The Standard of Care for People with Binge Eating

In the last couple of years, many people seeking treatment for any binge eating (primarily bulimia, binge eating disorder or compulsive overeating) look to GLP-1 agonists medications as a way to cure their eating disorder. There may be a limited role for these medications in treating binge eating, but the mainstay of treatment is unchanged and often very successful.

Cognitive Behavioral Therapy is the central component of treating any binge eating disorder. The first step is logging food including the specifics of the meal, time of eating, whether it’s a binge or not and the thoughts and feelings around eating at that moment.

The process of logging has several key benefits: separation from the food to assess eating with more perspective, understanding the emotional and hunger cues that trigger binge eating and working together with the therapist to approach binging as a symptom that they can figure out together. Even more importantly, logging impresses upon the patient that there is a way to figure out how to stop binging.

Medications like Prozac and Topamax also play a role in decreasing binge urges but are a supplementary part of treatment rather than a cure. Working with a dietitian helps educate the patient about meal planning and the need for regular meals throughout the day to regulate hunger and fullness cues. Last, treating other concomitant psychiatric disorders, such as anxiety, depression and ADHD, makes stopping binging much more successful.

The new GLP-1 medications have confused the standard of care for binge eating. The lay concept of food noise in particular can push people with binge eating towards these medications. For laypeople, food noise means hunger caused by dieting and undereating. This new class of medication suppresses hunger for many people thereby making it easier to eat less in an unhealthy way and ignore hunger cues.

The term food noise describes very accurately the preoccupation with food that people with binge eating experience. It’s not a surprise that people with binge eating find this term validating; however, conflating food noise for someone with binge eating to food noise for someone without an eating disorder is problematic.

The biggest risk is that people with binge eating may think the GLP-1’s can cure their eating disorder and that food noise is a more universal symptom. The medications don’t treat binge eating on their own and almost always set people back who are in the process of treatment for an eating disorder and learning how to regulate their eating. Therapy and appropriate medications need to be the primary way to move forward.

The new GLP-1 medications have some limited use to treat people with binge eating, but the standard of care is very effective and must remain the first steps towards recovery. Food noise is a very apt description of thoughts around food for people with binge eating, but the term isn’t clinical and does not change how someone with binging can get better.