Treatment Approach for Binge Eating Disorder
Cognitive-behavioral therapy (CBT) is the first-line treatment for binge eating disorder, with lisdexamfetamine as the only FDA-approved medication for moderate-to-severe cases, and combined therapy showing superior outcomes for patients with comorbid obesity. 1, 2
First-Line Psychological Treatments
- Cognitive-behavioral therapy (CBT), particularly CBT-Enhanced (CBT-E), is the cornerstone psychological treatment for binge eating disorder, focusing on normalizing eating behaviors and addressing psychological aspects like fear of weight gain and body image disturbance 1, 3
- Interpersonal psychotherapy (IPT) has also demonstrated efficacy with durable benefits after treatment completion 1
- Dialectical behavior therapy (DBT) shows some effectiveness for reducing binge eating behaviors 1, 3
- Guided CBT self-help (CBTgsh) interventions have demonstrated efficacy as lower-cost, scalable options with potential for broader implementation 1
Pharmacological Treatment Options
- Lisdexamfetamine (LDX) is the only FDA-approved medication specifically for "moderate-to-severe" binge eating disorder 1
- Fluoxetine at 60 mg/day has shown efficacy for bulimia nervosa but is not specifically FDA-approved for binge eating disorder 4
- Research with other "off-label" medications has yielded modest and mixed outcomes with limited long-term data 1
Combined Treatment Approach
- Recent research shows that combined CBT+LDX treatment produces superior outcomes compared to either treatment alone for binge eating disorder with comorbid obesity 2
- Combined CBT+LDX achieved the highest binge eating remission rate (70.2%) compared to CBT alone (44.7%) or LDX alone (40.4%) 2
- For patients with comorbid obesity, LDX alone produced the highest rate of ≥5% weight loss (53.2%), followed by CBT+LDX (42.6%), while CBT alone rarely produced significant weight loss (4.3%) 2
Treatment Selection Algorithm
For patients with BED without obesity or weight concerns:
For patients with BED with comorbid obesity:
- Consider combined CBT+LDX as the most effective approach for both binge eating remission and modest weight loss 2
- If medication is contraindicated, behavioral weight loss therapy (BWL) may be an effective alternative that approximates CBT for reducing binge eating while also producing modest weight loss 1
For patients with moderate-to-severe BED with limited access to psychological treatments:
Technology-Based Interventions
- Guided computer-based interventions (CBIs) and videoconferencing show promise for treating eating disorders and may help overcome barriers such as shame, stigma, and shortage of specialized providers 5
- Online guided self-help CBT interventions have been developed specifically for binge eating disorder and are being evaluated in randomized controlled trials 6
- Technology-based interventions may be particularly useful for patients living far from specialized eating disorder treatment centers 5
Treatment Monitoring and Follow-up
- Regular assessment of binge eating frequency, eating disorder psychopathology, and weight (if relevant) is essential 2, 3
- Early response to treatment (rapid response) is a significant predictor of good outcomes 1, 7
- The presence of overvaluation of body shape and weight is a predictor that may indicate need for more intensive intervention 1, 7
Common Pitfalls and Caveats
- Many people with BED suffer in silence and shame, go untreated, and rarely receive evidence-based treatments 1
- Adherence to technology-based interventions can be challenging, with only about 57% of participants completing full treatment courses 5
- Nearly all research combining medications and psychological treatments has failed to enhance outcomes compared to psychotherapy alone, with the recent exception of CBT+LDX for BED with obesity 1, 2
- While CBT is effective for reducing binge eating, it typically does not produce significant weight loss in patients with comorbid obesity 2