- Management and Outcomes of Binge-Eating Disorder (BED)
- Objectives. To evaluate the effectiveness and comparative effectiveness of treatments for patients with binge-eating disorder (BED) and bariatric surgery patients and children with loss-of-control (LOC) eating. Studies of BED therapies include pharmacological interventions, psychological and behavioral interventions, or combinations of approaches. We examined whether treatment effectiveness differed in patient subgroups and described courses of illness for BED and LOC eating.
Data Sources. We searched MEDLINE,® EMBASE,® the Cochrane Library, Academic OneFile, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) through 1/19/2015. Eligible studies included randomized controlled trials (RCTs), nonrandomized trials, meta-analyses, and, for course of illness, cohort and case-control studies.
Review Methods. Pairs of reviewers independently selected, extracted data from, and rated the risk of bias of relevant studies; they graded the strength of evidence using established criteria. We conducted meta-analysis for some treatment outcomes.
Results. Of 52 included RCTs of treatment; 48 concerned BED therapy. Course of illness evidence came from 15 observational studies. We examined four major outcomes: binge eating and abstinence, eating-related psychopathology, weight, and general psychological and other outcomes. Second-generation antidepressants (as a class), topiramate (an anticonvulsant), and lisdexamfetamine (a stimulant) were superior to placebo in achieving abstinence and reducing binge episodes and/or binge days and eating-related obsessions and compulsions. Second-generation antidepressants decreased depression. Topiramate and lisdexamfetamine produced weight reduction in study populations that were virtually all overweight or obese. A few formats of cognitive behavioral therapy (CBT)—therapist-led, partially therapist-led, and guided self-help—were superior to placebo in achieving abstinence and reducing binge frequency. CBT for BED was generally ineffective for reducing weight or depression in this population. Therapist-led CBT was not superior to either partially therapist-led CBT or structured self-help CBT for binge-eating and weight outcomes. Behavioral weight loss treatment produced greater weight loss than CBT at the end of treatment but not over the longer run. Topiramate, fluvoxamine, and lisdexamfetamine were associated with sleep disturbance including insomnia; topiramate and lisdexamfetamine were associated with sympathetic nervous system arousal, headache, and GI upset. We found no evidence on bariatric surgery patients. Treatments for LOC eating in children did not achieve superior weight reduction outcomes. Evidence on course of either illness was limited. Early adolescent BED and LOC eating predicts such behaviors in the future.
Conclusions. BED patients may benefit from treatment with second-generation antidepressants, lisdexamfetamine, topiramate, and CBT. Additional studies should address other treatments, combinations of treatment, and comparisons between treatments, treatment for postbariatric surgery patients and children, as well as the course of these illnesses.
- Authors of Report
- Methodology description
- We conducted focused searches of MEDLINE® (via PubMed), EMBASE®, CINAHL (nursing and allied health database), Academic OneFile, and the Cochrane Library. An experienced research librarian used a predefined list of search terms and medical subject headings (MeSH). The librarian completed the searches for the draft report on 6/23/2014; she conducted a second (update) search on 1/19/2015 during peer review.
We searched for relevant unpublished and grey literature, including trial registries, specifically ClinicalTrials.gov and Health Services Research Projects in Progress. AHRQ requested Scientific Information Packets (SIPs) from the developers and distributors of interventions identified in the literature review. We included unpublished studies that met all inclusion criteria and contained enough information to permit us to make a standard risk-of-bias assessment. We searched reference lists of pertinent review articles for studies that we should consider for inclusion in this review, including our earlier review on this topic.
Trained members of the research team reviewed article abstracts and full-text articles. Two members independently reviewed each title and abstract using the predefined inclusion and exclusion criteria. Studies marked for possible inclusion by either reviewer underwent a full-text review. Two members of the team independently reviewed each full-text article. If both reviewers agreed that a study did not meet the eligibility criteria, it was excluded; each reviewer recorded the primary reason for exclusion. If reviewers disagreed, they resolved conflicts by discussion and consensus or by consulting a third member of the review team. We screened unpublished studies and reviewed SIPs using the same title/abstract and full-text review processes. The project coordinator tracked abstract and full-text reviews in an EndNote database (EndNote® X4).
We developed a template for evidence tables using the PICOTS framework and abstracted relevant information into them using Microsoft Excel. We recorded characteristics of study populations, interventions, comparators, settings, study designs, methods, and results. Six trained members of the team participated in the data abstraction. One reviewer initially abstracted the relevant data from each included article; a second more senior member of the team reviewed each data abstraction against the original article for completeness and accuracy.
- The data in this project was entered retrospectively by importing data from Microsoft Excel files.
Abstracted data for this project can be found in the following tabs of the extraction forms: design, baseline, arm details, outcome details, and adverse events when applicable.
All quality data can be found in the Quality Assessments file.
- Funding Source
- Agency for Healthcare Research and Quality (AHRQ)