How to curb the binge eating urge

WebMD Weight Loss Clinic - Live Events Transcript
Event Date: March 2003

Binge eating is probably the most common eating disorder, but its cycle of shame and powerless feelings can make it hard to reach out for help. We learned where to turn for support and treatment when WebMD Live welcomed eating disorder expert Christopher G. Fairburn, MD, author of Overcoming Eating Disorders.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live, Dr. Fairburn. How prevalent is binge eating?

Fairburn: This not an easy question to answer. In part that's because one has to define what you mean by binge eating. One person's binge could be another person's snack. If you asked people on questionnaires, do you binge eat, somewhere between a quarter and half the female population will say yes.

However, there are technical definitions of what is a binge used by clinical researchers, and if these definitions are used to define clinically significant binge eating, then the number of people in the population who binge eat is much smaller than the one I just said. Using the technical definition of binge eating, then between about 5% to 10% of women regularly binge eat. And of these, less than half have an "eating disorder."

Moderator: What is the technical definition?

Fairburn: Perhaps I should explain how clinicians define binge eating. There are two features that have to be present for an episode of eating to be classed as a "binge."

The amount eaten must have been truly large for the circumstances at the time; in other words, the context is taken into account. So for example, one has to eat more on Thanksgiving Day for an episode of eating to be classed as a binge, because everyone eats more on Thanksgiving Day.
There must be a sense of loss of control over eating at the time. In other words, the person must feel their eating is outside their control.

Now what I've described is the technical definition of the binge, but there is something I'd like to add: This is that some people have repeated binges that are quite small in size. For example, this is seen in anorexia nervosa. These episodes of eating are very distressing for people and they are accompanied by a sense of loss of control. Technically, they are not classed as true binges, but are subjective binges.

I have to stress how important it is that there is loss of control during the episode. For it is this feature that distinguishes binge eating from simple overeating that we all engage in at times.

Member: Doctor, I'm 15 and I'm more than positive that I am a binge eater. I'm not "overweight" but the doctor says he thinks I'm just a "carb addict." I've gone on a diet where I couldn't eat a lot of carbs. That didn't help. This has been going on since October. What is your advice?

Fairburn: There are a few extra things I need to know.

Do your binges involve eating large amounts of food?
Do you feel out of control at the time?
Between your binges, do you diet a lot?
Do you make yourself sick or vomit after your binges?

Member: They CAN involve eating a very large amount, but in the past four months or so, my mom has been keeping all junk food out of the house. So when I do binge, it's on fruit and yogurt, and I have a real problem with bread. I do feel out of control, definitely. I do not make myself sick, but I constantly worry about what I'm going to eat, how I'm going to feel after I eat; it's always on my mind. All I want to do is eat. I'll say to myself, "Today, I'm not going to eat a lot; I'm going to have this and this for breakfast," etc.

Fairburn: You sound as if you have a binge eating problem and it might well be a good idea to try to tackle it. What many people do in the first instance is to follow one of the self-help programs, since they can be very helpful. Alternatively, or if the program does not work, then you might want to get help from a psychologist or school counselor.

Moderator: Of course, diagnosing over the web is not what we are trying to do here. Finding a doctor who will listen to you and see you in person is always the next step. Good luck to you!

Also, Dr. Fairburn tells me he's too modest and embarrassed to say that the best-tested self-help program is his own. You can read all about it in his book.

Member: Dr. Fairburn, if you know you have a problem with binging, overeating, AND body image but your insurance won't cover a therapist, what resources can you turn to? Do you think Overeaters Anonymous is helpful?

Fairburn: Overeaters Anonymous provides many people with binge eating problems with a lot of support and encouragement. But as someone who specializes in helping people with binge eating problems and researching their cause and treatment, I have to admit that I have reservations about some of the claims made by Overeaters Anonymous. For example, it is sometimes claimed by OA that people who binge eat are addicted to certain foods. There is no evidence whatsoever that this is the case. So I think Overeaters Anonymous can be very helpful in the support it provides, but some of the information and recommendations it makes are not consistent with the scientific evidence about the causes and treatments of binge eating problems.

If you'd like to learn more about this, you could read chapter seven of my book, Overcoming Binge Eating, which discusses the relationship between addiction and binge eating. It's written for the general public.

Member: For me, there definitely is a loss of control, I often feel like I am watching myself make a huge mistake, and I am aware that I don't want to do it, but I am helpless

Fairburn: That description is very typical of many people who binge eat. It's a very unpleasant experience.

Member: I cannot eat normal amounts of certain foods -- I binge on pasta. I cannot just eat a serving -- rather, I eat huge quantities. I am OK with most foods; just not pasta. Help.

Fairburn: Usually people who binge eat on a very specific food either are actively avoiding that food at all other times or have very specific association attached to that food. Does either of these situations apply to you?

Member: I didn't actively avoid the food until I realized it was what I binged on.

Fairburn: This might seem bizarre, but your "solution" to your problem of binging on pasta might well be making it much worse. With most people, it is extremely helpful in trying to stop this type of binge eating for them to actually eat in small quantities the food they're trying to avoid eating, but only at times when they feel in control. I suggest that you try eating pasta on occasions in which you're feeling in control and see what happens to the binges.

Member: Dr. Fairburn, I binge in response to my emotions, whether happy, sad, lonely, whatever. I tell myself and others that I respond to stress well with exercise, but I seem to find myself binging and exercising like mad as a response to the same stresses.

Fairburn: What you describe is common. Binge eating is one way of affecting one's mood, as is exercising. So both forms of behavior can come to be used as a means of coping with feeling bad. The basic problem is that you are having difficulty coping with and accepting your mood states, and so either binge or exercise to adjust your mood. You might want to consider getting help for this.

Moderator: What are the long-term health consequences of binge eating?

Fairburn: There are none. That is to say there are no adverse effects of binge eating itself, but if anyone overate regularly, they are going to be at risk of developing obesity. This has many adverse health consequences, as we all know. The only other associated problem is if one purges -- that is, vomits or takes laxatives -- after binge eating, then the purging has adverse effects on one's health.

"Dieting creates craving for the foods one is avoiding [which is] why people often binge on the very foods they are avoiding."

Member: In all my many years of therapy for my eating disorder I've heard that we often eat for emotional reasons and if we could get to that underlying reason and solve that, we could then deal with the food issues, but it seems like I eat just because I WANT to eat.

Fairburn: It is very difficult for me to answer your question. Often emotional problems of the type we've discussed already contribute significantly to binge eating, but I would want to make a distinction between what caused you to start binge eating in the first place and what is keeping your binge eating going now.

On the other hand, it is definitely true that there's a small group of people who seem to binge eat simply because they enjoy eating, although usually these people are not truly binge eating, since they don't have a sense of loss of control at the time.

Member: Dr. Fairburn, how do you go about finding the cause of a person's binge eating?

Fairburn: This is a complex and interesting problem. If the goal is to help someone overcome their binge eating problem, then the main question is why are they binging now. In other words, the question of importance is, what is keeping their eating problem going? What is maintaining it? A separate question is, what started the person's binge eating in the first place?

Often people seek help for binge eating problems many years after they first started to binge. In this instance, what caused them to binge in the first place -- say when they were 15 years old --may not be relevant to them now when they are 25 years old. So, from the point of view of overcoming a binge eating problem, the issue is what is keeping the person binge eating now, rather than why did they start binge eating many years ago.

The typical sorts of thing that keep binge eating problems going are the following:

Having rigid rules about what one should and shouldn't eat. This makes some people prone to binge eat.
Not eating enough in general. This makes one physiologically prone to overeat at times.
Having difficulty coping with unpleasant mood states. This, as we discussed earlier, makes some people prone to binge whenever they feel bad about themselves.

Member: So are you suggesting that therapy is a solution?

Fairburn: There is good researched evidence that certain specific types of therapy have a marked effect on binge eating problems. Equally, there is certain evidence that certain types of other therapy are less effective. So, it is important to get the right type of therapy.

Member: Which types?

Fairburn: Good question. There are two leading evidence-based therapies. The first is called cognitive behavior therapy, and the second is called interpersonal therapy. Both therapies are well known and well tested.

Member: Do antidepressants help reduce episodes of binging? How do you know when it's time to try an antidepressant?

Fairburn: Another good question. One type of binge eating problem is called bulimia nervosa. People with this problem may benefit from antidepressant drugs. It has been shown that these drugs reduce their frequency of binge eating (and purging), although not many people stop altogether. The beneficial effects of antidepressant drugs in bulimia happen whether or not one is depressed in mood -- in other words, one does not need to feel depressed to necessarily benefit.

It must be added that not much is known about how long the beneficial effect of antidepressant drugs last in terms of their effect on binge eating. In contrast, it is well established that the effects of the two psychotherapies that I mentioned earlier are, in most cases, lasting.

Member: How readily will doctors use antidepressants if you present them with the evidence of a binge eating disorder?

Fairburn: If you present doctors with evidence that you have bulimia nervosa -- that is, you binge eat and purge afterwards -- then many doctors will readily prescribe antidepressant medication, since their effect on bulimia nervosa is well known.

QUESTION

Binge eating disorder is best described as… See Answer

Member: I binge but do not purge.

Fairburn: As regards other binge eating problems, then it is far less clear cut that antidepressants are helpful. Therefore, it is reasonable for doctors to have reservations about prescribing/recommending antidepressant medication in this instance.

Member: How do you feel about appetite-suppressing supplements and medications to prevent binges?

Fairburn: There is no evidence at all to support the use of appetite suppressants in the treatment of bulimia. There is a little evidence to support their use with other binge eating problems, but it really is a very little bit of evidence. Personally, I would not recommend taking them.

Member: I heard that dieting only makes binge eating worse because you try something new, fail, and then want to eat again to make yourself feel better. Is that true?

Fairburn: Your statement is partially true. For many people, dieting makes their binge eating worse, but not for the reason you say. The reason that this happens seems to be that dieting creates craving for the foods one is avoiding. This is the reason why people often binge on the very foods they are avoiding. In addition, if one is dieting very strictly, then there are physiological pressures that are making one binge.

Member: So, what should a binge eater do that is dieting? Just stop dieting and bring any type of food back into the house? I'm scared to stop "dieting" because I'm afraid I'll binge on those foods that I brought back into my life.

Fairburn: Your fears are understandable, and reasonable. It is difficult to do this. Again, I would recommend following one of the evidence-based self-help programs that explain how to do this step by step. You will find that they help you do this gradually in a systematic way, so that you don't become unstuck.

Member: What are the evidence-based self-help programs? Where do I find these programs?

Fairburn: There are three evidence-based books, but only one is published in the U.S. It is called Overcoming Binge Eating and is a paperback published by Gilford Press in New York. I'm afraid that I am the author. It can easily be obtained by any bookseller. It was published in 1995. It has been tested in many research studies in the U.S. and elsewhere in the world.

Moderator: Thanks to Christopher Fairburn, MD for being our guest. For more information about binge eating problems and their causes, and to explore self-help treatment, read Overcoming Binge Eating, by Christopher G. Fairburn, MD.

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