While overeating and obesity are now endemic in the U.S. and are associated with metabolic derangement and psychiatric morbidity and increased mortality, Binge Eating Disorder (BED) is a poorly understood and complex disease involving multiple systems in both the body and the brain. In U.S. adults, BED affects 2.8 million adults and is observed across all racial and ethnic groups: prevalence rates are comparable among Whites (1.4%), Latinos (2.1%), Asians (1.2%) and African Americans (1.5%). The average age of onset is 21.
Common characteristics of BED include:
- A pattern of eating more food than most people would in a similar time period under similar circumstances
- Feeling out of control during a binge eating episode
- Experiencing negative emotions such as shame, depression and fear after a binge eating episode
- Binges occur at least once a week for a period of three months or more
Less common but not less important symptoms often include at least one of the items listed below:
- Eating extremely fast
- Eating beyond satiety (feeling full)
- Eating large amounts of food when not feeling hunger
- Eating alone or discreetly to conceal one’s binge eating
- Self-disparaging thoughts or beliefs about oneself after a binge eating episode
In contrast to anorexia and bulimia, persons with BED do not obsess about or engage in compensatory behaviors (rigorous exercise or purging) to eliminate or “burn” calories after a binge. This suggests that brain reward resulting from the anticipation and consumption of highly palatable foods plays a role in the pathophysiology of BED. Moreover, most persons with BED are not obese and are not preoccupied with their weight any more than same-aged cohorts with an eating disorder.
Binge Eating Disorder Treatment
To date, the current evidence-based treatment modalities for BED include individual therapy (cognitive behavioral therapy and motivational enhancement therapy), mindfulness meditative-based interventions, family systems and couples therapy, and psychodynamic psychotherapy. Other less researched but also important treatment modalities include:
- Movement classes
- Nutritional education
- Relapse prevention
- Art therapies, psychodrama
- Equine therapy
Supportive psychiatric care and medication management for co-occurring depressive disease and anxiety is not uncommon. Yet, until recently there has never been an FDA-approved medication solely indicated for the treatment of BED.
New Pharmacological Treatment
Lisdexamfetamine (Vyvanse®) is a federally controlled (C-II) CNS stimulant commonly prescribed for the treatment of ADHD. Lisdexamfetamine is a prodrug of dextroamphetamine. It is rapidly absorbed from the gastrointestinal tract and converted to dextroamphetamine, which animates the drug’s psychoactive activity. All amphetamines are sympathomimetic amines that activate stimulant activity in the CNS.
With Lisdexamfetamine and most stimulant medications, dopamine 2 receptors in the midbrain, prefrontal and orbital frontal cortex undergo a marked upregulation to accommodate the exogenously induced increases of dopamine. Although the exact therapeutic action responsible for the clinical response is not fully known, stimulants are also thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron, thus increasing the release of these monoamines into the synapse.
The clinical trials in humans with BED revealed a robust response for decreasing relapse using sophisticated regressional analysis to account for extraneous variants within both the study and control groups.
Certainly, more studies are needed to advance our understanding of BED, which will hopefully produce additional efficacious treatments. Certainly, addiction to highly palatable food comes to mind whenever modulation in central dopamine and dopamine 2 receptors occur in the prefrontal areas.
There is much work to be done.