We all can remember a time when we ate bowl after bowl of ice cream without planning to. Or felt so stuffed after three helpings of Thanksgiving sweet potato casserole that we wished we were wearing baggy sweatpants. For people with binge eating disorder (BED), however, out-of-control eating happens often—at least once a week.
BED can lead to major feelings of depression, guilt, and shame. It also increases risk for certain health conditions, such as obesity and type 2 diabetes. There are treatments that can help, however. And most recently, the medication semaglutide has shown promise.
To learn more details about BED and the latest research about treatments, read on.
What is binge eating disorder?
BED is the most common eating disorder in America. It affects an estimated 2.3% of women and 0.3% of men, research shows. Unlike bulimia, in which people eat large amounts of food and then purge the food by vomiting or using laxatives (or in some cases, by over-exercising to avoid weight gain), BED involves overeating without the purging element.
“Binge eating disorder involves compulsive eating that is connected to the reward center in the brain,” says Cathy Epps, PharmD, Chief Pharmacist with ReflexMD. “It has a different set of drivers than bulimia.” Feelings of extreme shame often follow bouts of uncontrolled eating. This leads to restricted eating, which then can trigger another round of compulsive overeating, creating an endless cycle.
This disorder can affect anyone at any age. However, BED most commonly occurs in teens and people in their 20s. The average age of onset is 21, according to the National Institute of Mental Health.
If binge eating is a concern, semaglutide can help.
Symptoms of BED include eating an unusually large amount of food—often thousands of calories, very quickly, even when you’re not hungry—until you are uncomfortably full. People with BED experience extreme distress about their behavior. They most commonly overeat when they are alone, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Friends and family may have no idea they are dealing with this mental health condition.
The connection between BED, obesity, and diabetes
People of any size can have BED, but it’s more common in those who have obesity. And there’s a strong correlation between BED and type 2 diabetes.
One recent study found that around 20 percent of people with type 2 diabetes have an underlying eating disorder, most commonly BED. This may be because of the focus on food control and weight management needed to manage diabetes, according to NIDDK.
There also may be a reverse connection at play. In those who have BED, excessive weight gain can contribute to a diabetes diagnosis.
Current treatments for BED
Getting compulsive overeating under control often takes a combination of medication and talk therapy. Cognitive behavioral therapy (CBT), research has found, is a recommended treatment. It involves recognizing the thoughts and triggers that lead to compulsive eating. It also means learning different ways to cope and to normalize eating.
Doctors prescribe different medications to treat BED, depending on the person’s health and other conditions, such as depression, anxiety, or substance abuse. Some SSRI antidepressants can help, though they can come with a range of side effects. An anticonvulsant called topiramate (used to treat epilepsy) has been used off-label to treat the disorder. Right now, the only FDA-approved medication to treat BED is lisdexamfetamine.
“This is a medication for ADHD that also acts as an appetite suppressant,” Dr. Epps explains. It’s been effective. But it’s also a controlled substance with the potential to become addictive. And in recent years, there have been chronic shortages of the medication.
The role of semaglutide in BED treatment
There is a new game in town for treating BED. A few preliminary studies over the past few years have shown the potential of glucagon-like peptide (GLP-1) medications, including semaglutide, for treating BED, with minimal side effects. That said, much more research needs to be done.
Along with their effects on insulin and blood sugar, these medications work by both slowing digestion and sending signals to your brain about hunger and fullness. Side effects mainly include GI issues, such as constipation, diarrhea, and nausea.
One retrospective study of 98 patients attending an obesity clinic found that those taking semaglutide had a significantly greater reduction in binge eating compared with those treated with lisdexamfetamine and topiramate.
Other GLP-1s may also help. A recent review found that GLP1-RAs such as liraglutide show promise in reducing how often people binge eat, their body weight, and comorbidities. This is possibly due to changes in how the brain signals the body that it’s full as well as its food reward pathway.
“GLP-1 seems to have great potential for treatment of these disorders,” says Dr. Epps. “It slows motility in the GI tract, and it gives that vagal response in which it goes up to your brain and tells you, Hey, you’re full, so stop eating!”
Some of the research is showing that GLP-1 also suppresses the reward impulse in the brain in BED, she points out. It may also work on reducing compulsive behavior.
Unlike lisdexamfetamine, GLP-1 is not a controlled substance. It also has other health benefits, primarily controlling blood sugar and aiding in weight loss, as well as potentially lowering the risk of heart and kidney disease, studies show.
More work needs to be done, adds Dr. Epps. “There aren’t any clear, double-blind, placebo-controlled studies right now, but there is definitely promising information coming out, and there is great potential for it,” she says.
The bottom line on BED and semaglutide
For people whose body weight and health conditions qualify them to take semaglutide (generally that includes those with type 2 diabetes or a body weight in the overweight or obesity range, according to Mayo Clinic), the medication may also have the added benefit of getting binge eating disorder under control.
It’s important to remember that the drug works in conjunction with behavioral changes. “Hopefully, if someone has been on semaglutide therapy and they’re also receiving cognitive behavior therapy, by the end of the treatment, they will be in a different headspace and will have new coping behaviors they can use,” Dr. Epps says. “When it’s used in conjunction with CBT, I think semaglutide will really be able to help.”
If you worry about binge eating and think semaglutide might be right for you, talk to your doctor or chat with a ReflexMD Wellness Advisor now.