Homeostatic or Hedonic Binging?
Saturday, April 9, 2011
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.
Members of the Canadian Obesity Network can download Best Weight for free.
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Saturday, April 9, 2011
Dr. Sharma,
Are you then recommending a food intake of approximately 1,550 – 1,600 calories per day?
Sunday, April 10, 2011
The individual caloric requirements are variable – the point is that before diagnosing emotional or hedonic binges it is prudent to first rule out homeostatic or hunger binges.
Sunday, April 10, 2011
I really hope Dr. Sharma was citing 1600 calories a day as a bare minimum (for someone small and inactive, for example)
After all, that was the “semistarvation” level that Ancel Keys used in his WWII study, and it was little enough food to cause some really disturbing psychological effects.
Sunday, April 10, 2011
Thanks.
Sunday, April 10, 2011
“…as a bare minimum (for someone small and inactive)…
or for someone who is female, older and/or has lower energy requirements because of prior weight loss.
(Ancel Keys subjects were young non-obese men)
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Monday, April 11, 2011
Does it really make a difference if you eat breakfast within half an hour, or an hour and fifteen minutes? I take medication in the morning and I cannot eat anything for at least half an hour, and the doctors even recommend waiting a full hour. If waiting that long really makes a big difference in eating behavior, then that’s something we need to take into consideration.
Monday, April 11, 2011
“Does it really make a difference if you eat breakfast within half an hour, or an hour and fifteen minutes?”
It probably doesn’t – the point here is to have an early breakfast – the sooner after waking up the better (don’t leave home without it!).
Monday, April 11, 2011
I’ve read similar recommendations before and I’ve always wondered when you recommend people stop eating. Do you continue to snack after supper, and if so, to what limit? Do you have snacks up until 2.5 hours before bed, or do you fast from supper until breakfast? What would you recommend for those who are not active in the evening vs. those who do physical activity in the evening?
Monday, April 11, 2011
I would add to the above: Have patients assess immediately before eating for their level of hunger and, separately, their desire to eat. It’s tedious, perhaps, but valuable, both for clinical information and for the patient’s own insight. If I can get patients to rate both of these things on the Likert-type scale of their choosing, some patterns become very clear. (Sometimes one snack isn’t necessary and can be eliminated, sometimes meals need shifting, sometimes one snack is often motivated solely by desire to eat from other cues…)
Another part of reducing binge-type behavior is becoming aware of hunger and eating cues earlier, so this kind of monitoring is helpful.
I don’t know if I would change the DSM criteria as above. I see too many ED patients who intentionally restrict, knowing they will binge (and sometimes purge) later, or who are overweight and intentionally restrict intake, citing ‘dieting,’ when out of the house because of social stigma.
Tuesday, April 12, 2011
or for someone who is female, older and/or has lower energy requirements because of prior weight loss.
This is what I don’t understand: if doctors acknowledge that prior weight loss causes lower energy requirements (basically requiring people to eat less and less in order to maintain a relatively high weight), then why do you keep recommending dieting and weight loss surgery? Do you think it’s good for people to be forced to eat so little? One of your newer posts talks about iron deficiencies. Maybe fat people tend to have nutritional deficiencies because they’re unable to eat enough to meet their nutritional requirements without gaining weight, thank to prior dieting. Why would it be healthy for a fat person to starve when it’s not healthy for someone thinner? Fat people still have nutritional requirements that are best met be eating food.
Tuesday, May 3, 2011
I have some thoughts with the differentiation between the two types of binging. As Ellie points out, many people intentionally restrict, only to binge later. Typically the restriction itself begins for emotional and psychological reasons. By the time that person binges I think then it is often for both homeostatic and hedonic reasons, not neatly separated.
I like Ellie’s idea of assessing hunger and need to eat immediately prior to eating, but I would add to notice mood and fatigue levels at those times, and to equally reflect on hunger, mood and fatigue when they are restricting. Only by going with affect and other cues around the whole cycle I think can you begin to fully address what is going on for each person.