Obtaining long-term recovery: advances in optimizing treatment outcomes in patients with binge-eating disorder

Binge-eating disorder (BED) is a complex and disabling eating disorder (ED) associated with considerable burden and impairments in quality of life and physical/mental health. It has been recognized as a formal ED category since 2013, however BED is still underdetected and undertreated. This review summarizes the advances in the understanding of the pathophysiology of BED as well as the evidence on the efficacy of the existing treatments. The authors searched Scopus, PubMed, ClinicalTrials.Gov, and ANZCTR with terms including ‘assessment’ OR ‘treatment’ OR ‘diagnosis’ OR ‘mechanisms’ AND ‘binge eating’ OR ‘binge-eating disorder’ for manuscripts published between January 2013 and April 2023. Most of the trials on treatments of BED have been in people of high weight with weight loss as an outcome. Nevertheless, less is known about the treatment of this condition in people with body mass index (BMI) within the normal range where weight stabilization may be a more appropriate goal. Moreover, there is a need for an enhanced appreciation of the role of combination treatment to improve overall outcomes. Also, there are important opportunities for future research in understanding the mechanisms of action and effectiveness of BED treatments.

暴食障碍（Binge-eating disorder, BED）是一种复杂且具有致残性的进食障碍（Eating Disorder, ED），可给患者带来显著负担，并严重损害其生活质量与身心健康。该病症自2013年起被正式列为进食障碍分类中的独立类别，但目前仍存在检出不足、治疗不充分的问题。本综述总结了当前学界对暴食障碍病理生理学的研究进展，以及现有治疗手段有效性的相关证据。作者以‘评估（assessment）’OR‘治疗（treatment）’OR‘诊断（diagnosis）’OR‘机制（mechanisms）’AND‘暴食（binge eating）’OR‘暴食障碍（binge-eating disorder）’为检索策略，在Scopus、PubMed、ClinicalTrials.Gov及ANZCTR数据库中检索了2013年1月至2023年4月发表的相关研究论文。目前多数针对暴食障碍治疗的临床试验均以超重人群为研究对象，且将体重减轻作为主要结局指标。然而，针对体重指数（Body Mass Index, BMI）处于正常范围人群的暴食障碍治疗研究相对匮乏，此类患者的治疗目标或许更适宜设定为体重稳定。此外，学界仍需进一步重视联合治疗在改善整体预后中的作用。同时，未来在阐明暴食障碍治疗的作用机制与临床有效性方面，仍存在诸多值得探索的研究方向。