NO MORE BINGING!
Binge-eating is a condition where a person eats uncontrollably. It affects up to 4 percent of all americans. Binge-eaters binge -- on average -- at least two days per week for at least six months. There are no f-d-a approved treatments for binge-eating, but now one drug helps binge-eaters limit uncontrolled eating.
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Emily Wollman has been dieting most of her life, but avoiding food often did more harm than good.
Emily Wollman
Former binge-eater
"I would go and get anything that I had been deprived of."
Emily would eat up to three pints of ice cream and a half box of cookies during a binge. She says it deflected issues she didn't want to deal with.
Emily Wollman
"Food becomes like the Band-Aid you put on your emotional wounds."
Psychiatrist Nathan Shapira says binge-eating is a common outlet for emotions. Now, he's trying to stop the binging with the anticonvulsant drug topiramate or topamax.
Nathan Shapira, M.D., Ph.D.
Psychiatrist
University of Florida
Gainesville, FL
"One of the mechanisms of this compound may have a direct effect on, say, the satiety center or the appetite disregulation."
Earlier studies in epilepsy patients show the drug lessened appetites.
Nathan Shapira, M.D., Ph.D.
"About 80 percent of them had completely stopped binge-eating on topiramate, versus about a quarter on placebo. People would typically go from binge-eating five times a week, down to one or less a week."
For some, that was a surprise.
Nathan Shapira, M.D., Ph.D.
"They described that they used to be able to eat a Big Mac and fries, and now all they could eat was a Happy Meal, and it was very disturbing to them."
For Emily, coming to peace with herself and her body helped defeat her binging.
Emily Wollman
"I've gotten to the point where I can even -- when I'm really connected to myself -- like, cook a bowl full of spaghetti and, to the strand, know how much to put on the plate."
But, for those who need an extra push, help is on the way.
About 20 sites across the country are beginning trials to further test topiramate for binge-eating disorders that are associated with obesity. Researchers are hoping to enroll 360 patients. Topiramate is FDA approved for epilepsy.
BACKGROUND: Experts say binge eating disorder is probably the most common eating disorder, affecting as many as 4 million Americans. It is characterized by recurrent episodes of over eating without starving (anorexia) or purging (bulimia). This disorder is usually associated with being overweight and is very commonly associated with other psychiatric illnesses. There are some rare genetic disorders and medications that may induce binging. Psychiatrist Nathan Shapira, from the University of Florida in Gainesville, says, "There's a tremendous need for help with binge eating disorder. It's common. It's disabling for many people. It controls their life. Any effective medicine that would help with this disorder would be incredibly useful." Currently, there are no FDA-approved treatments for binge eating disorder.
HOW THE DRUG WORKS: Topiramate (Topamax) is an anticonvulsant medication that is FDA-
approved for epilepsy. The drug is soon to be approved for migraines and researchers are studying it as a potential treatment for obsessive-compulsive disorder and diabetic neuropathy. Topiramate acts as an antagonist on the glutamate system in the brain. Animal models show that if glutamate is injected, the animals will eat in a very ferocious way. The idea is that one of the mechanisms of the drug may have a direct effect on the glutamate system and deregulate appetite, causing weight loss and less desire to binge.
RESULTS: Several earlier studies show topiramate is effective for treating binge eating disorder. In one open-label study, 13 women received 100 milligrams to 1,400 milligrams a day of topiramate. Nine of those patients displayed a moderate or better response to binging symptoms and that response was maintained for up to two and a half years. In another study, 61 participants received 25 milligrams to 600 milligrams a day of topiramate in a 14-week double-blind trial. Results of that study show 94 percent of patients who received topiramate had significant reductions in binge frequency compared to 46 percent on placebo. The reduction was sustained for more than one year. Dr. Shapira reports people would typically go from binge eating five times a week down to one or less a week. Researchers also observed significant weight loss. More than 80 percent of patients reached a point where they were not binge eating at all. The most common side effects, reported in less than 10 percent of patients, were dry mouth, cognitive problems, headache and paresthesia, a sensation of pricking, tingling, or creeping on the skin.
THE NEXT STEP: Twenty sites will participate in the phase III trial and the goal is to enroll about 360 patients. Participants will receive either the medication or a placebo.
Nikki Ricciuti, R.N., LMHC
University of Florida
Gainesville, FL
(352) 265-0162
Copyright © 2003 Ivanhoe Broadcast News, Inc.
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