Background: Binge eaters differ from overeaters because they do not have control over their behavior. It is not simply overindulging, or an addiction problem, but binge eaters are compelled to overeat. This presentation will explore many of the "weight loss" medications that are on the market, most of which are ineffective.
I Overview of Binge Eating Disorders
II Pharmacological Management of Obesity
Neural Circuits
Phenylethylamine
Noradrenaline
Amphetamine
Lisdextroamphetamine
Atomoxatine
Phentermine
Antidepressants
Tricyclic
SSRI
Others
Sibutramine
Bupropion
Fenfluramine
Bupropion/ Naltrexone (Contrave®)
Naltrexone (Vivitrol®)
Phenteramine/ Topiramate
Bupropion/ Zonisamide (Empatic®)
Acamprosate (Campral®)
Binge eaters differ from overeaters because they do not have control over their behavior. It is not simply overindulging, a bad habit or poor overall self-control, but binge eaters are compelled (pressure by an internal force or drive seemingly beyond their control) to overeat. The DSM-5 describes this behavior as recurrent episodes marked by a feeling of lack of control even when he or she is not hungry. Regardless of how full the person may feel, the binge eater is hardwired to chemically reward themselves by overeating highly palatable foods (if available) when tempted beyond the point of caloric need. Neuronal circuits and neural loci (nuclei) that mediate reward, motivation, decision making, impulse control and mood are overridden or distorted when a person wants or needs to control his/her mood or compulsion for a particular trigger food (which may be more related to sensory criteria than chemical makeup). The physiological process underlying hedonic eating is not fully understood. Binge eaters are compelled to eat and there is activation of the same regions of the brain as an alcoholic or drug addict.
This behavior does not necessarily indicate it is an addiction problem, but could lie anywhere along the continuum of a conditioned response, urge, craving, obsession, compulsion, abuse or dependence. Highly palatable food alone does not address and explain why bingers when in their “binge state” will massively consume bland veggies, uncooked macaroni, spoiled foods or even pick items scavenged out of garbage cans. So far there is little known about the “best practice interventions”. Research is inconclusive due to the high placebo rates of treatment for BED in research designs. The medications used in the treatment of substance abuse may have utility in understanding these chemical reward systems. This presentation will explore many of the “weight loss” medications that are on the market from antidepressants, anticonvulsants and opioid receptor antagonists.
Dr. Carson has been involved in the clinical treatment of obesity, addictions and eating disorders for over 35 years. Dr Carson graduated from Duke and Duke University Medical School and received his doctorate at Auburn University. He is currently the Executive Director of FitRx, an intensive outpatient treatment program addressing people of size located near Nashville, TN. Dr Carson is an active Board member of iaedp and the Binge Eating Disorder Association (BEDA). He is the author of "Harnessing the Healing Power of Fruits" and the recently published "The Brain Fix: What’s the Matter with Your Gray Matter?"
Dr. Kevin Wandler has been the Medical Director at Remuda Ranch Treatment Centers for 18 years. He specializes in the treatment of women with eating disorders and co-occurring conditions. He is Board Certified in Psychiatry; has added qualification from the American Board of Psychiatry and Neurology in Addiction Medicine; and has certification from the American Society of Addiction Medicine. In addition, Dr Wandler is an iaedp Fellow and CEDS certified. Dr Wandler is the current President of iaedp. Dr. Wandler presents frequently at national eating disorder and chemical dependency conferences.
