How should I approach the management of a patient with binge eating disorder in primary care?

Approach to managing a patient with binge eating disorder (BED) in primary care:

• Explain to the patient that psychological treatments aimed at reducing binge eating have limited effects on body weight and that weight loss is not a primary treatment goal. Refer to obesity management guidelines if weight loss is desired separately.

• Offer a binge-eating-disorder-focused guided self-help programme using cognitive behavioural self-help materials, supplemented by brief supportive sessions (for example, 4 to 9 sessions of about 20 minutes each over 16 weeks) focusing on adherence to the programme.

• If guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks, offer group eating-disorder-focused cognitive behavioural therapy (CBT-ED), typically consisting of 16 weekly 90-minute group sessions over 4 months. This should include psychoeducation, self-monitoring, daily food intake planning, identifying binge cues, body exposure training, and relapse prevention strategies.

• If group CBT-ED is unavailable or declined, consider individual CBT-ED, typically 16 to 20 sessions, which includes developing a psychological formulation, advising regular meals and snacks, addressing emotional triggers, monitoring binge episodes and weight, and addressing body image issues. Patients should be advised not to attempt weight loss during treatment as dieting may trigger binge eating.

• Do not offer medication as the sole treatment for binge eating disorder.

Additional considerations: Provide information and support to the patient and their family or carers as appropriate, respecting patient confidentiality and preferences. Monitor for any physical or mental health comorbidities and refer promptly to specialist eating disorder services if needed.