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Binge-Eating Disorder Interventions: Review, Current Status, and Implications

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Abstract

Purpose of Review

Binge-eating disorder (BED) is a serious psychiatric problem associated with substantial morbidity that, unfortunately, frequently goes unrecognized and untreated. This review summarizes the current status of behavioral, psychological, pharmacological, and combined treatments for BED in adults with a particular focus on recent findings and advances.

Recent Findings

Certain specific psychological treatments, notably CBT and IPT, and to some extent DBT, have demonstrated efficacy and are associated with durable benefits after treatment. Certain specific lower-cost scalable interventions, notably CBTgsh, have demonstrated efficacy and have potential for broader uptake. An important advance is the emerging RCT data indicating that BWL, a generalist and available behavioral lifestyle intervention, has effectiveness that approximates that of CBT for reducing binge eating and eating-disorder psychopathology but with the advantage of also producing modest weight loss. There exists only one pharmacological agent (LDX) with approval by the FDA for “moderate-to-severe” BED. Research with other “off label” medications has yielded modest and mixed outcomes with a few medications statistically superior to placebo over the short-term and almost no longer-term data. Nearly all research combining medications and psychological treatments has failed to enhance outcomes (combined appears superior to pharmacotherapy-only but not to psychotherapy-only).

Summary

Many people with BED suffer in silence and shame, go untreated, and rarely receive evidence-based treatments. Patients and practitioners need to recognize that research has identified several effective interventions for BED, and these can work quickly for many patients. Future research should identify treatments for those who do not derive benefit from initial interventions, identify additional pharmacological options, test agents with relevant mechanisms of action, and utilize innovative adaptative “SMART” designs to identify treatments to enhance outcomes among initial responders and to test alternative treatments to assist initial non-responders.

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Funding

This research was supported, in part, by the National Institutes of Health grant R01 DK117072. Dr. Grilo was also supported by grants R01 DK49587, R01 DK114075, and R01 DK112771. Funding agency played no role in the content of this paper.

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  1. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Carlos M. Grilo

  2. Yale Program for Obesity Weight and Eating Research (POWER), New Haven, CT, USA

    Carlos M. Grilo

  3. Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA

    Adrienne Juarascio

  4. Drexel University Center for Weight, Eating and Lifestyle Science (WELL), Philadelphia, PA, USA

    Adrienne Juarascio

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Dr. Grilo declares no conflicts of interest. Dr. Grilo reports broader interests, which did not influence this research, including Honoraria for lectures and CME activities at universities and scientific conferences, and Royalties from Guilford Press and Taylor & Francis Publishers for academic books.

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Grilo, C.M., Juarascio, A. Binge-Eating Disorder Interventions: Review, Current Status, and Implications. Curr Obes Rep 12, 406–416 (2023). https://doi.org/10.1007/s13679-023-00517-0

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