Experts update global guidelines on treating eating disorders with medication

Guidelines on the pharmacological treatments of eating disorders have been updated to include new recommendations for the use of medication for binge-eating disorder and bulimia.

The update was issued by World Federation of Societies of Biological Psychiatry (WFSBP), 12 years after the guidelines were first published in 2011. The update was developed by a task force of 35 leading eating disorders experts from Africa, Asia, Australia, Europe, and the Americas, and was led by Dr Hubertus Himmerich from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) King’s College London.

According to current national and international guidelines, such as those of UK’s National Institute for Health and Care Excellence (NICE), the main recommended therapeutic approaches for eating disorders consist of psychotherapy, diet counselling and physical health monitoring. However, in recent years there has been a rapid increase in the evidence behind biological therapy options and specifically psychopharmacological treatments. To provide patients and healthcare professions with insight into the current options for medications to help treat eating disorders the WFSBP has developed an update on the guidelines based on the recent scientific research. 

Lead on author on the updated guidelines, Dr Hubertus Himmerich, Clinical Senior Lecturer at the King’s IoPPN and consultant psychiatrist at the South London and Maudsley NHS Foundation Trust said:

“As we understand more about the biology of eating disorders, we are gaining greater insight into which medications could help treat patients with these conditions. For this update to the WFSBP guidelines we tried to include all published pharmacological studies in eating disorders to provide a reference text for clinicians. This means a healthcare professional can check all the medications that have been tested in a certain eating disorder and the outcomes of the studies that have evaluated them as treatments. We hope the update to the guidelines will inform task forces for the development of national guidelines in the future.”

Some of the main messages in the updated guidelines include:

• A new recommendation for lisdexamfetamin, a medication that has been used for patients with ADHD, as a pharmacological treatment for people with binge-eating-disorder. This novel recommendation is based on four randomised controlled trials (RCTs) with high quality and one relapse-prevention RCT.
• A new recommendation for topiramate, a medication used in epilepsy and migraine, for the pharmacological treatment of bulimia nervosa and binge-eating disorder. Topiramate is not recommended during pregnancy and breast feeding.
• A continued recommendation for the antidepressant fluoxetine for the treatment of people with bulimia nervosa.
• A limited recommendation on the use of olanzapine, an anti-psychotic medication, for the treatment of anorexia nervosa because the available evidence is restricted to weight gain, and its effect on psychopathology is less clear.

The update to the guidelines considered all available studies of treatment with medications in eating disorders and assessed the quality, potential biases and shortcomings of these studies. Particular attention was paid to the acceptability and the safety of all medications tested in eating disorders.

The guidelines provide a treatment recommendation and a grading of the strength of this recommendation for all eating disorders in the DSM-V. The guidelines also advise against the use of certain medications, if a medication has serious side effects, if patients tend to stop the medication after a short time, if there are known potential negative long-term consequences or if the medication is not effective.

‘The WFSPB guidelines for the pharmacological treatments of eating disorders’ by Himmerich, H. et al (2023)  were published in the World Journal of Biological Psychiatry. DOI: 10.3109/15622975.2011.602720