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April 24, 2013
Jewish World Review
Ask the Harvard Experts: Are there drugs to help control binge eating?
Michael Craig Miller, M.D.
Binge eating affects 1 percent to 3 percent of people in the United States --- and you can stop
Q: I'm overweight and have a problem with binge eating, although I never purge. I see a nutritionist and started an exercise program, but is there any medicine that can help?
A: Binge eating affects 1 percent to 3 percent of people in the United States. It's not easy to stop. But nutritional support and exercise can improve your chances.
A dozen or more drugs have been studied to treat binging. Research shows modest success. A few drugs target appetite directly. Others treat underlying problems (like depression or anxiety) that may lead to binging.
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There is limited guidance about what drug helps which people. Two drugs, given primarily for weight loss, may also help binge eaters.
Orlistat (Xenical) blocks enzymes that break down fat. The body absorbs less fat, leading to lower weight and lower blood lipid levels. In at least one study, people taking orlistat were better able to quit binging. Side effects -- cramps, gas, and diarrhea -- are usually mild.
Phentermine (Adipex) suppresses appetite. It's the most common drug treatment for obesity. There is some evidence that people taking it binge less. It is a stimulant. But the potential for abuse seems low. Side effects are high blood pressure, heart palpitations, edginess or insomnia.
Antidepressants (venlafaxine, duloxetine), antiseizure (topiramate) and anti-craving (naltrexone, acamprosate) drugs can also affect the biology of appetite. They may curb the impulse to binge. They can also cause weight loss, while providing some relief for depression or anxiety.
Medication is never the most important part of therapy for binge eating. It can nudge you in the right direction. But it's almost never enough on its own. Psychotherapy is usually part of the program. It can help you with behavior change, self-image, or emotional ups and downs, to name a few.
Work with your doctor to find a treatment plan that makes sense for you. Even if you don't lose weight, you will gain many health benefits from better nutrition and more exercise.
(Michael Craig Miller, M.D., is a Senior Medical Editor at Harvard Health Publications. He is an Assistant Professor of Psychiatry at Harvard Medical School and an associate physician at Beth Israel Deaconess Medical Center, Boston, MA.)
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