Management and Outcomes of Binge-Eating Disorder in Adults: Current State of the Evidence - Clinician Summary | AHRQ Effective Health Care Program

Management and Outcomes of Binge-Eating Disorder in Adults: Current State of the Evidence - Clinician Summary | AHRQ Effective Health Care Program

Clinician Summary – May 24, 2016

Management and Outcomes of Binge-Eating Disorder in Adults: Current State of the Evidence

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Table of Contents

• Focus of This Summary
• Background
• Conclusions
• Overview of Clinical Research Evidence
• Gaps in Knowledge and Limitations of the Evidence Base
• Applicability
• What To Discuss With Your Patients
• Source
• Appendixes

Focus of This Summary

This is a summary of a systematic review evaluating the evidence regarding the effectiveness, comparative effectiveness, and adverse effects of treatments for adults with binge-eating disorder (BED). The review assessed psychological interventions, behavioral weight-loss treatment, and pharmacological interventions. The systematic review included 57 studies and one systematic review published through January 19, 2015. This summary is provided to assist in informed clinical decisionmaking. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Background

In May 2013, the American Psychiatric Association (APA) recognized BED as a distinct eating disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the shift from provisional to formal diagnosis of BED, the APA changed the criteria for frequency and duration of BED based on the expanded peer-reviewed literature, thereby bringing both criteria in line with those for bulimia nervosa (see the full DSM-5 criteria in Appendix 1 below).

The lifetime prevalence of BED among adults in the United States is 2.8 percent based on DSM-IV criteria; it is likely to be slightly higher based on DSM-5 criteria. BED tends to be slightly more common in women and is more common among individuals who are overweight or obese.

BED is associated with significant impairment in roles related to education or employment and dissatisfaction with personal relationships. It is also considered a substantial health problem separate from obesity and may be independently related to chronic pain, other psychiatric disorders, and diabetes.

BED treatment includes various approaches that target the core behavioral and psychological features of the condition and mood regulation. Psychological and behavioral therapy interventions include cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and dialectical behavior therapy (DBT). Descriptions of all these interventions are given in Appendix 2. In January 2015, the U.S. Food and Drug Administration (FDA) approved lisdexamfetamine, a central nervous system stimulant, as a treatment for BED. Other commonly used pharmacological interventions include anticonvulsants and antidepressants.