Weight Management and Eating Disorders

Introduction to Weight Management Medications

• Weight management medications should be monitored for efficacy and safety monthly for the first 3 months, then at least every 3 months, as recommended by the American Gastroenterological Association 1
• Medication should be discontinued if less than 5% weight loss is achieved at 12 weeks, according to the American Gastroenterological Association 1

Medication Selection for Weight Management

• In patients with cardiovascular disease, sympathomimetic agents like phentermine should be avoided; lorcaserin and orlistat are safer alternatives, as suggested by the American Gastroenterological Association 1
• For patients with Type 2 diabetes, GLP-1 analogues and metformin are recommended as they promote weight loss while reducing hyperglycemia, as recommended by the American Gastroenterological Association 1

Treatment of Eating Disorders

• Cognitive Behavioral Therapy (CBT) is recommended, focusing on what can be eaten rather than what cannot, and addressing beliefs about "forbidden" foods and worst-case scenarios, as part of a comprehensive approach to challenge dysfunctional thoughts about food 2
• Guided internet/computer-based CBT can be effective, especially for patients with trauma history or fear of stigmatization, and can provide between-session support and monitoring 3
• Family-Based Treatment (FBT) is recommended as the first-line treatment for adolescents and young adults with involved caregivers, while CBT and Interpersonal Therapy (IPT) may also be effective 4
• The American Psychological Association recommends CBT as a first-line treatment for bulimia nerviosa, focused on reducing binge eating and purging behaviors, with technology-based interventions such as internet/computer-guided CBT as a useful complement to treatment, especially for patients with a history of trauma or fear of stigmatization 3

Medications for Binge Eating Disorder

• The following medications are recommended for binge eating disorder:

Nutrition and Weight Restoration

• Establishing individualized weekly weight gain goals, structured meal planning, gradual increase in caloric intake, and monitoring to prevent refeeding syndrome are recommended, with a goal of achieving a BMI >18.5 kg/m² 3, 5
• Regular monitoring of weight and nutritional status, as well as ongoing evaluation of eating behaviors and trauma symptoms, is necessary for patients with eating disorders, according to the American Psychiatric Association 5

Treatment Approach and Pitfalls

• A multidisciplinary team approach, including medical, psychiatric, psychological, and nutritional expertise, is recommended for optimal treatment outcomes, as suggested by the American Psychiatric Association 5
• Factors such as longer duration of the illness, lower BMI, alcohol abuse, and poor social adaptation are associated with a worse prognosis, highlighting the need for early and comprehensive intervention 4
• Underestimating the severity of anorexia as a serious mental illness, premature return to sports or activities before adequate weight restoration, failing to involve a multidisciplinary team, inadequate monitoring for medical complications, not addressing underlying trauma, and focusing solely on weight rather than normalizing eating behaviors are common pitfalls to avoid, as recommended by the British Journal of Sports Medicine guidelines 4

Return to Play and Competition

• Patients with a BMI <16 kg/m² or severe purging behaviors require categorical restriction from training and competition until appropriate treatment and weight restoration, as recommended by the British Journal of Sports Medicine guidelines 4
• Athletes diagnosed with anorexia nervosa who have a BMI <16 kg/m² must be categorically restricted from training and competition, and return to play is only allowed after achieving a BMI >18.5 kg/m², cessation of bingeing and purging, and close follow-up with a multidisciplinary team, as recommended by the British Journal of Sports Medicine guidelines 4

Safety Monitoring

• Careful monitoring of blood glucose is needed when using medications that affect appetite, particularly stimulants, in patients with diabetes 1
• Regular assessment of vital signs is necessary, particularly with stimulant medications or medications containing phentermine, to ensure patient safety 12