If Binge Eating Disorder is a Control Problem, Drug Research and Neuroscience May Provide Insights for More Effective Assessment and Treatment

Binge eaters differ from overeaters because they do not have control over their behavior. It is not simply indulging, a bad habit or poor overall self-control, but binge eaters are compelled to overeat. The DSM-5 describes this behavior as recurrent episodes marked by a feeling of lack of control even when he or she is not hungry. The physiological process underlying hedonic eating is not fully understood. Binge eaters are compelled to eat and there is activation of the same regions of the brain as an alcoholic or drug addict. Neuronal circuits and neural loci (nuclei) that mediate reward, motivation, decision making, impulse control and mood are overridden or distorted when a person wants or needs to control their mood or compulsion for a particular trigger food (which may be more related to sensory criteria than chemical makeup). So far there is little known about the 'best practice interventions'. Research is inconclusive due to the high placebo rates of treatment for BED in research designs. The medications used in the treatment of substance abuse may have utility in understanding these chemical reward systems. This presentation will explore many of the 'weight loss' medications that are on the market from antidepressants, anticonvulsants and opioid receptor antagonists.