Combining Pharmacological and Psychological Treatments for Binge Eating Disorder: Current Status, Limitations, and Future Directions
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Binge eating disorder (BED) is characterized by recurrent binge eating and marked distress about binge eating without the extreme compensatory behaviors for weight control that characterize other eating disorders. BED is prevalent, associated strongly with obesity, and is associated with heightened levels of psychological, psychiatric, and medical concerns. This article provides an overview of randomized controlled treatments for combined psychological and pharmacological treatment of BED to inform current clinical practice and future treatment research. In contrast to the prevalence and significance of BED, to date, limited research has been performed on combining psychological and pharmacological treatments for BED to enhance outcomes. Our review here found that combining certain medications with cognitive behavioral therapy (CBT) or behavioral weight loss (BWL) interventions produces superior outcomes to pharmacotherapy only but does not substantially improve outcomes achieved with CBT/BWL only. One medication (orlistat) has improved weight losses with CBT/BWL albeit minimally, and only one medication (topiramate) has enhanced reductions achieved with CBT in both binge eating and weight. Implications for future research are discussed.
KeywordsBinge eating disorder Obesity Cognitive behavioral therapy Behavioral weight loss Medication Pharmacotherapy
The authors thank Dr. Scott Crow and Dr. Michael Devlin for their reviews and constructive comments on this manuscript.
Compliance with Ethical Standards
Conflict of Interest
The authors report that they have no financial or other conflicts of interest with respect to the content of this paper. No academic, pharmaceutical, or industry entity of any kind influenced this review study or the preparation of this report in any manner.
Dr. Carlos M. Grilo reports grants from the National Institutes of Health, consulting fees from Shire and Sunovion, honoraria from the American Psychological Association and from universities and scientific conferences for grand rounds and lecture presentations, speaking fees for various CME activities, and consulting fees from American Academy of CME, Vindico Medical Education CME, General Medical Education CME, Medscape/WebMD Education CME, and book royalties from Guilford Press and from Taylor Francis Publishers.
Dr. Deborah L. Reas has no financial or other conflicts of interest to disclose.
Dr. James E. Mitchell reports grants from the National Institutes of Health and book royalties from Guilford Press, Routledge Press, and American Psychiatric Press.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Preparation of this paper was supported, in part, by National Institutes of Health (NIH) Grant K24 DK070052 (Grilo). The NIH had no role or influence on the content of the paper nor does the content reflect the views of the NIH.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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