orlistat and Binge-Eating-Disorder

Binge eating disorder (BED) is characterized by recurrent binge eating and marked distress about binge eating without the extreme compensatory behaviors for weight control that characterize other eating disorders. BED is prevalent, associated strongly with obesity, and is associated with heightened levels of psychological, psychiatric, and medical concerns. This article provides an overview of randomized controlled treatments for combined psychological and pharmacological treatment of BED to inform current clinical practice and future treatment research. In contrast to the prevalence and significance of BED, to date, limited research has been performed on combining psychological and pharmacological treatments for BED to enhance outcomes. Our review here found that combining certain medications with cognitive behavioral therapy (CBT) or behavioral weight loss (BWL) interventions produces superior outcomes to pharmacotherapy only but does not substantially improve outcomes achieved with CBT/BWL only. One medication (orlistat) has improved weight losses with CBT/BWL albeit minimally, and only one medication (topiramate) has enhanced reductions achieved with CBT in both binge eating and weight. Implications for future research are discussed.

Topics: Anti-Obesity Agents; Binge-Eating Disorder; Bulimia Nervosa; Cognitive Behavioral Therapy; Fructose; Humans; Lactones; Obesity; Orlistat; Randomized Controlled Trials as Topic; Topiramate; Weight Loss

This study was a randomized placebo-controlled trial testing the addition of orlistat to behavioral weight loss for obesity in Spanish-speaking-only Latino/as with versus without binge eating disorder (BED) performed at a community mental health center serving educationally- and economically-disadvantaged patients. Latino/as have high rates of obesity but are under-represented in obesity treatment studies and despite comparable-to-or-higher rates of BED than Whites, Latino/as are under-represented in BED treatment studies. BED is associated with obesity but whether it predicts/moderates treatment outcomes remains uncertain. Thus, this study also tested whether BED prospectively predicts/moderates outcomes.. Seventy-nine obese Spanish-speaking-only Latino/as with BED (N=40) versus without BED (N=39) at a community mental health center were randomly assigned to four-months of orlistat-plus-BWL or placebo-plus-BWL. BWL was culturally-enhanced modification of Diabetes-Prevention-Program delivered in weekly sessions in Spanish. Orlistat (120 mg tid) and matching-placebo delivered with standard clinical-management. Participants were assessed independently throughout treatment, post-treatment, and six-month follow-up.. 78% completed treatments; completion rates did not differ significantly by medication or BED. Intent-to-treat mixed-models analyses revealed significant improvements in binge eating, eating-psychopathology, and depression, and significant--albeit modest--weight-loss. Overall, the addition of orlistat to BWL was not associated with greater improvements; however, BED moderated weight-loss: orlistat-plus-BWL produced significantly greater weight-loss in non-BED group but not in BED. Improvements were maintained through 6-month follow-up; BED significantly predicted/moderated increases in eating concerns and depression following treatment. Within BED-group, binge-eating remission rates were 65% (post-treatment) and 50% (follow-up).. In this controlled trial performed at community mental health center serving educationally- and economically-disadvantaged Spanish-speaking-only Latino/as with co-morbid psychiatric needs, we observed outcomes for the BWL plus orlistat/placebo medication that approximate or are slightly dampened relative to the literature for efficacy trials with much more restrictive obese and BED samples. In this complex patient group, adding orlistat to BWL produced greater weight-loss than adding placebo among obese patients without BED but not among those with BED. Although 50% of BED patients maintained abstinence from binge-eating following these specific obesity treatments (BWL plus orlistat/placebo), BED was a negative prognostic indicator for some outcome variables.. clinicaltrials.gov Identifier: NCT00516919.

Topics: Adult; Aged; Anti-Obesity Agents; Binge-Eating Disorder; Community Mental Health Centers; Female; Health Behavior; Hispanic or Latino; Humans; Lactones; Male; Middle Aged; Obesity; Orlistat; Poverty Areas; Treatment Outcome; Weight Loss; Young Adult

To examine whether changes in different aspects of dietary restraint in obese patients with binge eating disorder (BED) participating in a treatment study predict outcomes.. Fifty obese patients with BED in a randomized controlled study of orlistat administered with cognitive-behavioral therapy, guided-self-help (CBTgsh) completed dietary restraint measures at baseline, during- and post-treatment, and three-month follow-up.. Change in the restraint scale of the Eating Disorder Examination-Questionnaire did not predict binge abstinence or 5% weight loss. Increased flexible restraint subscale of the Three Factor Eating Questionnaire (TFEQ) during treatment significantly predicted binge abstinence at post-treatment and three-month follow-up and 5% weight loss at post-treatment. Change in the rigid restraint subscale of the TFEQ predicted binge abstinence at post-treatment.. Our findings clarify further pathologic and adaptive aspects of restraint and suggest the importance of enhancing flexible restraint in order to improve both binge eating and weight loss outcomes.

Topics: Adult; Anti-Obesity Agents; Binge-Eating Disorder; Cognitive Behavioral Therapy; Diet; Feeding Behavior; Female; Follow-Up Studies; Humans; Lactones; Male; Middle Aged; Obesity; Orlistat; Predictive Value of Tests; Self Care; Surveys and Questionnaires