End Binge Eating Now
Binge eating disorder (BED), different from occasional overindulging, is the uncontrollable eating of large amounts of food in a short time. Unlike bulimia, a person with BED usually doesn't purge, fast, abuse diuretics or laxatives, or overexercise. Estimates suggest that 2 percent of Americans (as many as 4 million) have this disorder many are obese or overweight. The concerns are physical, psychological, and social. Large amounts of food eaten by binge eaters are typically high in fats and added sugars, and may lack sufficient vitamins and minerals. With the likelihood of overweight and obesity comes an increased risk for serious health problems, including diabetes, heart disease, high blood pressure, gallbladder disease, and some cancers. Binge eating often results in depression, embarrassment, and social isolation those with the disorder are often upset by both the problem and their inability to control their eating. Although the cause of BED isn't clear, there's a link to...
Binge eating disorder (BED), also known as compulsive overeating, has been designated as a psychiatric disorder requiring further study by the American Psychiatric Association. Like bulimics, individuals suffering from binge eating disorder indulge in regular episodes of gorging, but unlike bulimics, they do not purge afterward. Binges are accompanied by a similar sense of guilt, embarrassment, and loss of self-control seen among bulimics. Because of the tremendous number of calories consumed, many people with BED are overweight or obese, and as a result they are more prone to complications such as high blood pressure, diabetes, high cholesterol, and heart disease.
Eating disorders can result in malnutrition. Bulimia is a condition marked by periods of binge eating followed by purging. This differs from compulsive overeating, or binge eating, which occurs when an individual eats compulsively but does not purge and becomes overweight. Starvation, either from the lack of available food or from self-imposed starvation, as in anorexia nervosa, will also cause malnutrition.
Paul felt at a loss about how to help Sarah lose weight. I told him that childhood weight issues are complex and a topic of debate among parents and pediatricians alike. We know that restricting a child's food intake does not work. Rather, restricting kids' food tends to result in sneak eating, binge eating, guilt, shame the same stuff that adults encounter when they blow their diets. But this time, the parents become the food police an undesirable family dynamic.
T.J. is a 32-year-old Caucasian, married woman, gravida 2, para 1, seeking prenatal care in the 11th week of gestation. Medical history reveals current BN, the onset of which occurred in the third month postpartum of her previous pregnancy. Since the onset of BN at age 27, T.J. has engaged in binge eating-purging cycles at least twice per day, consuming approximately 2,200 kcal of high-fat, high-carbohydrate snack-type foods during each binge with subsequent vomiting. She reports problems with my teeth and frequent heartburn. T.J. denies laxative, diuretic, or enema use, but admits to moderate exercise of fast-paced walking of up to 2 h per day. She was dissatisfied with her body shape and inability to quickly lose weight after her first pregnancy and is fearful that she will lose control of her body weight during this pregnancy. She gained 47 lb during her first pregnancy. T.J. currently weighs 145 lb and is 5' 7 . Laboratory values are within normal limits. She reports having the...
The primary objective for BN is to disrupt binge eating-purging episodes and eating restraint so that intake becomes more consistent, and to stop other compensatory behaviors As stated above, macronutrient distribution of total energy in both AN or BN should be made up of 45-65 carbohydrate, 10-35 protein, and 20-35 dietary fat or lipids. Adjustments may be needed based on food aversions, gastrointestinal complaints, continued binge eating-purging episodes, or other issues. Vitamin and mineral supplementation is warranted in pregnant women with AN or BN. A prenatal supplement that meets but does not exceed 100 of the Dietary Reference Intake for micronutrients for adult women is suggested to allow for consumption of food-based nutrients and to avoid excessive intakes that may potentially occur from binge eating. A thorough discussion of prenatal supplements is found in Chap. 14.
In addition to adequate calorie and nutrient intake, and appropriate exercise and physical activity, various lifestyle factors should be considered when planning for appropriate weight gain during pregnancy. Occupation, leisure activities, stress level, and habitual dietary behaviors (i.e., eating out, eating cues, binge eating) are important considerations for weight management programs. Behavior modification strategies may need to be implemented for women who have problems with habitual unhealthy dietary behaviors (See Chap. 9, Anorexia Nervosa and Bulimia Nervosa during Pregnancy ). All of these factors should be taken into consideration in consultation with a registered dietitian and in collaboration with the supervising physician.
Episodes of binge eating (ie, consuming a large amount of food in a short period) followed by purging (via laxatives, diuretics, enemas, or self-induced vomiting) that have occurred at least twice a week for 3 mo A sense of lack of control during the bingeing or purging episodes Severe body image dissatisfaction and undue influence of body image on self-evaluation Eating disorders not otherwise specified (EDNOS) All the criteria for anorexia nervosa are met except amenorrhea
Energy needs increase in the last two trimesters to support the maternal and fetal products of pregnancy as well as spare protein to build these new tissues. Weight gain serves as a proxy indicator that these tissues have developed normally (see Chap. 2, Optimal Weight Gain ). What is unique in AN is the controlled intake of food energy in those with restricting type. Intakes of 200-700 kcal per day, typical of an individual with restricting-type AN, are simply inadequate to supply the energy required for most successful pregnancies. In binge eating-purging-type AN and purging-type BN, adequate and even overly abundant kilocalories may be consumed but are purged before the body has the opportunity to either fully digest or absorb nutrients. With nonpurging-type BN, adequate energy may be consumed however, laxative, diuretic, and or enema use as well as excessive exercise may result in malabsorption, excessive excretion, or altered utilization of nutrients such that the stream of...
Total energy intake still must be reduced to produce weight loss. Many fat-free convenience foods are highly processed, with high sugar contents and few micronutrients unless the foods are fortified. The diet is often difficult to follow and may promote binge eating Saunas Weight loss is primarily water, and any weight lost is quickly
Clearly, a significant number of individuals go into obesity surgery with preexisting eating-disordered behavior. To maintain the weight loss that typically follows surgery, they have to change their eating patterns dramatically. General normalization of eating behavior has been reported characterized by fewer meals, less food consumed at each meal, less eating between meals, and less eating in response to strong emotions.1719 Severe binge eating becomes virtually impossible following gastric bypass due to the severely restricted stomach. Despite this, patients with a preexisting eating disorder continue to have disordered-eating patterns.
The integrated physiology of the interactions of these opposing neuropeptides is evident from their weight-related alterations. Following weight loss, the deceasing levels of insulin and leptin lead to activation of NPY AgRP neurons and inhibition of POMC neurons (23). These counterregulatory changes induce accelerated food intake and accumulation of fat. Defects along the melanocortin signaling pathway, such as those seen in transgenic mice with targeted disruption of the MC4 receptor (knock-outs), result in hyperphagic and massive obesity (24). Recently, fairly widespread functional mutations of the human MC4 receptor have been demonstrated in patients with severe childhood obesity (25) and also linked to binge-eating disorder (26). It should be noted, however, that the majority of obese patients have no demonstrable mutations in MC4, yet such persons may possibly benefit from future therapies targeting activation of MC4 pathways. Indeed, intransal administration of a melanocortin...
For some people, food is often used to relieve stress or adapt to difficult situations. When these behaviors become maladaptive, eating disorders might result. Not surprisingly, obese people have a higher prevalence of two distinct eating disorders binge-eating syndrome and night-eating syndrome. Binge eating is a feeling of loss of control while consuming an amount of food that is larger than most people would eat. Binge eating is twice as prevalent in obese patients than nonobese patients.23 Moreover, relative to obese patients who do not binge eat, binge eaters have higher BMIs, as well as higher rates of comorbid depression and anxiety.24 Among bariatric-surgery patients, the prevalence of preoperative binge eating ranges from 13 percent to 49 percent.25 Night-eating syndrome, first recognized by Stunkard in 1955, is defined by ingestion of 50 percent of the daily caloric intake after the evening meal, awakening at least once a night for three nights a week to eat, and morning...
More aggressive and intensive inpatient care may be warranted if monitoring and evaluation shows a worsening of the eating disorder, IUGR, or other fetal growth and development problems. In AN or BN, a reduction in body weight to less than 75 of expected hypokalemia, hyponatremia, or hypochloremic alkalosis dehydration hyperemesis gravidarum cardiovascular changes prolonged fasting uncontrolled binge eating-purging cycles severe depression suicidal ideation and any obstetrical complication are justification for hospitalization.
If you suspect a friend or a family member has anorexia, bulimia, or binge eating disorder, don't wait until a severe weight problem or a serious medical problem proves you are right. There's plenty you can do before that happens For people with BED, a weight-loss diet alone may not be successful. Losing weight and keeping it off may be harder (for physical and emotional reasons) than for people without an eating disorder. Normal-weight people with binge eating disorder shouldn't be on a weight-loss diet.
Characterized by extreme voluntary weight loss due to self-starvation or binge eating followed by purging, AN occurs in 0.5-3 of the female population 3, 4 . Clinical signs and symptoms of AN include an emaciated appearance, prepubertal features, lethargy, lanugo, alopecia, acrocyanosis, hypothermia, swollen joints, pitting edema, and bradycardia and hypotension. Biochemical evaluation often shows fluid and electrolyte disturbances and hypercarotenemia as well as endocrine and hematologic abnormalities such as hypothyroidism and anemia, respectively. Several cardiovascular irregularities develop along with a host of gastrointestinal complications, particularly in those with the binge eating-purging type of AN. Osteoporosis and skeletal fractures are common in persons with AN. Some may experience peripheral neuropathy and seizures. Mortality is as high as 22 in women with long-term AN 5 .
See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors. Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Follic Acid Physiology, Dietary Sources, and...
A clinical diagnosis of bulimia nervosa requires that the behavior occur at least two times a week for a minimum of three months. SEE ALSO Addiction, Food Anorexia Nervosa Binge Eating Body Image Eating Disorders Eating Disturbances. Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, which are followed by purging to prevent weight gain. During these incidents, unusually large portions of food are consumed in secret, followed by compensatory behaviors such as self-induced vomiting or diuretic and laxative abuse. Although the types of food chosen may vary, sweets and high-calorie foods are commonly favored. Bulimic episodes are typically accompanied by a sense of a loss of self-control and feelings of shame.
A relapse in eating disorder symptoms in women who were previously in remission may occur during pregnancy 56 . In active AN or BN, body dissatisfaction and low body esteem may worsen during pregnancy 61 in addition to an increased frequency of restricting, binge eating-purging, and nonpurging behaviors 36, 44, 46, 51, 58 . Conversely, AN or BN symptoms and behaviors improved during pregnancy in women receiving treatment 45, 46, 53, 54 and not currently receiving treatment 47, 49, 55, 61-63 . Yet, postpartum resumption of AN and BN behaviors occurred with some regularity 45, 46, 48, 49, 54, 55, 62, 63 .
An eating disturbance shares many similar characteristics with eating disorders, but is less severe in scope. As a result, many abnormal dietary patterns and behaviors, such as binge eating, excessive exercising, weight cycling, and chronic dieting may involve many of the same attitudes and impulses as eating disorders, though they do not meet the clinical criteria for diagnosis.
Mandenoff et al. (36) proposed that with a monotonous diet, in a predictable environment, the endogenous opiate system is not necessary for the control of eating. However, with stress, fasting and the consumption of highly palatable foods it plays a role. In the rat, a stressor, such as pinching the tail, will induce a naloxone-reversible increase in eating (37). Mandenoff et al. (36) suggested that if a stress-induced release of endorphin is not enough to protect the animal, it is adaptive to eat and increase blood glucose levels. In this way further endorphin release can be stimulated. The authors pointed to the parallels between the stress-induced increase in rodent eating and the stressed humans who snack on palatable foods. As discussed above, there is a close association between negative mood and chocolate craving. The possibility that the binge eating of palatable foods may be modulated by the endogenous opiate systems has also been considered. Abnormally high levels of...
Investigations of so-called chocolate addicts have revealed no particular tendency for such individuals to be obese. Indeed, in a preliminary study of chocolate addiction, the range of BMI in subjects was 16.441.0 with a mean of 25.3, suggesting a normal distribution of weight (64). However, when interviewed about their attitudes to chocolate, despite 84 providing positive descriptions of chocolate, 25 believed that chocolate was fattening and 14 described chocolate as 'unhealthy'. This demonstrates the ambiguity of chocolate's identity in consumers who eat chocolate to excess. In a further study of chocolate addicts, Macdiarmid and Hetherington (65) reported that consuming chocolate was accompanied by a significant increase in feelings of guilt. When chocolate addicts were classified according to whether or not they met criteria for binge eating
In the case of anorexia, these medications are most effective if employed after successful weight restoration is achieved, at which time they can be useful for relapse prevention and the treatment of coexisting psychiatric conditions. SSRIs are also used in preventing binge relapses among bulimics, although their effectiveness ceases once the medication is discontinued. Although antidepressants have also been employed in the treatment of binge eating disorder, outcomes have not been sufficiently positive to warrant recommendations for their use.
Biochemical or laboratory values are generally normal in women with AN or BN. During semistarvation in AN, catabolic and compensatory mechanisms mobilize tissue stores, releasing nutrients to the serum pool. As a result, hypercarotenemia is often found in women with moderate to severe AN. Yet when serum concentrations of nutrients are low, severe AN is likely. At this point, several B vitamins, including B6 and B12, and minerals, such as zinc, will show signs of depletion. Dehydration in either AN or BN may falsely normalize or elevate several biochemical markers of nutritional status, such as serum albumin and iron. Thus, establishing normal hydration is important for accurate nutrition assessment. Vitamin and mineral supplement use is common in AN and BN and may mask nutrient deficiencies. Elevated blood lipids may be noted in the majority of women, due to liver and hypothalamic dysfunction in AN and inappropriate intake of dietary fats or lipids in AN or BN during binge eating.
There are various types of eating disorders, each with its own physical, psychological, and behavioral manifestations. They are classified into four distinct diagnostic categories by the American Psychiatric Association anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. This illness has two subtypes the restricting type, in which weight loss is achieved solely via reduction in food intake, and the binge eating purging type, in which anorexic behavior is accompanied by recurrent episodes of binge eating or purging. To qualify for a clinical diagnosis of bulimia nervosa, binge eating and related compensatory behaviors must take place at least two times a week for a minimum of three months. Sufferers are classified into one of two subtypes the purging type, which employs laxatives, diuretics, or self-induced vomiting to compensate for bingeing, or the nonpurging type, which relies on behaviors such as excessive exercising or fasting to...
With food the minute she arrived home after school. I advised her to stop dieting, start eating breakfast and lunch, and eat reasonably at night. She changed her habits and stopped binge eating after school. Alicia followed my recommendations to eat 2,300 calories, divided into four even-sized meals breakfast, first lunch, second lunch (after school), and dinner. When she returned two weeks later she reported with a big smile, When I get home after school, I no longer act like a maniac in the kitchen, eating whatever I can get my hands on. I feel so much better and am even losing a little weight because I'm not binge eating. Having a substantial breakfast and lunch helps me feel better and gives me enough energy to have fun with my students. I'm less irritable back to my old happy self. And, most important, I'm back in control of my food.
Many individuals with eating disorders report habitual dieting prior to the onset of their illness. Repeated dieting during adolescence increases the risk of eating disorders, with some patients reporting attempts at weight loss as early as age nine. The incidence of eating disorders may be as much as incidence number of new cases reported eight times greater among girls with a history of dieting, with the initiation each year of a weight loss regimen often marking the onset of the eating disorder itself. Dietary restriction may result in alterations in brain chemistry that can further increase anorexic tendencies, while hunger resulting from caloric restriction can set off binge eating, thus establishing a pattern. While most healthy individuals who attempt to lose weight can stop at any given time, depression and major life stresses in combination with habitual dieting can predispose others to develop an eating disorder. see also Addiction, Food Anorexia Nervosa Bulimia Nervosa...
We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.