In binge-eating disorder, behavioral weight loss therapy (BWL) with or without naltrexone-bupropion is associated with significant improvements to binge eating behaviors and weight loss. These study results were published in AJP in Advance.
Patients (N=136; mean age, 46.5 [SD, 12.23] years, 81.6% women; 77.9% White) with binge eating disorder and body mass index between 30.0 and 50.0 kg/m2 were recruited from Yale University between 2017 and 2021. Study participants were randomly assigned to receive either two 8 mg naltrexone and 90 mg sustained-release bupropion tablets twice a day (n=32), BWL plus naltrexone-bupropion (n=35), BWL plus placebo (n=35), or placebo (n=34) for 16 weeks. The BWL intervention was delivered individually in a 45-minute session and focused on gradual lifestyle changes in caloric intake, nutrient quality, and physical activity. The primary outcomes were changes in binge eating behaviors and weight. Binge eating remission was defined as no binge eating episodes in the previous 28 days.
The study population included whose binge eating onset occurred at a mean age of 28.32 (SD, 13.40) years, and 31.7% had more than a college education.
Remission from binge eating was achieved by 31.3% of the naltrexone-bupropion recipients, 57.1% of the BWL and naltrexone-bupropion recipients, 37.1% of the BWL and placebo recipients, and 17.7% of the placebo recipients. For remission, BWL (χ2, 7.45; P =.006) and naltrexone-bupropion (χ2, 4.18; P =.004) both had a significant effect. Patients who received BWL (odds ratio [OR], 2.84; 95% CI, 1.34-6.03) and naltrexone-bupropion (OR, 2.19; 95% CI, 1.03-4.63) were more likely to achieve remission compared with patients who did not receive BWL or naltrexone-bupropion, respectively.
Throughout the study, there was a BWL-by-time interaction (F[4,407], 5.99; P <.0001) and naltrexone-bupropion-by-time interaction (F[4,407], 2.57; P =.04) on the frequency of binge eating.
The rates of achieving at least 5% weight loss at the post-treatment assessment were 18.8% for the naltrexone-bupropion recipients, 37.1% for the BWL and naltrexone-bupropion recipients, 31.4% of the BWL and placebo recipients, and 11.8% of the placebo recipients. For weight loss, only BWL had a significant effect (χ2, 6.36; P =.01). Patients who received BWL were more likely to achieve weight loss of at least 5% than patients who did not receive BWL (OR, 2.97; 95% CI, 1.27-6.91).
Throughout the study, there was a BWL-by-time interaction on the percent of weight loss (F[3,111], 10.70; P <.0001).
For secondary outcomes of eating disorder psychopathology scores, depression scores, eating behaviors, and cholesterol levels, BWL interventions consistently had more favorable outcomes than the interventions without BWL.
The study may have been limited by the small cohort sample sizes and by not including a BWL only cohort.
Study authors concluded, “BWL and naltrexone-bupropion were associated with significant improvements in patients with binge-eating disorder and obesity, with BWL demonstrating superior improvements.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Grilo CM, Lydecker JA, Fineberg SK, Moreno JO, Ivezaj V, Cueorguieva R. Naltrexone-bupropion and behavior therapy, alone and combined, for binge-eating disorder: randomized double-blind placebo-controlled trial. Am J Psychiatry. 2022;appiajp20220267. doi:10.1176/appi.ajp.20220267