In a culture that unfortunately overvalues dieting and weight loss, you may be surprised to learn that the most common eating disorder in the US, and elsewhere around the world, is binge eating disorder.
Some public figures have spoken out about this kind of eating disorder. But, it largely lurks in the shadows of the public conversation about eating disorders. This leaves individuals who are experiencing the symptoms confused and unsure how to stop the problem.
Binge eating is characterized by a feeling of loss of control while eating a large amount of food. There is also some research to suggest that experiencing a loss of control while eating a more typical amount of food is also problematic for people. Guilt and shame are common after loss-of-control eating episodes. Over time, binge sizes and frequency tend to increase if the problem is not addressed.
What are other features of binge eating?
There are five common characteristics associated with binge eating:
- Eating very rapidly
- Eating more so than normal
- Eating past fullness and into discomfort
- Eating despite not feeling hungry
- Eating alone or secretly due to embarrassment about food consumption
- Negative feelings after eating
For a formal diagnosis of binge eating disorder to apply, an individual must experience at least three of features above during loss-of-control eating episodes.
People with binge eating disorder experience binge episodes repeatedly, at least once a week for at least three months, on average, to meet criteria for the formal eating disorder. Of course, many people describe more frequent binge eating over more prolonged periods of time as well. For some, this results in weight gain.
Binge eating is distressing to those who experience it, and it can result in negative feelings and thoughts about one’s image or self.
What makes binge eating disorder different from bulimia nervosa?
Binge eating is a prominent symptom of both eating disorders. Guilt and body dissatisfaction following binge episodes are also shared phenomenon.
However, bulimia nervosa is also defined by the presence of behaviors inaccurately believed to ‘make up’ or compensate for binge eating episodes.
This may include:
- Self-induced vomiting,
- Fasting outside of binges,
- Extreme exercise in response to binge eating episodes, or
- Misuse of laxatives or other similar medications.
Purging behaviors carry several serious health risks. Self-induced vomiting in particular also has implications on oral health. And, though it sometimes comes as a surprise to individuals using these behaviors, they are not effective means of weight control.
In binge eating disorder, purging behaviors to compensate for binge eating episodes are absent.
Do people with binge eating disorder have overweight or obesity?
Every eating disorder symptom can be experienced by an individual of any size. Binge eating disorder is no exception. It can occur in individuals across the weight spectrum.
However, for some, the symptom of binge eating is associated with weight gain over time. And, in studies relying on community samples, approximately 40% of people with binge eating disorder will also have obesity. It is important to remember though that being in a body mass index (BMI) category of overweight or obesity is not in and of itself indicative of an eating disorder or the presence of any unusual eating behaviors.
What treatments help for binge eating disorder?
Talk Therapy
The most commonly recommended talk therapy with the strongest evidence-base is cognitive behavioral therapy.
Cognitive behavioral therapy helps individuals to improve their pattern of eating outside of binges, providing key education on the connection between undereating and binge eating. The therapy also teaches people to develop alternative coping strategies for stress and rethink their thinking about eating and self-image. If applicable, the role of weight stigma in perpetuating the problem is also explored. This type of therapy is often effective in reducing symptoms in as early as four to six weeks. It can also have added benefits on mood, anxiety, and day-to-day functioning.
If cognitive behavioral therapy alone is not fully effective, or if it is unrealistic or undesirable to be in a weekly psychotherapy, there are other options.
First, there is a self-help form of cognitive behavioral therapy that can be beneficial for binge eating.
Second, interpersonal psychotherapy, can be helpful for some people with binge eating disorder. This type of talk therapy focuses on how relationships and role transitions in life may be maintaining binge eating and associated symptoms. People learn about and get to practice communication skills that may help improve relationship-related stress.
Medication
Lastly, there are medications that address binge eating and sometimes co-occurring symptoms as well. Lisdexamfetamine (commonly known as Vyvanse) has been approved by the Federal Drug Administration for use in binge eating disorder. This stimulant curbs appetite and reduces cravings, effectively stopping the urge to binge throughout the day. However, this class of medication may not be advised for individuals with any history of being underweight for their body’s needs.
Multiple randomized controlled trials of antidepressant medications have shown that this class of medications helps reduce and control binge eating as well. On average, antidepressants don’t have much of an effect on weight in one direction or another.
Small pilot studies are also underway using the latest class of weight-loss agents, GLP-1s, in individuals at higher weights with binge eating disorder. However, a lot much more research is needed to understand the risks versus potential benefits of these types of medications for people with eating disorders, including binge eating disorder.
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