Cognitive behavioral therapy (CBT) and certain medications have been shown to be effective for binge eating disorder (BED), but no controlled studies have compared psychological and pharmacological therapies. We conducted a randomized, placebo-controlled study to test the efficacy of CBT and fluoxetine alone and in combination for BED.
108 patients were randomized to one of four 16-week individual treatments: fluoxetine (60 mg/day), placebo, CBT plus fluoxetine (60 mg/day) or CBT plus placebo. Medications were provided in double-blind fashion.
Of the 108 patients, 86 (80%) completed treatments. Remission rates (zero binges for 28 days) for completers were: 29% (fluoxetine), 30% (placebo), 55% (CBT+fluoxetine), and 73% (CBT+placebo). Intent-to-treat (ITT) remission rates were: 22% (fluoxetine), 26% (placebo), 50% (CBT+fluoxetine), and 61% (CBT+placebo). Completer and ITT analyses on remission and dimensional measures of binge eating, cognitive features, and psychological distress produced consistent findings. Fluoxetine was not superior to placebo, CBT+fluoxetine and CBT+placebo did not differ, and both CBT conditions were superior to fluoxetine and to placebo. Weight loss was modest, did not differ across treatments, but was associated with binge eating remission.
CBT, but not fluoxetine, demonstrated efficacy for the behavioral and psychological features of BED, but not obesity.
"BED is linked with heightened medical and psychosocial problems   and greater health-care utilization  relative to obese individuals without BED (NBO). Although certain psychological/behavioral  and pharmacological  treatments are effective for reducing binge-eating and associated psychopathology, most of these interventions generally result in minimal weight loss with obese BED patients  . It has been suggested, however, that treatments that reduce binge eating may interrupt further weight gain . "
[Show abstract][Hide abstract] ABSTRACT: Objective:
To examine weight change trajectories among overweight and obese patients with binge eating disorder (BED) versus without (NBO) during the year prior to seeking treatment.
Participants were 97 (75 women, 22 men) overweight and obese patients recruited for the same weight-loss treatment in primary care; 26 (27%) met DSM-5 BED criteria. Participants were assessed with the Eating Disorder Examination and completed self-report questionnaires about their weight histories and the Beck Depression Inventory-II.
Participants' self-reported current weight and measured current weight were significantly correlated and did not statistically differ. Reported weight changes during the year prior to seeking treatment differed significantly by group: BED patients gained an average of 18.3lb (8.2kg) whereas NBO patients gained an average of 1.5lb (0.7kg). Among BED patients, but not NBO, weight change during the prior year was positively correlated with greater eating-disorder psychopathology, binge-eating frequency, frequency of overeating at lunch and dinner, and depression scores. For the overall group, BED status and binge-eating frequency each made independent significant contributions to predicting weight change in the past year.
Findings suggest BED patients are gaining considerably more weight during the year prior to treatment than NBO patients. BED treatment may interrupt a steep weight gain trajectory and prevent further weight gain for BED patients suggesting need for early intervention. Primary care physicians should screen for BED when overweight and obese patients present with rapid weight gain.
Journal of Psychosomatic Research 08/2014; 77(2):151-154. DOI:10.1016/j.jpsychores.2014.05.006 · 2.74 Impact Factor
"Investigators followed standard training protocols used in previous treatment studies . After complete review of all criteria and all interview items, including their rationale and probing methods, new research clinicians observed trained assessors delivering interviews and rated training tapes. "
[Show abstract][Hide abstract] ABSTRACT: Treatments for obese patients with binge eating disorder (BED) typically report modest weight losses despite substantial reductions in binge eating. Although the limited weight losses represent a limitation of existing treatments, an improved understanding of weight trajectories before treatment may provide a valuable context for interpreting such findings. The current study examined the weight trajectories of obese patients in the year before enrollment in primary care treatment for BED. Participants were a consecutive series of 68 obese patients with BED recruited from primary care centers. Doctoral-level clinicians administered structured clinical interviews to assess participants' weight history and eating behaviors. Participants also completed a self-report measure assessing eating and weight. Overall, participants reported a mean weight gain of 9.5 lb in the past year, although this overall average comprised remarkable heterogeneity in patterns of weight changes, which ranged from losing 40 lb to gaining 62 lb. Most participants (65%) gained weight, averaging 22.5 lb. Weight gain was associated with more frequent binge eating episodes and overeating at various times. Most obese patients with BED who present to treatment in a primary care setting reported having gained substantial amounts of weight during the previous year. Such weight trajectory findings suggest that the modest amounts of weight losses typically reported by treatment studies for this specific patient group may be more positive than previously thought. Specifically, although the weight losses typically produced by treatments aimed at reducing binge eating seem modest, they could be reinterpreted as potentially positive outcomes given that the treatments might be interrupting the course of recent and large weight gains.
"Treatments for binge-eating behaviour A number of pharmacological treatments with differing mechanisms of action have been examined for binge eating in a number of disorders, particularly BED (Reas & Grilo, 2008). These include : the selective serotonin reuptake inhibitors (SSRIs), fluvoxamine (Hudson et al. 1998; Pearlstein et al. 2003), sertraline (McElroy et al. 2000), fluoxetine (Arnold et al. 2002; Devlin et al. 2005; Grilo et al. 2005), citalopram (McElroy et al. 2003a) and escitalopam (Guerdjikova et al. 2008); the noradrenaline reuptake inhibitor (NRI), atomoxetine (McElroy et al. 2007a) ; the anti-obesity agents, d-fenfluramine (a serotonin releaser and reuptake inhibitor) (Stunkard et al. 1996), sibutramine (a serotonin and noradrenaline reuptake inhibitor) (Appolinario et al. 2003; Milano et al. 2005; Mitchell et al. 2003; Wilfley et al. 2007) and orlistat (Golay et al. 2005) ; and the anticonvulsants, topiramate (McElroy et al. 2003b, 2007b) and sonisamide (McElroy et al. 2006). All of these drugs have been shown to exert positive effects (of moderate effect size) including reductions in binge-eating frequency and short-term reductions in weight (y3 kg) (Reas & Grilo, 2008), with larger effects on weight observed only with sibutramine , orlistat, topiramate and sonisamide. "
[Show abstract][Hide abstract] ABSTRACT: Endogenous opioids and μ-opioid receptors (MORs) have long been implicated in the mechanism of appetite control and, in particular, hedonic processes associated with food evaluation, consumption and orosensory reward processes. In animal models of binge eating, selective MOR antagonists suppress food consumption. In humans, non-selective opioid receptor antagonists reduce hedonic taste preferences and food intake, particularly for palatable foods, and cause short-term weight loss. These effects have been linked to direct stimulation of MORs and modulation of dopamine release within the reward circuitry including the nucleus accumbens. These findings suggest that reduction of MOR-mediated hedonic and motivation processes driving consumption of highly palatable foods may be a promising therapeutic approach and provide a strong rationale for developing safer and more selective MOR antagonists or inverse agonists for disorders of 'appetitive motivation' including obesity and binge-eating disorder.
The International Journal of Neuropsychopharmacology 06/2009; 12(7):995-1008. DOI:10.1017/S146114570900039X · 4.01 Impact Factor
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