ANZAED response to ‘Binge eating disorder treatment controversies’

To the Editor,

We thank Dr Paterson for his letter in response to our recent article on the treatment of binge eating disorder (Paterson, 2019).

We would like to offer a correction to our recent article. Where it was stated bulimia nervosa (BN) is contraindicated for use of lisdexamphetamine (LDX), it should have been stated that LDX is not indicated for the treatment of BN. While there are plans to conduct a treatment trial of LDX in BN (https://clinicaltrials.gov/ct2/show/NCT03397446), there is currently insufficient evidence to support the recommendation of LDX for the treatment of this disorder. We agree with Dr Paterson that more research is welcome in this space, but at this stage maintain that clinicians should not prescribe LDX to treat BN.

Dr Paterson speculated about the weight-inclusive treatment paradigm, Health At Every Size® (HAES). As highlighted in our original article (ANZAED, 2018), there are diverse views regarding the appropriateness of including weight loss as a goal in eating disorder treatment. This is an area where more research is needed, both to improve the long-term effectiveness of behavioural weight loss (BWL) interventions and to investigate the effectiveness of alternative approaches, such as HAES. Given that HAES is less well understood generally, we take this opportunity to provide more background on this paradigm here.

HAES® was developed by the Association for Size Diversity and Health in the context of multiple factors. These include the poor long-term effectiveness of BWL (see ANZAED, 2018), the removal of specific weight requirements from eating disorder diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and the rising interest within the eating disorder field to treat high weight alongside eating disorder symptoms. HAES® calls for a shift in focus away from weight onto well-being and for the field of eating disorders to address what is considered stigmatising attitudes among its clinicians and academics. Proponents of HAES® point to research that demonstrates that the health risks associated with higher weight (especially overweight to mild obesity) have been overstated (Romero-Corral et al., 2006) and that weight stigmatisation itself contributes to body dissatisfaction and further weight gain. Similar to other models of eating disorder treatment, the HAES® approach promotes health and recovery-focussed behaviours; however, this is in the absence of a focus on weight loss and includes consideration of weight bias and stigma within the community. Emerging evidence for this approach suggests that it is associated with health benefits; however, more research is required to confirm these findings.