Behavioral Therapy Plus Naltrexone-Bupropion Combination May Reduce Binge Eating
Written By: Dr. Luca Lavagnino
Binge Eating Disorder (BED) is the most common eating disorder in the United States. It is characterized by recurrent (i.e. weekly) episodes of overeating with a sense of loss of control. It is often associated with embarrassment and shame, leading frequently to conditions such as anxiety and depression, and reluctance to seek help. Furthermore, BED is associated with high body weight and comorbid medical conditions, including type 2 diabetes. It poses formidable challenges to diet and lifestyle changes that are needed to address medical conditions, and the development of effective treatment approaches is crucial.
Specific psychotherapeutic approaches have been developed for BED: the evidence for cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT) in BED is well-established, and other therapies, such as Acceptance and Commitment Therapy, Dialectical Behavior Therapy, and mindfulness-based interventions have shown promising results. However, it is often difficult for patients to have access to professionals that are trained in these treatments, and there are aspects of the problem (i.e. losing weight gained through overeating) that are often resistant to psychotherapy. Lisdexamfetamine is the only FDA-approved medication for the treatment of BED at this time. It has been shown to reduce both BED symptoms and body weight, but its use is contraindicated for persons with a history of substance misuse. Many patients do not benefit even from the best available treatments of BED, and it is currently unclear whether medications can have a synergistic effect with psychotherapeutic interventions. There is clearly a need for research on novel pharmacological interventions and combination strategies for the treatment of BED, especially treatments that can address both binge eating and overweight/obesity.
In a recent paper, Grilo and colleagues tested the effectiveness of an FDA approved obesity medication, a naltrexone-bupropion combination, and behavioral weight loss therapy (BWL), a psychological treatment for BED. BWL was delivered in weekly sessions focused on gradual behavioral lifestyle changes including caloric decreases with a goal of 1500 kcal/day and increase in physical activity, and included weekly homework assignments. The authors tested the medication against placebo alone, and in combination with BWL, allowing to uncover the separate effects of the psychological and pharmacological treatment on binge eating. A sample 136 subjects with overweight/obesity and BED was enrolled and evaluated for changes in their symptoms and their weight over a 16-week period. Results showed that binge eating remission rates (defined as zero binge episodes in the previous 28 days) were 17.7% for the placebo group, 31.3% for the naltrexone-bupropion group, 37.1% for the BWL+placebo group, and 57.1% for the BWL+naltrexone-bupropion group. The statistical analysis showed that BWL was associated with nearly three times higher odds of remission, whereas naltrexone-bupropion was associated with roughly two times higher odds of remission. BWL was superior to no BWL in inducing 5% or more weight loss, while medication had no significant effect on weight.
It is important to note that some people might have contraindications to treatment with naltrexone (e.g. individuals treated with opioids) and bupropion (i.e. subjects with seizures), and might thus not be able to receive this treatment.
Also worth noting is that the dietary indications that are part of BWL are quite restrictive (1500 kcal/day) and might be difficult to follow.
In conclusion, the study by Grilo et al. reports on a novel combined treatment (medication + behavioral intervention) for BED that leads to improvement in both binge eating and overweight. Overall, BWL demonstrated superior improvements compared to naltrexone-bupropion. Future studies will help to better establish which people are most likely to benefit from this treatment and what its role is in the context of currently available treatments for BED.