LAS VEGAS — Adding a weight-loss medication to cognitive-behavioral therapy for binge eating disorder produced a higher remission rate and greater weight loss than cognitive-behavioral therapy alone in a randomized, double-blind, placebo-controlled trial.
More than a third (36%) of 25 obese binge eaters had a 5% weight loss with the combination of cognitive-behavioral therapy (CBT) and orlistat (Xenical), Carlos M. Grilo, Ph.D., reported at the annual meeting of North American Association for the Study of Obesity.
Fewer patients in the control group met the 5% standard for weight loss: only 8%, compared with the 36% of patients on combined therapy. The control group of 25 patients received CBT and a placebo.
Remission was achieved by nearly two-thirds (64%) of the combination therapy group during the 12-week study, and 52% were still in remission 3 months after the end of treatment, according to Dr. Grilo, director of the eating disorder program in the department of psychiatry at Yale University, New Haven.
In the control group, only 36% achieved remission, which was defined as no binge eating for at least 28 consecutive days.
The dosage of orlistat used in the combined therapy group was 120 mg, three times a day.
The average weight loss of 4·4 kg in the combined therapy group was small, but it was encouraging because helping binge eaters to achieve any degree of weight loss has been a major challenge. “This may appear modest, but with this patient group, it is a promising first step,” Dr. Grilo said at the meeting, which was cosponsored by the American Diabetes Association. The control group lost less weight on average—only 1·9 kg.
The Eating Disorder Examination interview was used to assess outcomes. After patients finished the program, they were encouraged to stay on a three-meal, three-snack-a-day regimen.
The trial enrolled 50 consecutive obese patients, mean age 47, who met strict criteria for binge eating. Predominantly white and female, the population averaged 13·5 binge-eating episodes per month and had an average body mass index of 36 kg/m2. Sixty percent had at least one additional psychiatric disorder, the most common of which was major depression.
“The severity of our patients is similar to most CBT trials and greater than most medication trials,” Dr. Grilo said. In both arms of the study, he noted, 78% of patients completed the treatment.
CBT was the same for both groups, and it consisted primarily of guided self-help with six individual meetings.
CBT has been the best-established treatment for binge eating to date, but it has produced modest results, according to Dr. Grilo.
“The cognitive-behavioral therapy guided self-help was given by specialists—doctoral-level research clinicians with experience in CBT as well as obesity and eating disorders,” Dr. Grilo said. “It's unknown whether similar outcomes would be seen with generalists.”
The approach needs to be extended to other patient groups, especially diabetic binge eaters who were excluded from the study, he said. Longer follow-up, as well as replication of the trial, is also needed.