Binge Eating Disorder:
7. Guidelines
James E Mitchell, M.D.
Guidelines
• Agency for Healthcare Research and Quality (A.H.R.Q.)
• N.I.C.E.
• Eisenberg Center for Clinical Decisions and Communications
Science – Baylor (NIH sponsored)
• Review and Meta-analysis (Ann. Int. Med., funded by
A.H.R.Q., in press)
Agency for Healthcare Research and Quality:
Comparative Effectiveness Review #160
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“Management and Outcomes of BED” (N = 52 RCT’s of Treatment)
-Second
generation antidepressants>placebo
Improved BE abstinence
- Lisdexamfetamine>placebo
↓Binge eating episodes
↓Binge eating days
↓Eating-related Ob/Co
-Second
↓ Depression
- Topiramate>placebo
generation antidepressant>placebo
-Topiramate>placebo
-Lisdexamfetamin>placebo
↓Weight
NICE Guidelines
Psychological Treatments for Binge Eating Disorder
- As a possible first step, patients with binge eating disorder should be encouraged to follow an evidence-based selfhelp programme. (B)
- Health care professionals should consider providing direct encouragement and support to patients undertaking an
evidence-based self-help programme as this may improve outcomes. This may be sufficient treatment for a limited
subset of patients. (B)
- Cognitive behaviour therapy for binge eating disorder (CBT-BED), a specifically adapted form of CBT, should be
offered to adults with binge eating disorder. (A)
- Other psychological treatments (interpersonal psychotherapy for binge eating disorder, and modified dialectical
behaviour therapy) may be offered to adults with persistent binge eating disorder. (B)
- Patients should be informed that all psychological treatments for binge eating disorder have a limited effect on
body weight. (A)
- When providing psychological treatments for patients with binge eating disorder, consideration should be given to
the provision of concurrent or consecutive interventions focusing on the management of comorbid obesity. (C)
- Suitably adapted psychological treatments should be offered to adolescents. (C)
Pharmacological Interventions for Binge Eating Disorder
- As an alternative or additional first step to using an evidence-based self-help
programme, consideration should be given to offering a trial of a SSRI antidepressant
drug to patients with binge eating disorder. (B)
- Patients with binge eating disorders should be informed that SSRIs can reduce binge
eating, but the long-term effects are unknown. Antidepressant drugs may be sufficient
treatment for a limited subset of patients.
CBT
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- CBT
- CBT-gsh
Improved BE abstinence
Decreased BE frequency
- CBT-partial therapist
CBT Ineffective for depression, weight
Not superior to CBT-partial therapist
Not superior to CBT-gsh
BWL>CBT for weight loss short-term only
Eisenberg Center for Clinical Decisions and
Communications Science – Baylor (NIH)
- High Confidence
CBT increases BE abstinence, decreases BE episodes/wk,
decreases eating-related psychopathology
LDX increases BE abstinence, decreases BE episodes/wk,
decreases eating-related obsessions and compulsions
Second generation antidepressants increase BE abstinence,
decreases BE episodes/wk
BED in Adults: Systematic Review and Meta-analysis
(Funded by the Agency for Healthcare Research and Quality)
CBT, LDX, SGAs and Topiramate decreases BE episode and related
psychopathology
LDX and Topiramate reduce weight
(Brownley et al., Ann Int Med, in press)
RCTs Combined Psychotherapy/Pharmacology
________________________________________________________________________________________
(Grilo et al, Curr Psych Rep 18:55, 2016)
(N = 14 Trials)
Combinations Studied:
CBT/BWL/Desipramine
Orlistat/Hypocaloric diet
CBT/Fluoxetine
Orlistat/CBT-gsh
CBT/Fluvoxamine
Orlistat/BWL
CBT/Topiramate
Orlistat/BWL/CBT-gsh
CBT/Zonisamide
Sibutramine/CBT-gsh
Conclusions:
Little support: CBT & Antidepressants
Limited support: Orlistat & CBT-gsh
Some support: CBT & Topiramate
Questions/Comments?