Binge Eating

Most of us overeat from time to time, and many people often feel they've eaten more than they should have. Eating a lot of food obviously does not always mean that a person has an eating problem.

However, eating problems, excess weight gain, and obesity are concerns for a great many men and women. Eating and weight gain problems may be the result of bad eating patterns, health issues, biology, and psychological issues. As part of a vicious cycle, an eating problem can, in turn, lead to its own set of health and psychological problems.

Problems with food, eating, and weight control are endemic in the U.S. An eating problem reflects itself as a preoccupation with, and/or a problem with, body weight, shape and diet. Typically, if you have an eating disorder, you'll have unhealthy eating behavior. This may include overeating or an extreme and unhealthy reduction of the amount of food you eat. Either way, the person feels bad about their eating, body shape, weight, or all three.

How and why you eat is affected by many factors including appetite, family training, eating pasterns, friends, cultural issues, your health, and your biological and psychological makeup.

The main types of eating problems, as defined by the DSM 1V-TR of the American Psychiatric Association, are obesity and excess weight, the eating disorders (anorexia nervosa and bulimia nervosa) and binge-eating. Most often, eating problems develop during the childhood and teenage years, but many people do not experience these problems until adulthood. Eating disorders frequently show up along with other mental health issues, such as depression, alcohol abuse or drug abuse, and anxiety disorders.

A person with a binge eating disorder consumes a large amount of food in a short period of time (typically within two hours), and does it often. Having a binge eating disorder means being unable to control the amount of food consumed. You are unable to stop eating, even when you are full. Therefore, many with the disorder tend to be overweight. Binge-eating disorder is associated with feelings of self-disgust and shame and these feelings in turn often trigger additional binge-eating, creating a vicious cycle.

Some of the following information has been adapted from the U.S. National Institutes of Health website.

How do I know if I have binge eating disorder?

Experts generally agree that most people with serious binge eating problems often eat an unusually large amount of food and feel their eating is out of control. People with binge eating disorder also may:

eat much more quickly than usual during binge episodes
eat until they are uncomfortably full
eat large amounts of food even when they are not really hungry
eat alone because they are embarrassed about the amount of food they eat
feel disgusted, depressed, or guilty after overeating.

How common is binge eating disorder, and who is at risk?

Binge eating disorder is probably the most common eating disorder. Most people with this problem are either overweight or obese, but normal-weight people also can have the disorder.

About 2 percent of all adults in the United States (as many as 4 million Americans) have binge eating disorder. About 10 to 15 percent of people who are mildly obese and who try to lose weight on their own or through commercial weight-loss programs have binge eating disorder. The disorder is even more common in people who are severely obese.

Binge eating disorder is a little more common in women than in men; three women for every two men have it. The disorder affects blacks as often as whites. No one knows how often it affects people in other ethnic groups.

People who are obese and have binge eating disorder often became overweight at a younger age than those without the disorder. They might also lose and gain back weight (yo-yo diet) more often.

What causes binge eating disorder?

Mental health professionals do not know exactly why some people move beyond normal eating behavior. We do know that this is a complex process, and usually no one factor is the cause or reason. We also know that eating disorders, like obesity, anorexia, bulimia, and binge eating, are real problems that are treatable.

As many as half of all people with binge eating disorder suffer from depression or have been depressed in the past. Whether depression causes binge eating disorder or whether binge eating disorder causes depression is not known.

It is also unclear if dieting and binge eating are related. Some people binge eat after dieting. Dieting here means skipping meals, not eating enough food each day, or avoiding certain kinds of food. These are unhealthy ways to try to change your body shape and weight.

Studies suggest that people with binge eating may have trouble handling some of their emotions. Many people who are binge eaters say that being angry, sad, bored, worried, or stressed can cause them to binge eat.

Certain behaviors and emotional problems are more common in people with binge eating disorder. These include abusing alcohol, acting quickly without thinking (impulsive behavior), not feeling in charge of themselves, not feeling a part of their communities, and not noticing and talking about their feelings.

Researchers are looking into how brain chemicals and metabolism (the way the body uses calories) affect binge eating disorder. Other research suggests that genes may be involved in binge eating, since the disorder often occurs in several members of the same family. This research is still in the early stages.

What are the complications of binge eating disorder?

People with binge eating disorder are usually very upset by their binge eating and may become anxious and depressed. Research has shown that people with binge eating disorder report more health problems, stress, trouble sleeping, and suicidal thoughts than people without an eating disorder do. People with binge eating disorder often feel bad about themselves and may miss work, school, or social activities to binge eat.

People with binge eating disorder may gain weight. Weight gain can lead to obesity, and obesity puts people at risk for many health problems.  Most people who binge eat, whether they are obese or not, feel ashamed and try to hide their problem. Often they become so good at hiding it that even close friends and family members do not know they binge eat.

Eating disorders are complex, and treating them involves the development of a comprehensive plan that involves psychological support, psychological interventions, nutritional counseling, and, when necessary, medical care and monitoring. Many people with eating disorders do not recognize or admit that they have a problem. As a result, they may strongly resist getting and staying in treatment. Family members and trusted friends can be helpful in ensuring that the person with an eating disorder receives needed treatment and support.

If you think you might have binge eating disorder, it is important to know that you are not alone. Most people who have the disorder have tried but failed to control it on their own. You may want to get professional help. Talk to your health care provider about the type of help that may be best for you. The good news is that most people do well in treatment and can overcome binge eating.

There are several different ways to treat binge eating disorder.

Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It teaches them how to change the way they act in tough situations. It also helps them feel better about their body shape and weight. Reality therapy can also be very effective.

Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas.

Drug therapy, such as antidepressants, may be helpful for some people.

Other therapies being tried include weight loss surgery (gastrointestinal surgery); exercise used alone or in combination with cognitive-behavioral therapy; and self-help. Self-help books, videos, and groups have helped some people to control their binge eating. Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder.

The more you understand about binge eating, bulimia nervosa, and other eating disorders the better you can cope with their effects. Reaching out for information and assistance can help you live a healthier and more fulfilling life. People who suffer from binge eating and other eating problems can get help from a mental health professional such as a psychologist, psychiatrist, or clinical social worker. For more information about binge eating, bulimia nervosa, and other eating and weight control issues, please visit the websites listed below and the glossary that follows.

Below is an Obesity, physical activity, and weight control glossary adapted from the U.S. government"s National Institutes of Health website. 

A

Adipose tissue (add-ih-POS-e) Fat tissue in the body.

B

Bariatric surgery (bear-ee-AT-ric) Surgery on the stomach and/or intestines to help the patient with extreme obesity lose weight. Bariatric surgery is a weight-loss method used for people who have a body mass index (BMI) above 40. Surgery may also be an option for people with a BMI between 35 and 40 who have health problems like heart disease or type 2 diabetes.

Bioelectrical impedance analysis (BIA) (im-PEE-dance) A way to estimate the amount of body weight that is fat and nonfat. Nonfat weight comes from bone, muscle, body water, organs, and other body tissues. BIA works by measuring how difficult it is for a harmless electrical current to move through the body. The more fat a person has, the harder it is for electricity to flow through the body. The less fat a person has, the easier it is for electricity to flow through the body. By measuring the flow of electricity, one can estimate body fat percent.

Body mass index (BMI) A measure of body weight relative to height. BMI can be used to determine if people are at a healthy weight, overweight, or obese. To figure out BMI, use the following formula: A body mass index (BMI) of 18.5 up to 25 refers to a healthy weight, a BMI of 25 up to 30 refers to overweight and a BMI of 30 or higher refers to obese.

C

Calorie (CAL-or-ee) A unit of energy in food. Foods have carbohydrates, proteins, and fats. Some beverages have alcohol. Carbohydrates have 4 calories per gram. Proteins have 4 calories per gram. Alcohol has 7 calories per gram. Fat has 9 calories per gram.

Carbohydrate (kar-bow-HIGH-drate) A major source of energy in the diet. There are two kinds of carbohydrates @ simple carbohydrates and complex carbohydrates. Simple carbohydrates are sugars and complex carbohydrates include both starches and fiber. Carbohydrates have 4 calories per gram. They are found naturally in foods such as breads, cereals, fruits, vegetables, and milk and dairy products. Foods such as sugar cereals, soft drinks, fruit drinks, fruit punch, lemonade, cakes, cookies, pies, ice cream, and candy are very rich in sugars.

Cholesterol (ko-LES-te-rol) A fat-like substance that is made by the body and is found naturally in animal foods such as meat, fish, poultry, eggs, and dairy products. Foods high in cholesterol include liver and organ meats, egg yolks, and dairy fats. Cholesterol is carried in the blood. When cholesterol levels are too high, some of the cholesterol is deposited on the walls of the blood vessels. Over time, the deposits can build up causing the blood vessels to narrow and blood flow to decrease. The cholesterol in food, like saturated fat, tends to raise blood cholesterol, which increases the risk for heart disease. Total blood cholesterol levels above 240 mg/dl are considered high. Levels between 200-239 mg/dl are considered borderline high. Levels under 200 mg/dl are considered desirable.

D

Diabetes Mellitus (dye-uh-BEE-teez) A disease that occurs when the body is not able to use blood glucose (sugar). Blood sugar levels are controlled by insulin, a hormone in the body that helps move glucose (sugar) from the blood to muscles and other tissues. Diabetes occurs when the pancreas does not make enough insulin or the body does not respond to the insulin that is made. There are two main types of diabetes mellitus: type 1 diabetes and type 2 diabetes. [See definitions]

Diet What a person eats and drinks. Any type of eating plan.

E

Energy expenditure The amount of energy, measured in calories, that a person uses. Calories are used by people to breath, circulate blood, digest food, and be physically active.

F

Fat A major source of energy in the diet. All food fats have 9 calories per gram. Fat helps the body absorb fat-soluble vitamins, such as vitamins A, D, E, and K, and carotenoids. Some kinds of fats, especially saturated fats, [see definition] may cause blood cholesterol to increase and increase the risk for heart disease. Other fats, such as unsaturated fats [see definition] do not increase blood cholesterol. Fats that are in foods are combinations of monounsaturated, polyunsaturated, and saturated fatty acids.

G

Gastrointestinal surgery (to treat obesity) See bariatric surgery.

Gestational diabetes (jest-AY-shun-ul) (dye-ah-BEE-teez) A type of diabetes mellitus that can occur when a woman is pregnant. In the second half of her pregnancy, a woman may have glucose (sugar) in her blood at a higher than normal level. In about 95 percent of cases, blood sugar returns to normal after the pregnancy is over. Women who develop gestational diabetes, however, are at risk for developing type 2 diabetes later in life.

Glucose (GLU-kos) A building block for most carbohydrates. Digestion causes carbohydrates to break down into glucose. After digestion, glucose is carried in the blood and goes to body cells where it is used for energy or stored.

H

HDL See high-density lipoprotein.

Healthy weight Compared to overweight or obese, a body weight that is less likely to be linked with any weight-related health problems such as type 2 diabetes, heart disease, high blood pressure, high blood cholesterol, or others. A body mass index (BMI) of 18.5 up to 25 refers to a healthy weight, though not all individuals with a BMI in this range may be at a healthy level of body fat; they may have more body fat tissue and less muscle. A BMI of 25 up to 30 refers to overweight and a BMI of 30 or higher refers to obese.

High blood pressure Another word for “hypertension.” Blood pressure rises and falls throughout the day. An optimal blood pressure is less than 120/80 mmHg. When blood pressure stays high, greater than or equal to 140/90 mmHg, then it is considered high blood pressure. High blood pressure increases the risk for heart disease and stroke.

High-density lipoprotein (HDL) (lip-o-PRO-teen) A form of cholesterol that circulates in the blood. Commonly called “good” cholesterol. High HDL lowers the risk of heart disease. An HDL of 60 mg/dl or greater is considered high and is protective against heart disease. An HDL less than 40 mg/dl is considered low and increases the risk for developing heart disease.

Hydrogenation (high-dro-jen-AY-shun) A chemical way to turn liquid fat (oil) into solid fat. This process creates a new fat called trans fatty acids. Trans fatty acids are found in margarine, shortening, and some commercial baked foods like cookies, crackers, muffins, and cereals. Eating a large amount of trans fatty acids may raise heart disease risk.

I

Insulin (IN-sah-lin) A hormone in the body that helps move glucose (sugar) from the blood to muscles and other tissues. Insulin controls blood sugar levels.

L

LDL See low-density lipoprotein.

Lipoprotein (lip-o-PRO-teen) Compounds of protein that carry fats and fat-like substances, such as cholesterol, in the blood.

Low-density lipoprotein (LDL) (lip-o-PRO-teen) A form of cholesterol that circulates in the blood. Commonly called “bad” cholesterol. High LDL increases the risk of heart disease. An LDL less than 100 mg/dl is considered optimal, 100-129 mg/dl is considered near or above optimal, 130-159 mg/dl is considered borderline high, 160-189 mg/dl is considered high, and 190 mg/dl or greater is considered very high.

M

Metabolism (meh-TAB-o-liszm) All of the processes that occur in the body that turn the food you eat into energy your body can use.

Monounsaturated fat (mono-un-SATCH-er-ay-ted) Fats that are in foods are combinations of monounsaturated, polyunsaturated, and saturated fatty acids. Monounsaturated fat is found in canola oil, olives and olive oil, nuts, seeds, and avocados. Eating food that has more monounsaturated fat instead of saturated fat may help lower cholesterol and reduce heart disease risk. However, it has the same number of calories as other types of fat, and may still contribute to weight gain if eaten in excess.

N

Nutrition (new-TRISH-un) (1) The process of the body using food to sustain life. (2) The study of food and diet.

O

Obesity (oh-BEE-si-tee) Having a high amount of body fat. A person is considered obese if he or she has a body mass index (BMI) of 30 kg/m2 or greater.

Overweight Being too heavy for one’s height. It is defined as a body mass index (BMI) of 25 up to 30 kg/m2. Body weight comes from fat, muscle, bone, and body water. Overweight does not always mean over fat.

P

Pancreas (PAN-kree-as) A gland that makes enzymes that help the body break down and use nutrients in food. It also produces the hormone insulin [see definition] and releases it into the bloodstream to help the body control blood sugar levels.

Physical activity Any form of exercise or movement. Physical activity may include planned activity such as walking, running, basketball, or other sports. Physical activity may also include other daily activities such as household chores, yard work, walking the dog, etc. It is recommended that adults get at least 30 minutes and children get at least 60 minutes of moderate physical activity most days of the week. Moderate physical activity is any activity that requires about as much energy as walking two miles in 30 minutes.

Polyunsaturated fat (poly-un-SATCH-er-ay-ted) A highly unsaturated fat that is liquid at room temperature. Fats that are in foods are combinations of monounsaturated, polyunsaturated, and saturated fatty acids. Polyunsaturated fats are found in greatest amounts in corn, soybean, and safflower oils, and many types of nuts. They have the same number of calories as other types of fat, and may still contribute to weight gain if eaten in excess.

Protein (PRO-teen) One of the three nutrients that provides calories to the body. Protein is an essential nutrient that helps build many parts of the body, including muscle, bone, skin, and blood. Protein provides 4 calories per gram and is found in foods like meat, fish, poultry, eggs, dairy products, beans, nuts, and tofu.

R

Registered Dietitian (R.D.) A health professional who is a food and nutrition expert. A person who has studied diet and nutrition at an American Dietetic Association (ADA) approved college program and passed an exam to become a registered dietitian.

S

Saturated fat (SATCH-er-ay-ted) A fat that is solid at room temperature. Fats that are in foods are combinations of monounsaturated, polyunsaturated, and saturated fatty acids. Saturated fat is found in high-fat dairy products (like cheese, whole milk, cream, butter, and regular ice cream), fatty fresh and processed meats, the skin and fat of chicken and turkey, lard, palm oil, and coconut oil. They have the same number of calories as other types of fat, and may contribute to weight gain if eaten in excess. Eating a diet high in saturated fat also raises blood cholesterol and risk of heart disease.

T

Trans fatty acids A fat that is produced when liquid fat (oil) is turned into solid fat through a chemical process called hydrogenation (See definition). Eating a large amount of trans fatty acids also raises blood cholesterol and risk of heart disease.

Type 1 diabetes (dye-uh-BEET-eez) Previously known as “insulin-dependent diabetes mellitus,” (IDDM) or “juvenile diabetes.” Type 1 diabetes is a life-long condition in which the pancreas stops making insulin. Without insulin, the body is not able to use glucose (blood sugar) for energy. To treat the disease, a person must inject insulin, follow a diet plan, exercise daily, and test blood sugar several times a day. Type 1 diabetes usually begins before the age of 30.

Type 2 diabetes (dye-uh-BEET-eez) Previously known as “noninsulin-dependent diabetes mellitus” (NIDDM) or “adult-onset diabetes.” Type 2 diabetes is the most common form of diabetes mellitus. About 90 to 95 percent of people who have diabetes have type 2 diabetes. People with type 2 diabetes produce insulin, but either do not make enough insulin or their bodies do not use the insulin they make. Most of the people who have this type of diabetes are overweight. Therefore, people with type 2 diabetes may be able to control their condition by losing weight through diet and exercise. They may also need to inject insulin or take medicine along with continuing to follow a healthy program of diet and exercise. Although type 2 diabetes commonly occurs in adults, an increasing number of children and adolescents who are overweight are also developing type 2 diabetes.

U

Underwater weighing A research method for estimating body fat. A person is placed in a tank, underwater, and weighed. By comparing weight underwater with weight on land, one can get a very good measure of body fat.

Unsaturated fat (un-SATCH-er-ay-ted) A fat that is liquid at room temperature. Vegetable oils are unsaturated fats. Unsaturated fats include polyunsaturated fats, and monounsaturated fats. They include most nuts, olives, avocados, and fatty fish, like salmon. [See definitions]

V

Very-low calorie diet Also called “VLCD.” A person following a VLCD eats or drinks a commercially prepared formula that has 800 calories or less, instead of eating food. A VLCD can allow a person to lose weight more quickly than is usually possible with low-calorie diets, but should only be used under the supervision of a health care provider.

W

Waist circumference A measurement of the waist. Fat around the waist increases the risk of obesity-related health problems. Women with a waist measurement of more than 35 inches or men with a waist measurement of more than 40 inches have a higher risk of developing obesity-related health problems, such as diabetes, high blood pressure, and heart disease.

Weight control Achieving and maintaining a healthy weight by eating well and getting regular physical activity.

Weight-cycle Losing and gaining weight over and over again. Commonly called “yo-yo” dieting.

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