- Behavioral weight loss therapy can help people with binge-eating disorder stop bingeing and lose weight.
- Naltrexone-bupropion may also be helpful for those with binge-eating disorder.
- A new study suggests that the combination of these treatments may prove even more effective than either one alone.
Binge-eating disorder can cause significant suffering. It is terrifying to be controlled by cravings for food and the loss of control can fill people with shame, guilt, and self-loathing. Medical consequences, like excessive weight gain, diabetes, and elevated cholesterol can be devastating.
The disorder poses challenges for treatment, too. Cognitive behavioral and interpersonal therapy are the mainstays of psychotherapeutic treatment. Vyvanse is the only medication approved by the FDA for binge-eating disorder. However, this medication is a stimulant and has abuse potential, and it can raise heart rate and blood pressure. Topiramate also reduces binge eating and promotes weight loss but it can cause sleepiness and have cognitive side effects. Selective serotonin reuptake inhibitors (SSRIs) can reduce binge eating but do not promote weight loss generally. Many people continue to struggle despite available treatments.
A New Study
To learn more about ways to treat binge-eating disorder, researchers chose to study two treatments that are established for obesity but not well-studied in people with binge-eating disorder: behavioral weight loss therapy (BWL) and naltrexone-bupropion.
BWL is a behavioral therapy that does not require higher-level training to learn, has been extensively studied for weight loss, and is effective in helping overweight individuals lose weight. A few small studies have also shown this therapy can reduce binge eating for people with binge-eating disorder while also supporting weight loss, with studies showing up to 74 percent remission rates for binge eating, and 5.1 percent for weight loss.
BWL is manualized, and its modules are straightforward, involving goal-setting, monitoring food intake and activity, stimulus control to reduce triggers, and problem-solving. It encourages moderate calorie reduction to 1,500 calories per day, improving nutrition quality, including fat reduction, and physical activity of 30 minutes five times per week.
Naltrexone-bupropion is a combination pill that has been FDA-approved for the treatment of obesity and has been shown to promote mean weight losses of up to 6 kg (27 lbs). Advantages of this medication over some of the other weight loss pills include greater weight loss (compared to orlistat and liraglutide). Downsides are that you can’t take it with opioid pain pills, and it carries a slight increased risk for higher blood pressures, heart rate, seizure, and liver inflammation. It also has a black box warning for increased risk of suicide; some people experience some depression symptoms. The two medications act together to increase the activity of pro-opiomelanocortin neurons, which reduces appetite.
In the study, 136 individuals with binge-eating disorder (80 percent women, mean age 47, mean body mass index 37) were randomized to one of four groups: placebo, naltrexone-bupropion, BWL plus placebo, and BWL plus naltrexone-bupropion (32 mg/day of naltrexone and 360 mg/day of bupropion, both sustained-release) for 16 weeks.
Binge eating outcomes showed promising results for both treatments: 31 percent stopped binge eating with medication, 37 percent stopped with BWL plus placebo, 57 percent of people stopped in the group that got both active treatments, and only 18 percent stopped with placebo alone.
Both the medication and the therapy were also effective for weight loss. Whereas only 12 percent lost more than 5 percent of their body weight in the placebo group, 19 percent lost more than 5 percent with mediation alone, 31 percent with BWL and placebo, and 38 percent when they received both active treatments.
Statistical testing indicated that medication was significantly more effective than placebo for remission from binge eating, and that BWL was significantly more effective than no BWL for both binge eating and weight loss.
Although both treatments are promising, especially BWL—which showed statistically significant effects on both body weight and binge eating in this study—there are some words of caution for those thinking to use either or both of these treatments with their patients.
Regarding naltrexone-bupropion, in previous studies of obesity, long-term dropout rates for this medication are high, reaching almost 50 percent after one year of treatment. This is true for the other weight loss medications, too, which may not provide sustained weight loss for many individuals. Long-term success rates for BWL are also not as well-established.
For people with binge-eating disorder, rebound weight gain after weight loss can be dangerous: the weight comes back on fast with bingeing, and people can get caught in a vicious yo-yo dieting cycle. This study was only 16 weeks and we don’t yet know what the long-term outcomes will be for people for either treatment.
On the plus side, these treatments might offer something new that the field desperately needs. Binge-eating disorder is often treated in eating disorder programs that do not encourage weight loss as a goal. Although taking weight loss off the table can help people stop bingeing, this approach can be less than ideal for people who have serious medical consequences from higher body sizes, for example. BLW and naltrexone-bupropion, alone or combined, might be able to help people reduce binge eating and lose weight at the same time.
It seems promising that both behavioral weight loss therapy and naltrexone-bupropion could be considered reasonable treatment choices for people who are trying to recover from binge-eating disorder.
Carlos M. Grilo, Ph.D., Janet A. Lydecker, Ph.D., Sarah K. Fineberg, M.D., Ph.D., Jorge O. Moreno, M.D., Valentina Ivezaj, Ph.D., Ralitza Gueorguieva, Ph.D. Naltrexone-Bupropion and Behavior Therapy, Alone and Combined, for Binge-Eating Disorder: Randomized Double-Blind Placebo-Controlled Trial. (2022) American Journal of Psychiatry. doi: 10.1176/appi.ajp.20220267