Wednesday, October 26, 2022

Behavioral Therapy Plus Naltrexone-Bupropion Combination May Reduce Binge Eating

A combination of behavioral weight loss therapy and the medications naltrexone and bupropion appears to reduce symptoms of binge-eating disorder in people with comorbid obesity, according to a report in AJP in Advance.

“[T]he effectiveness of [behavioral weight loss therapy] for binge-eating disorder was observed across broad outcomes reflecting eating, psychological, and metabolic clinical domains,” wrote Carlos Grilo, Ph.D., a professor of psychiatry and psychology at of Yale University, and colleagues. Grilo is also director of the Program for Obesity, Weight and Eating Research at Yale.

Participants were recruited through advertisements and were included if they met DSM-5 criteria for binge-eating disorder, were age 18 to 70 years, and had a body mass index (BMI) between 30.0 and 50.0 (or at least a BMI of 27.0 with obesity-related comorbidity). The Eating Disorder Examination interview was used to assess binge-eating frequency and eating disorder psychopathology at baseline and following treatment. Weight and height were measured at baseline, and weight was measured at monthly and posttreatment assessments.

A total of 136 participants were randomized to one of four 16-week treatments: placebo (n=34), naltrexone-bupropion (n=32), behavioral weight loss therapy plus placebo (n=35), or behavioral weight loss therapy plus naltrexone-bupropion (n=35). Behavioral weight loss therapy was delivered in individual 45-minute sessions. Behavioral techniques included goal setting, monitoring food intake and physical activity, stimulus control to achieve and maintain the lifestyle changes, and problem-solving skills to overcome challenges.

A total of 57.1% of patients in the behavioral weight loss therapy plus naltrexone-bupropion group achieved remission (defined as no episodes of binge eating during the previous 28 days). Remission rates were 17.7% in the placebo group, 31.3% in the naltrexone-bupropion group, and 37.1% in the behavioral weight loss therapy plus placebo group. The rates of participants who achieved at least 5% weight loss were 11.8% in the placebo group, 18.8% in the naltrexone-bupropion group, 31.4% in the behavioral weight loss therapy plus placebo group, and 38.2% in the behavioral weight loss therapy plus naltrexone-bupropion group.

“These findings are encouraging given the well-known difficulty in producing weight loss in patients with binge-eating disorder and comorbid obesity,” the authors concluded.

For related information, see the Psychiatric News article “Eating Disorders: Current Knowledge and Treatment Update.”

(Image: iStock/KathrynHatashitaLee)

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