Homeostatic or Hedonic Binging?

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.

Homeostatic or Hedonic Binging?

In our experience, the majority of patients who struggle with binge-eating episodes do not eat regularly throughout the day, and tend to struggle with binge behaviours from mid-afternoon onward. In these patients, the binge is likely precipitated by true physical or homeostatic hunger (a need for calories) rather than a hedonistic emotional appetite (need for comfort foods). Well-distributed calories and the use of more satiating protein-rich foods may be enough to resolve the disorder in these patients.

The difference between patients with homeostatic and hedonic binge-eating disorder is so marked that we wonder whether the presence of meal or snack-skipping should be included in the upcoming DSM-V (estimated release: May, 2012) as an exclusionary criterion for the diagnosis of binge-eating disorder.

Before diagnosing someone with binge-eating disorder, you should first ensure that a subtle form of homeostatic hunger is not triggering or encouraging their behaviour. Have patients follow the eating instructions below to see whether their binge eating resolves:

Breakfast containing a minimum of 350 kcal with at least 15 g of protein, to be consumed within 30 minutes of waking

Snacking every 2.5 hours between meals with snacks containing 100–200 kcal and at least 8 g of protein

Lunch containing a minimum of 300–400 kcal with at least 15 g of protein

Dinner containing a minimum of 400 kcal with at least 15 g of protein

For every hour of sustained exercise, add an additional 100–150 kcal that are primarily carbohydrate based

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

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