Tackling excess body weight in people with binge eating disorder

Abstract

Binge eating disorder (BED), marked by recurrent binge eating in the absence of compensatory behaviours, is experienced by around 40% of obese people who have an associated increased risk of a number of chronic (e.g. cardiovascular) diseases and allcause mortality (Da Luz et al., 2018). Although reduction of eating disorder (ED) symptoms and weight loss seem two obvious treatment goals for larger bodied people with BED, there are on-going clinical debates regarding the most appropriate treatment goals/ options. The most controversial aspect of these debates concerns dieting to reduce weight. While healthcare professionals specialising in weight-loss often encourage people to reduce their excess body weight through dieting, concerns have often been raised by ED professionals as this challenges a core postulation of ED theories, i.e., that dieting precipitates binge eating (Australia and New Zealand Academy for Eating Disorders, 2018). However, reviewed empirical evidence highlights that moderate and supervised dieting does not induce binge eating in overweight or obese adults and even reduces it in adults engaging in these behaviours (Da Luz et al., 2018). Most of the extant treatment programmes for EDs or excess body weight still tackle only one or the other condition (Da Luz et al., 2018). However, evidence-based psychological therapies for EDs do not address weight loss. Conversely, behavioural weight-loss treatment (BWLT) programmes for overweight or obese people do not address ED pathology, including body image concerns, binge eating and its triggers (i.e. negative emotions) (Da Luz et al., 2017). Therefore, innovative treatments for overweight or obese people with BED are needed that simultaneously address ED pathology and weight loss (through moderate dieting which, as noted, does not seem to induce binge eating). The new multi-disciplinary and manualised therapy ‘Healthy approach to weight management and food in EDs’ (HAPIFED) integrates features of the best available psychological (e.g. enhanced cognitive-behavioural) therapy for BED with BWLT strategies most likely to lead to long-term weight loss and approaches aiming at increasing appetite awareness and reducing eating as a means of regulating emotions. A detailed description of HAPIFED, developed for all people with BED who are overweight or obese, is provided elsewhere (Da Luz et al., 2017). Supplementary Table 1 summarises the treatment components of BWLT and HAPIFED. Although the acceptability and utility of HAPIFED in reducing weight and ED pathology (including binge eating and body image concerns) at the end of treatment was shown (Da Luz et al., 2017), clinical trials need to test the long-term effectiveness of HAPIFED, which can be attractive to overweight or obese people with comorbid BED who view absence of ED pathology and weight loss as important treatment goals (Da Luz et al., 2018).