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If you're binge eating, emotional distress may be the cause

March 30, 2008 12:16 am

THE BOY eats in secret. He just got his driver's license, and he sits in a car in the pizzeria parking lot, polishing off an entire pie before he drives home. It happens a few times a week: He feels out of control, eats immense amounts of food, and afterward feels bloated and ashamed.

In junior high school, he was able to control his weight, but he's overweight now and afraid of being exposed. This boy, who I worked with, is not alone. There are many more like him.

It's not clear how many children and teens have binge eating disorder, but about 3 percent of adults struggle with binge eating. And up to a quarter of obese people suffer from the problem, which, ironically, gets worse when people diet.

Binge eating is more common in people who suffer from addictions to alcohol and drugs, or who have anxiety or depression. Also, the premenstrual time of women's cycles is a particularly vulnerable time for bingeing, according to a Michigan State University study.

Bingeing is defined as eating much more than normal in two hours, past the point of fullness.

FEELINGS, NOT POUNDS

Distress can both trigger and follow binges, so it makes sense to address emotions. Cognitive-behavioral therapy by a psychiatrist, psychologist or social worker is the most effective treatment, according to the American Journal of Psychiatry.

Medications, such as the anti-seizure drug Topamax and anti-obesity drug Meridia, may be helpful for some people.

Losing weight is not a cure for binge eating disorder, as the problem is driven by emotions rather than pounds. Research shows that while gastric bypass surgery may help people lose weight, it doesn't cure binge-eating disorder. I've met people who have quickly lost more than 100 pounds after gastric bypass surgery, only to gain it all back. They had untreated eating disorders.

SELF-HELP FOR BINGES

Not everyone is ready to go out and admit they need help. People who are just beginning to deal with their problems may feel more comfortable reading about emotional eating. I recommend reading "The Four-Day Win," by psychologist Martha Beck.

Also, researchers say an Internet-based program developed by psychologists and psychiatrists can help teens.

The 16-week program, called StudentBodies2--Binge Eating Disorder, emphasized weight maintenance, not weight loss. Yet the high-school student volunteers actually lost some weight, and kept it off for at least nine months.

The program, piloted at high schools in California and Idaho, taught students about setting realistic goals, keeping food and activity diaries, being in touch with feelings of hunger and fullness and the role of social support. It also educated them about eating disorders and body image, among other things.

There are also online programs for adults dealing with binge eating, but I wasn't able to find independent studies of their effectiveness.

EATING WELL

Along with seeing a psychological professional, I believe it's also crucial to work with a registered dietitian. A good dietitian can recommend a structured plan for slow weight loss. That's crucial, because skipping meals or following low-calorie diets actually can trigger binges.

Also, a good dietitian can help people learn to recognize and avoid patterns of emotional eating. For example, I knew a woman who overate when she came home from work around 7 p.m. each night. I suggested she journal not just what she ate, but also her emotions before and after eating. She also recorded how hungry she was on a scale of 1 to 10, (1 being ravenous and 10 being stuffed to the gills) both before and after meals.

The woman discovered she binged on weeknights from a combination of job stress and extreme hunger, because she hadn't eaten since noon--seven hours earlier. Simply by realizing this, she was able to plan healthy afternoon snacks. This cut her urge to binge after work. Also, her therapist helped her learn to deal with stress.

Between the new coping skills and awareness of her eating patterns, the woman stopped her nightly binges, ate three meals a day and some snacks, and eventually lost weight without dieting.

Jennifer Motl welcomes reader questions via her Web site, brighteating.com, or mailed to Nutrition, The Free Lance-Star, 616 Amelia St., Fredericksburg, Va. 22401.