New research proves that targeting hunger signals works better than traditional therapy for veterans with binge eating disorder

The Hidden Struggle

Imagine feeling completely out of control around food. You know you’re not hungry, but you can’t stop eating. The sight of certain foods triggers an overwhelming urge that feels impossible to resist. For millions of people struggling with binge eating disorder, this scenario is all too familiar.

Binges are episodes where a person rapidly consumes large amounts of food in a short period of time, often accompanied by a sense of loss of control and distress. These binges can lead to significant physical and emotional consequences.

The numbers are staggering: Binge eating affects up to 65% of female veterans and 45% of male veterans – much higher rates than in the general population. Military service often involves eating quickly, periods of food deprivation, and “making weight” requirements, which can severely disrupt natural hunger and fullness signals.

Understanding Binge Eating Disorder

Binge eating disorder (BED) is a serious and often misunderstood eating disorder that affects millions of people worldwide. Characterized by recurring episodes of consuming unusually large quantities of food in a short period, BED is marked by a sense of loss of control during these eating episodes. According to the National Eating Disorders Association, binge eating disorder is the most common eating disorder, surpassing both anorexia nervosa and bulimia nervosa in prevalence. Despite its frequency, BED is frequently overlooked or mistaken for a lack of willpower, when in reality, it is a complex mental health condition that requires professional treatment.

Recognized as a distinct diagnosis in the Diagnostic and Statistical Manual (DSM-5) published by the American Psychiatric Association, binge eating disorder involves more than just occasional overeating. Individuals with BED experience persistent distress about their eating behavior, often accompanied by negative feelings such as guilt, shame, and anxiety. These emotions can further fuel the cycle of binge eating, making it difficult to break free without support. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) highlights that BED can lead to significant health complications, including weight gain, obesity, diabetes, and other physical and mental health conditions.

Diagnosis of binge eating disorder involves a thorough evaluation of eating habits, mental health, and physical well-being by a qualified healthcare professional. Symptoms typically include eating large amounts of food in a short period, feeling unable to stop eating, and experiencing emotional distress related to eating episodes. Many people with BED also struggle with co-occurring mental health conditions such as depression, anxiety, or obsessive-compulsive disorder, which can complicate recovery and require integrated treatment approaches.

Treatment for binge eating disorder is most effective when tailored to the individual’s needs. Cognitive behavioral therapy (CBT) is a helpful and widely used approach that addresses the negative feelings and behaviors associated with BED. In some cases, medications such as certain antidepressants or ADHD medication may be prescribed to help manage symptoms. A mental health professional can work with individuals to develop a comprehensive treatment plan, which may include group sessions, individual therapy, and support groups. Establishing regular eating habits and addressing underlying emotional triggers are also key components of successful treatment for binge eating.

It is important to remember that binge eating disorder is not simply about food or dieting—it is a multifaceted disorder that impacts both mental and physical health. Seeking help from a healthcare professional is the first step toward recovery. With the right treatment and support, individuals can overcome binge eating disorder, improve their mental well-being, and develop a healthier relationship with food and their bodies. If you or someone you know is struggling, resources like the National Eating Disorders Association hotline and online support groups offer support and guidance. Hope starts with reaching out, and recovery is possible.

A Historic Scientific Breakthrough

Dr. Kerri Boutelle and her team at UC San Diego’s Center for Healthy Eating and Activity Research (CHEAR) have achieved something unprecedented in eating disorder research. Their groundbreaking study, published in JAMA Network Open in August 2025, is the first to prove that any treatment works better than cognitive behavioral therapy (CBT) for binge eating disorder in adults.

In their CHARGE study (Controlling Hunger and Regulating Eating), the team’s “Regulation of Cues plus Behavioral Weight Loss” (ROC+BWL) treatment significantly outperformed CBT – the current gold standard treatment that has dominated the field for decades. The study focused on adult veterans, with an average body mass index (BMI) of 34.8.

What makes this breakthrough so significant? The benefits were sustained even six months after treatment ended, and the results were even stronger for veterans with severe binge eating disorder.

How ROC Works: Training Your Internal GPS

Think of ROC like recalibrating your body’s internal GPS system for eating. Most traditional treatments focus on changing thoughts and behaviors around food. While helpful, this approach often falls short because it doesn’t address the underlying disconnect many people have with their body’s natural signals.

ROC was specifically developed to address disrupted eating patterns in individuals with binge eating disorder, with a focus on restoring a healthy eating pattern as a foundation for recovery.

ROC takes a different approach by targeting two key areas:

Food Responsiveness

This is how strongly you react to external food cues – the aroma of fresh cookies, seeing a pizza commercial, or walking past your favorite restaurant. People with high food responsiveness often feel like these triggers control them rather than the other way around.

Satiety Responsiveness

This refers to how well you can detect and respond to your body’s fullness signals. Many people with eating difficulties have lost touch with these subtle internal cues that tell us when we’ve had enough.

The ROC program uses practical exercises to help people:

• Recognize the difference between physical hunger and emotional cravings
• Practice tolerating food cravings without acting on them
• Strengthen their ability to detect true hunger and fullness
• Develop skills to resist eating when not physically hungry

The CHARGE Study: Groundbreaking Results

The CHARGE study followed 129 veterans (average age 47, 59% male, average BMI 34.8) over five months of treatment plus six months of follow-up. From nearly 1,900 veterans who inquired, 129 met the strict criteria and were randomly assigned to either ROC+BWL or traditional CBT. Both ROC+BWL and CBT are interventions used to treat binge eating disorder. Both groups attended weekly 90-minute sessions. The interventions led to significant reductions in participants’ body weight, as measured by weight loss and changes in BMI. The results were historic.

Binge Eating Reduction:

• 23% greater reduction in binge eating risk at the end of treatment
• 21% sustained advantage six months after treatment ended
• ROC+BWL participants went from 58 people with loss-of-control episodes at baseline to just 26 (45%) at the end of treatment
• CBT participants went from 58 to 37 (64%) – still good, but significantly less effective

Weight Loss:

• Greater weight loss during the 5-month treatment period (0.71 BMI point difference)
• Sustained caloric intake reduction of 280-300 calories per day that lasted through follow-up
• Weight differences didn’t persist at follow-up, but eating behavior changes did

Most remarkably, the benefits were even stronger for veterans with full binge eating disorder (12+ episodes in 3 months), showing that the sicker the patient, the more ROC+BWL helped compared to standard therapy.

Why This Changes Everything

This is the first study in history to prove that any treatment works better than CBT for binge eating disorder. Dr. Boutelle notes that the only other treatment ever directly compared to CBT was interpersonal psychotherapy, which showed “equivocal results” – meaning no clear winner. The research is groundbreaking.

It targets the root mechanisms

While CBT, a form of talk therapy, focuses on changing thoughts and behaviors (“top-down”), ROC+BWL works on both mental strategies AND the body’s physical hunger/fullness systems (“top-down and bottom-up”)

The benefits last

Unlike many eating disorder treatments that show short-term gains, ROC+BWL participants maintained their improvement in binge eating six months after treatment ended

It works for the sickest patients

Veterans with full binge eating disorder – the most severe cases – showed the strongest response to ROC+BWL

It addresses a treatment gap

Traditional CBT reduces binge eating but rarely leads to meaningful weight loss. ROC+BWL tackled both problems simultaneously.

This new approach could significantly impact the landscape of treating eating disorders by offering a more comprehensive solution that addresses both behavioral and physical aspects, potentially improving outcomes for individuals seeking help.

What This Means for the Future

Dr. Boutelle’s team concludes: “ROC+BWL targets both appetitive traits and reduction in energy intake, which could provide multiple distinct skills to manage urges to binge eat and overeat and provide a more durable treatment.”

For Everyone

This approach encourages moving away from restrictive diet culture, promoting body acceptance and intuitive eating. It may also benefit individuals struggling with disordered eating, not just those with diagnosed binge eating disorder, by addressing a broader range of unhealthy eating patterns.

The Implications are Far-reaching

For Veterans

This research offers hope for more effective treatment of a condition that affects nearly half of all veterans. The military culture of rapid eating, food restriction, and weight requirements creates the perfect storm for binge eating – but now there’s a treatment specifically designed to address these underlying mechanisms.

For Everyone

While this study focused on veterans, the principles apply broadly. Many people have lost touch with their natural hunger and fullness signals due to dieting, stress, trauma, or simply living in our food-abundant environment.

For Treatment

This represents a paradigm shift from external food rules to internal body wisdom – teaching people to trust and respond to their own physiological signals rather than fighting against them.

The Road Ahead

The researchers emphasize that more studies are needed, particularly:

• Longer-term follow-up studies
• Testing in civilian populations, including young people as well as adults
• Comparing ROC alone (without calorie restriction) vs. ROC+BWL
• Understanding which patients respond best to which approach

Current availability

The ROC program is offered at UC San Diego’s CHEAR and through various research studies for eligible participants. The CHEAR center offers support for individuals seeking help with eating disorders. Dr. Boutelle’s team is working on creating treatment manuals to help other therapists learn this approach.

Hope for the Future

For the millions of people who feel trapped by their relationship with food, this research offers genuine hope. The idea that we can retrain our bodies to recognize and respond appropriately to hunger and fullness signals – and that these changes can be lasting – is truly revolutionary.

If you or someone you know struggles with binge eating or feeling out of control around food, know that effective help is available and getting better all the time.

This research was published in JAMA Network Open and supported by the Department of Defense and the National Institutes of Health. For more information about CHEAR’s programs, visit chear.ucsd.edu.

Disclaimer: This blog post is for educational purposes only and is not a substitute for professional medical advice. If you’re struggling with eating difficulties, please consult with a qualified healthcare provider.