It’s the most common eating disorder in the United States, but most people who struggle with binge eating disorder (BED) will never get treatment — or at least the right treatment. There are many reasons this happens, including shame, weight bias and lack of understanding of what eating disorders look like.
I’ve previously written about how many people with “atypical” anorexia nervosa — atypical meaning the person doesn’t look emaciated — go undiagnosed or are poorly treated. In some ways, the BED story is similar. “I feel like eating disorders across the board get missed,” said certified eating-disorder specialist and registered dietitian Jennifer McGurk, owner of Eat With Knowledge in Nyack, New York. “Many people aren’t aware that their eating behaviors are disordered, partly because it’s almost become ‘normal’ to have disordered eating behaviors in this society.”
It’s estimated that up to 3.5% of women and 2% of men will develop BED, which became officially recognized as an eating disorder in 2013. The criteria for diagnosis include having binge-eating episodes at least once per week — on average — for three months or longer, with some of these characteristics:
- Eating an amount of food that is definitely larger than what most people would eat in a similar, distinct period of time — say, 90 minutes — under similar circumstances.
- A sense of lack of control over eating during the episode (such as a feeling that you can’t stop eating or control what or how much you are eating).
- Eating faster than normal, perhaps to the point of discomfort, and often when you weren’t feeling hunger. Feeling shame, distress or guilt afterward.
- Not regularly using unhealthy behaviors, such as vomiting, to compensate for the binge eating.
I heard McGurk speak on BED at the Academy of Nutrition and Dietetics’ annual Food & Nutrition Conference & Expo in October, and in a recent conversation, she pointed out that binge eating is not simply “overeating” or a lack of willpower, and that while binge-eating episodes tend to involve “forbidden” foods — such as “junk” food or other foods considered to be unhealthy — some people binge on fruits and vegetables, too. She also said that even if people don’t meet all of the diagnostic criteria, they deserve help, but that shame is a major barrier to seeking it. “People don’t want to tell people what’s going on, and there’s a lot of secrecy,” she said. This is one reason why if you think you have a problem, it’s worth answering this question: Do you eat differently when you’re alone?
If someone is in a higher-weight body, the shame may be even more acute, because our society is attached to the idea that body weight is entirely within personal control. Research estimates that more than two-thirds of people who currently have BED are going untreated, and fewer than half of people who develop BED will ever receive treatment. Weight stigma and bias are partly to blame. Although people of all body weights can develop BED, two-thirds of people who actually get diagnosed have a body mass index (BMI) in the “obese” range. Because of the false assumption that many people in higher-weight bodies binge eat, they are more likely to be diagnosed, but they’re also more likely to experience weight stigma and feel more pressure to diet, both of which can trigger and sustain BED.
“I feel like higher-weight individuals feel more shame generally, not just about their eating behaviors,” McGurk said. “And people in lower-weight bodies with binge eating disorder get missed because no one thinks to ask them.”
Unfortunately, when someone with BED does seek help, they’re likely to go looking in the wrong place. Three in 10 people with BED seek help through weight-management programs — and it’s unclear how many seek individual advice on weight loss from doctors or dietitians. This is a problem, because trying to treat BED with rules and willpower may make it worse.
“What we know from tried and true research is that restriction fuels binge eating,” McGurk said. “People don’t realize this, especially people seeking weight-loss services, because they’ve been told their whole lives to eat 1,200 calories.” She said restriction can come from actual dieting or simply the idea that we should be dieting, as well as from food insecurity.
Even is someone isn’t restricting calories, restricting certain foods in the name of “health” can be problematic for those who are predisposed to BED or other eating disorders. “I see all the people for whom that doesn’t work,” McGurk said. “I see all the people who end up bingeing. It’s important to remember that there are other ways to be healthy.”
Dieting, and its food restrictions, kicks off the “binge-eating cycle,” with the resulting lack of satisfaction, combined with an emotional or other trigger in the person’s life, causing a binge. Then, the person feels bad for bingeing, and resolves to restart the diet — and the cycle repeats. This can happen to some degree in anyone who restricts food for weight loss or health reasons, but in someone who is already struggling with BED, or is predisposed to it, the binges may reach clinically diagnosable levels.
Triggers can also include mental food restrictions — eating a food but feeling you shouldn’t — strong emotions, and the need to numb out, avoid or procrastinate, McGurk said. That’s one reason why intuitive eating — an approach to eating based on internal cues of hunger, fullness and satisfaction — is a crucial part of the treatment process, because it helps people reconnect with their bodies. She said it’s also important to learn to recognize triggering thoughts and emotions and have a plan for how to take care of yourself when binges do happen. “It’s important for people to know that eating disorders are treatable, and recovery is possible.”
Have questions or need help? Call the National Eating Disorders Association helpline at 1-800-931-2237 or visit nationaleatingdisorders.org.