Binge Eating Liraglutide Intervention

All applicants will be initially screened by phone and/or electronically to determine whether
they potentially meet eligibility criteria. Those who appear to meet eligibility criteria and
remain interested in the trial will be scheduled for an in-person interview.

The in-person interview will be conducted by a psychologist or Masters' level staff member,
who will obtain informed consent and evaluate subjects' behavioral eligibility (i.e.,
willingness and appropriateness to participate) using structured and semi-structured clinical
interviews including: an examination of the applicants' BED symptoms, their mood,
suicidality, and other general psychopathology. Participants will also be asked to complete
questionnaires assessing eating behavior, demographic characteristics, frequency of specific
eating behaviors related to loss of control, risk of substance dependence with the
consumption of high fat/sugar foods, alexithymia, night eating syndrome, sleep patterns and
quality, and attitudes towards food cravings.

Subjects who remain interested and pass this portion of the assessment will proceed to meet
with the study physician or nurse practitioner, who will obtain a medical history and conduct
a physical examination to determine medical eligibility. Subjects will also have an
electrocardiogram (EKG), fasting blood test, and a urine pregnancy test (for females of child
bearing age) to confirm eligibility.

Upon successful completion of the screening visit, subjects will be asked to eat as they
normally would for 2 weeks. Once per week over these two weeks they will receive a brief
survey through REDcap to assess their binge eating episodes for eligibility.

Subjects who continue to meet eligibility criteria assessed at the screening visit and during
the run-in period will be scheduled for a randomization visit at the Center within 3 weeks of
their screening.

Subjects will be randomly assigned to the two interventions in equal numbers (i.e., 1:1
ratio). The subject's weight, blood pressure, and pulse will then be measured. Following
randomization, all subjects will have a medical visit with the study physician or nurse
practitioner who will instruct them in the use of liraglutide 3.0 (as described later) and
provide the first month's supply of medication.

After randomization, subjects will return at week 1 to assess rate of response. Subjects will
return for study visits every two weeks thereafter, at weeks 3, 5, 7, 9, 11, 13, 15, and 17.

These study visits include a brief medical visit (10-15 minutes) with a physician or nurse
practitioner to monitor their response to the medication or any changes in health. Vitals and
weight will be taken. Additionally, binge episodes, mood, suicidality, and symptom
improvement will be assessed by the psychologist or Masters' level trained study staff.
Participants will be asked also to complete questionnaires assessing quality of life,
obsessions related to food, and food cravings prior to each treatment visit for the secondary
outcomes:

In summary, study visits will consist of the medical visit, completion of written surveys,
review of structured interviews with the study staff and review of medication adverse events.
These visits are expected to last about 30-40 minutes. The study assessments at week 17 will
consist of the previously listed procedures and measures in addition to the questionnaires
and blood tests conducted at baseline.

Inclusion Criteria:

1. BMI > 30 kg/m2 or BMI ≥ 27 - 29.9 kg/m² in the presence of at least one weight-related
comorbid condition, such as binge eating disorder, hypertension, or dyslipidemia.
There is no upper BMI limit for this trial.

2. Age ≥ 21 years and ≤ 70 years

3. Meet full DSM 5 criteria for BED

1. Recurrent episodes of binge eating characterized by both consuming an abnormally
large amount of food in a short period of time compared with what others might
eat in the same amount of time under the same or similar circumstances and
experiencing a loss of control over eating during the episode.

2. These episodes feature at least 3 of the following:

i. consuming food more rapidly than normal; ii. eating until uncomfortably full; iii.
consuming large amounts of food when not hungry; iv. consuming food alone due to
embarrassment; v. feeling disgusted, depressed, or guilty after eating a large amount
of food. c. Significant distress about the binge episodes is present. d. Binge
episodes must occur, on average, at least once per week for 3 months.

4. All races and ethnicities are included

5. Eligible female subjects will be:

- non-pregnant, evidenced by a negative urine dipstick pregnancy test

- non-lactating

- surgically sterile or postmenopausal, or they will agree to continue to use an
accepted method of birth control during the study

6. Ability to provide informed consent before any trial-related activities

7. Subjects must:

- have a primary care provider (PCP) who is responsible for providing routine care

- have reliable telephone or Internet service to communicate with study staff

- understand and be willing to comply with all study-related procedures and agree
to participate in the study by giving written informed consent

- plan to remain in the Philadelphia area for the next 6 months or more

Exclusion Criteria:

1. Pregnant or nursing, or plans to become pregnant in the next 6 months, or not using
adequate contraceptive measures

2. Personal or family history of medullary thyroid cancer or multiple endocrine neoplasia
syndrome type 2

3. Uncontrolled hypertension (systolic blood pressure ≥ 160 mm Hg or diastolic blood
pressure ≥ 100 mm Hg)

4. Type 1 diabetes

5. Type 2 diabetes

6. A combination of fasting glucose ≥ 126 mg/dl, combined with an HbA1c >6.5, will be
used to indicate the presence of diabetes, an exclusion criterion

7. Recent history of cardiovascular disease (e.g., myocardial infarction or stroke within
the past 6 months), congestive heart failure, or heart block greater than first degree

8. Clinically significant hepatic or renal disease

9. Thyroid disease, not controlled

10. History of malignancy (except for non-melanoma skin cancer) in past 5 years

11. The presence of current anorexia nervosa or bulimia nervosa

12. Current major depressive episode, active suicidal ideation, or lifetime history of
suicide attempts. We will exclude participants who have a Patient Health
Questionnaire-9 (PHQ-9) [31] score > 15, or a score of > 1 on the suicidal ideation
item, as well as any risk of suicidality as measured by a score of 4 or 5 on the
Columbia-Suicide Severity Rating Scale (C-SSRS)[32].

13. Psychiatric hospitalization within the past 6 months

14. Self-reported alcohol or substance abuse within the past 12 months, including at-risk
drinking (current consumption of ≥ 14 alcoholic drinks per week)

15. Diagnosis current or past psychosis

16. Use in past 3 months of medications known to treat BED (such as lisdexamfetamine),
induce significant weight loss (i.e., prescription weight loss medications), or induce
weight gain (e.g., chronic use of oral steroids, second generation antipsychotics)

17. Currently receiving behavioral or pharmacological treatment for BED

18. Loss of ≥ 10 lb of body weight within the past 3 months

19. Known or suspected allergy to trial medication(s), excipients, or related products

20. Hypersensitivity to liraglutide or any product components

21. The receipt of any investigational drug within 6 months prior to this trial

22. Previous participation in this trial (e.g., randomized and failed to participate)

23. History of pancreatitis

24. History of gastrointestinal surgery (unless it was an adjustable gastric band that has
been removed).