Compulsive overeating: causes, symptoms, diagnosis, treatment

Compulsive overeating is characterized by episodes of overeating, not entailing inappropriate compensatory behavior, such as causing vomiting or using laxatives. The diagnosis is clinical. There is growing evidence that the most effective treatment is the standard behavioral program to reduce body weight.

Compulsive overeating affects 2-4% of the general population and becomes more common with weight gain, reaching 30% among obese patients in some weight loss programs.

Unlike bulimia nervosa, compulsive overeating, as a rule, is observed in obese people and promotes completeness due to excessive consumption of calories. Patients with compulsive overeating are usually older than patients with anorexia nervosa and bulimia and more often (approximately 50%) men.

In patients with compulsive overeating, the disorder usually leads to distress, especially if they are trying to lose weight. About 50% of patients with obesity and compulsive overeating are in a state of depression compared to less than 5% of obese patients without compulsive overeating.

Most patients are treated in traditional weight loss programs, in which little attention is paid to compulsive overeating. Patients agree to such an intervention, because they are usually more concerned about their body weight than compulsive overeating. The presence of compulsive overeating does not limit the decrease in body weight in these programs.

Evaluation of treatment is hindered by the variability of compulsive overeating. Without treatment, there may be improvement, and the placebo effect is very high. Cognitive-behavioral therapy effectively helps to control compulsive overeating, but has a weak effect on body weight, possibly due to compensatory (non-compulsive) overeating. Drug therapy using SSRIs helps control both compulsive overeating and weight, but withdrawal is often accompanied by a relapse. Paradoxically, the most effective treatment for compulsive overeating is the standard behavioral program to reduce body weight, which contributes not only to weight loss, but also to control over compulsive overeating.

Self-help groups following the principles of Alcoholics Anonymous, such as Anonymous Gluttons or Anonymous food dependents, help some patients with compulsive overeating.

The presence of compulsive overeating does not prevent the use of surgical methods of treatment in patients with severe obesity.