Obesity and Binge Eating Disorder

By Mark Cohen, DSW, MPH

Although surveys indicate that more than one third of Americans are overweight, a distinct subgroup of the overweight population suffers from a much more serious condition—compulsive overeating, or as professionals call it, “binge eating disorder.” The National Institute of Mental Health (NIMH) states that 2 to 5 percent of Americans experience binge eating disorder in any 6-month period, characterized by eating excessive amounts of food within a discrete period of time coupled with a lack of control over eating during each episode (i.e., “I can’t stop”).

NIMH also states that people with binge eating disorder have some of the same symptoms as those who suffer from bulimia; however, they don’t purge and as a result, don’t suffer the medical or emotional consequences of purging. Binge eaters do experience a multitude of health problems including excessive weight gain accompanied by increased risk of heart attack, high blood pressure, high cholesterol, diabetes, kidney disease, cancer, and stroke. As with other eating disorders, binge eating also has an adverse impact on families as they observe their loved one getting sicker, occasionally going on a crash diet and losing weight, only to gain it back as the cycle begins again. Family members struggle with anger, frustration, sadness and disappointment as the pattern continues to persist.

Challenges to Recovery

Since binge eating does not randomly occur, overeating seems to meet some need for those who suffer. Eating is very comforting—it can help us push unpleasant feelings away, deal with boredom, allow us to feel satisfied and taken care of, and preoccupy us so that we don’t have to deal with stress or pain. Food also tastes good and provides satisfaction. Compulsive overeaters can have all sorts of reasons for bingeing, but their condition takes on a life of its own and transforms from a source of comfort to a monumental, self-destructive condition that negatively impacts the quality of life.

Compulsive overeaters can be successfully treated and return to a “normal life” without the many physical, emotional, and behavioral difficulties that they previously encountered. The key to recovery is combining the motivation to get well and live differently with a good primary treatment experience, followed by a solid continuing care program that helps avoid relapse. The goal for is to first “get off” and then “stay off” the binge eating merry-go-round. To achieve a state of ongoing wellness, each compulsive overeater must do two things: 1) make their recovery the top priority in their life and 2) simultaneously be willing to change. Without these ingredients, recovery becomes virtually impossible.

There are several barriers to keeping one’s recovery on course. The first is that you need to eat each day, so you have to interact with food. Alcoholics can stay away from alcohol and gamblers can avoid settings where their compulsion will be activated. But those with eating disorders can’t avoid food even though they can routinely control what their consumption (portion size becomes a central issue for binge eaters). A part of the primary treatment experience, then, is changing how, when, and what we eat.

A second challenge is that each day presents multiple opportunities for getting into trouble with food. Just go and buy gasoline; while you’re paying for it you’ll see all the snack foods that are there for the taking. Third, food establishments, advertisements, and supermarkets are everywhere and serve as “ongoing reminders” of the comfort that a compulsive overeater used to get from food misuse. And fourth, a lot of socialization occurs through the sharing of food. These very daunting obstacles to staying well highlight the need to change in many ways to remain in recovery.

Goals for the Compulsive Eater

Those who suffer from this illness need to be learning and practicing new ways of dealing with the many challenges that life throws our way and not allow a lapse (which is a temporary deviation from modifying our eating behavior) to become a full-blown relapse (which is returning to the way we functioned prior to receiving treatment). Recovery, then, is dependent upon adopting new coping strategies, finding new ways to deal with feelings, identifying “high risk situations” and avoiding them whenever possible, and engaging in the routine use of new tools to get through life’s daily difficulties. To accomplish this, compulsive overeaters need to utilize a support system that maximizes a proactive response to healthy living and minimizes the isolation and self-delusion that accompany the disorder. Being able to avoid a relapse is the ultimate goal for all those who suffer from eating disorders. This is equally true for compulsive overeaters.

Evidence-based treatments include cognitive-behavioral therapy (CBT), behavior therapy, dialectical behavior therapy, and interpersonal therapy (IPT). In addition, some medications, such as SSRI’s and antidepressants have been found to decrease binge frequency

More Support Is Necessary

Relapse rates for compulsive overeaters are incredibly high. Those who do best after receiving primary treatment have multiple supports—family members, friends, and most importantly, other recovering binge eaters. But in addition to support, recovery requires professional help to change and a program for achieving and maintaining these necessary changes as they are integrated into day-to-day living. The vast majority of compulsive overeaters don’t have the necessary support network, professional guidance and readily usable tools to deal with life’s daily challenges. And so, extremely high rates of relapse are an anticipated outcome. Eating disorders professionals are encouraged to build additional resources that utilize knowledge of relapse prevention in facilitating recovery from binge eating disorder.

Reference

1. Practice Guidelines for the Treatment of Patients with Eating Disorders, Third Edition. American Psychiatric Association, May 2006. (http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm)

About the Author

Mark Cohen, DSW, MPH, is President of EATSANE, LLC (www.eatsane.com), a relapse prevention program for compulsive overeaters.

Obesity and Binge Eating Disorder