What is the recommended treatment for binge eating disorder?

Treatment for Binge Eating Disorder

Cognitive-behavioral therapy (CBT) is the first-line treatment for binge eating disorder, demonstrating superior efficacy compared to medication alone, with remission rates of 55-73% when delivered by trained therapists. 1, 2

First-Line Psychological Treatments

• CBT and Interpersonal Psychotherapy (IPT) have demonstrated the strongest efficacy for treating binge eating disorder, with durable benefits after treatment completion 2, 3
• Guided computer-based interventions (CBIs) implementing CBT principles show medium to large effects for reducing binge eating behaviors and eating disorder psychopathology 4, 5
• Dialectical Behavior Therapy (DBT) has also shown some effectiveness for binge eating disorder 2
• Self-help CBT interventions (CBTgsh) are effective lower-cost, scalable options for patients with limited access to specialized care 2

Treatment Algorithm

1. Initial Assessment and Treatment Planning:

   • Evaluate eating patterns, frequency of binge episodes, and associated psychological distress 6
   • Assess for co-occurring psychiatric disorders, which are common in eating disorders 7, 6
   • Conduct physical examination including vital signs, height, weight, BMI 6
   • Order laboratory assessment including complete blood count, comprehensive metabolic panel, and electrolytes 6

2. First-Line Treatment:

   • Begin with therapist-led CBT specifically designed for eating disorders, focusing on normalizing eating behaviors and addressing psychological aspects like body image disturbance 6, 3
   • Standard CBT protocols typically consist of 16-20 sessions over 4-5 months 4, 2
   • For patients with limited access to specialized care, guided computer-based CBT interventions can be effective alternatives 4, 5

3. For Patients with Comorbid Obesity:

   • Behavioral Weight Loss (BWL) therapy has shown effectiveness comparable to CBT for reducing binge eating with the added benefit of modest weight loss 2
   • Treatment should first address disordered eating before focusing on weight management 8

4. For Non-Responders to Initial Treatment:

   • Patients who fail to respond to initial interventions should be offered therapist-led CBT, which has shown 61% remission rates in non-responders 9

Pharmacological Options

• Lisdexamfetamine (LDX) is the only FDA-approved medication for moderate-to-severe binge eating disorder 2
• Fluoxetine at 60 mg/day has been studied but was not found to be superior to placebo for binge eating disorder, with remission rates of only 29% compared to 30% for placebo 10, 1
• Combining medication with CBT does not significantly enhance outcomes compared to CBT alone 1, 2

Multidisciplinary Team Approach

• Treatment should be delivered by a coordinated team incorporating medical, psychiatric, psychological, and nutritional expertise 6
• The team typically includes:
  • A primary care physician for medical monitoring and coordination of care 6
  • A mental health practitioner delivering specialized eating disorder-focused psychotherapy 6
  • A registered dietitian providing nutritional rehabilitation and meal planning 6

Important Considerations

• Rapid response to treatment is a significant predictor of positive outcomes 3
• Overvaluation of body shape and weight is associated with poorer treatment outcomes 3
• Technology-based interventions may help overcome barriers such as shame, stigma, and shortage of specialized providers 5, 6
• Adherence to technology-based interventions can be challenging, with only about 57% of participants completing full treatment courses 5

Follow-up and Maintenance

• Regular monitoring of patients is essential, including assessment of binge eating frequency and psychological distress 6
• Maintenance treatment should be considered for responding patients to prevent relapse 2
• Patients should be periodically reassessed to determine the need for continued treatment 6