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NEDA TOOLKIT for Parents Patients with a history of repeated weight loss followed by weight gain (“yo-yo” dieting) or patients with an early onset of binge eating may benefit from following programs that focus on decreasing binge eating rather than on weight loss [II]. The anticonvulsant medication topiramate is effective for binge reduction and weight loss, although adverse effects may limit its clinical utility for some individuals [II]. Zonisamide may produce similar effects regarding weight loss and can also cause side effects [III]. There is little empirical evidence to suggest that obese binge eaters who are primarily seeking weight loss should receive different treatment than obese individuals who do not binge eat [I]. iv. ii. Other Psychosocial Treatments Substantial evidence supports the efficacy of individual or group CBT for the behavioral and psychological symptoms of binge eating disorder [I]. IPT and dialectical behavior therapy have also been shown to be effective for behavioral and psychological symptoms and can be considered as alternatives [II]. Patients may be advised that some studies suggest that most patients continue to show behavioral and psychological improvement at their 1- year follow-up [II]. Substantial evidence supports the efficacy of self-help and guided self-help CBT programs and their use as an initial step in a sequenced treatment program [I]. Other therapies that use a “non-diet” approach and focus on self- acceptance, improved body image, better nutrition and health, and increased physical movement have been tried, as have addiction-based 12-step approaches, self-help organizations, and treatment programs based on the Alcoholics Anonymous model, but no systematic outcome studies of these programs are available [III]. iii. Medications Substantial evidence suggests that treatment with antidepressant medications, particularly SSRI antidepressants, is associated with at least a short- term reduction in binge eating behavior but, in most cases, not with substantial weight loss [I]. The medication dosage is typically at the high end of the recommended range [I]. The appetite-suppressant medication sibutramine is effective for binge suppression, at least in the short term, and is also associated with significant weight loss [II]. Combining Psychosocial and Medication Treatments For most eating disorder patients, adding antidepressant medication to their behavioral weight control and/or CBT regimen does not have a significant effect on binge suppression when compared with medication alone. However, medications may induce additional weight reduction and have associated psychological benefits [II]. Adding the weight loss medication orlistat to a guided self- help CBT program may yield additional weight reduction [II]. Fluoxetine in conjunction with group behavioral treatment may not aid in binge cessation or weight loss but may reduce depressive symptoms [II]. b. Night Eating Syndrome Progressive muscle relaxation has been shown to reduce symptoms associated with night eating syndrome [III]. Sertraline has also been shown to reduce these symptoms [II]. Definitions The three categories of endorsement are as follows: [I] Recommended with substantial clinical confidence [II] Recommended with moderate clinical confidence [III] May be recommended on the basis of individual circumstances Links Link to Full Summary: http://www.guideline.gov/content.aspx?id=9318 Link to Information for the Public: http://www.nice.org.uk/nicemedia/pdf/cg009publicinf oenglish.Pdf Page | 55