Obtaining long-term recovery: advances in optimizing treatment outcomes in patients with binge-eating disorder

ABSTRACT

Introduction

Binge-eating disorder (BED) is a complex and disabling eating disorder (ED) associated with considerable burden and impairments in quality of life and physical/mental health. It has been recognized as a formal ED category since 2013, however BED is still underdetected and undertreated.

Areas covered

This review summarizes the advances in the understanding of the pathophysiology of BED as well as the evidence on the efficacy of the existing treatments. The authors searched Scopus, PubMed, ClinicalTrials.Gov, and ANZCTR with terms including ‘assessment’ OR ‘treatment’ OR ‘diagnosis’ OR ‘mechanisms’ AND ‘binge eating’ OR ‘binge-eating disorder’ for manuscripts published between January 2013 and April 2023.

Expert opinion

Most of the trials on treatments of BED have been in people of high weight with weight loss as an outcome. Nevertheless, less is known about the treatment of this condition in people with body mass index (BMI) within the normal range where weight stabilization may be a more appropriate goal. Moreover, there is a need for an enhanced appreciation of the role of combination treatment to improve overall outcomes. Also, there are important opportunities for future research in understanding the mechanisms of action and effectiveness of BED treatments.

KEYWORDS:

• Binge-eating disorder
• diagnosis
• pathophysiological mechanisms
• pharmacotherapy
• psychotherapy
• emerging treatments

Article highlights

• BED is highly prevalent among people with high body mass index (BMI) but also affects those with BMI within the normal range. Moreover, BED is associated with other disturbed eating behaviors, such as grazing.

• BED has been conceptualized as an impulsive/compulsive ED with altered reward sensitivity and food-related attentional biases.

• There is a high comorbidity between BED, mood disorders, emotional dysregulation, and suicidality.

• Manualized psychological interventions for BED demonstrated positive effects on binge eating outcomes and ED psychopathology but their efficacy on weight loss is inconsistent. Overall, improvements are sustained up to 1 year after treatment.

• Lisdexamfetamine is the only medication approved to treat BED in adults. Although other agents showed efficacy in improving specific BED domains, their use may be limited due to unclear effects on weight (e.g. antidepressants) and tolerability issues (e.g. anticonvulsants).

• Novel treatments, such as liraglutide, naltrexone/bupropion, virtual reality, and noninvasive neurocognitive approaches demonstrated promising preliminary results in different BED domains, but a more robust investigation is required.

Declaration of interest

P Hay has received sessional fees and lecture fees from the Australian Medical Council, the Therapeutic Guidelines Publication, and the New South Wales Institute of Psychiatry. She has also received royalties from Hogrefe and Huber, McGraw Hill Education and Blackwell Scientific Publications. Furthermore, she has received research support from CAPES, the National Health and Medical Research Council (NHMRC) and the Australian Research Council (ARC). Finally, she is Chair of the National Eating Disorders Collaboration in Australia (2019-) and is a consultant to Takeda Pharmaceuticals. JC Appolinario has received research grants, consultancy fees, and advisory board fees from Takeda Pharmaceuticals. He receives/has received royalties/honoraria from Artmed Panamericana Editora. He has also received a research grant from the Brazilian National Research Council (CNPq). 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737175.2023.2273392.

Additional information

Funding

The present study was funded in part by the Brazilian Federal Foundation for Support and Evaluation of Graduate Education (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES)—Finance Code 001.