Binge eating disorder (BED) is the most common eating disorder, thought to occur is approximately 2% of adult Americans, but the prevalance is much higher in people with overweight/obesity, women, and people ages 18-35 years. BED was officially added to the diagnostic manual in 2012. It is important to talk about because it can cause psychological distress as well as physical conditions such as overweight/obesity and its related conditions. There are safe and effective ways to treat BED. Let's bring more awareness and open dialogue to this important condition.
BED is defined as eating large amounts of food in a short period of time with a feeling of lack of control that leads to extreme distress, poor self-image and feelings of unhappines about body weight. It can be mild, moderate, or severe. Binge eating frequently occurs in private. It may be planned out and with certain foods.
The causes are thought to be both a genetic predisposition combined with environmental factors. The environmental factors can be related to food and body image, such as modeling of certain eating patterns or media related body images. It is notable that these environmental influences are more likely to happen to young people with the genetic predisposition to BED since the genetics tend to run in families where eating patterns are observed. Environmental factors can also be less specific, such as abuse, divorce, or low self-esteem.
Extreme dieting can also increase the risk of binge eating. After significant weight loss, cravings can increase. Additionally, in some cases, people are not comfortable with the way they feel or look at a lower weight. This may be more common in people with a history of abuse. In the Rainier Medical program, some of the ways in which BED is addressed to try to reduce the risk of binge eating following significant weight loss via a medical protocol are:
- word choice: avoiding the use of words like "good, bad, cheating" in describing eating
- focusing on positive health habits, such as eating on time and drinking enough water and getting enough sleep, rather than number of pounds lost per week
- eating 5 times a day, starting within an hour of waking up, so you do not go more than 3 hours without eating
- avoiding lists of foods that you "can" or "can't" have and emphasizing that each individual chooses what they eat at all times
- setting goal weights that are higher than "ideal" body weights, but at the level where the most health benefit has been achieved. The more weight that is lost, the stronger the cravings may be following weight loss,
- focusing on following the medical protocol for a specific period of time, then transitioning to a maintenance program that varies by individual preferences and encouraging remote patient monitoring or other form of follow up so that if weight regain begins to occur, action is taken early so larger amount of weight does not need to be lost again (i.e. lose 10 pounds eight times, but not 80 pounds again)
- treating each individual with a holistic approach, including any other medical issues or psychological symptoms.
Treatment has been shown to be effective in BED, both by reducing the frequency of binge eating episodes and by reducing weight gain that has occurred due to binge eating. Treatment consists of three main categories: cognitive behavioral therapy, environmental influences, and medication. Cognitive behavioral therapy is aimed at any underlying psychological symptoms, such as anxiety or low body image. There are medications that are used to treat BED also, both on and off-label. The risks, benefits, potential side effects, and precautions should be discussed on an individual basis.
My goals with this blog are to help people with the following:
- Identify if you think you may have BED and talk about it with a licensed medical professional trained in this area or obtain a referral to one. Embarassment, shame or guilt may be barriers to this important step. Hopefully, this blog destigmatizes this condition.
- Obtain treatment for BED itself as well as any co-existent psychological issues, with the goal to be improving body image and reducing binge eating episodes. This may include cognitive behavioral therapy, medication, or both.
- Obtain treatment for excess weight, if present, to reach a healthier body weight and reduce the risk of health complications from excess weight, when the timing is right, if appropriate and desired.
For more information, click here or make an appointment with Dr. Sutherland or your trusted health professional.
Take Back Your Peace,
Valerie Sutherland, MD