Binge Eating Disorder (BED) is characterized by the consumption of a large amount of food in a discrete period of time. It is the most common eating disorder in the United States, and it affects people of all racial and ethnic groups. About 1.25% of adult women and 0.42% of adult men have binge eating disorder. About 1.6% of teens age 13 to 18 years old are affected (National Institutes of Health).
Someone with BED feels out of control during the eating episodes. There is secrecy and shame about the behaviors, and often the individual knows the behavior is unhealthy but feels helpless to stop the cycle. Feelings of shame, guilt, and depression often follow, causing the individual to isolate themselves.
Binge Eating Disorder and Diet Culture
Weight cycling and weight gain are the byproducts of this eating behavior. Many individuals can present with BED in average sized bodies; others will be in larger bodies. It’s important to understand that the body size is not the problem. In fact, it is the eating behaviors, underlying attitudes, and other co-existing psychiatric disorders that define BED. So, when these individuals come into treatment, the focus is on behavior, not weight. At Sanford Comprehensive Treatment for Eating Disorders (SCTED), we do not treat “obesity”.
Dieting is a risk factor for the development of BED, as well as other eating disorders. This is especially acute when a “diet rule” is broken. The feelings of hunger or diet “failure” can trigger binge eating. For these reasons, eating regular and pleasing meals are important to prevent the physiological and psychological responses that can lead to binge eating. At SCTED, our clinical kitchen is a safe space to learn intuitive cooking and eating behaviors. It also reintroduces our patients to the social aspects of food.
BED and Substance Use
Sometimes eating disorders and substance use disorders (ED, SUD) appear at the same time, or coexist. For others, the substance use disorder may appear during or after recovery from an eating disorder. Conversely, eating disorder issues may appear/reappear after a period of abstinence from substance use. This phenomenon is sometimes called symptom substitution. In other words, the underlying issues which led to the eating disorder have not yet resolved, so the individual turns to another means to numb feelings or establish a sense of control.
The substances most commonly misused by those with eating disorders are caffeine, tobacco, alcohol, laxatives/diuretics, appetite suppressants (amphetamines), heroin, and cocaine. Coexisting SUD and ED are most common in the population with bulimia or binge eating disorder.
Medical Care Avoidance
Individuals in larger bodies have often avoided medical care due to the shame about being weighed. They also avoid the expected judgment and intervention from medical staff. Therefore the #1 medical complication for these individuals is substandard medical care. This means early diagnosis of other illnesses is often missed. Medical professionals are a part of our society and therefore not immune from weight bias. Giving directives like “just lose weight” or “you can have knee surgery if you lose twenty pounds” do more harm than good. They can even trigger new desperate dieting techniques.
Shame is a trigger for binge behaviors, so it’s not uncommon for us to hear stories about individuals coming home from a physician visit and bingeing. Feelings of desperation can also cause the individual to begin new, ever more restrictive diets. Eventually, the person will revert to old eating behaviors, because restrictive dieting is very difficult to sustain over time, Most individuals who diet restrictively will gain back what they lost and more.
Health at Every Size
The Sanford Comprehensive Treatment for Eating Disorders philosophy is all part of the Health at Every Size (HAES) approach. HAES honors body diversity. HAES also embraces the concept that all foods fit into a balanced eating pattern. Likewise, HAES encourages movement for the joy involved, not to lose weight. In spite of strong scientific evidence, HAES is not well accepted in the medical community or society at large. Consequently, it takes time for patients and their families to accept the idea that being in a larger body is not a sign of poor willpower.
With BED, the problem has often existed in secret for ten years or more before treatment is sought. BED does respond to outpatient treatment by a HAES-informed team; but like individuals with Bulimia Nervosa, there may be co-existing substance use, significant depression, and PTSD due to past traumas, and self-harming behaviors. When these symptoms are increasing, along with acceleration of the binge eating, it may be time to seek a higher level of care.
If you are concerned about someone you love…
Denial of the problem, or of the seriousness of the problem, are common in individuals with eating disorders. Lying to cover behaviors is also common. This may well be a process which requires several conversations. But don’t look the other way. If you see something which concerns you, say something. The earlier an individual gets to treatment, the better the chances for his/her long-term recovery. And recovery IS possible. Don’t lose hope!