Appetite Suppressants for Binge Eating Disorder: Insights into their Use
Binge Eating and Appetite
Binge eating disorder (BED) is characterized by a loss of control when eating. Individuals often report feelings of guilt, anxiety, sadness and bingeing until they feel sick. However, when common treatments such as cognitive behavior therapy, interpersonal therapy, and dialectical behavior therapy are used, there is little or no weight loss from the treatment. But many who seek treatment for BED are concerned about their weight.
Due to this concern, some appetite suppressants have been used to help weight loss and decrease bingeing episodes. A couple have been found to be unsafe, but one, even though it is not a true appetite suppressant, has been approved to be sold over the counter.
Trials and Tribulations
In the 1990s, appetite suppressants for binge eating disorder began to be used as a treatment. The first appetite suppressant was called redux, but it was found that there were unacceptable risks associated with its use. Then, clinical trials began to focus on sibutramine which helped with weight loss and reduced binge eating episodes. But in 2008 it was taken off the market in the United States, Canada, and the United Kingdom. While it tested well in clinical trials, the risks of stroke and cardiovascular disease outweighed the benefits.
Currently, the main drug used to treat weight loss and binge eating episodes orlistat which affects the body’s ability to absorb fat. Normally, stomach enzymes called lipases break down fats so that they can be absorbed from your digestive tract. Orlistat binds to and inhibits the action of these enzymes so that there is less fat available to be absorbed - it is excreted instead.
When orlistat was used to help people lose weight, a meta-analysis found that those who used it lost 2.8-3.2kg more than the placebo group. Two studies published in Obesity Research and Biological Psychiatry found that orlistat helped to control binge eating when compared to a placebo group.
Additional Appetite Suppressants
There are a few additional appetite suppressants which are being considered for use in treating binge eating disorder. Some examples are topiramate and zonisamide. However, they have unwanted side effects which include cognitive impairment and tingling or numb skin. Though they have been shown to help short term weight loss, side effects keep them from being regularly prescribed. However, topiramate is used to treat binge eating disorder in some cases.
While true appetite suppressants for binge eating disorder help weight loss and reduce episodes of binge eating, the risks are seen to outweigh the benefits. Other prescription drugs such as topiramate and zonisamide which have similar effects as appetite suppressants have many unwanted side effects. Orlistat is the only medication, now available over the counter, which helps weight loss and reduces binge eating episodes.
NB: The content of this article is for information purposes and is not intended to replace sound medical advice and opinion.
Coutinho, W. (2009). The first decade of sibutramine and orlistat: a reappraisal of their expanding roles in the treatment of obesity and associated conditions. Arq Bras Endocrin Metabol, 53(2), 262-270.
Golay, A., Laurent-Jaccard, A., Habicht, F., Gachoud, J. P., Chabloz, M., & Kammer, A. (2005). Effect of orlistat in obese patients with binge eating disorder. Obesity Research, 13(10), 1701-8.
Grilo, C. M., Masheb, R. M., & Salent, S. L. (2005). Cognitive behavior therapy guided self-help and orlistat for the treatment of binge eating disorder: a randomized, double-blind, placebo-controlled trial. Biological Psychiatry, 57(10), 1193-1201.
Yager, J. (2008). Binge Eating Disorder: The Search for Better Treatments. American Journal of Psychiartry, 165(1), 4-6.