Binge eating disorder

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Binge eating disorder is a psychiatric disorder in which a subject:

  • periodically does not exercise control over consumption of food
  • eats an unusually large amount of food at one time
  • eats much more quickly during binge episodes than during normal eating episodes
  • eats until physically uncomfortable
  • eats large amounts of food, even when they are not really hungry
  • always eats alone during binge eating episodes, in order to avoid discovery of the disorder
  • often eats alone during periods of normal eating, owing to feelings of embarrassment about food
  • feels disgusted, depressed, or guilty after binge eating

Binge eating is an element of another eating disorder, bulimia nervosa. In Bulimia, however, episodes of binge eating are followed by purging, periods of fasting, or performance of strenuous exercise - indeed, "exercise bulimia," in which a person eats normally but then engages in strenuous exercise, is an inverse form of bulimia. People with binge eating disorder, by contrast, do not purge, fast or engage in strenuous exercise after binge eating. Additionally, people with bulimia are typically of normal weight or may be slightly overweight (the purging, etc., have little to no effect on the subject's body fat), whereas people with binge eating disorder are typically overweight or obese.

Binge eating disorder is similar to, but it is distinct from, compulsive eating. People with binge eating disorder do not have a compulsion to overeat and do not spend a great deal of time fantasising about food. On the contrary, some people with binge eating disorder have very negative feelings about food. As with other eating disorders, binge eating is an expressive disorder - that is, the disorder is an expression of a deeper, psychological problem.

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Occurrence and risk factors

Binge eating disorder is probably the most common eating disorder. Most people with this problem are either overweight or obese (discussed below), but people of normal weight can also 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 is found in all ethno-cultural and racial populations, not just among people of Euro-Caucasian ancestry.

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.

As to the distinctions "overweight" and "obese," the 1998 National Institutes of Health Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults artificially defines overweight as a body mass index (BMI) of 25 to 29.9 and obesity as a BMI of 30 or more. BMI is calculated by dividing weight (in kilograms) by height (in meters) squared.

The BMI, however, is simply a mathematical re-presentation of the old height-weight charts, and the science underlying it is just as unsound - because it measures body weight instead of body fat percentage. By the NIH standards, almost all professional athletes in sports that emphasise anaerobic exercise are medically obese - despite not having the proverbial ounce of fat on them - because they have more muscle mass than non-athletes of the same height, and muscle weighs more than fat. Of course, most Americans are not professional athletes.

New research appears to show the problems associated with obesity are more to do with living a sedentary lifestyle than with excessive body fat. Endurance swimmers, for example, are typically very fit and healthy despite having excess body fat. This is because the excess body fat serves the function of preventing hypothermia by insulating the endurance swimmer from the prolonged exposure to water that the speed swimmers do not experience.

Otherwise, the best indications whether someone's weight is normal, overweight (i.e., over-fat), obese, or morbidly obese, etc., appear to be geometrical dimensions of the torso. To wit:

1. Normal Weight: The distance from the sternum to the pelvis, measured along the service of the skin, describes a line that is straight, slightly concave, or slightly convex.

2. Overweight: The distance from the sternum to the pelvis describes a noticeably concave line, but the excess belly fat does not interfere significantly with the torso's range of normal motion.

3. Obese: The distance from the sternum to the pelvis describes a markedly concave line, and the excess belly fat interferes significantly with the torso's range of normal motion, and may also interfere with the normal range of motion of the limbs.

4. Morbidly obese: The subject has such an excess of body fat that it cannot be contained in the belly region but is spread throughout the torso, causing significant interference with the normal range of motion of the torso and limbs. In extreme cases, mobility of the head and neck may be restricted.

5. Underweight: The distance from the sternum to the pelvis describes a noticeably convex line, but the lack of a proper percentage of body fat does not interfere significantly with normal body function. Complications leading to death can result.

6. Severely Underweight: The distance from the sternum to the pelvis describes a markedly convex line, and the lack of a proper percentage of body fat interferes significantly with normal body function. The ribcage will be noticeable, and the lack of a proper percentage of body fat may be visible at throughout the body at joints and other prominently bony sections.

7. Morbidly Underweight: The subject has such an absence of body fat that the ribcage and other bony parts of the body are visible under the skin, owing partly to atrophied muscle tissue. Normal body function is severely impaired and death may result.

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Causes

No one knows for sure what causes binge eating disorder. As many as half of all people with binge eating disorder have been depressed in the past. Whether depression causes binge eating disorder or whether binge eating disorder causes depression is not known.

Many people who are binge eaters say that being angry, sad, bored, or worried can cause them to binge eat. Impulsive behavior (acting quickly without thinking) and certain other emotional problems can be more common in people with binge eating disorder.

It is also unclear if dieting and binge eating are related. Some studies show that about half of all people with binge eating disorder had binge episodes before they started to diet.

Researchers also are looking into how brain chemicals and metabolism (the way the body uses food energy) affect binge eating disorder. This research is still in the early stages.

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Complications

People with binge eating disorder can get sick because they may not be getting the right nutrients. They usually eat large amounts of fats and sugars, which don't have a lot of vitamins or minerals.

People with binge eating disorder are usually very upset by their binge eating and may become very depressed.

People who are obese and also have binge eating disorder are at risk for

Most people with binge eating disorder have tried to control it on their own, but have not been able to control it for very long. Some people miss work, school, or social activities to binge eat. Persons who are obese with binge eating disorder often feel bad about themselves and may avoid social gatherings.

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 don't know they binge eat.

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Dieting

People who are not overweight should avoid dieting because it sometimes makes their binge eating worse. Dieting here means skipping meals, not eating enough food each day, or avoiding certain kinds of food (such as carbohydrates or fats). These are unhealthy ways to try to change your body shape and weight. Many people with binge eating disorder are obese and have health problems because of their weight. People with binge eating disorder who are obese may find it harder to stay in a weight-loss program. They also may lose less weight than other people, and may regain weight more quickly. (This can be worse when they also have problems like depression, trouble controlling their behavior, and problems dealing with other people.) These people may need treatment for binge eating disorder before they try to lose weight.

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Treatment

People with binge eating disorder, whether or not they want to lose weight, should get help from a health professional such as a psychiatrist, psychologist, or clinical social worker for their eating behavior. Even those who are not overweight are usually upset by their binge eating, and treatment can help them. 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 also teaches them how to change the way they act in tough situations. 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.

Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. The methods mentioned here seem to be equally helpful. For people who are overweight, a weight-loss program that also offers treatment for eating disorders might be the best choice.

If you think you might have binge eating disorder, it's 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. The good news is that most people do well in treatment and can overcome binge eating.

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References

  • Fairburn, C.G. (1995). Overcoming Binge Eating. New York: Guilford Press, ISBN 0898629616. This book discusses who binges and why, how bingeing differs from overeating, and how a binge eater can gain control. It presents a step-by-step program for overcoming binge eating.
  • Grilo, C.M. (1998). "The Assessment and Treatment of Binge Eating Disorder." Journal of Practical Psychiatry and Behavioral Health 4 pp. 191–201. This article, written for health professionals, reviews the literature on binge eating disorder with a particular focus on its assessment and treatment. Implications for practice and future research are discussed.
  • Siegel, M.; Brisman, J.; & Weinshel, M. (1988). Surviving an Eating Disorder: New Perspectives and Strategies for Family and Friends. New York: Harper & Row, ISBN 006015859X. This book discusses family therapy, psychopharmacology, hospitalization policies, insurance coverage, and support services for binge eating disorder patients and their families.
  • Stunkard, A.J. (1959). "Eating Patterns and Obesity." Psychiatric Quarterly 33 pp. 284–295. This classic paper provides one of the first descriptions of binge eating in obese individuals.
  • Yanovski, S.Z. (1993). "Binge Eating Disorder: Current Knowledge and Future Directions." Obesity Research 1 (4) pp. 306–323. This review of existing research on binge eating disorder, geared to health professionals, describes treatment methods, discusses their effectiveness, and recommends that doctors treating obese patients be aware of the disorder.
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See also

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External links

This article is taken from the public domain NIH Publication No. 99-3589, updated February 2001.de:Binge Eating

fr:Hyperphagie nl:Eetbuienstoornis fi:BED

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