Barriers: Binge Eating Disorder

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.

EATING DISORDERS

A wide range of abnormal eating behaviours, ranging from simply skipping meals (disordered eating) to full-blown DSM-diagnosable binge-eating disorders, can pose significant barriers to obesity treatment. While some of these disorders can be dealt with as part of the obesity-management strategy, severe eating disorders require specialized behavioural interventions that are generally beyond the scope of general practice. Such patients should be referred to an eating disorder specialist before you initiate a weight-management program.

Binge-Eating Disorder

Binge eating, also called compulsive overeating, is probably the most common eating disorder and is present in 2% of all adults. Among mildly obese people in self-help or commercial weight-loss programs, 10% to 15% have a binge-eating disorder, and prevalence rises to as much as 40% among those with severe obesity. Binge-eating disorder is slightly more common in women, with three women affected for every two men.

Obese people with binge-eating disorder often became overweight at a younger age than those without the disorder. They may also have more frequent episodes of losing and regaining weight (weight cycling).

Binge eating is different from normal increases in appetite and occasional or contextual overeating (e.g., holiday meals). This disorder is also different from binge-purge syndrome (bulimia nervosa) because people with binge-eating disorder do not usually purge afterward by vomiting or using laxatives. People with a binge-eating problem eat unusually large amounts of food and do not stop eating when they become full. They binge regularly and describe feeling out of control and powerless to stop eating. Binge episodes may be triggered by negative emotions such as stress, anxiety, hurt, frustration, anger, sadness or boredom. Many find it comforting and soothing to eat food at such times, but after a binge they are likely to feel guilty and sad about their lack of control. People with binge-eating disorder are extremely distressed by their binge eating and often have very low self-esteem. Many have a history of emotional, physical or sexual abuse or unresolved grief. They usually rate their social environment regarding relationships as less supportive and cohesive.

Some people miss work, school or social activities in order to binge eat. Obese people with binge-eating disorder often feel badly about themselves, are preoccupied with their appearance, and may avoid social gatherings. Most feel ashamed and try to hide their problem. They are often so successful that close family members and friends do not know about their binge eating. Most will have tried to control it on their own, but will have had only short-term success.

The causes of binge eating disorder are still unknown. Up to half of all people with binge-eating disorder have a history of depression, but whether depression is a cause or consequence of the disorder is unclear. Impulsive behaviour and certain other psychological problems may be more common in people with binge-eating disorder. The relationship between binge eating and childhood abuse, post-traumatic stress and unresolved grief is addressed below.

Although binge eating is strongly associated with a history of dieting, it is unclear whether dieting actually promotes binge-eating disorder. While findings vary, early research suggests that about half of all people with binge-eating disorder had binge episodes before they started dieting. However, strict dieting may worsen binge eating.

People who are not overweight or who are only mildly obese should avoid strict dieting, as it may worsen binge eating. However, many people with the disorder are severely obese and have medical problems related to their weight, making losing weight and keeping it off important treatment goals.

Several studies have found that people with binge-eating disorder find it harder to comply with obesity treatment. Binge eaters are also more likely to regain weight quickly. For these reasons, people with the disorder may require treatment that focuses on their binge eating before they begin obesity treatment. Normal-weight patients who are frequently distressed by their binge eating may also benefit from treatment.

Several methods are currently used to treat binge-eating disorder. Cognitive-behavioural therapy teaches patients techniques to monitor and change their eating habits and how they cope with difficult situations. Interpersonal psychotherapy helps people examine their relationships with friends and family, and make changes when problems are identified. Treatment with medications such as antidepressants may be helpful for some individuals. Self-help groups can also be a source of support. The choice of treatment should be discussed with the patient and a mental health professional with experience in this area.

© 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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