ProSource (American Council on Exercise)
Are We Exacerbating Binge Eating in Our Clients?
When Carol* began working with me, I assumed she was like many of my other clients who simply needed to make healthier lifestyle choices. But after working with her for several months and essentially seeing no changes in her body, I began to wonder if there was something deeper going on.
I initiated conversations with her about emotional eating and using food as comfort. She admitted to using food as a sort of security blanket and feeling out of control around food. If it was there, she’d eat it, even if she wasn’t hungry. There was a lot of shame surrounding her lack of control. She questioned why she didn’t have the willpower to stop these habits.
Turns out, for those with binge eating disorder (BED), willpower has nothing to do with it.
What Is Binge Eating Disorder?
“In 2013, the American Psychiatric Association identified Binge Eating Disorder as a distinct category of an eating disorder, alongside anorexia and bulimia,” explains Kari Anderson, Ph.D., L.C.M.H.C., C.E.D.S., clinical director at Green Mountain at Fox Run, Ludlow, Vt. “Interestingly, BED occurs in more people than anorexia and bulimia combined, and yet it often goes unrecognized and untreated.”
Over the past 20 years, there have been more than 1,000 published studies that have supported the idea that BED is a valid, specific diagnosis. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), key diagnostic features of BED include:
Recurrent and persistent episodes of binge eating. An episode of binge eating is characterized by both of the following:
– Eating, in a discrete period of time (for example, within any two-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
– A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
Binge eating episodes are associated with three (or more) of the following:
– Eating much more rapidly than normal
– Eating until feeling uncomfortably full
– Eating large amounts of food when not feeling physically hungry
– Eating alone because of being embarrassed by how much one is eating
– Feeling disgusted with oneself, depressed or very guilty after overeating
Marked distress regarding binge eating
The binge eating occurs, on average, at least once a week for three months
Absence of regular compensatory behaviors (such as purging—in other words, they don’t make themselves vomit after a binge, as would be the case with bulimia).
Why Can’t They Just Stop?
“Binge eating is associated with intense food cravings that override the brain’s signals of fullness and satisfaction and the rational intention for self-care,” says James Greenblatt, M.D., chief medical officer of Walden Behavioral Care in Waltham, Mass., and author of Answers to Appetite Control: New Hope for Binge Eating and Weight Management. “You keep eating even when you are not hungry and food satisfies you less and less.”
Greenblatt states that this is essentially food tolerance, a hallmark condition of addiction that requires more and more of the substance—in this case, food—to elicit the same sensation or response. “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry,” he explains. “Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations as the individual hyper-focuses on pursuing reward and relief by ingesting more of the addictive substance. Food addiction is specifically defined as a chronic, relapsing problem that encompasses three phases: one, binge intoxication; two, withdrawal; and three, craving.”
These cravings, says Greenblatt, are born out of a genetically based biochemical disorder that skews the body’s natural signals of hunger and satiety. He also explains that certain foods, such as refined sugars, gluten and dairy, can cause addiction-like symptoms and affect the ability to control food intake.
For instance, after being broken down in the body, casein, the protein found in dairy, and gluten, the protein found in certain grains, become peptides that are forms of morphine to the brain (casomorphin and gliadorphin, respectively). Have you ever wondered why comfort food is called comfort food? It’s not just a nostalgic thing. While you may have warm, fuzzy memories of your grandmother’s homemade macaroni and cheese, there is actually a very real, physiological reason why eating it makes you feel good. It is literally soothing to your brain.
There are also numerous studies that show that withdrawal from sugar causes symptoms that are similar to a drug addict going through withdrawal: shakiness, chattering teeth, tremors, agitation and hyperactivity.
How Does This Relate to BED?
“A pattern of chronic overeating alters the function of various centers in the brain, including the cortex, amygdala and limbic system, and also creates imbalances of dopamine, the ‘feel good’ neurotransmitter,” explains Greenblatt. “Consequently, deep physical cravings become so strong they are impossible to control simply by stubborn resolve or thought alone. Ruminations about food, regrets around meals and emotional connections to foods become constant and burdensome, fueling a chronic and relapsing addiction that mimics addictions to other substances.”
“Binge eating is often a way to attempt to manage uncomfortable or unpleasant emotions that have felt unmanageable,” explains Tiffany Phillips, M.A., L.M.F.T., clinical program manager at The Renfrew Center of Nashville. “It is a short-term solution to a long-term issue.