Battle of the binge
The good news for people with extreme eating urges is that the disorder responds well to treatment, writes Ruth Nichol.
Binge-eating disorder wasn’t recognised as a distinct eating disorder by the American Psychiatric Association until 2013. That means it has been studied less extensively than other eating disorders such as anorexia and bulimia, and there are fewer statistics available about it.
Most existing data comes from the US, where binge-eating disorder is estimated to affect three times as many people as anorexia and bulimia combined – about 3.5% of women and 2% of men. However, although eating disorders have typically been more common in women, it’s now thought men may be equally affected by binge-eating disorder.
A diagnosis of binge-eating disorder is made if someone has at least one episode of extreme eating a week for at least three months. “Bingeing is not over-eating,” says Auckland eating-disorders specialist Jan Geary. ”It’s eating a large amount of food in a very short period of time and it’s always accompanied by a sense of being out of control.”
Most people feel ashamed and embarrassed by their behaviour and do it in secret. However, unlike bulimia, they do not try to vomit afterwards. Bulimia affects about 1.5% of women, including Princess Diana, who in her explosive 1995 BBC Panorama interview with Martin Bashir said she developed “rampant bulimia” after finding out Prince Charles was having an affair with Camilla Parker Bowles.
Geary says that no one knows exactly what causes binge-eating disorder. Eating disorders of all kinds tend to run in families, but it’s hard to know whether that’s because of genetic factors or shared attitudes towards food. She says having a larger body during childhood can be a predisposing factor, possibly because it leads to dieting, which then tips over into binge eating. Other possible contributing factors include coming from a family where food is used as a reward, and the generally greater availability of energy-dense food.
The good news is that binge-eating disorder responds well to treatment.
Geary uses an approach developed by British eating-disorders specialist Christopher Fairburn called enhanced cognitive behaviour therapy (CBT-E).
Treatment starts with the affected person keeping a real-time record of everything they eat, as well as any relevant thoughts and feelings associated with eating. “This often reveals how frequently they are bingeing – they may think they are doing it once a week but it’s actually four times a week.”
At the same time, they are encouraged to establish a regular pattern of eating, with three planned meals a day and snacks in between. Geary says many binge eaters have chaotic eating patterns, and it’s important to introduce a more normal regime to help prevent bingeing.
Other elements of treatment include finding alternative activities as distractions from the bingeing urge, such as going for a walk or having a shower or a bath.
It’s also important to eliminate dieting of any kind and to stop thinking in terms of “forbidden foods”. “Often people with binge-eating disorder avoid more energydense food, then they eat it in a binge,” says Geary. “It’s about learning how to have some pizza or caramel slice and then stop, rather than carrying on.”
Fairburn recommends having about 20 treatment sessions in as many weeks. However, Geary says although this is usually successful for people with bulimia, it can take longer than 20 weeks to rein in binge eating.
“They might be in their thirties or forties or fifties and they have been eating in a chaotic way for most of their lives.
For some people, committing to normal eating is a huge undertaking and they really have to put the hours in.”
“Bingeing is not overeating. It’s eating a large amount of food in a very short period of time with a sense of being out of control.”
symptoms of addiction.
“Even if you are not fully clinically addicted, but are hooked enough on these foods that you are eating an extra couple of hundred calories a day, that is sufficient for your weight to begin creeping up and for you to be at greater risk of diet-related disease,” says Gearhardt. “It doesn’t take a full-blown addiction to start to have negative consequences because of an addictive substance.”
PERSONAL CONTROL
Gearhardt is a fan of taking control over your own personal food environment. That might mean getting rid of ultraprocessed products and stocking the home and workplace with enjoyable naturally occurring foods such as strawberries or nuts.
“It’s best not to starve yourself,” she says, “because when we’re really hungry, the gut peptides that tell us we’re in need of calories prime the reward system of the brain that goes awry in addiction. I also suggest that people monitor what their triggers are out in the world. There are going to be external cues such as certain fast-food restaurants or vending machines, but also internal cues such as emotions or boredom. The more you equip yourself with this knowledge, the easier it is to go about your day and have a plan for when those things arise.”
Gearhardt isn’t preaching complete abstinence – she is fond of chocolate peanut Kind bars that are made and sold in the US. “But there might be foods that are super-high-risk for you – such as double chocolate chunk ice cream or salt and vinegar crisps. And there might be times when trying to eat a riskier food is going to set you up to fail, such as late at night or when you’ve had a stressful day and are really tired. If you can’t ever eat them in moderation, maybe it’s time to take a break from these foods, almost as if you have an allergy to them.”
It is especially difficult to negotiate the modern food environment if you are a parent. As the mother of a small son, Gearhardt empathises, and in her work she studies children at every developmental stage, including infants as young as two weeks, trying to understand the effect on the brain of exposure to sugar and ultraprocessed foods in early life, when the reward systems are developing.
“You don’t want to make your child feel shame or fear about their eating, and yet we know that early childhood and adolescence is a time when they are establishing eating habits and are at high risk of obesity and even binge-eating disorders.”
There are many pathways to obesity, concedes Gearhardt, and our biological bias towards unhealthy junk food can’t be blamed for the entire problem. In fact, it is possible to have a body mass index (BMI) that is in the normal range and still show signs of addiction in your eating. And whereas some people binge-eat, others don’t have any loss of control. Instead, they do what Gearhardt describes as the equivalent of chain-smoking, dosing with a snack or sweet treat every couple of hours throughout the day.
We have a history of being slow off the mark when it comes to recognising addictive substances. For food addiction, it is still early days. However, the YFAS has been translated into more than 10 languages and cited several hundred times, so Gearhardt is confident it now has momentum.
“On the face of it, food does seem different. We all need to eat, it’s legal, it’s not intoxicating, and yet our over-consumption of these not-naturally-occurring, ultra-processed junk foods is one of the biggest killers in the world today,” she says.
Whereas the science community might be slow to recognise the problem, Gearhardt says most ordinary people don’t need much convincing. “When I talk to people outside of this world, they’re like, ‘Are you kidding me? Why are you even researching this?”
study showed that when rats were fed a diet of junk food, they became so hooked that when it was taken away and replaced with a healthy meal, they chose to starve.