Monday, November 05, 2001

Binge-eating treatable with medication




By Tim Bonfield
The Cincinnati Enquirer

        For Craig McManiman, that urge to feast on fast food is more than an issue of self-control. It's a symptom of a chemical imbalance in his brain.

        And that means it can be treated with medication.

        Since February, Mr. McManiman has lost 46 pounds and sharply reduced his binge-eating episodes by taking an anti-depressant and a medication originally designed to control epileptic seizures.

        “I've been through countless weight-reduction programs, all without success,” Mr. McManiman said. “For me, this is the first thing that has allowed me to get over the hump.”

        Mr. McManiman's treatment reflects a medical approach to eating disorders that differs from many other diet programs. It focuses on the brain as the source of obesity.

        Experts say this treatment may become common in years to come, because researchers are studying a host of psychiatric medications as possible treatments for eating disorders.

        “Our view is that obesity and depression have many similarities,” said Dr. Susan McElroy, director of the UC Physicians Weight Management Program. “Our whole concept is that to treat obesity you have to get eating behaviors under control. To do that you have to get mood disorders treated adequate ly.”

        For several years, Dr. McElroy and other researchers at the University of Cincinnati's psychiatry department have been studying links between brain chemicals and obesity.

        After publishing several studies in the past three years, Dr. McElroy and her colleagues decided in August 2000 to open a private weight control center to put their theories into practice.

        Mr. McManiman was among the early study par ticipants, one of more than 125 regular clients of the UC Physicians' program.

        Weight problems have plagued Mr. McManiman, 46, for most of his life. He weighed 310 pounds in eighth grade, he said.

        Over the years, he has tried many diets and exercise regimens. Most helped him lose weight for a while, only to regain it within months. He also spentseveral years in counseling to help him deal with emotional issues related to growing up with an alcoholic father.

        “I have an addictive nature, but instead of alcohol, I used food as a comfort measure,” Mr. McManiman said.

        But even that understanding wasn't enough to beat the problem, he said.

        Binge eating describes uncontrollable episodes of excessive food consumption that is estimated to occur in about 2 percent to 5 percent of the U.S. population, ac cording to the National Institute of Mental Health. Although many binge eaters are obese, some aren't, Dr. McElroy said.
       

"I was ashamed of myself'
               Four to five times a week, Mr. McManiman would binge. An hour or two after lunch or dinner, he'd eat two large hamburgers, fries and a large drink. Or an entire medium pizza, plus a hoagie and large drink.

        “I would eat regardless of whether I was hungry or not,” Mr. McManiman said. “I used to eat in my car or after my family went to bed at night because I was ashamed of myself.”

        Mr. McManiman's obesity was playing havoc with his health. He takes medications to control high blood pressure and high cholesterol. His wife has long worried that he'd die of a heart attack or be disabled by a stroke long before reaching retirement age.

        In some ways, Mr. McManiman diagnosed his own binge eating problems. As clinical coordinator of social services at Children's Hospital Medical Center, his career exposes him to a lot of medical research news. As more information began emerging about binge eating, he started to recognize the symptoms in himself.

        Mr. McManiman said he learned about Dr. McElroy's program through a newspaper ad and decided to take a chance.

        Unlike the litany of appetite suppressing pills on the market, or the new drug orlistat (brand name Xenical) that blocks fat uptake , the medications preferred by the UC Physicians group focus on brain chemicals related to mood disorders.

        Dr. McElroy diagnosed Mr. McManiman with depression and with binge eating disorder. She prescribed Wellbutrin to manage his depression and Topamax to control his binge-eating urges.
       

Drug's role a mystery
               At first glance Topamax seems like an odd medication for weight control because it won initial approval in 1996 as a break-through treatment for epilepsy.

        However, doctors who were treating epileptics noticed that many of their obese patients lost weight as a side effect of the drug. Those clinical observations prompted Dr. McElroy to launch a study in 1998 in which 61 people tried Topamax or a placebo for 14 weeks.

        According to an abstract presented earlier this year at a scientific meeting of the American Psychiatric Association, most participants reported significant reductions in weight and in binge eating episodes.

        Despite observing the benefits, scientists don't know exactly how Topamax helps binge eating. In theory, the drug helps stabilize mood swings, which in turn may help prevent eating urges, Dr. McElroy said.

        The use of anti-depressant drugs has become common for controlling bulimia and binge eating disorder.

        But Topamax is different because it is an anti-seizure medication, said Dr. Marsha Marcus, chief of the eating disorders program at the University of Pittsburgh School of Medicine and a spokeswoman for the Virginia-based Academy for Eating Disorders.

        ""People are trying it. We've tried it in a couple of cases and we haven't been that thrilled with it. It's a heavy-duty drug that is reasonably difficult to tolerate,” Dr. Marcus said.

        Minor side effects of Topamax include fatigue, slowed thinking and loss of memory. Rare, but more dangerous side effects include kidney stones and a type of glaucoma.

        Dr. Ann Kearney-Cooke, director of the Cincinnati Psychotherapy Institute, said the use of Topamax should still be considered experimental.

        “This is a promising approach, but we have to be careful because there has not been a lot of research yet,” Dr. Kearney-Cooke said. “This is not something I'd suggest a lot of doctors start putting their patients on.”
       

Control of disorders
               Under close medical supervision, Topamax in combination with the anti-depressant have helped Mr. McManiman. He recently weighed in at 245 pounds, down from 291 pounds in February. His waist size has shrunk from 50.25 inches to 44.75 inches.

        His Body Mass Index (BMI) score, a combined measure of weight and height, has dropped from 41 to 33. Scores from 30 to 40 are considered obese. Scores above 40 are considered morbidly obese. Scores from 25 to 30 are considered overweight.

        In addition, Mr. McManiman says he feels the urge to binge only once or twice a month rather than four or five times a week.

        The effects of the Topamax appear significant because Mr. McManiman did not have as strong an improvement with only an anti-depressant.

        Beyond Topamax, several other psychiatric drugs also appear useful in controlling eating disorders.

        Dr. McElroy has authored and co-authored several studies reporting beneficial effects from prescribing “serotonin reuptake inhibitors” to control obesity. Drugs that have been tested with positive results include sertraline (brand name Zoloft); fluvoxamine (brand name Luvox) and citalopram (brand name Celexa).

        Several of these drugs are prescribed at the UC Physicians weight management clinic even though they haven't been specifically approved by the FDA as medicines to control obesity.

        So-called “off-label” use of medications is common, especially in psychiatry, Dr. McElroy said. Once a drug has FDA approval for a specific use, doctors have wide latitude to study and prescribe that medication for related problems.

        According to Dr. McElroy, people like Mr. McManiman can expect to take their obesity control medications for the rest of their lives — much like diabetics who depend on insulin shots to compensate for a non-functioning pancreas.

        “We're learning that obesity isn't simply a matter of willpower. Obesity is a lifetime illness that requires lifetime treatment,” Dr. McElroy said.

       



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