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Conquer Your Weight

Episode #79: Have You Ever Wondered If You Have Binge Eating Disorder?



Show Notes

June 27, 2024

In this week's episode, we're talking about binge eating disorder. In our society, we often talk about binging casually, but many people struggle with feeling out of control with their eating or eating in response to an emotion or trigger beyond hunger. Today's episode will teach you what to look for to understand if you may be dealing with binge eating disorder.

In next week's episode, we'll continue the conversation, talking about emotional eating.

For more information, please visit www.sarahstombaughmd.com.

Transcript

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode. I'm excited to share with you this is going to be a two-part series where we talk about binge eating disorder and really just binging behaviors in general. So we'll talk a little bit about the formal diagnosis of binge eating disorder, talk about the diagnosis, some of the treatment options. And even if you're listening and thinking, oh my gosh, I don't have that, I don't know if that's important, I want you to take a listen because there's sort of the formal definition of binge eating disorder. And then it's really interesting how there are many people who find themselves, I would say, in a situation where they're binge eating disorder light, they may have aspects of emotional eating, may have aspects where they're feeling out of control with their eating, but may not really formally fit the definition of binge eating disorder. And that is often a really tough and tricky space because there's not always clear treatment for that. And so I would love for you to take a listen both to today's episode as well as the one that will air next week. The conversation today is a little bit more about binge eating disorder, what that looks like, the treatment. And then next week I'll be bringing in a special guest with me and we'll talk a little bit more about the therapy and coaching around it, talking about emotional eating, how this can play a role certainly in binge eating. But honestly for many of us, we experience times in our life where we're escaping from a negative emotion in order to stop feeling that we're escaping with food. Other people may have other ways in which they escape. But here on the Weight Loss podcast, we're certainly talking about how emotional eating plays a role for us. So let's dive in and talk a little bit about binge eating disorder because I think it's something that everybody has heard of, but a lot of times we don't necessarily stop and think about what is the definition. It's so interesting. Ice cream, every single patient who comes into my clinic for eating disorders, and very frequently people realize they have binge eating disorder and no one has even told them that, asked them that, suggested it previously. And starting to understand and treat that condition can really be life shifting and life altering for people. And they find that all of a sudden where they felt really out of control, they're able to get in touch with their body, understand the reasons that they're eating, and start to choose foods, for example, that are more in line with our health goals, how to build in any type of food so that there's not this restrictive component, which interestingly is a major aspect of binge eating disorder. So I'm so excited to share this all with you. If you're listening to today's episode and thinking, oh my gosh, maybe I do have binge eating disorder, I would love to support you with that. If you are in Illinois or Virginia where I'm licensed to practice medicine, I would love to see you as a patient in my clinic. But honestly, even if you're not and you're just looking for support, shoot me a message. You can contact me on the website at www.sarahstombaughmd.com. I would love to connect with you, help look at resources for someone who's in your area, and it is my goal to support anyone who's having questions and please reach out. I would love to support you with that. So let's dive in a little bit and talk about binge eating disorder. So simply binge eating disorder is when you've eaten a really large amount of food in a pretty short timeframe and feeling like there's not a lot of control over what you're eating, maybe how much you're choosing to eat, and that these behaviors are happening with some frequency. And if that is happening, you might have binge eating disorder. So let's talk a little bit formally the diagnosis, the criteria according to the DSM-5. So this is the diagnostic manual of any type of psychiatric or mental health condition. The official criteria diagnoses are these: one, there must be eating in a discreet period of time within any two hour period. For example, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. With that, there is a sense of lack of control over eating during the episode, like a feeling that you can't stop eating, maybe you can't control what you're eating or how much you were eating. And then in addition to that, having three of the following five symptoms: one, eating more rapidly than normal, two, eating until feeling uncomfortably full. Three, eating large amounts of food when not feeling physically hungry. Four, eating alone because of feeling embarrassed by how much you are eating and five, feeling disgusted with oneself, maybe feeling depressed or very guilty afterwards. What's important to know is there should be distress about the symptoms. It should be distressing to the person. They're feeling frustrated, they're feeling upset, they wish this wouldn't happen, but it does and it feels really out of their control and it needs to occur at least once a week for three months. And then also that there's not any sort of compensatory behavior. So when we think about a condition like bulimia, for example, bulimia is marked by binging and purging. So someone may have an episode where they've over eaten really significantly, and then in order to compensate for that, they may turn to purging behaviors. For example, maybe they're abusing laxatives, maybe they're over exercising to try to compensate for that increased amount of food that they had eaten during that period of time. So in binge eating, there is just the binge episodes without any sort of purging afterwards, and it's really distressing. People often feel very out of control during these episodes, and it's not something they share with others, their friends, their family, people in their lives may actually have no idea that this is going on. Sometimes in our society, I feel like we joke about bingeing and there can be this casual conversation about it. But the reality is people who are having true binge eating episodes, they're doing this in complete privacy and solitude. They are not binging around their friends, around their family. They're often eating at abnormal times. So it's very common to have binging episodes in the evening. That is the period of time in our day in which for one, all of the stressors of the day have compounded. And then two, our brain is already starting to click off, move into this sort of sleep mode, and we don't can't willpower our way through it, which a lot of times is how people try to get beyond their binge eating disorder. And so at nighttime, the cravings are really intense. Any emotions from the day are finally having an opportunity to start sneaking in. And that's times where binge episodes are very common, but it can happen at any time of day. A lot of times may happen in the kitchen, but if there's people in the kitchen, if their family's still awake, people are often eating in different locations. And so people may commonly eat in their car, maybe they're stopping by a restaurant or a drive-through or a gas station on the way home from work, and they're eating in the car, they may be eating in a closet in their office, kind of stashing foods in interesting places. And it's really, it's challenging because people who have binge eating disorder, like I said, are often very frustrated. They're very confused. It is their escape mechanism when they're feeling like they've had a really challenging day. And a lot of people with binge eating disorder go misdiagnosed or more importantly, just underdiagnosed. It's a condition that it's one of the most common eating disorders. In fact, it's the second most common eating disorder. But interestingly, the most common eating disorder is a more broad category of undiagnosed like other specified feeding or eating disorders. So really a binge eating disorder is the most common eating disorder that has a specific definition, and the rates of it are variable. Most of the estimates are 2% and 3%, maybe one and a half and 3% depending on the studies that you look at. And you can imagine that people who are having episodes of binging may be more likely to have obesity, and we certainly find that that is true. The inverse, however, is not true. We know that there are people with obesity who did not have binge eating disorder. So there are certainly two separate entities, but binge eating disorder can put you at increased risk for obesity. Interestingly, even at a normal weight, binging episodes can put people at risk for metabolic syndrome. So things like insulin resistance, diabetes, pre-diabetes, high blood pressure, high cholesterol, elevated waist circumference, increased fat mass in the central part of our body. A lot of times that is because the types of food that are consumed during binge episodes are typically foods that are more highly processed compared to foods that are maybe consumed during a traditional meal. So binge eating disorder is very common. And interestingly, patients coming into my clinic, like I said, I screen every single person for eating disorders and is interesting just how common it is and how underdiagnosed it is. So if it's something you're thinking about and you're listening to this thinking, oh my gosh, I wonder, I think I meet criteria for that. I would encourage you to see a physician, ideally that would be someone who is trained either in eating disorders or in obesity medicine who is used to both the diagnosis and the treatment of binge eating disorder. The treatment of binge eating disorder often includes medication management and often includes therapy as well. These two different components are really important for supporting treatment of it because one of the most interesting parts of binge eating disorder is there's often a cycle of restriction and binging that happens. And so a lot of our really traditional dietary advice actually can worsen or make binge episodes more likely for people who have undiagnosed and then untreated binge eating disorder. So let me give you an example. So you know what I mean. When we think about a piece of dietary advice, for example, where you say, okay, eat no flour and no sugar for the next six weeks, that is sound medical advice in the sense that making those type of dietary changes could really improve one's health. However, making that type of dietary recommendation without screening someone for binge eating disorder may be more likely to set them up for a binging episode. So when there are foods that are perceived as off limits, and this may be true for people in general, we know that the human mind is a little bit rebellious. If you tell us not to do something, it almost gets stuck in our psychology like, Hey, I really want to do that thing. And so if you think about not doing something, there's this rebellious part of your brain that's like, Ooh, do that. And so when I tell myself I can't have any flour or sugar for the next six weeks, there's part of your brain that's like, who are you to tell me what to do? And then there's part of your brain that's now just thinking about it all the time. And every time you see a cookie or you see bread, or you see a soda or you see candy or you see ice cream, or you see a muffin or whatever the thing is, you're constantly reminded, I can't have that. I can't have that, I can't have that. And this restriction will often drive a binging cycle. And after the binge happens, there's a lot of guilt, sometimes shame that comes up and people may feel really badly about themselves because they've overeat in a really significant way. And a lot of times the immediate thought that their brain offers to them is it's just, okay, I'll make up for that tomorrow. Tomorrow I'm only going to have 500 calories, or I'll make sure to skip breakfast tomorrow or tomorrow. I'm only going to have a salad or something that feels like, okay, I can sort of make up for this. All hope isn't lost. I haven't blown my diet plan. I'll get back on the horse tomorrow. And then tomorrow comes. And let's say you had a plan of I'm only going to eat salads tomorrow, so skip breakfast, lunch comes, you eat a salad, dinner comes, you eat a salad. And by the evening you've been thinking about some of those other foods. You're really ravenous for them. Maybe you're not even fully satiated from a hunger standpoint, you've been really restrictive and all day long just I'm only allowed to have salad. I'm only allowed to have salad. I'm only allowed to have salad. And now those thoughts are really overwhelming and can drive the next binging episode. And there's a cycle that often happens where we restrict in a certain way. And that restriction you can only hold onto for so long before the binge is this almost release from that restriction. And then after the binge happens, the guilt, shame, other negative emotions that come up drive the initiation of the next restriction cycle. We can only hold on for so long. We escape from that by binging, and it can be this really challenging cycle to work through. So what I want to assure you is there is treatment available and we can help you work through binge eating disorder. For one, we know that there's medications that can be really supportive for the treatment of binge eating disorder. There are medications that are FDA approved for it. There's new medications, like even some of the GLP-1 receptor agonists that you hear people talking about all the time, the Wegovy, Zepbound, Ozempic, Mounjaro. These medications are being studied for the treatment of binge eating disorder. There's medications like Vyvanse, which we traditionally think of for the treatment of ADD or ADHD. These medications can be really supportive in the treatment of binge eating disorder, as well as other medications that are often used off-label in order to decrease food cravings. And when you pair that with coaching work, with therapy work, it can be really valuable because a lot of times if you think about bingeing as an action, it's happening in response to other things that have happened. Like we talked about binge eating episodes, for example, most commonly happen in the evening, but they can certainly happen at any time of day. And if you talk to someone with binge eating disorder or someone who's thinking about their bingeing episodes, it's really common that it's driven by a very strong negative emotion. And so I've had patients who've shared with me, they were in a work meeting that was very frustrating, and they just felt as their frustration built, that urge to turn to food was building as well. And so a lot of times this very strong negative emotion will overcome us. And instead of addressing that emotion, we escape from that emotion into food. And like I said, there are certainly other ways into which people escape, but for people who are struggling with food escapism, they're more likely than to struggle with weight and feel like that they have this aspect of emotional eating that they just don't feel fully in control of over, which can be really challenging. So there's this very strong negative emotion that then can drive the desire to eat food, that sort of urge and craving and leaning into food. A lot of times too binging may happen as the result of shame. So when we feel shame in a work situation, in a family situation, and it can be even just perceived shame, we've been conditioned to feel this in certain ways, that these really intense negative emotions are the ones that are most likely to drive a binge eating episode. The challenging thing is we talked about that cycle where there can be shame that both derives the episode and then shame that comes after the episode. That may set us up for restriction, binging, restriction, binging. And so though, looking at what are some of the emotions that are driving us into binge cycles, are there ones that are common? A lot of times people may identify a handful of negative emotions that they find coming up most frequently, and then working through those with an experienced therapist, with an experienced coach who's trained to work with patients in binge eating disorder can be a valuable way to start understanding what is happening with those negative emotions. Why are those negative emotions coming up? Can we learn how to process those? Another thing that we think about in binge eating disorder is working on that restriction piece and working to reduce that part of it. So when we think about really traditional weight loss advice, a lot of diet advice that's given looks at things like calorie counting, decreasing calorie count, and maybe avoiding certain food groups, for example. And that type of thinking, as I've shared, can be really detrimental in binge eating disorder because those foods become off limits and drive that craving even more. So when we think about the binge episode happening later in the day, especially at the end of the day, there's often also a hunger component. Maybe not often, but sometimes there's a hunger component that's also playing a role. If our body has not been adequately nourished throughout the day, at the end of the evening when we're both dealing with the emotions of the day that restriction throughout the day, if our body is also physically hungry, of course it's going to be even more challenging when that drive to have a binge episode arises. How could you resist that if you are also hungry? And so one of the things we look at is making sure to distribute energy throughout the day, making sure that earlier in the day, whether someone is starting at breakfast time or at lunchtime, that the meals that they're eating throughout the day are foods that are very fiber rich, foods that are very protein rich, maybe foods that have some good healthy unsaturated fats, things that provide satiety so that our body is feeling nourished throughout the day, and at least we've supported ourselves in that way, which can really reduce some of that hunger. That can then play a role as well. When we're thinking about the treatment of binge eating, it takes these different components thinking about what is the dietary advice that we're giving? Is it supportive of nourishing our bodies and helping us to be in line with our goals? If there are foods that are more likely to trigger us, are we thinking about how to approach those in a way that feels loving, that feels nourished, that feels planful? Can we choose to eat these foods in our diet in a way that is intentional? And then what are the other things we can do to support ourselves with a therapist or a coach potentially with medications? If you've listened to this and you're thinking, gosh, yeah, I might have binge eating disorder, maybe I qualify for it, is there anything that's available to help me? The answer is yes, and I would love to connect with you to learn about that. In next week's episode, we are going to talk more about that emotional eating component and how that plays a role both in formal binge eating disorder, but also honestly, I think in just about everybody. I don't know if I've ever met someone who feels like they've never turned to food as a result of emotion. And so talk a little bit about some of those different emotions, how those may drive our eating behaviors. So thank you so much for joining me today. Stay tuned for next week's episode as we continue this conversation. I look forward to seeing you all next week. Take care. bye-bye.
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