Remove the Stigma Around Binge Eating Disorder

CONFERENCE REPORTER

Carlos M. Grilo, PhD, in his talk at the Annual Psychiatric Times® World CME Conference™, discussed the latest updates in diagnosing, understanding, and treatment options for patients with binge-eating disorder (BED).

“My biggest take home,” Grilo said, “is to avoid stigmatizing. Ask what language your patient would like used when discussing their weight.”

BED is a DSM-5 eating disorder, characterized by the consumption of large amounts of food while experiencing a loss of control. To classify as binge eating disorder, at least 3 of the 5 behavioral indicators must be met: 1) the patient must eat rapidly; 2) the patient must eat large amounts of food even when not hungry; 3) the patient must eat to the point of discomfort; 4) the patient will eat alone due to embarrassment; and 5) the patient will feel disgusted, depressed, or guilty about their eating.

Studies of adults with BED reveal that patients have both elevated psychiatric and medical comorbidity. The most common psychiatric comorbidities include mood disorders, anxiety, and substance use disorders. Medical comorbidities include obesity, chronic pain conditions, and cardiometabolic problems, like diabetes or hypertension.

When discussing pharmacotherapy treatment options for BED, Grilo noted that there is only 1 FDA-approved medication: lisdexamfetamine. Lisdexamfetamine is used for moderate to severe BED, taken once daily in the morning. Patients must be monitored carefully, as it has a black box warning that notes its high potential for abuse. 

Pharmacotherapy for treating BED is an emerging research topic. While several small clinical trials have found medications superior to placebos for reducing binge-eating, those studies only gauged the short-term, limited effects. Next to no data exists regarding long term effects.

A larger variety of psychological and behavioral treatments exist to treat BED. Specific focal psychological treatments, like cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), are well-established, significantly reduce binge eating, and have approximately 50% remission rates. Behavioral weight loss (BWL), a generalist treatment, achieves comparable binge-eating reductions and produces some weight loss.

Grilo concluded his talk with a number of suggestions. First and foremost, be prepared to recognize BED. Once you have assessed the psychiatric and medical comorbidities, consider pharmacological, psychological, and combined therapy options. Let your patient know that treatments exist that may help, often quickly. Discuss options and alternatives, and above all, avoid stigmatizing.

The Annual Psychiatric Times® World CME Conference™ was held October 15 – 17. More information can be found here. Next year’s conference is scheduled for September 30 – October 2, 2021, in San Diego.