Self-help a viable approach For patients without coverage, and those wary of traditional therapy yet motivated to work on the problem independently, self-help treatment may be a viable option. The approach uses books or other materials to guide patients through a program built on cognitive behavioral therapy. Like traditional CBT, the programs help patients develop a structured eating plan and correct the self-defeating thoughts and behaviors that lead to binges. "Say your in-laws are coming this weekend, and you know it's a stressor for you. You make a plan for how you're going to handle that without bingeing," says Striegel-Moore. According to studies in 1998 and 2001, self-help approaches were effective in reducing binges and improving patients' attitudes about eating. Recommended self-help books include Overcoming Binge Eating and Getting Better Bite by Bite. And the newest frontier in self-help is computer-based programs. With a grant from the National Institute of Mental Health, for example, Bulik developed a program called Preventing Overweight with Exercise and Reasoning (POWER), which she describes as "therapy on a CD." The program uses realistic vignettes, self-paced lessons and interactive quizzes to help patients understand why they binge and to help them make better eating choices. "Patients love it because it's so interactive," Bulik says. "Computer-based programs are the future of self-help." Other approaches While cognitive behavioral therapy is the most proven therapy for binge eating disorder, other approaches have shown promise, such as interpersonal therapy, which explores issues in the patient's relationships. A 2002 study which compared CBT with interpersonal therapy to treat 162 BED patients found recovery rates were equivalent in both groups. And while some may believe a conventional diet program is the answer -- from Atkins to Jenny Craig to Weight Watchers -- the approach hasn't been well-tested for treating binge eating disorder. Some studies have found that BED patients lose as much weight as non-BED patients in traditional weight-control programs. But some experts advise against the approach. "My experience is, by the time patients are talking to a doctor about this problem, they've already tried dieting programs and it didn't help," Hudson says. Furthermore, "some of these programs say, ‘Our program can't fail -- it's you who failed.’ So if the patient doesn't succeed, they feel worse than before." The role of medications Although there is no FDA-approved drug specifically for binge eating disorder, several medications have been found effective in clinical trials.
  • Selective serotonin reuptake inhibitors (SSRIs) are most commonly used to treat BED. In randomized trials, they have been found more effective at reducing binge eating than in inducing weight loss.
  • Some appetite suppressants have been shown to reduce binge eating and body weight in patients with BED.
  • A small number of anti-convulsant medications have been tested in clinical trials for BED, and have been shown to decrease binges and reduce weight. The drugs often have troublesome side effects, however, including dizziness, fatigue and difficulty concentrating.
The question of whether and when to use medication ultimately depends on the patient's, and the doctor's, preference. Hudson recommends first trying CBT, and if the patient doesn't show sufficient improvement, medication can be tried, either alone or with therapy. Striegel-Moore recommends using medication primarily for patients with comorbid anxiety or depression, and using it to complement, not replace, therapy. The AHRQ evidence report states that "combining medication and CBT may improve both binge eating and weight loss, although sufficient trials have not been done to determine which medications are best at producing weight loss." No magic bullet Unfortunately, successful treatment for binge eating disorder is neither quick nor easy, and relapses are common. Even the most effective treatments typically take 10-15 weeks to work. And, for reasons that aren't fully understood, the treatments that have helped patients stop bingeing have shown little success in helping them lose weight. This underscores the need for further study and better treatments -- and the importance of perseverance for those struggling to overcome binge eating. "It's incredibly hard to lose weight long-term," Striegel-Moore says. "We live stressful lives, we're surrounded by cheap unhealthy food, and we don't exercise enough. For anyone to get control over binge eating -- or any eating disorder -- requires truly lasting behavioral change." RELATED LINKS News articles Bingeing Now Seen as Most Common Eating Disorder
Washington Post, Feb. 1, 2007 3% of Americans are binge eating
WebMD Medical News, Feb. 1, 2007 Published research reports and clinical guidelines The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication
Biological Psychiatry, Feb. 1, 2007 Management of Eating Disorders: An Evidence Report Prepared for the Agency for Healthcare Research and Quality
April 2006 Practice Guideline for the Treatment of Patients With Eating Disorders: A Quick Reference Guide
American Psychiatric Association, July 2006 International Journal of Eating Disorders, special issue: The Current Status of Binge Eating Disorder
July 2003 Pharmacologic Treatment of Binge Eating Disorder
International Journal of Eating Disorders, July 2003 DSM-IV Diagnostic Criteria for Binge Eating Disorder
Eating Disorder Referral and Information Center Patient resources and referrals Information on Binge Eating Disorder, from National Institute of Diabetes and Digestive and Kidney Diseases Eating Disorder Referral and Information Center Academy for Eating Disorders, provider search Association for Behavioral and Cognitive Therapies, provider search Have comments or questions on this article? Please e-mail the author, Sara Selis, at sselis@cmp.com.
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