Reflections on the 2015 Binge Eating Disorder Association Conference from Theresa Fassihi, PhD

I had the opportunity to attend the sixth national Binge Eating Disorder Association (BEDA) conference this weekend.  The theme was “Many Paths, One Journey.”  BEDA founder and CEO Chevese Turner explained that individuals can take many paths on their journey towards recovery.  The presentations demonstrated that, indeed, there are many ways that eating disorders are getting treatment and one approach is not likely to work for everyone.  Yet, it is important to rely on science and research to guide us towards the paths most likely to be effective. The first Keynote presentation by Dr. John Cryan of Ireland covered the exciting new field of microbiotics, demonstrating that the microbes that colonize our gut are greatly affected by our diet, our environment and our levels of stress and can impact our appetite and eating behaviors, including propensity to binge.  There is much left to learn, but the clear message is that a healthy gut leads to a healthy brain, and a diverse and varied diet and mastery of stress is good for the gut – and the brain. Many other exciting topics were covered at the conference.    Medications that may enhance BED treatment were discussed.  Binge eating occurs across disorders and about 95 percent of people with eating disorders engage in the behaviors, so finding ways to reduce urges is important.  ADHD has been found to precede and be a risk factor for the development of binge eating disorder, so Vyvanse, a medication developed for ADHD, has been studied and found to have some efficacy for reduction of binge eating.  Although Vyvanse has some appetite suppression effect, the actual mechanism of action that helps BED long-term is its enhancement of executive functioning and impulse control.  Researchers and specialist clinicians discussed ways we might apply the medication in the context of therapy and weighed the pros and cons of adding this medication or combining it with others that have been helpful, such as SSRIs. Several speakers noted that there may be different subtypes of binge eating disorder with different etiologies and therefore different methods will be needed to treat them.  Dr. James Greenblatt noted that appetite is a very complex system that we don’t fully understand so a combination of medications may be best. The strongest evidence continues to be available for psychological treatment, specifically CBT for binge eating disorder when it is delivered by a trained clinician.  Other promising modalities include couples-based therapy for binge eating, movement therapies such as yoga and dance, and creative meal challenges and food exposures. One disheartening fact Chevese noted is that only 7 percent of people with BED get diagnosed and 70 percent of those who are diagnosed remain untreated.  Many at the conference cited weight stigma as a possible explanation for the terrible neglect of this disorder.  We are encouraged to challenge biases wherever we encounter them, including within ourselves. Hopefully, this annual conference will continue to reach more and more people with its message of compassion, care and commitment to best practices.