When food rules you

Binge eating disorder (BED) is the new kid on the block when it comes to problem eating – and it’s increasingly affecting middle-aged people. HFG Nutritionist Claire Turnbull investigates.

When we think of eating disorders, anorexia and bulimia, usually affecting teen girls and young women, are common culprits.

But BED, which was officially classified as an eating disorder in 2013, has become more common than other types of eating disorders, with middle-aged women and men suffering the most.

Overeating versus binge eating

Many of us admit to overeating or the occasional binge on special occasions and holidays. We can easily use food to alleviate stress or comfort negative emotions, and even because we’re bored. Then there’s just good old temptation: sometimes it’s too hard to resist fresh baking or cheese and crackers, even though we know they might be extra to requirements!

Binge eating, however, is far more ominous than the occasional overindulgence: it’s a serious mental illness. People who binge regularly eat huge amounts of food, far more than normal portions, in a relatively short period of time.

For BED to be diagnosed, these binges will happen at least once a week for at least three months. Some sufferers may even binge 14 times (or more) a week.

People with BED usually aren’t hungry and feel completely out of control when they binge, eating until they feel uncomfortably full. They often eat alone as they are embarrassed and say they feel depressed, guilty and even disgusted with themselves afterwards.

Warning signs of BED

• Overeating or binge eating regularly (at least three times a week)
• Using food to ‘eat’ your emotions
• Being overweight with a dysfunctional eating and/or dieting history
• Anxiety or depression
• Secretive behaviour, such as hiding food

What causes BED

Genetics

It’s thought that our genes may be at play as eating problems tend to run in families.

Upbringing

The relationship someone develops with food and the general health of their family as they are growing up is significant, says Dr Jan Geary, a psychologist specialising in eating disorders. “If you grow up learning that food can be used as a way of managing difficult feelings, this may put you at risk of developing binge eating issues later in life,” she says.

Living with a relative who is overweight, has dysfunctional behaviours with food or struggles with depression also increases the risk of BED.

Harsh words

If someone has been criticised about their weight, shape and eating habits, it increases the likelihood of developing BED.

Depression

Binge eating is more common in those who struggle with depression and anxiety. People with low self-esteem and/or a history of being overweight are also at risk.

Environment

Now that food is available everywhere, any time, bingeing is far more common. When food was less accessible and mainly eaten at home, binge eating was unusual.

Dietary restriction

Restricting foods – not eating enough – can lead to bingeing. When hunger intensifies you can easily overeat or binge.

Dietary restraint

Not eating certain types of food, which could mean banning treats or cutting out food groups. Eating disorder dietitian Estella Leek says this can lead to craving the banned foods, then losing control and eating large amounts of them.

Effects of binge eating

Health issues

People with BED have an increased risk of weight gain and becoming obese, which goes hand in hand with a number of health problems, including:

• Type 2 diabetes
• Kidney problems
• High cholesterol
• High blood pressure
• Heart disease
• Digestive problems
• Osteoarthritis and muscle pain
• Sleep disturbances, including apnoea.

Mental health

Emotional and psychological stress plays a large part in this disorder. Studies have shown people with BED have a lower quality of life, with high rates of anxiety, depression and substance abuse.

People with BED may also struggle in relationships and feel like they don’t want to interact with the outside world, so it can be easy for them to withdraw socially and become isolated.

They can also display the following behaviours:

• Obsession with food
• Preoccupation with their body shape and weight
• Sensitivity to other people’s comments regarding food, weight and lifestyle
• Self-harm or suicide attempts
• Secretive behaviour, such as hiding food and food wrappers

Financial problems

Eating large amounts of food can be expensive, which can lead to financial problems and cause stress and conflict in relationships. Sufferers will sometimes even shoplift food if they can’t afford to pay for it.

Five tools to overcome binge eating

These techniques can help to get you on the road to recovery.

1. Food journaling

Keeping a record of what, when and why you eat can identify your triggers and bingeing patterns. You may notice that you binge eat after situations involving conflict, or when you have gone for a long time without food. It is really important not to judge what you record as ‘good’ or ‘bad’, but simply become mindful of what you are doing. Awareness is the first step when you want to make changes.

2. Practical solutions

When you know your triggers, you can work on finding solutions. For example, if stress is a trigger you could try delaying a binge with de-stressing techniques such as exercise, having a shower or writing down how you feel. A psychologist or eating disorder expert can help find solutions for you to manage your thoughts, feelings and circumstances.

3. Change your attitude to food

It’s crucial to create a healthy, positive relationship with food. Approach meals and snacks as things to be enjoyed and savoured, and work on ditching the idea that you need to diet or restrict what you’re eating. Embrace the philosophy of eating regular, balanced meals and snacks to nourish your health and well-being.

4. Eating regularly

Creating a structure for meals and snacks can be really helpful to normalise the way you eat. Psychologist Dr Geary and dietician Estella Leek suggest that eating five to six times a day can be helpful. By eating regularly you avoid feeling really hungry and triggering a binge.

5. Eat with awareness

Take time to plan, organise and prepare your meals, and sit down to eat without distraction and savour your food. The idea is to create a positive eating environment for yourself and be ‘present’ when you are eating. Start to tune into your hunger and fullness cues, too. Aim to eat when you’re truly hungry (not because you are bored, tired, angry, thirsty, or just because food is there) and stop when you are just full, rather than overfull.

Talking to the person with BED

It can be incredibly hard to watch a family member or friend struggle with BED but you can help them get to the point where they are ready to help themselves. Sadly, you can’t force or pressure someone into changing when they aren’t ready.

Prepare yourself with information and choose an appropriate time to talk to them by taking a non-judgmental.caring approach, Dr Geary suggests. Focus on the eating behaviours you have noticed, then ask how you can help. You could say:

“I’ve noticed there are a lot of food wrappers in your car/bag/bed and you have been eating takeaways every day lately. I’m concerned that you might be struggling. Is there anything I can do to help?”

Or: “I see you are spending a lot of money on food at the moment, and you aren’t eating with us at all anymore. You also seem to be unhappy recently. Is everything OK? Is there any way I can help?”

The reaction from your loved one with BED may vary from defensiveness to denial. If so, let them know you’ll be there if they need help and bring it up again when it feels right. For more advice on what to say, read Approaching someone you care about. When the person with BED is ready for help, show them this article or suggest making contact with a specialist or support groups (see below).

BED: A growing eating disorder

Statistics for BED are unclear in New Zealand but it is an eating disorder on the rise. Data from the US shows the disorder affects 3.5% of women, 2% of men and up to 1.6% of adolescents. However, these figures are thought to be on the low side.

But, when these numbers are compared to other eating disorders they are significant: only 0.5-1% of women suffer with anorexia nervosa and 1-2% have bulimia nervosa. Also, BED is probably under-reported as not everyone with these issues is ready to seek help and treatment.

Types of eating disorders

Bulimia nervosa This is different to BED: after episodes of binge eating, the person affected may vomit or ‘purge’ to avoid weight gain. To be officially diagnosed with bulimia nervosa the person will be bingeing and purging at least once a week for at least three months. Alongside bingeing and purging, people with bulimia may abuse laxatives, diet pills and/or diuretics to avoid weight gain.

Anorexia nervosa This eating disorder primarily affects adolescent girls and young women. It’s characterised by excessive dieting and severe weight loss, with a pathological fear of becoming fat. People with anorexia nervosa usually have an extremely distorted body image and are commonly in denial of the problem.

Case study: Elly Varrenti

Elly Varrenti has suffered from BED for about 30 years. The Australian writer and broadcaster shares her struggles and successes with the illness.

When did your BED start?

When I was around 19. I think it is a serious eating disorder or addiction that can be triggered by trauma. But I have stopped blaming circumstances.

What is a binge like?

I can eat a lot of junk food in a short space of time. Bingeing is not just overeating, like having a ‘guts-up’ at Christmas. It’s a temporary form of insanity. You know you’re going to feel bad afterwards but you can’t stop when you’re in it. It’s like your body is craving that food and you want more and more. Afterwards, you feel ashamed and a failure.

What foods trigger you to binge?

Sugar is a trigger – ice cream is my thing. Alcohol can trigger me too. It becomes disinhibiting, so I think ‘what the heck’ and start bingeing.

How do you eat between binges?

I eat healthily and exercise regularly. Like many people with BED, I have a lot of knowledge about nutrition and diets.

What have you tried to get better?

I’ve tried every diet in the world, health camps, boot camps, fad diets and fitness gimmicks. I’ve seen many health professionals and fitness experts and taken antidepressants (SSRIs).

Exercise has helped. When I ran marathons I didn’t want to binge as much, I stayed at a good weight and felt healthy, strong and ‘present’.

The biggest thing that has helped me is a 12-step programme (Overeaters Anonymous). I’ve been very sceptical about these programmes all of my life but I’ve found OA can help.

Also I find a lot of support in online communities – reading and learning about other people’s experiences is good.

How has BED affected your life?

It’s expensive – I can spend up to $30 on food for one binge and I can binge a few times a week. Some people steal money for binges or shoplift the food.

My behaviour around food also affects those around me negatively – my family and intimate relationships in particular.

I also have high cholesterol. As I’ve gotten older, I’ve found the bingeing takes much more of a toll on my body. It’s exhausting.

What’s your advice to other with this problem?

Read the book Fat is a feminist issue by Susie Orbach and The good girl’s drug: how to stop using food to control your feelings by Sunny Seagold.

And get support and be open about the conditon – the worst thing you can do is isolate yourself and hide away.

You can read more from Elly at www.ellyvarrenti.wordpress.com
Thanks to dietitian Estella Leek and Dr Jan Geary from Shelly Beach practice for their help with this story.

Getting help

Diagnosis and treatment

If you struggle with overeating or binge eating, seeing a health professional is important.

• First, talk to your GP who can suggest a support group or health professional, such as a dietitian or nutritionist, who can provide specialised help. Your GP will also be able to treat any mood problems which could be contributing to the eating disorder.
• After this, working with both a psychologist and a nutritionist, who can develop a recovery plan, is ideal.
• Treatment for BED may also involve techniques such as cognitive behavioural therapy (CBT), dialectical behavior therapy (DBT) and/or interpersonal therapy.
• The costs of seeing health professionals must be met by individuals as unfortunately, there is currently no funding to treat BED in New Zealand.

Support groups

Eating Disorders Association of NZ
NZ Eating Disorders Clinic
Mental Health Foundation
National Eating Disorders Collaboration
Overeaters Anonymous
Dietitians NZ
Shelly Beach Practice

Useful reads

Overcoming Binge Eating by Dr Christopher G Fairburn
Lose Weight for Life and Feel Good for Life by Claire Turnbull