What are the treatment options for Binge Eating Disorder (BED)?

From the Guidelines

Patients with binge-eating disorder should be treated with eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, in either individual or group formats, as this approach has been shown to be effective in managing the condition. According to the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1, this recommendation is based on a high level of confidence that the benefits of the intervention clearly outweigh harms. The guideline suggests that adults with binge-eating disorder who prefer medication or have not responded to psychotherapy alone may be treated with either an antidepressant medication or lisdexamfetamine. Some key points to consider in the treatment of binge-eating disorder include:

• Eating disorder-focused cognitive-behavioral therapy is a recommended approach, as it helps patients identify triggers and develop healthier coping strategies 1.
• Interpersonal therapy is also a recommended approach, and can be used in either individual or group formats 1.
• Medication options, such as antidepressants or lisdexamfetamine, may be considered for adults who prefer medication or have not responded to psychotherapy alone 1.
• Treatment should be tailored to the individual's specific needs and triggers, and may involve a combination of psychotherapy, medication, and lifestyle modifications. The American Psychiatric Association guideline provides a comprehensive approach to the treatment of binge-eating disorder, and eating disorder-focused cognitive-behavioral therapy or interpersonal therapy should be considered the first line of treatment 1.

From the FDA Drug Label

A phase 2 study evaluated the efficacy of lisdexamfetamine dimesylate capsules 30,50, and 70 mg/day compared to placebo in reducing the number of binge days/week in adults with at least moderate to severe BED The 50 and 70 mg/day doses were statistically superior to placebo on the primary endpoint The efficacy of lisdexamfetamine dimesylate capsules in the treatment of BED was demonstrated in two 12-week randomized, double-blind, multi-center, parallel-group, placebo-controlled, dose-optimization studies (Study 11 and Study 12) in adults aged 18 to 55 years Subjects from both studies on lisdexamfetamine dimesylate capsules had a statistically significantly greater reduction from baseline in mean number of binge days per week at Week 12 Table 7: Summary of Primary Efficacy Results in BED Study 11Lisdexamfetamine dimesylate capsules (50 or 70 mg/day)†4.79 (1.27)-3.87 (0.12)-1.35 (-1.70, -1.01) Study 12Lisdexamfetamine dimesylate capsules (50 or 70 mg/day)†4.66 (1.27)-3.92 (0.14)-1.66 (-2.04, -1.28)

Treatment of Binge Eating Disorder (BED): Lisdexamfetamine dimesylate capsules at doses of 50 and 70 mg/day are effective in reducing the number of binge days per week in adults with moderate to severe BED 2.

• Key findings:
  • The 50 and 70 mg/day doses were statistically superior to placebo on the primary endpoint.
  • Subjects on lisdexamfetamine dimesylate capsules had a statistically significantly greater reduction from baseline in mean number of binge days per week at Week 12.
• Recommended dose: 50 or 70 mg/day.

From the Research

Treatment Options for Binge Eating Disorder

• Cognitive-behavioral therapy (CBT) is a widely supported treatment for binge eating disorder (BED), with moderate to high efficacy in reducing binge eating frequency 3, 4, 5, 6.
• Interpersonal psychotherapy (IPT) is also a supported treatment for BED, although the evidence is modest 3, 4, 6.
• Pharmacological treatments, such as selective serotonin reuptake inhibitors (SSRI) and lisdexamfetamine, have shown some efficacy in reducing binge eating frequency, but the evidence is limited and the long-term effects are unknown 3, 7.
• Combined treatments, such as CBT plus medication, may be effective in reducing binge eating frequency and improving eating behaviors 7.
• Behavioral weight loss therapy can produce modest weight loss over the short-term, but the long-term effects are unknown 6.

Efficacy of Treatments

• CBT and IPT have been shown to be effective in reducing binge eating frequency and improving eating behaviors, but the effects on weight loss are limited 3, 4, 6.
• Lisdexamfetamine has been shown to have a modest effect on weight loss, but the evidence is limited and the long-term effects are unknown 3.
• The addition of fluvoxamine to CBT may enhance the effects of CBT on eating behaviors, but the evidence is limited 7.

Limitations and Future Directions

• There is a lack of long-term follow-up data on the efficacy of treatments for BED, particularly for pharmacological treatments 3, 7.
• There is a need for more research on the predictors and moderators of treatment outcomes, as well as the development of more effective treatments for BED 4, 6.
• The generalizability of treatment outcomes to diverse populations, such as adolescents and minorities, is limited 3, 4.