Susan (not her real name) came to see me for help with her weight gain when her body mass index (BMI) reached 34. She was worried about stress eating and her relationship with food, but had never discussed the details of what/when/how she ate with her doctor or any health care provider.
Her food diary looked pretty good, with reasonable choices for most of her meals, other than an occasional splurge here or there. She even did a bit of moderate intensity walking two or three times per week, unless she had to travel for work and was too busy. But probing further about disordered eating led to a formal diagnosis of Binge Eating Disorder for Susan. Let’s look closer at her situation.
At night, alone in her apartment, or especially in a hotel when traveling, Susan might be bored, stressed about her job, or she might find herself scrolling through her Match.com account, feeling bummed about her relationship situation. Often around 9 or 10 PM, she’ll wander into the kitchen and that’s when the trouble begins. She might start with a pint of ice cream, but if that’s not enough, she’ll dig into some granola bars she has into the pantry. She intends to eat one, but rarely stops at that. Sometimes, she’ll drive over to the nearest drug store to buy a large bags of chips, some Lucky Charms cereal, or candy, never meaning to finish it all, but often staring at the wrappers in her bed later, feeling disgusted and ashamed. This is Susan’s experience with Binge Eating Disorder (BED), which is not unusual, though not everyone experiences BED in the same way.
Binge Eating Disorder is a chronic disease that can lead to weight gain, and is associated with obesity. It can flare up intermittently, often aggravated by stressful life events, but it can also go into remission, especially when treated. It’s more common in women than in men, and symptoms often begin in the early 20s, though it can occur at any age. Approximately 3 – 4% of women in the United States have Binge Eating Disorder, but that number rises to a staggering 30% when we survey women in weight loss programs, because binge eating is more common in people struggling with excess weight.
What are the symptoms of Binge Eating Disorder? Typically, people describe eating a large amount of food in a short period of time, even when not hungry. This rapid eating is often accompanied by a feeling that you can’t stop or control the binge. Afterwards, people describe feeling disgusted, depressed, or guilty. Binge eating typically occurs alone, due to embarrassment about the amount or type of food eaten. In mild BED, binges may occur 1 – 3 times per week, but in more severe BED, binges can occur more than once a day. Not everyone’s binges look like Susan’s. Some people binge on less food than she does, maybe it’s a sleeve of cookies or ordering a late night pizza. Others keep eating and eating, moving from one food item to another, until they feel intensely full and only then does the binge end.
Binge eating disorder can be treated with therapy, as well as with medication. Typically, we start with therapy. Cognitive behavioral therapy (CBT) is the most widely studied intervention for BED, and can be very effective. CBT can be done 1:1 with a trained specialist, in a group setting, or even self administered! Other types of therapy that can help with binge eating include dialectical therapy and interpersonal therapy.
Medications that have been studied for Binge Eating Disorder include SSRIs (like fluoxetine/Prozac), anti-seizure medications (like topiramate/Topamax), and even meds for ADHD (like lisdexamfetamine/Vyvanse). When used in conjunction with therapy, these medications can be effective.
Whether you’re struggling with Binge Eating Disorder alone or in conjunction with weight gain, it’s important to get the right help. Your primary care doctor is a good resource to help you find experienced care in your community. Remember, you’re not alone! There’s no shame in having Binge Eating Disorder or in struggling with your weight. These are medical conditions that can be treated and managed. The important thing is to stop beating yourself up, to speak up, and to get help today.
Thanks for listening. I wish you the best of health!
Lisa Oldson MD
Board Certified in Obesity Medicine and Internal Medicine
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