ASBR ICEIPI 2022, 02 February 2023
* Author to whom correspondence should be addressed.
Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorders, can severely impact people’s physical and mental health. Among all psychological treatments, exercise has been examined lately as one of the novel methods. Multiple literature has proved its benefits on physical health, including improving cardiovascular function and growing skeletal musculature. Moreover, studies have demonstrated its benefits on treating depression and anxiety. However, exercise may be deemed inappropriate in treating eating disorders since patients usually engage in compulsive exercise. In addition to exercise treatment, medications have been broadly applied in eating disorder treatments. Major medications include Selective Serotonin Reuptake Inhibitors (SSRI) and anti-psychotics. This meta-analysis aims to determine whether exercise intervention or pharmacological therapy is more effective in treating eating disorders. The result shows little difference in overall effectiveness, but different treatments may impact different symptoms of patients. Future researchers should continuously investigate the effect of exercise intervention and various types of pharmaceuticals to determine their practical application in eating disorder treatment according to the characteristics of specific patients
eating disorders, pharmacotherapy, exercise intervention
1. American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. DSM 5. Washington, DC, US: Author.
2. Keel, P. K., Holm-Denoma, J. M., & Crosby, R. D. (2011). Clinical significance and distinctiveness of purging disorder and binge eating disorder. International Journal of Eating Disorders, 44, 311–316.
3. Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, and Rissanen A. (2007). Epidemiology and course of anorexia nervosa in the community. American Journal of Psychiatry, 164(8):1259-65.
4. Favaro A, Caregaro L, Tenconi E, Bosello R, and Santonastaso P. (2009). Time trends in age at onset of anorexia nervosa and bulimia nervosa. Journal of Clinical Psychiatry, 70(12):1715-21.
5. Hudson JI, Hiripi E, Pope HG Jr, and Kessler RC. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3):348-58.
6. Hsu, L. K. G. (1989). The gender gap in eating disorders: Why are the eating disorders more common among women? Clinical Psychology Review, 9(3), 393–407.
7. Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources. Eating Disorders, 22(1), 33-49.
8. angweth, B., Hudson, J. I., Pope, H. G. Jr., Hausmagn, A., DeCol, C., Laird, N. M., Tsuang, M.T. (2003). Family study of the aggregation of eating disorders and mood disorders. Psychological Medicine, 33, 1319-1323.
9. Altman, S. E., & Shankman, S. A. (2009). What is the association between obsessive-compulsive disorder and eating disorders? Clinical Psychology Review, 29, 638-646.
10. Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13(2), 153-160.
11. Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with Anorexia Nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724-731.
12. Linardon J, Wade TD, Garcia XD and Brennan L (2017c) The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology 85, 1080–1094.
13. Slade E, Keeney E, Mavranezouli I, Dias S, Fou L, Stockton S, Saxon L, Waller G, Turner H, Serpell L, Fairburn CG and Kendall T (2018) Treatments for bulimia nervosa: a network meta-analysis. Psychological Medicine 48, 1–8.
14. Bacaltchuk J, Trefiglio RP, Oliveira IR, Hay P, Lima MS and Mari JJ (2000) Combination of antidepressants and psychological treatments for bulimia nervosa: a systematic review. Acta Psychiatrica Scandinavica 101, 256–264.
15. Hughes PL, Wells LA, Cunningham CJ and Ilstrup DM (1986) Treating bulimia with desipramine. A double-blind, placebo-controlled study. Archives of General Psychiatry 43, 182–186.
16. Romano SJ, Halmi KA, Sarkar NP, Koke SC, Lee JS. A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. Am J Psychiatry 2002; 159(1): 96-102.
17. Powers, P. S., & Santana, C. (2004). Available pharmacological treatments for anorexia nervosa. Expert Opinion on Pharmacotherapy, 5(11), 2287–2292.
18. McElroy SL, Guerdjikova AI, Mori N, O’Melia AM. Current pharmacotherapy options for bulimia nervosa and binge eating disorder. Expert Opinon on Pharmacotherapy 2012; 13(14): 2015-26.
19. Hay, P. J., & Claudino, A. M. (2012). Clinical psychopharmacology of eating disorders: a research update. The International Journal of Neuropsychopharmacology, 15(2), 209–222.
20. Dunn, A. L., Trivedi, M. H., Kampert, J. B., Clark, C. G., & Chambliss, H. O. (2005). Exercise treatment for depression: efficacy and dose response. American journal of Preventive Medicine, 28, 1-8.
21. Martenstyn, J. A., Touyz, S., & Maguire, S. (2021). Treatment of compulsive exercise in eating disorders and muscle dysmorphia: protocol for a systematic review. Journal of Eating Disorders, 9(1), NA.
22. Liberati, A., Altman, D., Tetzlaff, J., Mulrow, C., Gøtzsche, P., Ioannidis, J., Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoSMedicine, 6(7),e1000100.
23. Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
24. Worboys M. (2013). The Hamilton Rating Scale for Depression: The making of a “gold standard" and the unmaking of a chronic illness, 1960-1980. Chronic illness, 9(3), 202–219.
25. Garner, D.M., Olmstead, M.P. and Polivy, J. (1983), Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorder., 2: 15-34.
26. Ferguson. (2009). An Effect Size Primer. Professional Psychology, Research and Practice, 40(5), 532–538.
27. Center for Evaluation and Monitoring (2021), Effect Size Calculator, https://www.cem.org/effect-size-calculator
28. Nickel, C., Tritt, K., Muehlbacher, M., Pedrosa Gil, F., Mitterlehner, F. O., Kaplan, P., Lahmann, C., Leiberich, P. K., Krawczyk, J., Kettler, C., Rother, W. K., Loew, T. H., & Nickel, M. K. (2005). Topiramate treatment in bulimia nervosa patients: A randomized, double-blind, placebo-controlled trial. The International Journal of Eating Disorders, 38(4), 295–300.
29. George Hsu, L. K., Clement, L., Santhouse, R., & Ju, E. S.(1991). Treatment of Bulimia Nervosa with Lithium Carbonate: A Controlled Study. The Journal of Nervous and Mental Disease, 179(6), 351–355.
30. Mitchell, J., Fletcher, L., Hanson, K., Mussell, M., Seim, H., Crosby, R., & Al-Banna, M. (2001). The relative efficacy of fluoxetine and manual-based self-help in the treatment of outpatients with bulimia nervosa. Journal of Clinical Psychopharmacology, 21(3), 298–304.
31. Rothschild, R., Quitkin, H. M., Quitkin, F. M., Stewart, J. W., Ocepek-Welikson, K., McGrath, P. J., & Tricamo, E. (1994). A double-blind placebo-controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives. The International Journal of Eating Disorders, 15(1), 1–9.
32. Romano, S. J., Halmi, K. A., Sarkar, N. P., Koke, S. C., & Lee, J. S. (2002). A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. The American journal of psychiatry, 159(1), 96–102.
33. Walsh, B. T., Gladis, M., Roose, S. P., Stewart, J. W., Stetner, F., & Glassman, A. H. (1988). Phenelzine vs Placebo in 50 Patients With Bulimia. Archives of General Psychiatry, 45(5), 471–475.
34. Levine, M. D., Marcus, M. D., & Moulton, P. (1996). Exercise in the treatment of binge eating disorder. International Journal of Eating Disorders, 19(2), 171–177. Carei, T. R., Fyfe-Johnson, A. L., Breuner, C. C., & Brown, M. A. (2010). Randomized controlled clinical trial of yoga in the treatment of eating disorders. Journal of Adolescent Health, 46(4), 346–351.
35. Chantler, I., Szabo, C. P., & Green, K. (2006). Muscular Strength Changes in Hospitalized Anorexic Patients After an Eight Week Resistance Training Program. International Journal of Sports Medicine, 27(8), 660–665.
36. Carei, T. R., Fyfe-Johnson, A. L., Breuner, C. C., & Brown, M. A. (2010). Randomized controlled clinical trial of yoga in the treatment of eating disorders. Journal of Adolescent Health, 46(4), 346–351.
37. Zou, H., Wang, D., Ren, H., Cai, K., Chen, P., Fang, C., Shi, Z., Zhang, P., Wang, J., Yang, H., & Zhong, H. (2020). Effect of Caloric Restriction on BMI, Gut Microbiota, and Blood Amino Acid Levels in Non-Obese Adults. Nutrients, 12(3), 631.
38. Haring, L., Koido, K., Vasar, V., Leping, V., Zilmer, K., Zilmer, M., & Vasar, E. (2015). Antipsychotic treatment reduces psychotic symptoms and markers of low-grade inflammation in first episode psychosis patients, but increases their body mass index. Schizophrenia Research, 169(1), 22–29.
39. Martínez-Ortega, J. M., Funes-Godoy, S., Díaz-Atienza, F., Gutiérrez-Rojas, L., Pérez-Costillas, L., & Gurpegui, M. (2013). Weight gain and increase of body mass index among children and adolescents treated with antipsychotics: a critical review. European Child & Adolescent Psychiatry, 22(8), 457–479.
40. Hughes, E. K., Goldschmidt, A. B., Labuschagne, Z., Loeb, K. L., Sawyer, S. M., & Grange, D. L. (2013). Eating Disorders with and without Comorbid Depression and Anxiety: Similarities and Differences in a Clinical Sample of Children and Adolescents. European Eating Disorders Review, 21(5), 386–394.
41. Cook, B. J., Wonderlich, S. A., Mitchell, J. E., Thompson, R., Sherman, R., & McCallum, K. (2016). Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines. Medicine and Science in Sports and Exercise, 48(7), 1408–1414.
42. Douglas, J. A., Deighton, K., Atkinson, J. M., Sari-Sarraf, V., Stensel, D. J., & Atkinson, G. (2017). Acute Exercise and Appetite-Regulating Hormones in Overweight and Obese Individuals: A Meta-Analysis. Journal of Obesity, 2017.
43. N. A. King, V. J. Burley, and J. E. Blundell, "Exercise-induced suppression of appetite: effects on food intake and implications for energy balance," European Journal of Clinical Nutrition, vol. 48, no. 10, pp. 715-724,1994.
44. Guo, S., Liu, F., Shen, J., Wei, M., & Yang, Y. (2020). Comparative efficacy of seven exercise interventions for symptoms of depression in college students: A network of meta-analysis. Medicine (Baltimore), 99(47), e23058–e23058. Zeeck, A., Schlegel, S., Jagau, F., Lahmann, C., & Hartmann, A. (2020). The Freiburg sport therapy program for eating disorders: a randomized controlled trial. Journal of Eating Disorders, 8(1), 1–31.
45. Sundgot-Borgen, J., Rosenvinge, J., Bahr, R., & Schneider, L. (2002). The effect of exercise, cognitive therapy, and nutritional counseling in treating bulimia nervosa. Medicine and Science in Sports and Exercise, 34(2), 190–195.
46. Thien, V., Thomas, A., Markin, D., & Birmingham, C. L. (2000). Pilot study of a graded exercise program for the treatment of anorexia nervosa. The International Journal of Eating Disorders, 28(1), 101–106.
47. Attia, E., Kaplan, A. S., Walsh, B. T., Gershkovich, M., Yilmaz, Z., Musante, D., &Wang, Y. (2011). Olanzapine versus placebo for out-patients with anorexia nervosa. Psychological Medicine, 41(10), 2177–2182.
48. McElroy, S. L., Hudson, J. I., Capece, J. A., Beyers, K., Fisher, A. C., & Rosenthal, N. R. (2007). Topiramate for the Treatment of Binge Eating Disorder Associated With Obesity: A Placebo-Controlled Study. Biological Psychiatry (1969), 61(9), 1039–1048.
The datasets used and/or analyzed during the current study will be available from the authors upon reasonable request.
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