The advertisement for a drug to treat B.E.D. kept appearing in commercials during our favorite TV series.
“What is B.E.D.? “ I asked but my spouse had no idea. “Bad Energy Day?” he responded. “No,” I answered, “it must have something to do with hunger because the drug is similar to amphetamine.“
Then it hit me. Binge Eating Disorder, that’s what it is. Interesting that a drug to take away hunger has been approved by the FDA. People who binge never eat only from physical hunger. Otherwise they would stop eating when the hunger is gone.“
I treated patients with binge eating disorder but insisted that I would do so only if they were also being seen by a psychotherapist. Even though the major symptom of binge eating disorder is the ingestion of enormous quantities of food in relatively few hours, the disorder is a psychiatric problem. Interventions focus on psychotherapy, along with nutritional advice to undo the weight gained from constant bingeing.
Binge eating disorder may affect as many as 1-5% of Americans, according to the National Eating Disorder Association. In fact it has its own association, BEDA, which offers Internet support and information as well as Internet contact with others who are living with this problem. It is only relatively recently that the binges have been viewed as more than a derangement of appetite, or an inability to adhere to a rational eating plan. People with this disorder feel helpless to prevent themselves from gorging. And because they do not compensate for their high calorie intake by starvation, laxative abuse, vomiting or excessive exercise, they may be morbidly obese. Women are more prone to having this disorder than men and the bingeing is often accompanied with anxiety, depression, guilt and self-loathing. Bingeing can occur several times a week, and sometimes a few times each day.
But bingeing is not the same as being very hungry and unable to stop eating until feeling stuffed. Teenage boys who can clean off a buffet table faster than a swarm of locusts are not bingeing; they just eat an enormous amount of food. Diners on a cruise ship may feel an obligation to eat gigantic quantities of food to compensate for the price of their trip, but they are not bingeing either.
Bingers eat in secret and often they consume only tiny amounts of food when they are eating with others. Moreover, binges are often planned for the time when the eater is alone. The binger goes food shopping so there will be food in the house that the binger enjoys eating. Or she might go to several restaurants in a crowded food court. Ordering take-out food from several restaurants is also done because it is embarrassing to order a large amount of food from the same restaurant all the time. I had a patient who shopped on Thursdays for weekend binges. She turned off her phone, pulled down her shades, and spent from Friday evening to Sunday afternoon eating until her stomach could no longer hold food. Then she would sleep and upon awakening, start bingeing again. She was never hungry. How could she be?
Bariatric surgery might seem to be an obvious solution to halting bingeing and restore normal weight. But according to experts, reducing the size of the stomach, or bypassing it altogether, might cause extreme side effects. Physically limiting the amount of food consumed doesn’t reduce the emotional pain causing the overeating. Without the psychiatric counseling before and following surgery to detect and help the underlying cause of binge eating, the bariatric patient is at risk for consuming much more food than the surgery allows and becoming extremely ill in the process.
In the winter of 2015, the FDA approved Vyvanse for the treatment of B.E.D. The drug is classified as a central nervous system stimulant like amphetamine, and had been already approved in 2007 to treat ADHD. Vyvanse decreases hunger when used for ADHD, and this may have been the reason it was tested on binge eating disorder patients. Two studies were carried out, each for 12 weeks, among 700 people with binge eating disorder. Compared with placebo treated subjects, the drug decreased the number of days each week people binged and also decreased the number of binges each day.
According to eating disorder experts, it is unclear how the drug works to reduce bingeing.(It is important to note that bingeing did not stop entirely in the studies.) Moreover, long-term results have not been reported. Questions to consider are… does the effect of the drug wear off or become even more effective over time? It is possible that the amphetamine-like drug removes the compulsion to eat, thus giving binge eaters a respite from their pathological focus on food. Instead of dealing with the constant bingeing with the guilt and shame of the aftermath, they now have emotional time to deal with the reasons for their overeating. In a sense they are like binge drinkers who go into recovery and while they are abstinent, attempt to deal with the causes for their excessive alcohol intake. It is obvious that helping such people would be useless while they are drinking. And so too, it may be that helping the binge eaters, while they are still bingeing constantly, would also be futile.
Vyvanse is not a magic pill, and its ability to decrease binges does not mean it can decrease the emotional antecedents to the binges. Replacing food as a coping mechanism will require more than a pill that takes away hunger. Eliminating binges is a long, complicated process requiring emotional healing and learning non-eating strategies to deal with future emotional upheavals. Removing hunger is necessary but not sufficient. But at least it is a beginning.