Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis

Abstract

Background: The best treatment options for binge-eating disorder are unclear.

Purpose: To summarize evidence about the benefits and harms of psychological and pharmacologic therapies for adults with binge-eating disorder.

Data sources: English-language publications in EMBASE, the Cochrane Library, Academic OneFile, CINAHL, and ClinicalTrials.gov through 18 November 2015, and in MEDLINE through 12 May 2016.

Study selection: 9 waitlist-controlled psychological trials and 25 placebo-controlled trials that evaluated pharmacologic (n = 19) or combination (n = 6) treatment. All were randomized trials with low or medium risk of bias.

Data extraction: 2 reviewers independently extracted trial data, assessed risk of bias, and graded strength of evidence.

Data synthesis: Therapist-led cognitive behavioral therapy, lisdexamfetamine, and second-generation antidepressants (SGAs) decreased binge-eating frequency and increased binge-eating abstinence (relative risk, 4.95 [95% CI, 3.06 to 8.00], 2.61 [CI, 2.04 to 3.33], and 1.67 [CI, 1.24 to 2.26], respectively). Lisdexamfetamine (mean difference [MD], -6.50 [CI, -8.82 to -4.18]) and SGAs (MD, -3.84 [CI, -6.55 to -1.13]) reduced binge-eating-related obsessions and compulsions, and SGAs reduced symptoms of depression (MD, -1.97 [CI, -3.67 to -0.28]). Headache, gastrointestinal upset, sleep disturbance, and sympathetic nervous system arousal occurred more frequently with lisdexamfetamine than placebo (relative risk range, 1.63 to 4.28). Other forms of cognitive behavioral therapy and topiramate also increased abstinence and reduced binge-eating frequency and related psychopathology. Topiramate reduced weight and increased sympathetic nervous system arousal, and lisdexamfetamine reduced weight and appetite.

Limitations: Most study participants were overweight or obese white women aged 20 to 40 years. Many treatments were examined only in single studies. Outcomes were measured inconsistently across trials and rarely assessed beyond end of treatment.

Conclusion: Cognitive behavioral therapy, lisdexamfetamine, SGAs, and topiramate reduced binge eating and related psychopathology, and lisdexamfetamine and topiramate reduced weight in adults with binge-eating disorder.

Primary funding source: Agency for Healthcare Research and Quality.

Figure 1

Effect of therapist-led cognitive behavioral therapy on abstinence from binge eating. RR = risk ratio.

Figure 2

Effect of lisdexamfetamine, 50 or 70 mg/d (top), and second-generation antidepressants (bottom) on abstinence from binge eating. RR = risk ratio.

Appendix Figure 1

Analytic framework for treatment effectiveness and harms. BMI = body mass index; GERD = gastroesophageal reflux disease; KQ = key question. * Effectiveness of treatment. † Differences between subgroups.

Appendix Figure 2

Flow diagram. AHRQ = Agency for Healthcare Research and Quality. * The figure was adapted from a larger report. Not all studies assessed for risk of bias are accounted for at the bottom of the figure because some populations are not included in the analysis in this article. † Three studies (3 articles) also are included for binge-eating disorder treatment (key questions 1, 2, and 3) synthesis.