Binge Eating Is More Than a Behavioral Disorder

New research is helping the medical community understand binge-eating disorders better, leading to more options for treatment and the ability to tailor a patient’s care in a way that improves the chance of success.

A person with binge-eating disorder regularly consumes large quantities of food, often quickly and to the point of discomfort. Some people who binge will purge by vomiting or excessive use of laxatives, while others do not try to rid themselves of the food. People with binge-eating disorder can be of normal weight or obese. They typically feel a loss of control during the binge and afterward feel shameful, guilty and weak. Binge eating affects 3.5 percent of women in the United States, 2 percent of men and up to 1.6 percent of adolescents, according to the National Eating Disorders Association (www.nationaleatingdisorders.org/binge-eating-disorder).

What Is Binge-Eating Disorder?

Binge eating involves both behavioral and physical factors that can amplify one another and motivate the patient to eat excessively. Both factors need to be addressed to successfully manage bingeing, but in the past treatment for binge eating focused almost entirely on behavioral traits.

Now, we are recognizing that physical factors play an important role, creating an opportunity for better medical intervention for people who binge.

For instance, researchers have determined that with weight gain there is damage to signaling pathways in the brain that make it hard for people to lose weight. The damage to the signaling pathways affects how the body and mind respond to a period of reduced food intake; essentially going overboard after a period of denial.

This happens when a person tries to lose weight by reducing food intake, perhaps with success for some period, but the brain eventually responds with an exaggerated desire for food and triggers a binge.

Imagine it as similar to a person holding his or her breath underwater for an extended time, and then finally coming up for air. When the body can breathe again, it does not resume a normal breathing rate.

Instead, the brain triggers a deep, gasping breath to take in more air than normal, making up for the air lost while underwater. That reaction is similar to what happens when the body has experienced reduced food intake and then, perhaps because of a stress or behavioral issue, the person lets down his or her guard. Once the barrier is removed, the brain needs to make up for the deprivation with a binge.

Cognitive Therapy Common

Such research confirms that binge eating is more than a behavioral disorder and is leading to more medical treatment for people who binge.

People who are binge eaters also tend to be distressed and respond to life stresses with eating, which is why past approaches to treatment focused almost exclusively on cognitive and behavioral therapy. A typical treatment plan included individual counseling, group and/or family therapy and nutrition counseling.

While behavioral therapy can be helpful and likely will be a part of any plan for treating binge eating, it is not enough for many patients. Those patients are more likely to find success with obesity and binge-eating specialists, who can draw on the most recent research and experience in the field to supplement therapy with appropriate medication options.

For some time now, physicians have treated this condition with medications that have been successful in psychiatry, such as antidepressants. Unfortunately, many antidepressants can cause weight gain even without the patient altering food intake or exercise. That can be frustrating for the patient and ultimately counterproductive.

Over time, this side effect can even exacerbate the bingeing because the patient grows increasingly unhappy with the lack of weight loss and gives up on the behavioral aspects of therapy. The patient may decide that there is no reason to work hard on behavioral and lifestyle changes if the weight remains the same, and that dejection can trigger more binge eating. In addition, some antidepressants can actually decrease the person’s sense of fullness when eating, leading to more food intake.

Some medications appear beneficial, until ongoing research reveals problems. Until recently, patients were often treated with a drug known as sibutramine, sold under several brand names, including Reductil, Meridia, Siredia and Sibutrex. Until 2010 it was marketed and prescribed as an adjunct in the treatment of obesity along with diet and exercise.

Sibutramine is no longer available in the United States and many other countries because the manufacturer decided to stop producing the drug based on information from a clinical study. In the study, people taking sibutramine had an increased risk of cardiovascular events such as heart attack and stroke.

New Treatment Options

More recently, some binge-eating patients have improved with the use of lisdexamfetamine (brand name Vyvanse), a prescription medicine used for treating attention deficit hyperactivity disorder (ADHD) in adults and children. This drug is similar to an amphetamine, and until recently the medical community did not seriously consider the idea of using an amphetamine to treat binge eating.

Research with Vyvanse, however, showed that the drug can address some of the physical aspects of binge eating. (For more information on Vyvanse, see: https://tinyurl.com/hdpbb3l.)

Another option is topiramate (brand name Topamax), an anticonvulsant drug used most commonly for treating epilepsy. It was approved in 2012 for use in combination with the appetite suppressant phentermine for weight loss. Topiramate sometimes is used in conjunction with Vyvanse. (For more information on medical treatment options, see: https://tinyurl.com/hw9358r.)

It is important to consider such medical treatment for binge eating because the evidence continues to mount that the disorder is not entirely behavioral. Binge eating has always been a difficult problem to treat because people who binge can be deeply ashamed and reluctant for anyone to know about the problem. That is largely because they perceive binge eating as a sign of weakness and lack of self control. They fear the judgment that may come from others.

That fear is well founded, unfortunately, because most people who have never experienced binge eating see it as an activity that the person can simply choose not to do.

We are finding from ongoing research, however, that physical components are involved and if you can manage that with medication, the patient will get much better results.

We also are coming to understand better the relationship of binge eating to other medical issues. Most people who are binge eaters are obese, tending to gain weight over time from excessive food intake, and binge eating has been established as a risk factor for the medical problems associated with obesity.

For instance, binge eaters are more likely to develop metabolic syndrome, which is characterized by an increase in blood sugar, a larger waist circumference, high levels of triglycerides and low levels of good cholesterol. Metabolic syndrome, in turn, is a risk factor for diabetes, cardiovascular disease and death from any cause.

Those associations show that binge eating puts the patient at risk for more than just gaining weight. When seeking care for a patient with binge-eating disorder, it is important to remember that our understanding of this problem has greatly improved in recent years, creating an opportunity for more effective treatment. Obesity and binge-eating specialists are benefitting from a growing body of research that illustrates the strengths and weaknesses of different treatment options, allowing them to provide a treatment plan that offers the patient the best chance for success.