In Search of Effective Treatment for BED

Vol. 28 / No. 5 — Eating Disorders Review

An important guideline is to stick to established protocols, according to a leading researcher.

Binge-eating disorder (BED) is now recognized as the most common eating disorder, affecting 3.5% of women and 2.0% of men. BED is three times more common than BN and AN combined, and more often diagnosed than breast cancer, HIV, and schizophrenia.

In a recent essay, Carlos Grilo, PhD, of Yale University School of Medicine, New Haven, CT, noted that all current approaches to treating patients with BED can be improved (J Clin Psychiatry. 2017; 78:20). Dr. Grilo writes that since only one-third to one-half of patients with BED seem to be helped by psychological and behavioral treatment, other ways must be found to help these patients.

The most common psychological and behavioral treatment interventions for BED, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), do not lead to weight loss. Behavioral weight loss (BWL) interventions achieve good outcomes plus modest short-term weight loss. What about adding pharmacotherapy to CBT in the treatment plan? According to Dr. Grilo, this seemingly logical approach has generally failed thus far. Results of controlled trials testing combination therapy have thus far been unclear. When medications are added to CBT or behavioral only modest improvement is reported.

The value of manualized treatments

Dr. Grilo recommends adhering to manualized protocols when using psychological and behavioral treatments for BED. Despite the temptation to integrate treatment based on individual clinical judgments, especially with challenging patients, research shows that evidence-based ED protocols can achieve excellent results.

Predicting outcome

A variety of patient characteristics, such as age, sex, ethnicity/race, and eating disorder psychopathology, have failed to be reliable predictors or moderators of outcome. However, as Dr. Grilo reports, early non-response to treatment has reliably predicted poor outcomes in several psychological approaches and medication trials as well. The patient who responds rapidly has predictably better chances for a good long-term outcome regardless of the individual treatment approach.

Dr. Grilo notes that early lack of response that is not associated with specific patient characteristics or severity of BED, “is a strong signal to clinicians to consider trying alternative treatments” (J Clin Psychiatry. 2017; 78:7). He further contends that clinicians should be trained to provide patients with BED with evidence-based treatments and suggests greater attention to predictors of response.