Michelle (00:00:00) - Welcome back to what I hope is your favorite show, the Nourish and Free podcast. My name is Michelle Yates. I'm a registered dietitian with my master's in health psychology, and I love having a tough conversations around topics like binge eating and healing, your relationship with food and nutrition, and health and wellness sciences so that you can ultimately live nourished and free. Because I believe we should be nourished and healthy and doing all the things to take care of ourselves as best as we can, but also doing so in a way that's free from a toxic relationship with food. And a lot of times knowledge is power. And so I like to use this podcast as a means to educate on a lot of different things, because I do find that in a lot of cases, that is helpful for taking the next step to be free from a toxic relationship with food or whatever else it is that you're struggling with when it comes to food. Today's topic is binge eating and binge eating disorder. I get a lot of questions about am I binge eating? Am I overeating? Am I emotional eating? And I do have some previous episodes on those things in particular, like how to tell the difference.
Michelle (00:01:07) - So I'll link those episodes in the show notes for you. But today I want to do a bigger deep dive into the topic of binge eating disorder and the health effects and risks that can come with binge eating. In general, binge eating is a massively growing public health concern worldwide. It's not just about overeating. Binge eating is a complicated emotional issue that many feel too ashamed to speak up about, and as a result, they suffer in silence. But there is absolutely hope and recovery is possible. So let's discuss the prevalence, the diagnostic criteria, some alarming consequences of binge eating, as well as some ways to reduce our risk and help manage binge eating. Before we dive in, I am so thankful for everybody that has been listening to this show and given me feedback, even your little notes and messages letting me know that you enjoyed a certain episode, or that you've been sending it to your friends, means the world. I put a lot of work into this show and I just love it, so thank you for being a part of it with me and spending some of your day with me in this way.
Michelle (00:02:18) - If you haven't already, please take the time to leave a review or rating. It helps my show get onto the charts and ultimately be found by more people who may need this show in order to live more nourished and free. So even just a small rating, or if you want to take the time to write a whole review, that is lovely. Whenever I get to read those, I love getting to read what your guys's thoughts and responses are to this show. So if you haven't done that yet, please take a minute to do so. To those of you who have, thank you so much. And would you consider sharing the show with a friend, or even just an episode that you think they would particularly enjoy? All right, let's dig into it. So with binge eating, let's first of all just define what that is for anybody that's unsure at this point. So binge eating is characterized as eating an amount of food, typically within a two hour window that is definitely larger than anybody else would eat in that same circumstance.
Michelle (00:03:11) - So holidays don't count because everybody else is doing that. Your birthday doesn't necessarily count because everybody would do that on their birthday. Maybe Super Bowl doesn't count. Everybody's eating a ton of food during the Super Bowl, you know? So for those of you who are not in the US, that's an American football thing. But if it's like a random Tuesday night or a random Sunday afternoon and you're alone and you're eating a large amount of food that nobody else would in that same circumstance, then we're looking at potential binge eating. There also needs to be a feeling of a loss of control during the episode. So feeling like you can't stop yourself, you can't control how much you're eating or what you're eating. You may be aware of it and you may not. You can go both ways. Some people feel like they dissociate from the eating episode, and then once all the food is gone, then they kind of snap back into it and they see, wow, I ate all of that. I didn't even realize others are fully engaged in the moment, fully aware of what's going on, but for whatever reason, they just like, feel like their body can't catch up with their brain or their brain can't can't catch up with their body either way.
Michelle (00:04:22) - So if we're looking at this definition, it actually isn't the most cut and dry explanation, is it, for what binge eating looks like? Because what one person might define as definitely more than somebody else in that same situation might be different than somebody else. Like, for example, I'm five one on a good day. Let's be honest, I'm more like five zero. but my I generally have a small frame. And so what would be a really large amount for me might actually be a normal amount for a man who's six five, £250, extremely athletic. That's probably perfectly normal for him. So. It's tricky, right? Because you do have to consider all of these different things that might influence what makes it a normal amount in that same circumstance. So it's not the best definition, but it's what we've got so far. And then when there's recurring episodes of bingeing. So at this point we've just been talking about binge eating as a symptom, not as a diagnosis. But if there's reoccurring episodes of this happening, then we may be looking at a clinical binge eating disorder.
Michelle (00:05:36) - Diagnosis. The official criteria for binge eating disorder is that the binge eating needs to be happening at least one day a week, for three months. It's also important to understand that this is not the same as bulimia nervosa, which involves compensatory behaviors like purging, laxative use, or exercise. Those with binge eating disorder do not try to get rid of the calories that they ate. With binge eating disorder, there's a great deal of distress over the binge, and they identify with at least three of the following statements. They're eating much more rapidly than normal eating until feeling uncomfortably full. Eating large amounts of food when not physically hungry. Eating alone because of being embarrassed by how much one is eating and feeling disgusted with oneself. Depressed or feeling guilty after overeating. There are many people who experience subclinical binge eating, or what I like to call casual binge eating, which is basically just that we're not meeting the criteria for a true binge, but for whatever reason, that individual still wants to call it a binge, or they're eating more than just a few bites extra than they normally do.
Michelle (00:07:00) - Just because it's not meeting the official criteria for a binge doesn't mean it's not worth paying attention to. So I want to make that clear that even if you don't meet these labels perfectly, or these explanations or examples perfectly, it doesn't mean that what you're experiencing is still right for you, or helpful for you or healthy for you. And I think we typically know that in our gut. Right? If something feels off. You don't always need a label or a perfect definition to justify that. You do need to do something about it. Binge eating disorder is a relatively new eating disorder diagnosis. It was only added to the latest version of the Diagnostic Statistical Manual for Mental Disorders, which is the DSM five, and that was released in 2013. Since then, we've learned a lot more about it and the different risks associated with it. We don't really know why it develops at this point, but we do know there are some factors that are involved, like genetics, socio environmental factors like our society's ideal body, potentially some differences in brain biochemistry, and potentially some dysregulation in the reward center of the brain and impulse control issues.
Michelle (00:08:23) - Binge eating disorder has an estimated prevalence of about 1.5% of women and 0.3% of men worldwide. But interestingly, when we look at just the United States, America that has higher rates of about 3.5% of women and 2% of men struggling with binge eating disorder. If we look at the stats for Americans, this is actually suggesting that binge eating disorder is more common than anorexia and bulimia combined, which normally when we think of eating disorders, we think of anorexia nervosa or bulimia nervosa. We don't necessarily think of binge eating disorder. Part of that is because, again, it's somewhat new to the DSM, but also I think just because it's something we don't really like to talk about either. Right. Because there's so much shame associated with it, which on that note, it's very likely that these stats are skewed because literally a part of the definition of binge eating disorder and the diagnostic criteria is a sense of guilt and shame being associated with these binge episodes. So it's reasonable to assume that not everybody's opening up about their struggles with binge eating.
Michelle (00:09:40) - And then another thing to to know is that the research that was done to come up with those numbers of 3.5% of women and 2% of men was not actually a great study. It was only performed on just over 9000 people, which is a tiny pocket of people compared to our US population of 332 million. So we don't even have the best data to know how many people are struggling with this. And just like from my personal experience as someone who a professional who's been working with this condition and talks about it on social media and markets towards individuals struggling with that. It is a huge problem. I have so many people that reach out to me on a daily basis, and it's interestingly too, a lot of the times they say they've never talked to anybody about it before me, which I feel so privileged and honored to be a part of that conversation with them. It also just goes to show that this is a bigger problem than most people realize, because a lot of the times we're just not talking about it in terms of children we are seeing.
Michelle (00:10:48) - According to two meta analyses from 2023 reviewing 39 studies, there's an estimation that about 1.3% of children and adolescents meet criteria for binge eating disorder and 3% for subclinical binge eating disorder. So that just basically means they're close to meeting the criteria, but not quite perfectly hitting all the criteria. Young adults are potentially the most at risk, as we are seeing some reports of binge eating disorder beginning in the late teenage years or early 20s. but it's I mean, it's been reported in young children and older adults as well. I actually do see this a lot. I feel like a lot of the women that I work with describe their bingeing, starting when they were in their late teens or early 20s. So I think there's something to that, to that transition from young adulthood to adulthood that is unsettling. And so maybe we're turning to food as a coping behavior coping mechanism and wanting some comfort. yeah. I think that there's definitely something there, but we need more research on that. Many individuals struggling with binge eating disorder are also struggling with obesity.
Michelle (00:12:01) - However, there are some reports saying that only half of the individuals struggling with binge eating disorder are obese. So it's really not helpful to assume just because somebody is obese that they have binge eating disorder and vice versa. So just putting this plug in there for anybody that needs to hear it today, do not assume something about somebody ever. But also especially if you're assuming anything about somebody based on their weight, just stop. Please. It's not helpful. It's probably not accurate. Which I mean, yeah. Like frequently consuming a high amount of calories can certainly contribute to obesity and the associated physical risks with that. But there are still individuals who are not obese. Right. So regardless of obesity and body size, we are seeing an association between binge eating disorder and chronic pain, other psychiatric conditions and diabetes. So this is definitely something that we need to take seriously in the public health space, because it has a lot of effects on people, and it can increase their risk for a lot of things. The biggest of which that we're concerned with is mortality rate.
Michelle (00:13:09) - For any eating disorder, we can expect a higher mortality rate. But binge eating disorder is strongly linked to lifetime mental health symptoms depression, anxiety, mood disorders, substance use disorders, borderline personality disorder, post-traumatic stress disorder and unfortunately, about 1 in 5 individuals struggling with binge eating disorder will attempt suicide. Also continuing on this trend of mental health and quality of life, a study done on over 2000 married women with binge eating disorder showed that binge eating is comparable to, or worse for a marriage than any other psychiatric condition. So needless to say, binge eating has a massive disruption on both the physical health and mental well-being of many people worldwide. So now that we know more about it, what it means, what it can do, the risks associated, who's struggling with it, which is everybody. How can we manage it? How do we manage binge eating? Well, first off, it's important to remember this is a relatively new diagnosis, so we're still seeking to understand it. It's incredibly complex. It's a biopsychosocial condition as we've discussed.
Michelle (00:14:33) - We're still trying to find the best treatment for it. There is a meta analysis looking at over 39 randomized controlled trials, and only about 50% of those with binge eating disorder actually had full abstinence from binge eating, meaning that only 50% of binge eaters are responding to treatment. This may worry you, or seem troubling, like there's no hope for half of the people that have binge eating disorder. But the thing with this meta analysis is that not all of the studies reviewed used the same treatment modalities, so what worked for some of the participants might have worked for the other participants if they had the same treatment modality. So just keep that in mind. There is another meta analysis comparing 28 different treatments, where researchers found that a certain drug, called lists, often mean a stimulant that aims to increase attention and decrease. Impulsiveness was fairly superior for decreasing binge episodes compared to antidepressants, and CBT or cognitive behavioral therapy was also generally more effective for reducing binge episodes than your standard weight loss program that involves calorie restriction and increased exercise.
Michelle (00:15:52) - You know, eat less, move more. so. There's yeah, some things there in terms of potential pharmacological interventions, mental health interventions. Before we dig into that even more, let's discuss what the goals of binge eating disorder treatment are. Because when we're looking for abstinence from binge eating, we want to have a normal and healthy eating pattern as well. We don't just want the binging to go away, we want there to be like a normal, happy, healthy relationship with food too. So we want to improve psychological well-being as well as regulate body weight if needed. And ideally, achieving these goals would also reduce the risks typically associated with binge eating and binge eating disorders. So how do we reach these goals? I've brought up cognitive behavioral therapy just a minute ago, so let's discuss that as well as like dig a little bit more into the therapeutic side of binge eating recovery. As a reminder, I'm not a mental health therapist. I've just studied this a lot. So CBT or cognitive behavioral therapy is assigned as grade A treatment for binge eating disorder.
Michelle (00:17:00) - And a couple of studies, we saw some promising remission rates of between 36% and 61% for those who underwent CBT. Interestingly, both studies were randomized, placebo controlled and double blind studies to test the effectiveness of fluoxetine alongside CBT, which fluoxetine is an antidepressant, or more specifically, an SSRI. In those studies mentioned, we didn't see any long term difference between using fluoxetine or using a placebo with CBT, but the studies were actually pretty small. So anyway, it's just kind of interesting to bring up that CBT was super helpful, but the fluoxetine wasn't necessarily making any difference. There is some evidence showing that self guided CBT has some really promising results, as well as interpersonal psychotherapy or IPT and dialectical Behavior Therapy or DBT. So anyway, we definitely need more research on the therapeutic and pharmacological interventions for binge eating. But this is just like kind of some of the data that's coming up and information that we have so far. So okay, so let's dig into my favorite part, the nutrition side of things as I am a dietitian after all.
Michelle (00:18:20) - So when it comes to nutrition interventions for binge eating disorder, remember that one of the goals of binge eating recovery is to normalize eating patterns and increase psychological well-being. Typically, when someone is experiencing guilt or shame around their food choices, the way they eat, and how their body looks, this can be a trigger to drive them deeper into binge eating as they try to seek some relief from those feelings. So for that reason, I find it makes more sense to help clients achieve a positive relationship with food, with emphasis on food neutrality, meaning there's no good foods or bad foods. I also find that teaching them to be more mindful and intuitive about their eating can help them to slow down when things are otherwise pretty chaotic. This, alongside reframing their thoughts around food or correcting any inaccurate beliefs about food and nutrition and addressing body image distress can help them to no longer feel the need to binge as those feelings of guilt and shame are no longer present. I've been working with women for a few years now in my program Nourished and Free, and we take very much this approach that I just mentioned.
Michelle (00:19:41) - And it's crazy. Women that have been struggling with binge eating for decades are suddenly, like, completely free from it in four months or less, just because we took the time to really dig in to their mindset around food, some body image things, their thoughts and feelings and correct any inaccurate beliefs that they have around it. And so it's incredibly powerful when you take the time to do that and you really dig deep into our relationships with food and with our body, instead of just going on another diet or just trying to lose weight, you know, like that. Is like for somebody that struggles with binge eating, that's just not helpful. It's completely missing the mark and what we really need to work on. Additionally, binge eating may oftentimes be the results of restricted eating or dieting. So again, it really doesn't make sense to just go on another diet. And a study done on 17 over 17,000 adolescents, researchers found an increase in the risk of binge eating as dieting increased. One likely explanation of this sensation that we have when we restrict our food and suddenly want more food as a result is neuropeptide Y.
Michelle (00:21:07) - I'm going to call it NPY, though, for the sake of making my life easier here. NPY is a chemical that belongs to a family of gut brain peptides, and it's produced in the brain, which triggers our drive to eat specifically carbohydrates. Why would we have a peptide that drives us to eat carbohydrates, you may ask? Because carbohydrates are our primary source of fuel. Contrary to popular belief, they are not bad for you. They do not make you fat. They are our primary source of fuel, and NPY is triggered in response to a caloric deprivation and increases the longer that we've fasted. What binge eaters typically think as an issue of willpower or discipline is actually not about discipline at all. Rather. It's their biology driving them towards food, specifically chemical. NPY is driving them to eat foods, specifically foods that are high in carbohydrates. So again, just trying to do another weight loss thing or trying to do another diet or restrictive eating pattern is not helpful for somebody who struggles with binge eating.
Michelle (00:22:22) - It's completely missing the bar, the mark and disregarding their biology and their psychology. And with all of like, the ridiculous diet advice out there preying on those who are desperate to lose weight, many are adopting these dangerous nutrition patterns that often involve deprivation, which can be a major trigger for binge eating. Actually, there was a study done with Nazi concentration camp survivors, so obviously you can't apply this to the whole world, right? But it's interesting nonetheless. Researchers found that binge eating was more likely to develop among those who had experienced deprivation and even though that's like a very specific study on a very specific population, I think that we can all point to a time in our life where we felt deprived of food, and because of that, we wanted it even more. Right? Like that's just kind of human nature. If you can't have something, you typically want it. The grass is always greener. You want what you can't have. With that being said, simply eating enough foods is one of the biggest ways that we can prevent binge eating.
Michelle (00:23:30) - In addition, taking CBT inspired approaches to how we think about food and health and our body image may have some significantly positive impacts on either reducing binge eating or alleviating it all together. And if you feel like you need help with those things, check out my show notes. Because I've got a couple of guides that you'll find incredibly helpful. One of them is all about how to create balanced meals and work out your meal timing so that you're preventing binge eating by just simply eating enough and eating enough of the right things. And then I've got some other ones that are more geared towards making sure that your mindset and your thoughts and beliefs around food and your body are supportive towards your relationship with food, your health goals, and ultimately preventing binge eating and preventing self-sabotage. So check out my show notes to get more info on those. Those will be a great way to get started with some of these strategies. There's a lot more research needing to be done on binge eating and binge eating disorder, but I hope this has helped you to understand some of the key modalities and ways that we can start to overcome this increasingly pressing issue.
Michelle (00:24:44) - So in summary, let's kind of recap what we talked about in this episode today. Binge eating is becoming an increasingly concerning public health issue, with an estimated 1.5% global prevalence going up to 3.5% in just America alone. Children and adolescents and young adults are no exception to this risk. Some estimates are showing that binge eating disorder is correlated with higher rates of obesity. But still, there are many with binge eating disorder who are not obese as well. Binge eating disorder is also highly linked to mental health conditions such as depression, anxiety, and substance abuse disorders, as well as suicide risk. Binge eating disorder is a result of a multitude of complicated neurological differences, psychological, socio environmental and genetic genetic factors, and it absolutely is not a case of just being weak willed or lazy. It's a complex issue involving biological, psychological, and sociological components. We need to address all of these components for both treatment and prevention of binge eating and binge eating disorder. Binging is a massive disruption for an individual's mental and physical health, and just ask anybody who's struggling with it, and they'll confirm binge eating is associated with a lot of distress and shame, and many individuals may not be seeking treatment as a result of that.
Michelle (00:26:15) - For those who do seek treatment, cognitive behavioral therapy has some promising results. As well as eating a well-balanced diet and preventing restriction induced binge eating, as well as correcting any inaccurate beliefs around food and nutrition, and doing some important body image work so that your binges are not guilt or shame or self-hate induced work on food neutrality. Normalize your eating patterns if possible, and ensure each meal is substantial enough to nourish and satiate you. And as I said, you can check out my show notes for some resources to help you get started with that. If you do want some more hands on support with this, and you feel like you really need to dig in with a professional and a hands on way, I'll have some info. On my show notes as well with how you can work with me. I hope you enjoyed this episode. Please be sure to drop a rating or review on the show and share this episode with a friend if you found it valuable.