“All eating disorders are serious medical conditions that can have a long-lasting impact on health and should be treated by experts in the field. Each may require a slightly different approach.” ~ Andrew Weil, M.D.
A compulsive overeater (binge eater) is an individual who compulsively eats but does not purge and usually becomes overweight. The overeater may eat three meals a day plus frequent snacks. He or she may overeat continually throughout the day, rather than consume large amounts of food during binges.
Most of us overeat from time to time, and many people often feel they’ve eaten more than they should have. Eating a lot of food does not always mean that a person has binge-eating disorder.
Doctors generally agree that most people with serious binge eating problems often:
- Feel their eating is out of control
- Eat what most people would think is an unusually large amount of food
- Eat much more quickly than usual during binge episodes
- Eat until they are so full they are uncomfortable
- Eat large amounts of food, even when they are not really hungry
- Eat alone because they are embarrassed about the amount of food they eat
- Feel disgusted, depressed or guilty after overeating
Binge eating also takes place in another eating disorder called bulimia nervosa. Persons with bulimia nervosa, however, usually purge, fast or do strenuous exercise after they binge eat. Purgers vomit or use a lot of diuretics (water pills) or laxatives to keep from gaining weight. Fasting is defined as not eating for at least 24 hours. Strenuous exercise, in this case, means exercising for more than an hour just to keep from gaining weight after binge eating. Purging, fasting and over-exercising are dangerous ways to try to control your weight.
Binge-eating disorder is probably the most common eating disorder. Most people with this problem are either overweight or obese, but normal-weight people also can have the disorder. [The 1998 NIH Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults define overweight as a body mass index (BMI) of 25 to 29.9 and obesity as a BMI of 30 or more. BMI is calculated by dividing weight (in kilograms) by height (in meters) squared.]
About 2 percent of all adults in the United States (more than four million Americans) have binge-eating disorder. About 10 to 15 percent of people who are mildly obese and who try to lose weight on their own or through commercial weight-loss programs have binge-eating disorder. The disorder is even more common in people who are severely obese.
Binge-eating disorder is a little more common in women than in men; three women for every two men have it. The disorder affects blacks as often as whites. No one knows how often it affects people in other ethnic groups.
People who are obese and have binge-eating disorder often became overweight at a younger age than those without the disorder. They might also lose and gain back weight (yo-yo diet) more often.
Most people with binge-eating disorder have tried to control it on their own, but have not been able to control it for very long. Some people miss work, school or social activities to binge eat. Persons who are obese with binge-eating disorder often feel bad about themselves and may avoid social gatherings.
Most people who binge eat, whether they are obese or not, feel ashamed and try to hide their problem. Often they become so good at hiding it that even close friends and family members don’t know they binge eat.
People with binge-eating disorder can get sick because they may not be getting the right nutrients. They usually eat large amounts of fats and sugars, which don’t have a lot of vitamins or minerals.
People with binge-eating disorder are usually very upset by their binge eating and may become very depressed. People who are obese and also have binge-eating disorder are at risk for:
- High blood pressure
- High blood cholesterol levels
- Gallbladder disease
- Heart disease
- Certain types of cancer
People who are not overweight should avoid dieting because it sometimes makes their binge eating worse. Dieting in this instance means skipping meals, not eating enough food each day, or avoiding certain kinds of food (such as carbohydrates). These are unhealthy ways to try to change your body shape and weight. Many people with binge-eating disorder have health problems because of their weight. These people should try to lose weight and keep it off. People with binge-eating disorder who are obese may find it harder to stay in a weight-loss program. They also may lose less weight than other people, and may regain weight more quickly. (This can be worse when they also have problems like depression, trouble controlling their behavior, and problems dealing with other people.) These people may need treatment for binge-eating disorder before they try to lose weight.
Symptoms of binge-eating disorder include recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a lack of control over eating during the episode.
The binge-eating episodes are associated with at least three of the following: eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of being embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after overeating. There is often marked distress about the binge-eating behavior.
Binge eating occurs, on average, at least two days a week for six months. Binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise). People with binge-eating disorder experience frequent episodes of out-of-control eating, with the same binge-eating symptoms as those with bulimia. The main difference is that individuals with binge-eating disorder do not purge their bodies of excess calories. Therefore, many with the disorder are overweight for their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge eating.
People with binge-eating disorder, whether or not they want to lose weight, should get help from a health professional such as a psychiatrist, psychologist or clinical social worker for their eating behavior. Even those who are not overweight are usually upset by their binge eating, and treatment can help them. There are several different ways to treat binge-eating disorder. Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people.
Researchers are still trying to find the treatment that is the most helpful in controlling binge-eating disorder. The methods mentioned here seem to be equally helpful. For people who are overweight, a weight-loss program that also offers treatment for eating disorders might be the best choice.
The treatment goals and strategies for binge-eating disorder are similar to those for bulimia, and studies are currently evaluating the effectiveness of various interventions. The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. To this end, nutritional rehabilitation, psychosocial intervention and medication management strategies are often employed. Establishment of a pattern of regular, non-binge meals, improvement of attitudes related to the eating disorder, encouragement of healthy but not excessive exercise, and resolution of co-occurring conditions such as mood or anxiety disorders are among the specific aims of these strategies. Individual psychotherapy (especially cognitive-behavioral or interpersonal psychotherapy), group psychotherapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective. Psychotropic medications, primarily antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly those with significant symptoms of depression or anxiety, or those who have not responded adequately to psychosocial treatment alone. These medications also may help prevent relapse.
People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation. For some people, treatment may be long-term.
If you think you might have binge-eating disorder, it’s important to know that you are not alone. Most people who have the disorder have tried but failed to control it on their own. You may want to get professional help. Talk to your health-care provider about the type of help that may be best. The good news is that most people do well in treatment and can overcome binge eating.
Treatment can save the life of someone with an eating disorder. Friends, relatives, teachers, therapists, dietitians, peer support groups and physicians all play an important role in helping the ill person start and stay with a treatment program. Encouragement, caring and persistence, as well as information about eating disorders and their dangers, may be needed to convince the ill person to get help, stick with treatment, or try again.