“We really do not have good, evidence-based information on how to help people manage their weight and health effectively after treatment for an eating disorder,” says Cynthia Bulik, PhD. She is the director of research at the University of North Carolina Center of Excellence for Eating Disorders and author of Crave: Why You Binge Eat and How to Stop.
The First Thing to Know About Treatment
Treatment for binge eating disorder does not focus on dieting or losing weight. Before you consider weight loss treatments, you need talk therapy to help you learn why you binge eat and how to change that behavior. You also need to work with a doctor and dietitian to create a healthy meal plan and exercise routine.
If you still have major health problems due to your weight after getting binge eating treatment, talk to a doctor “who understands the dangers of dieting for someone with a history of binge eating,” Bulik says.
“There is no reason to exclude weight loss treatment, or any form of treatment, from people with obesity,” says Abigail Natenshon, a licensed social worker and psychotherapist in Highland Park, IL, who specializes in eating disorders. “But self-understanding needs to happen first.”
Sometimes, doctors prescribe medication along with binge eating therapy. Topiramate (Topamax) is a drug that affects brain chemicals involved with appetite. It has been shown to help reduce or stop binges. One of the side effects is weight loss, so it is also used to treat obesity. Early studies suggest it is safe and it works in obese patients who have binge eating disorder.
Other drugs sometimes used to treat binge eating disorder, such as antidepressants, do not seem to have an effect on weight loss.
Weight Loss Surgery
Weight loss surgery, also called bariatric surgery, is an operation that makes the stomach smaller, so your belly feels full sooner. In theory, such surgery provides automatic portion control -- your belly simply holds less food.
“After surgery, bingeing becomes pretty impossible due to the smaller stomach,” says Eric DeMaria, MD, a bariatric surgeon at Bon Secours Maryview Medical Center in Portsmouth, VA.
But there is some debate about how well it works for binge eaters, who often keep eating after they feel uncomfortably full. There are also intragastric balloon procedures available that while not indicated for treatment for binge eating, can make you feel full.
One study that looked at how well some binge eaters did after surgery found that the patients successfully lost weight and improved their heart health -- more so than those without the disorder.
But other research says that patients with binge eating disorder have trouble losing weight after surgery. That’s why some doctors recommend counseling before the operation.
“Bariatric surgery ... is not a miracle cure,” Bulik says. “You have to change your eating habits dramatically. You should be well-prepared for the changes that have to occur” before having surgery.
It is possible that your binges could come back after surgery. Or you could develop other unhealthy eating habits.
“There is a concern that some people will develop other disorders after surgery, like grazing,” DeMaria says. “It’s fairly common for someone with one kind of eating disorder to morph into another one.”
What to Do Before Choosing Treatment
If you're thinking about trying weight loss surgery or medication, you should get counseling throughout the treatment. Make sure the doctor and surgeon know you have a history of binge eating. And tell them about your family’s medical conditions. Obesity can be passed down through families. This can affect your ability to lose weight.
“We all know losing weight is difficult,” says Caren Beasley, MD, the clinical director of bariatric medicine at Sentara Comprehensive Weight Loss Solutions in Norfolk, VA. “If it was easy, we all would have done it. You need to know what’s right for you.”