Worcester Telegram & Gazette
By Geraldine A. Collier
Whether it’s in a television show or a movie, Hollywood has treated binge eating as a joke, but for an estimated 1 to 5 percent of American adults who suffer from this threat to their health and their lives, there’s nothing funny about it.
Now, the federal Food and Drug Administration has approved, for the first time, a drug that could cure patients of that eating disorder.
The drug’s name is lisdexamfetamine (Vyvanse) and it has been used since 2007, under the name Adderall, as a treatment for attention deficit hyperactivity disorder. A mental stimulant, the drug helps the brain to focus and be less vulnerable to emotional changes, a factor that can contribute to binge eating problems.
“Binge eating is something different than just overeating,” said Dr. James M. Greenblatt, chief medical officer at Walden Behavioral Care. People with the disorder consume large amounts of food in a very short time — at least two days for six months — and feel totally out of control.
Further defined by the American Psychiatric Association’s standard reference for psychiatry, binge eaters exhibit at least three of the following behaviors:
> Eating more rapidly than normal;
> Eating until feeling uncomfortably full;
> Eating large amounts of food when you are not feeling physically hungry;
> Eating alone because of the embarrassment over how much food is being eaten;
> Feeling disgusted with oneself; feeling depressed or feeling guilty after overeating.
Unlike other eating disorders such as anorexia and bulimia where individuals tend to be in their teens and 20s, binge eaters tend to be a little bit older — in their 20s, 30s and 40s, according to Dr. Greenblatt. And the disorder affects more women than men.
Vyvanse’s use as a treatment for binge eating was approved at the end of January as a result of a FDA’s priority review program that provides for a quick review of drugs that are intended to treat a serious disease or condition and show an improvement over a current therapy.
In announcing its approval of Vyvanse, the FDA cited outcomes from two clinical studies involving 724 adults with moderate to severe binge eating disorders. In the studies, participants taking Vyvanse experienced a decrease in the number of binge eating days per week and had fewer obsessive-compulsive binge eating behaviors compared to those on an a placebo.
The most common side effects reported by people taking Vyvanse in the clinical trials included dry mouth, sleeplessness (insomnia), increased heart rate, jittery feelings, constipation and anxiety. However, more serious side effects are possible, including seizures in people with a history of them and sudden death in people who have existing heart problems or defects.
The FDA’s approval was issued with the caveat that Vyvanse can be addictive, but Dr. Greenblatt, who has worked with the drug for some years, said the first thing a physician will do before prescribing Vyvanse, an amphetamine, is “make sure that the patient doesn’t have a history of addiction; that they have not abused amphetamines in the past.”
Dr. Greenblatt sees Vyvanse as being used for six months to a year, as part of an overall therapy plan that includes behavioral and cognitive therapy as well as nutritional counseling. It’s estimated that a month’s supply of Vyvanse will cost about $250, but Dr. Greenblatt said most insurances will cover this.
Perhaps a disappointment for those who manage to shake off the binge-eating habit, it’s not going to take away the weight already gained. “Often people believe that, but it’s not the reality,” said Dr. Greenblatt.
But if binge eaters are successful in breaking away from their extreme eating habit, there’s other ways to get rid of the weight, including exercise and diet. And bariatric surgery also becomes a possibility.
“We often have patients at the Weight Center who exhibit symptoms related to binge eating disorder,” said Maisie Ostrye, clinical dietician at the UMass Memorial Weight Center on the University Campus.
All patients specifically interested in weight loss surgery are required to meet with one of the center’s medical doctors, a dietician and a psychologist. “Often times with patients who describe binge eating behaviors our psychologists will ask them to meet with an outside behavioral provider who specializes in disordered eating,” said Ms. Ostyre
Ms. Ostyre said one of the center’s psychologists does refer many patients to Walden, which is headquartered in Waltham and has an eating disorder clinic on Chandler Street in Worcester.
“If a patient is interested in (bariatric) surgery, binge eating or any other eating disorder is something that that patient must work through and get under control prior to proceeding with surgery,” said Ms. Ostyre.
If a patient does not work on these issues prior to surgery and continues on with them after surgery then it is almost inevitable that he or she will gain the weight back. “Basically weight loss surgery,” said Ms. Ostyre, “is not a “magic bullet for weight loss. The patient must be willing to put in the effort to make consistent long-term lifestyle and dietary changes.”