Binge Eating Disorder and the Road To Recovery
By Judith Matz, MSW, LCSW
The top three mistakes I’ve witnessed as people come to me for help with their Binge Eating Disorder are:
- Receiving prescriptions for restrictive eating
- Believing that understanding emotional issues will end the bingeing
- Assuming weight loss will/should occur as a criterion for successful recovery
If you’re seeking help for out-of-control eating, choose a therapist or other health professional who specializes in the treatment of Binge Eating Disorder (BED). You can expect to explore underlying emotional issues, as well as to learn how to reconnect with signals for hunger and satiation. If you’re a therapist treating BED, it’s important to acknowledge that we are members of the same culture our clients live in and have our own internalized biases and attitudes toward food, weight, and dieting. Adhering to a non-diet, weight-neutral approach on both the individual and cultural levels ensures that our clients will receive supportive and effective care on their road to recovery.
Receiving Prescriptions for Restrictive Eating
If you feel out of control with your eating—and if you’re gaining weight—it makes sense that you’ll look for ways to control your food intake. That might take the form of a specific diet—in fact, about 30 percent of people who seek weight-management programs have BED—or it may take the shape of a food plan that seems sensible. The key is that you’re trying to follow something that will reign in your bingeing.
According to the Binge Eating Disorder Association, “Within a diet- and thin-focused culture, the focus has been on weight loss as the goal. This ‘treatment’ is often promoted by well-intentioned friends, family, and professionals. But with binge eating, dieting is a causal factor in the development of binge eating disorder. So it’s essential for treatment to provide an alternative to dieting for improving health and body image. In fact, weight loss as a goal of treatment—as opposed to goals of improved self-care—can be damaging to the process of recovery.”
This means that when you try to restrict your eating for the purpose of weight loss, you are actually likely to eat more, since deprivation is a significant factor in triggering a binge. When I offer workshops, I ask the question: “If I told you that starting tomorrow, you can never have ice cream again, what would you do tonight?” The answer is always the same: People say they would eat a lot of ice cream—whether they’re hungry for it or not—and they’d eat way more than their body needs.
The diet mentality is so pervasive in our culture that you may not realize when it’s operating. This mind-set leads you to categorize foods as “good” and “bad” and tells you what you “should” and “shouldn’t” eat. Unfortunately, the diet mentality means that you may eat foods you don’t want because you’re “supposed” to, only to find yourself rebelling in the form of a binge.
Therapists aren’t immune from this good/bad thinking. Take the case of Natalie, who came to me because her binge eating had worsened over the past few months, despite her work with a therapist whom she found supportive in other areas of her life. Natalie told me that her therapist had offered the following piece of advice: “Don’t use butter when you cook your eggs.” Do you hear the diet mentality in that recommendation? Natalie enjoyed having eggs for breakfast (cooked in butter!), but the moment she was told not to use butter—which she understood implied the “fat is bad” message—she found herself bingeing on high-fat foods, including doughnuts and leftover birthday cake.
Take-away message: Make sure that treatment for BED gives people permission to experiment with all types of foods and discover for themselves what truly nourishes them. This approach ends the deprivation that comes from food restriction and the diet mentality, which can actually trigger and sustain binge eating.
Believing That Understanding Emotional Issues Will End Binge Eating
Most people struggling with binge eating will also say that they are emotional eaters. We know that BED often occurs along with anxiety or depression, and that some people who binge also have a history of trauma. If you’re trying to deal with challenging issues, it makes sense that you turn to food; after all, food is the way we’re calmed and soothed when we’re born into this world. Eating to make yourself feel better works in a certain way, and I always encourage my clients to stay compassionate with themselves—rather than yelling at themselves and/or feeling guilty—when they find themselves overeating.
At the same time, you may decide to work in a client/therapist relationship to heal underlying emotional issues and develop new strategies to manage uncomfortable feelings.
When I first started working with clients who wanted to end emotional overeating, I believed that understanding the underlying causes would lead to an end of overeating and bingeing. That’s the training I received in graduate school—I was taught that resolving core issues would lead to symptom relief, and I assumed this to be true in the treatment of BED. I remember that one of my first clients who struggled with bingeing did a great job of understanding why she overate. She was successful in resolving relationship issues and strengthening her self-esteem. Yet, she continued to binge on a regular basis.
I’ve learned since then that the diet/binge cycle takes on a life of its own, and that as important as it is to do the emotional work, it is essential to do the cognitive behavioral work of breaking the diet mentality and establishing a healthy relationship with food (as opposed to trying to eat only healthy foods!). Once I understood this premise, I referred my client to a non-diet group where she successfully ended her binge eating.
Learning to recognize cues for hunger and satiation is key to the treatment of BED. This type of eating—known as attuned or intuitive eating—helps you decide when, what, and how much to eat as you learn to trust your body’s physical cues, and has shown success in helping people to normalize their relationship with food. Here is a summary of the three steps of attuned eating:
- Learn to recognize when you are physically hungry. This requires tuning in to your stomach and noticing how it feels.
- Identify what your body craves in response to your physical hunger. In order to match your hunger with the food that will satisfy you, have a variety of foods available and withhold judgments about what you are supposed to eat.
- Pay attention to fullness in order to know how much to eat.
While these steps may seem simple at first glance, after years of disordered eating patterns, it usually takes time to fully integrate attuned eating, and working with a professional can offer much support as you navigate the ups and downs of this journey. That’s why it’s so important for therapists, dietitians, and other health professionals to feel grounded in a non-diet approach as they work with clients in this arena.
As you create a reliable, internal structure to feed yourself much of the time, you’ll be in a much stronger position to tackle any emotional aspects of your binge eating.
In Beyond a Shadow of a Diet: The Comprehensive Guide to Treating Binge Eating Disorder, Compulsive Eating, and Emotional Overeating, Ellen Frankel and I explain:
Not only must your client rule out deprivation as the trigger for her overeating, she must also build a stronger sense of self that will enable her to do the therapeutic work of learning to cope with feelings without her reliance on food.
This strengthened inner self evolves through her accumulation of attuned eating experiences; in fact, it is this self-attunement that is the key to ending overeating. Each time your client eats when she is hungry, she conveys to herself that she has needs. Each time she makes a match with a particular food, she communicates to herself that her needs are important and specific. Each time she stops when she is satisfied, she lets herself know that her needs can be fulfilled. These basic but significant acts provide your client with a consistent and reliable internal structure—important aspects of good caretaking. The positive, internal feedback she garners as she accurately responds to her hunger fosters trust and confidence in herself that was not possible when her eating patterns, and her perceptions of those behaviors, created havoc in her mind. As this internal transition occurs, your client will feel psychologically bolstered in a way that allows her to consider facing underlying issues.
Take-away message: Reconnecting with physical hunger is a necessary component of treating BED. Not only is it compatible with the therapeutic goal of working toward reducing emotional overeating, it is the key to helping people become in charge of their eating (as opposed to being in control) as they heal underlying issues.
Assuming Weight Loss Will/Should Occur as a Criterion for Successful Recovery
Many people with BED reach out to health/mental-health providers, saying, “I want to lose weight.” And many people with BED are told that they need to lose weight. Given cultural pressures around thinness, it’s understandable that there is a focus on the pursuit of weight loss. At the same time, conflating weight loss with recovery from BED is counterproductive on multiple levels.
There are all kinds of myths about BED and weight. It’s important to recognize that people with BED come in all shapes and sizes. There are people at higher weights who do not have BED, and there are people at lower weights who struggle with bingeing. You cannot tell if someone has an eating problem just by looking at them!
Likewise, as people normalize their relationship with food, they can end up at any size. As Frankel and I write in The Diet Survivor’s Handbook, “…even if everybody ate the exact same foods and engaged in the same amount of daily activity, there would still be a wide variation of body size.” There are complex factors that contribute to people’s weight, and they are not yet well understood. It’s not just a matter of calories in and calories out, and our weight-regulation system is largely outside of conscious control. Rather, factors such as genetics, frequency of yo-yo dieting, medications, and the environment can all influence body size. People often believe that when they end their bingeing, they’ll lose weight—if that happens, I think about that as a side effect of changing behaviors, rather than the main event. But weight loss is not a necessary component for recovery.
When the focus is on achieving a particular weight, people often stay trapped in the diet/binge cycle. If weight loss is the goal, then manipulating food—rather than honoring cues for hunger and fullness—becomes the pattern. The pursuit of weight loss can include overriding hunger signals, avoiding foods perceived to be “bad,” and overexercising. It’s important to note that these are the very same behaviors considered to be symptoms of eating disorders in lower-weight individuals. Research shows that while most plans and programs result in weight loss in the short run, the vast majority of people gain it back, with two-thirds ending up higher than their pre-diet weight, reinforcing that the pursuit of weight loss is counterproductive.
Instead, recovery from BED must focus on behaviors rather than the number on a scale. Eating when hungry, eating a wide variety of foods, and stopping when satisfied is a positive, sustainable behavior regardless of whether weight is lost. Engaging in physical activity for the purposes of pleasure and/or health benefits is a positive, sustainable behavior regardless of whether weight is lost. Practicing mindfulness or meditation is a positive, sustainable behavior regardless of whether weight is lost. And the list of positive, sustainable behaviors goes on and on.
The key is to find a weight-neutral stance, which means letting go of investment in an “ideal” weight and finding where your body lands when you take care of it the best you can, given your own unique circumstances. My clients typically find that working on body respect and acceptance—a necessary part of treatment with BED—is usually more challenging than the work of slowing down their binge eating. That’s because there is so much weight bias in our culture, and it affects just about everyone—people struggling with BED, their family, their friends, and even their health providers.
The Health At Every Size (HAES) framework, which we describe in Beyond a Shadow of a Diet, offers a positive approach to ending weight bias while encouraging healthful behaviors on an individual level and addressing social justice issues on a societal level. Although there are many myths about this paradigm, at its core, HAES encourages people to focus on behaviors that support physical, emotional, and spiritual well-being, rather than focusing on the pursuit of weight loss, and to respect the diversity of human beings when it comes to body size. The HAES framework allows people to become empowered and to stay active in their self-care without feeling that they are somehow giving up.
As one of my clients wrote:
At 37, the worldview that I accepted told me that I wasn’t really worthy of much with a larger body, even though I was a strong and courageous mother, loved by a wonderful and caring husband, and extremely successful as an elementary schoolteacher and teachers’ mentor. In my inner world, the only way to be worthwhile was to be thin. Now, the judgments are gone; the self-esteem issues are gone; righteousness when I stayed on a diet is gone. I don’t physically look like I thought I would, or even how I may eventually look someday—who knows?—but I’m happy, peaceful, and extremely thankful.
If you’re struggling with BED, I hope that you, too, will find that peace. And if you’re in the position of helping people recover from BED, I hope you’ll support people in moving away from the diet mentality and fear of fat as they heal their relationship with food and live fully in the world.
Take-away message: There’s no particular weight that indicates recovery from BED; rather, it is a function of normalizing eating, addressing other issues associated with binge eating behavior, and confronting cultural messages that encourage disordered behaviors. It is crucial for clinicians to address their own biases regarding body size so that they don’t—even unintentionally—promote weight stigma. And it’s important for everyone to understand internalized weight stigma, and to respect people of all sizes.
About the author:
Judith Matz, MSW,LCSW specializes in the treatment of eating and weight issues, is co-author of Beyond a Shadow of a Diet: The Comprehensive Guide to Treating Binge Eating Disorder, Compulsive Eating, and Emotional Overeating (2nd edition, 2014), The Diet Survivors Handbook: 60 Lessons in Eating, Acceptance and Self-Care (2006), and author of the new children’s book Amanda’s Big Dream (2015). Judith is a popular speaker at local and national conferences. Descriptions of her work have appeared in the media including Allure, LA Times, Fitness, Good Housekeeping, Self, Shape, Today’s Dietitian, Diabetes Self-Management, Psychotherapy Networker, NBC News Chicago with Nesita Kwan, Huffington Post Live, and she appears in the documentary America The Beautiful 2. Judith has a private practice in Skokie, IL.
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