Compulsive and Binge Eating
by Dr. Mo Lerner
I debated only briefly whether it was appropriate to discuss the sensitive
issue of excessive eating in a publication devoted to the admiration of
large people. But the kind encouragement of the editors, many letters from
readers, as well as the fact that I have always maintained that I would
be remiss as a physician if I did not acknowledge that there are negative
health and emotional sequelae for some large people, led me to tackle this
Let me begin by emphasizing that if people have consciously chosen to be
large and understand the potential sequelae...God bless them. Any examination
of excessive eating as a disorder should be aimed at those who are either
uncomfortable, have health problems, or simply want to change.
By strict definition a Compulsive Overeater is an individual who is driven
to eat "in excess" and either does not or cannot take action to
Binge or Impulsive Overeaters, on the other hand, will eat inordinate amounts
of food usually within the time span of two hours. They want, at some point,
to stop whether or not they have the control to do so.
The problem is that there is some blurring of definitions and, depending
on which of the scanty pieces of scientific literature you refer to, Pathological
Overeating Syndrome equals Binging equals Compulsive Eating. The lack of
data is mostly due to the fact that researchers have spent most their time
dealing with the more classic eating disorders, such as Bulimia and Anorexia.
Just so that we have it straight: A person with Bulimia may binge, but
he or she will also have a preoccupation with weight or size leading to
self-induced vomiting, starvation and the use of laxatives and/or diuretics.
Anorexia refers to an unfortunate morbid fear of being fat, and is associated
with literal starvation.
In order to simplify the issue I will use terms such as binging and compulsive
interchangeably when focusing on the troublesome aspects of overeating.
Most Binging involves large caloric intakes (often more than 20,000 calories
at a sitting), large amounts of food, usually in the afternoon and/or evening,
lack of control, and rapid consumption beyond satiety. There is a true compulsion
in that overpowering thought intrusions of specific foods or their preparation
can occupy the whole working day. The binging often occurs in private as
there is embarrassment and guilt. Binges are often present at night, in
a favorite place; often in front of the T.V.
There is undoubtedly a conditioned stimulus component to the problem, where
rituals tend to repeat themselves. I have a dog who used to wake me up in
the middle of the night hoping to get me to eat something so she might get
a leftover treat.
Tasting forbidden food often leads to "all or nothing" thinking,
that is, "if I had one cookie, I might as well eat the box". While
the binge may be started by exposure to sweets, contrary to popular belief,
most meals are high in fat and protein, i.e. buckets of chicken, pizzas,
steaks, etc. A trance-like state is often described. Termination of the
event occurs either at interruption of privacy or with an uncomfortable
bloat. It isn't uncommon for bingers to go for high fiber foods or try to
fast in the hope that this will help them "right" the damage they
Compulsive eaters cannot stand to see food wasting; they must finish it.
When surveyed many compulsive eaters talk about the circumstances prompting
an eating binge. They include tension, the taste of binge-provoking food,
being alone, craving specific foods, boredom, and eating exposure at social
Females from 20 to 50 are classically depicted as bingers, but I suspect
large numbers of males are also involved, hiding in the closet out of embarrassment.
There is no race or ethnic prevalence. People who suffer tend to have low
self-esteem and an inclination to impulsivity. Binge eaters may be perfectionists.
Interestingly there is some relationship with Seasonal Affective Disorder
and even Premenstrual Syndrome. 25 percent of fat people admit to some episodes
of binging. The classic story involves a family history or tendency toward
obesity, dieting, ravenous hunger, binging, guilt, dieting etc. There are
usually concomitant profound feelings of weight dissatisfaction and poor
Diets, or some other form of severe food restriction, are the most common
element. The $39 billion dollar diet industry likely plays a major role
in propagating the problem. Physical and emotional abuse in childhood is
often the initial trigger in the process. Parental discord and cohort bullying/teasing
are typical stories. One of the most familiar tales involves children whose
parents refused to allow them to eat dinner with the rest of the family.
There are a number of scientific theories on compulsive eating that involve
chemical transmitter problems. The brain registers emotions such as sadness
and feelings like hunger in response to certain chemicals coming in contact
with specific receptors. If the chemicals are in short supply or stuck somewhere
in the process, a number of medicines can start the flow again. This is
how anti-depressants work. It is also postulated that this is why many of
the depressive syndromes including Seasonal Affective Disorder (cabin fever)
and Premenstrual Syndrome (PMS) often have eating disorder features.
The behavior therapists feel that binging is mostly a matter of conditioning.
For example, childhood trauma leads to insecurity. Eating is a form of comfort,
but may lead to obesity and shame. The shame often leads to dieting which
results in rebound ravenous hinging and the vicious cycle goes on. After
awhile, just the mere taste, smell, or even the thought of the "comfort"
food may lead to this cycle.
Contrary to popular media stereotypes of the wicked villain (like Jabba
the Hut and Henry the Eighth), there is little scientific evidence linking
compulsive overeaters with hedonistic pleasure seekers. Most fat bingers
are not evil gluttons.
It is most likely that the cause of compulsive eating is multi-factorial
and involves a mix and match of all of the aforementioned.
What Seldom Works
Diets. The famous claims of late that certain drugs such as Methylamphetamines
alone or in combination will curb appetite and lead to weight loss are overblown.
The weight loss might be a mere 20 pounds and people usually must stay on
the drugs (which are not without serious side effects) indefinitely. Of
course, if overeating is a symptom of a serious underlying condition such
as major depression, there is a place for medication.
"12 step" type programs seldom work because they tend to treat
food like a poisonous substance and advocate abstinence. One doesn't have
to have a drop of alcohol for breakfast or a "power lunch", but
food must be eaten to survive, aside from its presentation at virtually
all social events in life. Therein lies the dilemma with these programs.
Although some of my colleagues suggest medication for people who desire
or must change their eating habits, I am not a fan of diet pills. On the
other hand, serious depression or mood disorders associated with binging
can benefit from pharmaceuticals.
Monoamine Oxidase Inhibiters (more popularly known as MAO Inhibitors) are
helpful in some anorexics and bulimics, but carry precautions especially
with regard to food interactions. Certain wines and cheeses may react with
these drugs to produce dangerously high blood pressure levels. Serotonin
Uptake Inhibitors (like Fluoxetine) that cause free flow of the chemicals
in the brain I referred to earlier, have also met with some success. Supportive-Expressive
Psychotherapy recognizes that each overeater has some prevalent stressors
in his or her life and works on coping strategies.
The Cognitive-Behavioral Approach
Cognitive-Behavioral Therapy involves monitoring an individual's habits
and readjusting them. Loneliness, boredom, and unstructured time are problems
which must be addressed in any form of therapy.
To begin with, one must get rid of negative body image, and regular eating
habits are essential. Start with regularity; no more than three to four
hours between meals and snacks, no skipping, always eat in the kitchen while
sitting. Leave food on the plate, discard leftovers, and never be coerced
into extra helpings. Eat with others whenever possible. Food preparation
is often useful, i.e. get unprocessed items instead of ready-made foods.
Learn to restrict momentum. Try one chip at a time. Get rid of the "all
or nothing" mentality. Never restrict calories because rebound binging
Use alternative behaviors and distractions to replace a binge. Walking
is best. It promotes a feeling of control and enhanced self-esteem. Swimming
is not bad but requires more preparation and there is often threatening
Develop strategies to avoid "triggers" or "stresses".
Always plan shopping in advance. Leave credit cards at home and take only
the money needed. Avoid super-markets, visit specialty stores, and carry
food home. Stock adequate supplies of acceptable foods like rice, beans,
or fiber cereals.
Get into self-gratification alternatives. How about sex or hot bathing?
Try games, especially social in nature.
Accept the likelihood that as a fat person you may never be thin, or the
vicious cycle of dieting and binge eating will recur. Immediate cessation
is neither reasonable nor successful. Maintenance means accepting relapses
and restarting the program.
While it is wonderful that fat admirers exist in this world, many people
have written to me about a sensitive problem. They often refer to a loved
one affectionately as a "feeder." But partners of compulsive eaters
should realize that as food facilitators they may be placing their loved
ones in a tenuous position.
Health problems, pregnancy, or simply a change in self-image or philosophy
may cause compulsive or binge eaters to want to alter their behavior. This
is very difficult if a family member or live-in has an erratic eating lifestyle,
thin metabolism and/or impulsive shopping habits. Similarly, leftovers or
the presence of "dangerous" foods may be too much to tolerate
for a binger who is trying to change.
Fat admirers have a special responsibility to be sensitive to these situations
and should seek professional guidance.
There, I've done it. Even heretic doctors have to listen to the needs of
their patients and their own hearts, whether or not those needs conform
to a particular or popular philosophy.
I trust that I have dealt with this delicate issue appropriately. Only
your feedback will tell me. Whatever your need or choice, be happy and celebrate