Preventing Binge Eating
In the two decades of my dietetic career, one eating disorder seems to be the most shame filled -- binge eating disorder. Binge eating disorder (BED) is the most common eating disorder in the United States and affects three times as many people diagnosed with anorexia and bulimia combined. However, it also appears to be the most misunderstood.
People with BED consume excessive amounts of food in a single sitting. During periods of bingeing, they experience a sense of loss of control over their eating. People often experience feelings of guilt or shame following these episodes. Most people struggling with binge eating disorder are overweight, however some are normal weight.
The cause of BED is multifaceted as it has biological, environmental and psychological roots.
Restricting food or food groups- We always want what we can’t have, and when we make extreme dietary restrictions, our bodies become food-focused and we develop food cravings. Some binge eaters will restrict for a few days and then binge eat their cravings for a few days. Others will restrict during the day and binge at night. Inevitably, most binge eaters feel guilty and remorseful after bingeing and then compensate by restricting the next day. This leads to a vicious tormented cycle.
Inadequate protein - When our bodies don’t have enough protein, we will feel hungrier than usual. Eating foods such as eggs, poultry, seafood and lean red meat will aid in fullness and help to keep blood sugar stable.
Dehydration - When our bodies are thirsty, we sometimes respond by eating food instead of drinking.
Grocery shopping on an empty stomach - Grocery shopping while hungry often causes people to buy more food than they actually need - and often these foods are used to binge later. If you must shop and are starving, buy an apple or protein bar when you get to the store. Eat it while you shop!
Buying binge foods - Some of the most common binge foods are cereal, peanut butter, chips and ice cream. Purchase these in portion controlled packages or enjoy them at restaurants in controlled amounts.
Having excessive cash or credit/debit cards with you - This is not always practical; however it is difficult to be impulsive with food when you don’t have money to pay for it.
Cooking too much food - Prepare your plate and store leftovers in the refrigerator before eating. Enjoy your meal with mindfulness.
According to Cynthia Hutchins MS LPC-S , binge eating can be one way to comfort and soothe emotions in response to stress. Food can temporarily distract painful or unfamiliar feelings. Feelings that are labeled, perhaps unconsciously as ‘bad,’ can be stuffed, and binge eating becomes a way to keep the ‘bad’ feelings at bay.
Ways to Stop Binge Eating
People with binge eating disorder can develop a positive and normal relationship with food. Treatment involves a multidisciplinary team including a physician, therapist and dietitian.
It’s not the most comfortable subject however, almost everyone experiences constipation at some point. Being constipated means that you have bowel movements less than three times a week and eliminating is difficult. Stools tend to be pellet formed and hard. The causes are numerous. Stress, changes in your eating habits, inactivity, resisting the urge to have a bowel movement, some medications particularly antidepressants and iron supplements are some reasons constipation occurs. People struggling with eating disorders are particularly prone to constipation. This is because food restriction creates delayed gastric emptying. In other words, if you don’t eat enough, there may not be enough bulk for elimination and the stomach takes too long to be emptied. Sometimes diarrhea results as a way to resolve constipation. If diarrhea occurs, you may be eating excessive salads, kale and whole wheat products.
There are some tricks for constipation relief:
Today is Ash Wednesday, which marks the start of Lent in the Christian calendar. Many Christians observe Lent by sacrificing something indulgent, typically some type of food or food group. Beware! My advice for those struggling with eating disorders is to avoid giving up a food or food group. Two common scenarios happen when a food or food group are eliminated. First, the reward centers in the brain may light up, “I haven’t had x in a while, I probably don’t need to eat it when Lent is over.” Because the ED’s brain is hard wired to quickly form habits and continue habits even if dysfunctional, re-introducing a food/food group after Lent is over may be problematic. Secondly, when a food or food group is eliminated many people begin to feel deprived and begin to obsess about eating that particular food. This cycle of elimination, deprivation, and obsession frequently leads to over or binge eating. This can happen to anyone!
Instead of sacrificing food, perhaps a healthier sacrifice could be to eliminate social media. Studies show that social media is linked to depression and low self esteem. Others have found that participating in the Lenten Positive Acts Challenge rewarding. This challenge calls for performing a positive act for every day between Ash Wednesday and Easter Sunday. These acts could be a nice smile to a stranger, walking a neighbor’s dog, or letting someone go in front of you in line. Acts of kindness are correlated with improved mood. Being kind to yourself and practicing self compassion could also be an abstinence or sacrifice. Replacing negative statements with life affirming statements are wonderful ways to stay recovery focused.
February 24 - March 4 is National Eating Disorder Awareness Week. One is every 20 people is dealing with an eating disorder. Additionally even more struggle with chaotic and negative relationships with food and body. Over half of adolescent girls engage in crash dieting, fasting, self induced vomiting and diet pills. Eating disorders have severe physical and emotional consequences, affecting productivity, relationships and valued living.
Full recovery is possible. Read on to hear about one young person's and her mother's story.
EK: Recovery from an eating disorder was the hardest thing I have ever done. Period. I disliked myself and I though starving my body and losing weight were the answer. II began treatment with a nutritionist and therapist and at the time, did not know how sick I was. I definitely did not know what an eating disorder was - but I had one. My nutritionist set up a very strict meal plan that I was mandated to follow. I hated the meal plan with every bone inside of me. I was terrified of food and gaining weight. For months, my meals were spent sobbing and screaming Fear, anguish and anger lived inside me. After a long time I finally realized that I was never going to recover unless I began to trust my mom and my team. They constantly reassured me, "food is scary, but not eating is NOT an option. Food is GOOD for you. You will not get fat after one meal. Food is energy. The scary thoughts that your mind is obsessed with will go away." I had to trust that these words were true. My team told me that one day I would believe the words were true and that day has finally come. Finally, I do believe those words and I repeat them to myself daily. Recovering from an eating disorder is a battle and most of the time it is a battle for your life. Many times I felt like quitting because the journey ahead was so overwhelming. I never thought recovery was possible. I thought the darkness that encumbered me would never end, but it did! You must never stop fighting. Put one foot in front of the next and one day you will reach the finish line.
MOM: Anorexia was the LAST thing I ever expected to face as a mother of 5 healthy, happy and well-adjusted children. I was totally blindsighted. It's a good thing my girl and I were close, because I would have never noticed the early, subtle signs of this monster. I watched it rob my teen of her joy, her confidence, her rationality, her inner peace, her outward beauty, her poise, her relationships, and sadder still...her innocence. It took over, and IT WAS WAR. Nothing was going to seek, kill, and destroy what God had blessed me with; a precious daughter, loved and cherished.
Treatment was swift, certain and rigorous. Appointments took over our days and tears and yelling took over our family meals But quitting, or even acquiescing to her eating disorder was never an option. She was going to win, not IT! Days turned into grueling weeks, into tedious months...and months.
Slowly, the fog cleared. Reason and rational thinking returned and my precious, beautiful daughter began to emerge, and the chains fell off. What was so shocking was watching who she became following the storm and chaos of recovery. Sure, much was lost, but so much more gained. She learned hard lessons about life and herself. Today, she stands tall, strong, confident and HEALTHY. She has been poured out and filled with truth and wisdom to lead her into young adulthood, poised for success that she defines..;not the world. My daughter is an inspiration to me and a miracle. She is a warrior and an overcomer. It is my hope that her story will inspire other stories of victory and recovery.
If you have concerns about yourself of someone else, please go to: https://www.nationaleatingdisorders.org/. It’s time we take eating disorders seriously as public health concerns. It’s time we bust the myths and get the facts. It’s time to celebrate recovery and the heroes who make it possible. It’s time to take action and fight for change. It’s time to shatter the stigma and increase access to care. It’s Time to Talk About It!
Dear Body of Mine,
First I would like to thank you for holding me up when I felt I was going to fall. You've always been there for me and I've never been there for you. I am sorry that I have treated you in a horrible way and purposely harmed you. I'm sorry for intentionally starving you and being destructive to you. I'm sorry for blaming my problems on you. I realize now that you are not the problem. The problem was me. My self loathing, my depression, my illness. I regret saying so many negatives about you. I called you names you didn't deserve. I bullied you. I treated you unfairly. I know now that you have provided me with legs to run with, arms to hug with, and a face that I can use to smile with. I promise, Body of Mine, from this day forward, I will love you no matter my size, weight, or problems. I will treat you with kindness.
Lose 100 pounds in 3 months! This is a JACKPOT for those who struggle with obesity. Sadly, contestants from the Biggest Loser, Season 8 may not think so. A study by scientists at a federal research center showed that after 6 years all but 1 contestant regained the weight they lost. Four of the contestants weigh even more than they did when they began the contest. Adding more salt to the wound, the contestants’ metabolic rates have declined dramatically, so now for them to maintain their heavier weights, they must take in significantly fewer calories than then they did pre-show.
Does this spell doom and gloom for those needing to lose weight? No. Gradual change leads to permanent change. Successful losers practice moderation in portions. Successful losers do not eliminate food groups or even their favorite foods. Successful losers avoid thinking, “I ate this cookie, so now I blew it,” and proceed to eat the box of cookies. Successful losers learn to deal with their feelings in other ways besides using food. Successful losers exercise regularly, but don’t make exercise their part-time job.
The biggest take home message is avoid becoming obese. If you notice yourself gaining excessively, treat this as any other medical problem. Be proactive and consult a doctor or dietitian.
Thirteen year old Sam eats only 4 foods: cereal and milk, pasta, peanut butter and bread. His parents have tried begging, “Just try one bite”, bribing, “I’ll give you $20.00 if you try these green peas,” and threatening, “You won’t grow unless you eat protein.” All to no avail. Sam is reluctant to try new foods. He dislikes the texture of eggs, yogurt, mashed potatoes and cheese. He gags on animal proteins. He hates the taste of fruits and veggies. Sam eats painstakingly slow, taking minuscule bites, pausing between bites and his family has typically cleaned the kitchen before he leaves the table.
Sam’s height has increased, however he has not gained weight in 1 year. He avoids social outings with friends because he is embarrassed about not being able to eat pizza or burgers with them.
Sam has Avoidant/Restrictive Food Intake Disorder (ARFID). This disorder has recently been included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. It is characterized by an inability to take in adequate nutrition for optimal growth, with a negative impact on weight and/or psychosocial functioning. It usually begins before age 6 and lasts longer than one month. There are three ARFID subgroups: sensory, little or no appetite, and aversive.
Overcoming ARFID is possible, however, not unlike other eating disorders, is a process, a marathon and requires much patience. An excellent read is “Helping Your Child with Extreme Picky Eating” by Katja Rowell, MD and Jenny McGlothinlin, MS, SLP
"I made her favorite pasta and she wouldn't take a bite." "All she'll eat is broccoli and fish." "Maybe she'll outgrow it."
These are among the typical concerns that I hear from parents whose child has been diagnosed with an eating disorder. It seems so simple, "just eat!" I wish it were simple. In fact, eating disorders are a complicated mental illness that have biological, psychological and cultural influences. Dr. Laura Hill, chief clinical officer of the Center for Balanced Living, a clinic specializing in eating disorders in Columbus, Ohio, adeptly explains eating disorders and the importance of a meal plan in this TED TALK.
“I’m not trying to lose weight, I’m eating clean and healthy.” While good nutrition is the cornerstone for health, can eating “clean and healthy” go too far? Where is the line between healthy and rigidity, and, where is the line between “clean” and an eating disorder?
Orthorexia is defined as an exuberant interest in healthy foods. People with orthorexia tend to idealize certain foods. For example, kale is a superstar antioxidant that not only fights cardiovascular disease, asthma, and rheumatoid arthritis but also prevents premature agng. Simultaneously people with orthorexia tend to demonize other foods; ice cream causes weight gain, cavities, heart disease, and (horrors!) is made from milk.
Orthorexia itself is not considered an eating disorder, however in susceptible individuals, transforms into an eating disorder. Madison, for example, began substituting fruit for her usual snack of chips or sweets. She progressed to eating only organic foods, whole grain foods, and foods without gluten. Soon she began eliminating entire food groups and making more food rules for herself. Her intake declined and she began losing excessive weight. Food became her primary source of self worth, happiness and value. Madison crossed the line between eating healthy to orthorexia and then crossed the line to an eating disorder. Madison was not interested in losing weight, she had modified her diet in order to eat healthier. She initially was concerned about the quality of her intake and then became concerned about the quantity of her intake.
The good news is that recovery is possible. People can learn to eat in a balanced way so that food and nutrition is valued, but does not interfere with living life.
A shout out to Mattel and Sports Illustrated for embracing beauty comes in all sizes. Mattel has launched the newest Barbie who comes in petite, curvy and tall. She even has feet that can wear flats! Interestingly Barbie was created as a gag gift for men’s bachelor party. Who knew that this alarmingly unrealistic figure would become the most purchased doll in the world.
The swim suit issue of Sports Illustrated has also been an icon for beauty standards. This year the cover features Ashley Graham, a plus sized supermodel and Rhonda Rousley, elite athlete. Rousley, who is has recovered from bulimia, is known for her body confidence, and now states “if anyone calls me fat one more time in my life, I’m going to kill them.” Amen to that!
When we think of Eating Disorders, we usually picture an emaciated, frail, skeleton of a girl that is often depicted on talk shows. The reality is people with eating disorders are not all skin and bones. Normal weight and overweight people can be plagued by the unrelenting intrusive thoughts about food and weight. Normal weight and overweight people can be restricting their food, self inducing vomiting and engaging in excessive, obsessive exercise. There are 30 million people suffering with eating disorders and 10 million are males. February 21-27 is National Eating Disorder Awareness week. To find out if you or someone you love may be struggling with an eating disorder, take the three minute confidential screening developed by The National Eating Disorders Association. This is a wonderful resource for individuals and parents, however it is not meant to replace a clinical assessment completed by a specialized licensed professional.
Please go to : http://screening.mentalhealthscreening.org/NEDA
Dear Teachers, Coaches and Counselors,
As a mom, thank you for the endless hours spent caring, supporting, mentoring and teaching young people. Your job is truly one of selflessness. As a dietitian with an expertise in eating disorders, I would like to pass on a few suggestions to promote normal eating and healthy body image. Even if Health is not your subject, random dialogue about weight and food can be potentially harmful to those young people who are struggling with eating disorders.
Are you looking for a summer job? Please note: if you are struggling with an eating disorder or even disordered eating, restaurant jobs are not a good choice! Food establishments are very tempting to want to work for. The pay is good and there are many to choose from. However, being surrounded by food, watching people eat, and working during meal times often can spell R E L A P S E. Just imagine that your shift that starts at 5:00 and ends at 11:00 pm. What happens to dinner? Imagine being flexible and eating dinner at 11:30 pm. Eating at night does not cause weight gain (unless you exceed your caloric requirements), but would you be OK with eating this late? Or would you eat dinner at 4:00? See how complicated this is! Additionally most people in recovery benefit by eating with other people. Your family and friends love you, but you may be on your own if dinner is at 4:00 or 11:30 pm.
So when looking for a summer job, think twice before applying at restaurants. Places to consider are craft stores, pet stores, shoe stores, book stores, and jewelry or accessory stores. And be sure to ask about lunch and dinner breaks!
Some of the best advice comes from my clients. Below are two statements of wisdom that can help keep you on the path of recovery:
“You can’t control the uncontrollable.” Yup, it’s true. Some things are not under the human power to control. One of those is the basic shape and size of your body. Your body is uniquely yours designed by your genetics. Food intake and exercise do play a role in your body shape, however if you have hourglass curves and yearn for a boyish figure, prepare for disappointment. Remember a German Shepard can’t be a Greyhound, no matter how healthy the German Shepard eats.
“Following my meal plan is part of my beauty routine.” A meal plan can be as basic as 3 meals, 1-2 snacks or more detailed, such as an exchange plan. Everyone, even those without eating disorders, can benefit by a meal plan. Regular meals boost energy, speed metabolism and help prevent overeating. Having regular meals requires weekly planning ahead and shopping and daily preparation and cleaning. This can be tedious and time consuming. When the process breaks down, we tend to make poorer choices.
Pam Chin-Lai, MS, RD, LD, CEDRD specializes in the nutritional rehabilitation of eating disorders in children, adolescents and adults.