Implementing AHRQ Effective Health Care Reviews

Helping Clinicians Make Better Treatment Choices

Management of Binge-Eating Disorder in Adults

 

Am Fam Physician. 2017 Mar 1;95(5):324-326.

Author disclosure: No relevant financial affiliations.

Key Clinical Issue

What are the benefits and harms of treatments for adults with binge-eating disorder?

Evidence-Based Answer

Therapist-led cognitive behavior therapy (CBT) reduces binge-eating frequency and increases binge-eating abstinence. (Strength of Recommendation [SOR]: A, based on consistent, good-quality patient-oriented evidence.) In short-term studies (six to 16 weeks), lisdexamfetamine, second-generation antidepressants, and topira-mate increased binge-eating abstinence and reduced binge-eating frequency and eating-related obsessions and compulsions. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Adverse effects of pharmacologic interventions were rarely severe (eTable A).

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eTable A.

Summary of Key Findings for the Adverse Effects of Pharmacologic Interventions to Treat Binge-Eating Disorder

Fluvoxamine vs. placebo

Fluvoxamine was associated with a higher number of events related to GI upset, sympathetic nervous system arousal, and sleep disturbance. ●○○

Lisdexamfetamine vs. placebo

Lisdexamfetamine was associated with greater insomnia (RR = 2.66; 95% CI, 1.63 to 4.31). ●●●

Lisdexamfetamine was associated with a greater risk of headache (RR = 1.63; 95% CI, 1.13 to 2.36). ●●●

Lisdexamfetamine was associated with a higher number of events related to GI upset, sympathetic nervous system arousal, and decreased appetite. ●●○

Topiramate vs. placebo

Topiramate was associated with a higher number of events related to sympathetic nervous system arousal. ●●○

Topiramate was associated with a higher number of other adverse events, including upper respiratory tract infection, taste perversion, difficulty with attention and memory, dizziness, confusion, and back pain. ●●○

No difference was found in the number of headaches. ●●○

No difference was found in the number of events related to GI upset or sleep disturbance. ●○○


Strength of evidence scale

High: ●●● High confidence that the evidence reflects the true effect. Further research is very unlikely to change our confidence in the estimate of effect.

Moderate: ●●○ Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of effect and may change the estimate.

Low: ●○○ Low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of effect and is likely to change the estimate.

Insufficient: ○○○ Evidence either is unavailable or does not permit a conclusion.

CI = confidence interval; GI = gastrointestinal; RR = relative risk.

Adapted from the Agency for Healthcare Research and Quality, Effective Health Care Program. Management and outcomes of binge-eating disorder in adults: current state of the evidence. Executive summary. Rockville, Md.: Agency for Healthcare Research and Quality; May 2016. https://effectivehealthcare.ahrq.gov/ehc/products/563/2212/binge-eating-clinician-160517.pdf. Accessed November 21, 2016.

eTable A.

Summary of Key Findings for the Adverse Effects of Pharmacologic Interventions to Treat Binge-Eating Disorder

Fluvoxamine vs. placebo

Fluvoxamine was associated with a higher number of events related to GI upset, sympathetic nervous system arousal, and sleep disturbance. ●○○

Lisdexamfetamine vs. placebo

Lisdexamfetamine was associated with greater insomnia (RR = 2.66; 95% CI, 1.63 to 4.31). ●●●

Lisdexamfetamine was associated with a greater risk of headache (RR = 1.63; 95% CI, 1.13 to 2.36). ●●●

Lisdexamfetamine was associated with a higher number of events related to GI upset, sympathetic nervous system arousal, and decreased appetite. ●●○

Topiramate vs. placebo

Topiramate was associated with a higher number of events related to sympathetic nervous system arousal. ●●○

Topiramate was associated with a higher number of other adverse events, including upper respiratory tract infection, taste perversion, difficulty with attention and memory, dizziness, confusion, and back pain. ●●○

No difference was found in the number of headaches. ●●○

No difference was found in the number of events related to GI upset or sleep disturbance. ●○○


Strength of evidence scale

High: ●●● High confidence that the evidence reflects the true effect. Further research is very unlikely to change our confidence in the estimate of effect.

Moderate: ●●○ Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of effect and may change the estimate.

Low: ●○○ Low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of effect and is likely to change the estimate.

Insufficient: ○○○ Evidence either is unavailable or does not

Author disclosure: No relevant financial affiliations.

Address correspondence to Juliana Llano, MD, at jal320@georgetown.edu. Reprints are not available from the authors.

REFERENCES

show all references

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013....

2. Agency for Healthcare Research and Quality. Effective Health Care Program. Clinician summary. Management and outcomes of binge-eating disorder in adults: current state of the evidence. Rockville, Md.: Agency for Healthcare Research and Quality; May 2016. https://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageAction=displayproduct&productID=2212. Accessed November 21, 2016.

3. Coffey SF, Banducci AN, Vinci C. Common questions about cognitive behavior therapy for psychiatric disorders. Am Fam Physician. 2015;92(9):807–812.

4. Devlin MJ. Binge-eating disorder comes of age. Ann Intern Med. 2016;165(6):445–446.

5. Yager J, Devlin MJ, Halmi KA, et al; American Psychiatric Association. Guideline watch (August 2012): practice guideline for the treatment of patients with eating disorders. 3rd ed. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/eatingdisorders-watch.pdf. Accessed November 29, 2016.

6. Schlup B, Meyer AH, Munsch S. A non-randomized direct comparison of cognitive-behavioral short- and long-term treatment for binge eating disorder. Obesity Facts. 2010;3(4):261–266.

7. Grilo CM, Masheb RM, Wilson GT, Gueorguieva R, White MA. Cognitive-behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: a randomized controlled trial. J Consult Clin Psychol. 2011;79(5):675–685.

8. Aigner M, Treasure J, Kaye W, Kasper S; WFSBP Task Force on Eating Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of eating disorders. World J Biol Psychiatry. 2011;12(6):400–443.

The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based upon the review. AHRQ's summary is accompanied by an interpretation by an AFP author that will help guide clinicians in making treatment decisions.

See the full review, clinician summary, and consumer summary.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

A collection of Implementing AHRQ Effective Health Care Reviews published in AFP is available at http://www.aafp.org/afp/ahrq.

 

 

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