Binge eating most effectively treated by CBT, lisdexamfetamine, SGAs




Cognitive-behavioral therapy, lisdexamfetamine, and second-generation antidepressants are the most effective treatments for adult binge-eating disorder, a systematic review by Kimberly A. Brownley, PhD, and her associates found.

A total of 34 trials were included in the review. Patients who received therapist-led cognitive-behavioral therapy (CBT) achieved binge eating abstinence at a rate of 58.8%, compared with 11.2% of those on a wait list. Just over 40% of patients achieved abstinence on lisdexamfetamine, compared with 14.9% on a placebo, and 39.9% of patients achieved abstinence on second-generation antipsychotics (SGAs), compared with 23.6% on a placebo.


Total eating-related obsessions and compulsions were significantly reduced in patients receiving lisdexamfetamine and SGAs, and CBT significantly improved eating-related psychopathology. Body mass index was not reduced in patients receiving SGAs or CBT, but was reduced in those receiving lisdexamfetamine and topiramate, compared with placebo. Symptoms of depression were reduced by SGAs, but not by CBT.

In a related editorial, Dr. Michael J. Devlin of the New York State Psychiatric Institute and Columbia University, New York, praised the review by Dr. Brownley and her associates as an expert summary of the “current evidence on binge-eating disorder.” He went on to make the connection between eating disorders and obesity, and discuss the prospects for interventions.

“The seeds of unhealthy eating that eventually lead to obesity, disordered eating, or both often are sown during childhood or adolescence, and interventions at the community and family levels in the context of enlightened public policy likely would yield significant benefit,” Dr. Devlin wrote. “Only by understanding binge-eating disorder at various levels of analysis and through different professional lenses will we ensure that its life span is shortened, to the benefit of our own.”

Find the full study (doi: 10.7326/M15-2455) and editorial (doi: 10.7326/M16-1398) in the Annals of Internal Medicine.

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