Binge eating disorder: Evidence-based treatments.

Binge eating is consumption of an unusually large amount of cod coupled with a feeling of loss of control over eating. Binge eating disorder (BED) is characterized by recurrent episodes of binge eating without inappropriate compensatory behaviors (eg, self-induced vomiting, misuse of laxatives, diuretics, or other agents, excessive exercise) (1) It is the most common eating disorder in the United States, with a lifetime prevalence of approximately 3.5% in women and 2% in men. (2) The diagnosis falls within the DSM-IV-TR category of eating disorders not otherwise specified, (1) but clinicians often view it as a distinct clinical phenomenon. In DSM-IV-TR, an individual would meet criteria for BED if he or she engages in regular binge eating behavior in the absence of recurrent compensatory behaviors [greater than or equal to] 2 days per week over 6 months. (1) Proposed changes for DSM-5 recognize a distinct BED diagnosis, reduce the frequency criterion to once per week and the duration criterion to the past 3 months, and shift the focus from binge days to binge episodes (Table 1, page 34). (3) Table 1 Proposed DSM-5 criteria for binge eating disorder A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances 2. a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating) B. The binge-eating episodes are associated with [greater than or equal to]3 of the following: 1. eating much more rapidly than normal 2. eating until feeling uncomfortably full 3. eating large amounts of food when not feeling physically hungry 4. eating alone because of feeling embarrassed by how much one is eating 5. feeling disgusted with oneself, depressed, or very guilty afterwards C. Marked distress regarding binge eating is present D. The binge eating occurs, on average, at least once a week for 3 months E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake disorder Source: Reference 3 [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] BED can occur in individuals of all body mass indices (BMI), but is common among individuals who are overweight or obese as well as those with depression or type 2 diabetes; BED can complicate treatment of these conditions. (2), (4), (5) Primary treatment goals are: * abstinence from binge eating * improved psychological functioning * appropriate weight regulation in overweight patients. We report on 3 approaches to BED treatment: medication only, behavioral intervention only, and medication plus behavioral intervention. This article provides insights about emerging changes in diagnostic criteria for BED as well as evidence-informed treatment options and recommendations. The evidence base We conducted a review of 23 BED studies: 7 medication only, 5 medication plus behavioral, and 11 behavioral only. We focused on studies conducted since September 2005 that included binge frequency, weight, and depression as primary outcomes (see Berkman et al (6) for a review of BED treatment studies before 2005). The studies included 2,527 participants (2,216 women and 311 men). Although the sex distribution of BED in the general population tends to slightly favor women,2 the proportion of women presenting for treatment generally is considerably higher than that of men. In studies that reported on race and/ or ethnicity, 1,639 participants were identified as white, 191 as African American, 25 as Hispanic, 2 as Asian, 1 as Native American, and 25 as "other. …