Some medications like Ozempic can transform how the brain responds to food – which is why researchers think these drugs hold such promise to treat binge-eating disorder. Photo / Ricardo Tomas, the New York Times
Some medications like Ozempic can transform how the brain responds to food – which is why researchers think these drugs hold such promise to treat binge-eating disorder. Photo / Ricardo Tomas, the New York Times
People taking drugs like Ozempic say their appetites evaporate. The constant “food noise” in their heads – wondering what they’ll eat next, and when– goes quiet.
Now, scientists are exploring whether those powerful effects could translate into a treatment for binge-eating disorder.
Binge eating disorder traps people in an agonising cycle: they eat a large amount of food in a short amount of time, past the point of feeling full and sometimes until they are in pain. They feel guilty and ashamed. Then they binge again. Scientists aren’t entirely sure what causes the condition, but one theory is that binge eating is a compulsive behaviour, involving the same brain circuits that help us form habits and contribute to addiction.
Medications such as Ozempic – originally developed to treat diabetes and now widely used for weight loss – can transform how the brain responds to food. That’s why researchers think these drugs hold such promise to treat binge eating disorder, said Trevor Steward, a University of Melbourne researcher who is running one of the first studies to test the drugs in people with the condition. The hope is the new generation of drugs can give people newfound control over the impulse to binge.
So far, the evidence that these drugs can help with binge eating disorder is largely anecdotal. But patients are already taking the medications for this purpose – and some say they’re working.
“There was something missing in my brain, and it’s fixed now,” said Joanie Smith, 66, who has taken Ozempic since 2022. She tried Jenny Craig, WeightWatchers, even hypnosis, but nothing fully helped with her bingeing until she took the drug.
But some doctors worry weight-loss drugs can go too far, leading patients to restrict how much they eat to a dangerous extent. And, they caution, binge-eating disorder is a complex condition, often linked to trauma or patterns of intensive dieting. Extinguishing hunger alone may not be enough to truly treat it.
Shebani Sethi, director of Stanford’s Metabolic Psychiatry programme, uses an array of tools to treat binge eating disorder. Those include the stimulant Vyvanse, the only drug the Food and Drug Administration has authorised for the condition, and anti-obesity medications such as Contrave and Qsymia, which work in part by tamping down hunger – though not as potently as the newer weight-loss drugs can.
Sethi also works with patients to develop meal plans that keep them satiated throughout the day. And often, she’ll use cognitive and dialectical behavioural therapy techniques to help people who binge eat understand when they are truly hungry and full.
In recent years, she has also started prescribing medications like Ozempic to some patients with both obesity and binge eating disorder. These medications are not typically the first treatment she tries, since they can be expensive and sometimes have difficult side effects. But when people do opt for the medications, they seem to work remarkably well. “Patients say they can start thinking about other things aside from food,” she said.
Heather Loeb, 40, who lives in Corpus Christi, Texas, had already tried Vyvanse and therapy to alleviate the binge eating disorder she has struggled with since high school. But after her psychiatrist prescribed Zepbound for the condition around six months ago, “it was just like my eating disorder vanished”, she said.
“I’m not coming home and getting into the pantry and eating everything in sight,” she added.
One of the few studies that has been done on binge-eating disorder and these medications looked at 48 patients with the condition who were treated at an obesity medicine clinic. Those who were taking semaglutide, the substance in Ozempic, saw their scores on tests assessing the severity of the disorder drop far more than people taking other anti-obesity medications or Vyvanse.
“The fact that it was doing better than the standard of care seemed striking, to put it mildly,” said W. Kyle Simmons, a professor of pharmacology and physiology at Oklahoma State University and an author on the study.
Ozempic is a prescription-only medicine used to help control blood sugar levels in adults with type-two diabetes. It has recently gained attention for its use in weight loss and the treatment of binge eating. Photo / 123RF
A ‘band-aid’ for a bigger problem
Weight-loss drugs could give people with binge eating disorder “back their brakes”, enabling them to stop overeating, said Dr Kimberly Dennis, a psychiatrist who is part of the National Eating Disorder Association’s clinical advisory council. But, she added, “you want to make sure the brake isn’t stuck on all the time”.
Dennis said she has seen some patients with eating disorders become malnourished from consuming too little food while on drugs like Ozempic.
Aaron Keshen, who helps run an eating disorder treatment programme in Nova Scotia, said he worried that the medications can hijack hunger cues to the point at which people have no appetite at all. That can be especially troubling for people with binge-eating disorder as they try to get in tune with their own hunger cues. Instead of learning to stop eating when they are satiated, patients who take these drugs may just barely eat, effectively trading one type of disordered eating for another.
He and other experts said any patient taking weight-loss drugs should be screened for eating disorders, so doctors can warn people with the condition about the risks and make sure they’re getting more comprehensive care.
Recovery is far more nuanced than just reducing how often someone binges, said Rachel Goode, an eating disorders researcher at the University of North Carolina at Chapel Hill. So often, people binge out of a desire to avoid negative feelings.
“What about all those underlying emotional and psychological issues, the trauma, the coping skills, the things that are often fuelling these eating disorders that still need support?” she said.
For Loeb, binges were a momentary break from the strain of work or parenting. Some days, she would call out sick from work, pick up an assortment of appetisers and entrees from Olive Garden and spread them on the table in front of her TV “like a picnic”, she said.
“I wasn’t sitting with my feelings,” she said. “I was just kind of swallowing them.”
On Zepbound, she rarely gets hungry. But she still gets overwhelmed. A few weeks into taking the drug, she gathered a pile of Doritos and fruit snacks, hoping to find that release. She only got through a few bites before she felt repulsed. Food had been an escape. But she now has to look for other ways to replicate that relief.
Sarah House, a 27-year-old in Seattle, is also accustomed to turning to food when she’s stressed. When she started taking the weight loss drug Wegovy last year, she was shocked by how quickly “the urge to binge just completely disappeared” – even in the frantic early days of caring for a new puppy.
But after six months, she could no longer find Wegovy in stock. Patients frequently have to go off weight-loss drugs because of shortages or insurance issues.
House started taking Vyvanse, which helps, but without Wegovy, she still binges sometimes. It can feel like her brain goes back on autopilot when she’s busy or stretched thin. She only thinks about eating more.
“These medications are a band-aid,” Dennis said. “You take the band-aid off, and the bleeding starts all over again.”
