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Objective: Binge-eating disorder (BED) is a prevalent, costly public health problem associated with serious functional impairments and heightened rates of psychiatric and medical comorbidities. Few evidence-based treatments are currently available for BED. We tested the effectiveness of cognitive-behavioral therapy (CBT), lisdexamfetamine (LDX), and combined CBT+LDX, for BED comorbid with obesity., Methods: Randomized controlled trial was conducted March 2019 to September 2023 at a single site. N=141 patients with BED (83.7% women, mean age 43.6, mean BMI 38.6 kg/m 2 ) were randomized to one of three 12-week treatments: CBT (N=47), LDX (N=47), or CBT+LDX (N=47); 87.2% completed independent posttreatment assessments., Results: Mixed models revealed binge-eating frequency decreased significantly in all treatments, with CBT+LDX having the largest reduction and significantly outperforming CBT and LDX, which did not differ. Intention-to-treat binge-eating remission rates differed significantly between treatments, with CBT+LDX having the highest remission rate (70.2%) followed by CBT (44.7%) and LDX (40.4%). Mixed models revealed percent weight loss increased significantly throughout treatment with LDX and CBT+LDX but remained unchanged in CBT. LDX and CBT+LDX had significantly greater percent weight loss than CBT starting after one month and through posttreatment. Intention-to-treat rates of attaining ≥5% weight loss differed across treatments, with LDX having the highest (53.2%), followed by CBT+LDX (42.6%) and CBT (4.3%). Analyses revealed significant reductions in eating-disorder psychopathology; CBT+LDX had largest reductions and significantly outperformed CBT and LDX., Conclusions: CBT, LDX, and CBT+LDX showed significant improvements in BED, with a consistent pattern of the combined CBT+LDX being superior to the two individual treatments, which differed little., Competing Interests: Dr. Grilo has received honoraria and royalties from Guilford Press and Taylor & Francis. The remaining authors report no financial relationships with commercial interests.

Background: Controlled research examining maintenance treatments for responders to acute interventions for binge-eating disorder (BED) is limited. This study tested efficacy of lisdexamfetamine (LDX) maintenance treatment amongst acute responders., Methods: This prospective randomized double-blind placebo-controlled single-site trial, conducted March 2019 to September 2023, tested LDX as maintenance treatment for responders to acute treatments with LDX-alone or with cognitive-behavioral therapy (CBT + LDX) for BED with obesity. Sixty-one (83.6% women, mean age 44.3, mean BMI 36.1 kg/m 2 ) acute responders were randomized to LDX ( N = 32) or placebo ( N = 29) for 12 weeks; 95.1% completed posttreatment assessments. Mixed-models and generalized-estimating equations comparing maintenance LDX v. placebo included main/interactive effects of acute (LDX or CBT + LDX) treatments to examine their predictive/moderating effects., Results: Relapse rates (to diagnosis-level binge-eating frequency) following maintenance treatments were 10.0% ( N = 3/30) for LDX and 17.9% ( N = 5/28) for placebo; intention-to-treat binge-eating remission rates were 59.4% ( N = 19/32) and 65.5% ( N = 19/29), respectively. Maintenance LDX and placebo did not differ significantly in binge-eating but differed in weight-loss and eating-disorder psychopathology. Maintenance LDX was associated with significant weight-loss (-2.3%) whereas placebo had significant weight-gain (+2.2%); LDX and placebo differed significantly in weight-change throughout treatment and at posttreatment. Eating-disorder psychopathology remained unchanged with LDX but increased significantly with placebo. Acute treatments did not significantly predict/moderate maintenance-treatment outcomes., Conclusions: Adults with BED/obesity who respond to acute lisdexamfetamine treatment (regardless of additionally receiving CBT) had good maintenance during subsequent 12-weeks. Maintenance lisdexamfetamine, relative to placebo, did not provide further benefit for binge-eating but was associated with significantly better eating-disorder psychopathology outcomes and greater weight-loss.

Background: Modest weight losses may be associated with improvements in cardiovascular disease risk factors (CVDRF) in patients with obesity. The effects of weight losses on CVDRF in persons with binge-eating disorder (BED) are unknown. This study prospectively examined changes in CVDRF among patients receiving behaviorally-based weight-loss treatment (BBWLT) who attained modest weight losses (≥5 to <10% and ≥10%)., Method: Of 191 participants, CVDRF variables were re-assessed in 168 participants at posttreatment and in 151 at 12-month follow-up. Participants who attained ≥5 to <10% weight loss were compared to those who did not on CVDRFs (total cholesterol, HDL, LDL, triglycerides, HbA1C, mean plasma glucose, heart rate, and systolic/diastolic blood pressure); similar comparisons were completed for those who attained ≥10% weight loss., Results: At posttreatment, ≥5 to <10% weight loss (N = 42; 25.0%) was associated with significant improvements in HbA1c and mean plasma glucose, whereas ≥10% weight loss (N = 40, 23.8%) was associated with significant improvements in total cholesterol, triglycerides, HbA1c, mean plasma glucose, and heart rate. At 12-month follow-up, ≥5 to <10% weight loss (N = 17; 11.1%) was related to significant improvements on HDL, triglycerides, HbA1c, and mean plasma glucose, whereas ≥10% weight loss (N = 40, 26.0%) was associated with significant improvements on all the CVDRF variables (except blood pressure)., Conclusions: Modest weight loss is associated with significant improvements in CVDRFs in patients with BED and obesity following treatment and at 12-month follow-up. Future work should examine whether improvements in CVDRF are attributable to weight loss per se and/or to other related lifestyle changes., Public Significance Statement: Individuals with binge-eating disorder and obesity who attain modest weight loss following treatment exhibit improvements in various measures of cardiovascular disease risk compared to those who do not. While weight loss has been challenging for individuals with binge-eating disorder, clinicians should inform patients of the potential health benefits of modest weight loss. Future research should investigate whether weight loss itself and/or related behavioral lifestyle changes drive improved cardiovascular disease risk factors., (© 2023 Wiley Periodicals LLC.)

Objective: This study examined baseline predictors of rapid response and its prognostic significance in a clinical trial of behaviorally based weight loss treatment (BBWLT) for binge eating disorder in patients with obesity., Methods: One hundred ninety-one participants receiving BBWLT were assessed at baseline, throughout treatment, and at posttreatment (6 months) by independent assessors. Rapid response was defined as ≥ 65% reduction in binge eating by the fourth treatment week. Patients with versus without rapid response were compared on demographic features, a broad range of current/past clinical and psychiatric variables, and treatment attitudes. Rapid response was used to prospectively predict posttreatment outcomes., Results: Rapid response, which characterized 63% (N = 120) of participants, was not associated significantly with any demographic features or with any current/past clinical and psychiatric variables. Higher ratings (at week one) regarding the logic of BBWLT and greater confidence that treatment would help with binge eating and weight loss were associated significantly with rapid response (at week four). Rapid response was prospectively associated with significantly better binge eating and weight loss outcomes., Conclusions: These findings indicate that rapid response to BBWLT for binge eating disorder prospectively predicts superior clinical outcomes in both binge eating and weight loss. Treatment attitudes, rather than patient demographic or clinical severity variables, are prospectively associated with rapid response., (© 2023 The Obesity Society.)