Binge Eating

Binging

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Overindulgence is not generally the same as binge eating. Binge eating is defined as consuming a large amount of food within two hours and being unable to control the amount consumed and to stop eating.

The amount of food eaten during a binge exceeds what most people would consume in the same time under similar circumstances. Holiday overeating, for example, would not meet this definition because it generally involves a conscious decision to overindulge and the amount consumed does not differ that much from that of the other diners. Research on binge eating indicates that binges typically occur at times of stress, often in the evening.

Binge-eating disorder (BED) was identified in 1959 but was not included as a medical diagnostic category until 1994. BED is characterized by frequent episodes of binge eating, occurring at least two days a week for six months.

Binge-eating episodes are associated with at least three of the following:

• eating rapidly
• eating until feeling uncomfortably full
• eating when not hungry
• eating alone because of embarrassment
• feeling disgusted, depressed or guilty after overeating.

To meet criteria for BED, a person must also experience marked distress about the binge eating and not regularly engage in self-induced vomiting, fasting or abuse of laxatives or diuretics.

Unlike other eating disorders, such as bulimia nervosa or anorexia nervosa, BED affects a substantial number of men. BED is more common among the severely overweight but can be found among people of any weight. Regardless of a person's weight, it is typical for the BED sufferer to feel overweight and to have a history of many attempts to lose weight. The onset of binge eating is often closely associated with dieting, typically occurring in late adolescence.

If individuals with BED are overweight, they may get considerable pressure to lose weight from health professionals and family. Yet many failed diets may lead them to feel powerless over the binge-eating pattern.

While individuals with BED often feel helpless to make changes, several effective treatments are available.

Cognitive behavioral treatment of binge-eating disorder resembles treatments developed for bulimia nervosa. Typically, it involves keeping a diary of food eaten, binge episodes and moods to identify patterns of events, situations or moods that trigger the binge-eating episodes. Individuals are taught coping skills to help deal with stressors that contribute to binge eating.

Studies indicate that cognitive behavioral treatment can eliminate or greatly reduce binge eating in most people. nterpersonal psychotherapy, another short-term treatment handled individually or in groups, also has been used effectively to treat binge-eating disorder. Initial research indicates that such antidepressants as Prozac may also be helpful in treating BED.

Obesity, a common problem among people with BED, is associated with many health problems. On the other hand, dieting and weight dissatisfaction appear to contribute to binge eating, so most BED treatments prescribe no dieting. Indeed, many popular treatments for "compulsive eating" advise people to give up any goals to lose weight if they are to gain control over eating. Such treatments focus on helping individuals accept their current weight.

Regardless of the attitude about weight loss, it seems clear that treatment should address poor body image, which individuals with BED often have. The message that needs to be communicated is that it is possible to feel good about themselves and their bodies despite their weight.

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