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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.

Members of the Canadian Obesity Network can download Best Weight for free.

Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network)

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7 Comments

  1. I had binge eating disorder and in my case I definitely believe it was caused by dieting.

    I had gradually made my way up to over 200 pounds (I am 5’3) when I decided to lose weight. I did it by counting calories, with some exercise, and 7 or 8 months later I was 70 pounds lighter. But I had become obsessed with calories and rules and weight, and all of a sudden I found myself experiencing episodes of out of control eating. I struggled and struggled, redoubling my vigilance after every binge in an effort to avoid weight gain. I was miserable enough to go see a therapist for the first time in my life, who told me this was outside of his expertise and referred me to a local eating disorders clinic. They put me on a waiting list, and I waited and waited, getting more and more depressed as the binges continued. I got depressed enough to be put on meds, and I no longer had the energy to compensate for my binges through restrictive eating, so I started to put the weight back on. By the time I got in at the eating disorders clinic, I had gained about 30-40 pounds. The clinic used cognitive-behavioural therapy and I was able to stop binging. No longer depressed, I was able to go on with my life, but as I returned to my pre-dieting lifestyle I put all the remaining weight back on (plus a few more pounds, for good measure) over the course of the next 4 years. Finally I decided to lose the weight again, but this time in order to prevent myself from descending into obsession, I decided I needed expert supervision and so I decided to see a dietitian. I told her my past and that I did not want to count calories or become obsessed. I see her every 4-6 weeks and show her my food diary and she provides valuable tips and guidance. We focus mostly on adding healthy foods to my diet, and getting variety and different nutrients. It’s been 2 years and I’ve lost 65 pounds, still a wee bit above a healthy BMI, and a much slower rate than the other time, but I’m happy because I’m not binging or obsessing, and I have the feeling this weight loss is sustainable.

    Anyway, my point is that dieting can definitely lead to binge eating, and people trying to lose weight should be careful how they go about it. My conviction is that it is better to be fat and mentally healthy than thin and obsessed/disordered. Obviously it is best if both the mind and the body are healthy.

    I recommend the book Overcoming Binge Eating by Dr. Christopher Fairburn.

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  2. 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.

    I’m so glad you included that. In the size acceptance community, it’s pretty much an accepted fact that dieting triggers binge eating. Many ex-dieters, upon getting involved in size acceptance, find that their problem with binge eating disappears. We think that the binge eating associated with dieting is actually more of a physiological response to semi-starvation than a psychological problem, although there are plenty of people for whom it is a pre-existing psychological problem that’s only worsened by dieting.

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  3. i dont consider myself on a diet its been well over a year since ive made lifestyle changes and part of that is counting calories ive lost a total of 90lbs feel great but yesterday i feel like i binged tell me if im wrong or right .i ate a whole loaf of raisin bread, not at one sitting but throughout the day is this considered binging? every now and again i do this .. umm i know i was overly tired yersterday because i had stayed out late the night before.So was feeling tired and lazy new i had made unhealthy choices and ive moved on but would you all consider that binging?

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  4. Dear Dr sharma:
    I have long considered myseft to be a binge eater, hower, with todays posting I have realized that I have disordered eating–a very different diagnosis so to speak. The contextual eating holidays, pot luck suppers, and other events where too much food is availableis a very week point for me. I have long ditched smorgs and buffets since they really make over eatinr easy. Even now that I am using the weight wise program I still eat meals too close together or too far apart. When my meals are too far apart I find that the later meal is too big–even if my bedtime snak is too far from my supper I can eat a large amount recently I ate a blow of All Bran 30 g, 1/2 cup skim milk, an orange, and an apple because it had been six hours since I last ate.
    I also know being a mental health consumer (one who has needed or continues to need mental health treatment) wether one condition causes another like the prevolance of depression or low self-esteem combined with other psyco- social disorders are as common as colds in winter.
    The real trick is figuring out which part of the problem to start treating first. After all good health without good mental isn’t really good health.
    Thank you for your insight.

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  5. stephanie: a binge is normally at one sitting and accompanied by a sense of loss of control, eating until you’re uncomfortably full. I think if it took you all day to eat the loaf it’s not a binge, but if it took under an hour it is. For me it was being possessed or something, pretty much impossible to stop once it started.

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  6. If you hear damaging comments, better to avoid them. The media bombards the television
    as well as print ads with svelte bodies of models
    that most women consider as the standard of a sound body.

    Renfrew Centers are affiliated with the Renfrew Center Foundation,
    whose mission is to support training, treatment, research and
    education for eating disorders.

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  7. Consequently, after riding the roller coaster up, he will come
    crashing down just as far: his blood sugar levels
    fall dangerously low after the body has struggled to clear out the unhealthy amount he had,
    and the serotonin in his brain falls to a minimum, leaving
    him depressed and anxious. Symptoms include sore throat, intestinal irritation,
    dehydration and swollen salivary glands.
    Whether you are even conscious of how much you are eating is sometimes questionable, which makes the condition even more
    serious.

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