Pharmacological treatment of binge eating disorder: update review and synthesis

Abstract

Introduction: Binge eating disorder (BED), a formal eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is characterized by recurrent binge eating, marked distress about binge eating, and the absence of extreme weight compensatory behaviors. BED is more prevalent than other eating disorders, with broader distribution across age, sex and ethnic/racial groups, and is associated strongly with obesity and heightened risk for psychiatric/medical comorbidities.

Areas covered: This article provides an overview of pharmacotherapy for BED with a focus on Phase III randomized controlled trials (RCTs). The search with minimal methodological inclusion requirements yielded 22 RCTs investigating several different medication classes; most were pharmacotherapy-only trials with 8 trials testing combination approaches with psychological–behavioral methods.

Expert opinion: The evidence base regarding pharmacotherapy for BED remains limited, although this year the FDA approved the first medication (i.e., lisdexamfetamine dimesylate; LDX) specifically for moderate-to-severe BED. Data from RCTs suggest certain medications are superior to placebos for reducing binge eating over the short term; almost no data exist regarding longer-term effects of pharmacotherapy for BED. Except for topiramate, which significantly reduces both binge eating and weight, tested medications yield minimal weight loss and LDX is not indicated for weight loss. Psychological–behavioral and combination approaches with certain medications yield superior outcomes to pharmacotherapy-only acutely and over longer-term follow-up.

Keywords:

• binge eating
• binge eating disorder
• medication
• obesity
• pharmacotherapy
• placebo

Declaration of interest

CM Grilo reports research grants from the NIH (Grant number: K24 DK070052), consulting and speaking fees from Shire, consulting fees from Sunovion, honoraria from the American Psychological Association and from universities and scientific conferences for grand rounds and lecture presentations, speaking fees for various CME activities, consulting fees from American Academy of CME, Vindico Medical Education CME; and General Medical Education CME, and book royalties from Guilford Press and from Taylor Francis Publishers. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Notes

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