment option for hyperphagia (excessive eating) associated with Binge Eating Disorder (BED) in adults. The recommended dosage is 30 mg to 70 mg once daily.
- Key points:
- The medication should be started at 30 mg once daily and titrated up to 50 mg to 70 mg once daily.
- The medication should be discontinued if binge eating does not improve.
- Lisdexamfetamine dimesylate capsules are not indicated or recommended for weight loss in general, but rather for the treatment of moderate to severe BED. 2
From the Research
Treatment Options for Hyperphagia (Excessive Eating)
The treatment options for hyperphagia, also known as binge-eating disorder (BED), include:
- Psychological and behavioral treatments, such as:
- Pharmacologic treatments, such as:
- Combination therapy, such as:
- CBT + LDX 6
Effectiveness of Treatment Options
The effectiveness of these treatment options varies, with:
- CBT and IPT being the most strongly supported interventions for BED, producing significant reductions in binge eating and associated eating disorder psychopathology 3, 4, 5
- BWL being effective in reducing binge eating and associated eating problems in BED patients, but not producing weight loss 3, 4
- LDX being an effective treatment for BED, reducing BED symptoms and body weight of patients with the disorder 6, 7
- Combination therapy (CBT + LDX) being superior to individual treatments, producing the largest reduction in binge-eating frequency and the highest remission rate 6
Mechanism of Action
The mechanism of action of LDX in treating BED is thought to involve a combination of effects on: