Lately, I’ve been diving into more information about binge eating and other types of disordered eating and, while I am not an expert nor am I a doctor, I wanted to compile some information which might be helpful to both fellow coaches and anyone who may be struggling with some of these challenges and is looking for a place to begin. I should note that these patterns are correlated with an underlying psychological component which may require the help of a qualified professional to address.
Much of what I will write is being repurposed in my own thoughts and words based on the work of Dr. Christopher Fairburn and things found to be effective through Mac-Nutrition Uni’s coursework.
Part of the reason I want to tackle this is that I have found there are possibly four types of people who struggle with binge eating or disordered eating that enter into a fat loss program:
–Those who have a history of binge eating but may not currently be struggling with it.
–Those who are currently struggling with it and openly discuss it.
–Those who are currently struggling with it and don’t initially discuss it but it does come up later in the working relationship.
–Those who are currently struggling with it and do not discuss it.
This post will aim to be helpful to all four of those and to anyone else who knows someone struggling with binge eating.
I should also note that not everyone who struggles with binge eating is overweight. Binge eating can also affect those who are underweight, such as those with anorexia nervosa.
If you are someone who struggles with binge eating (or know someone who does) this information is not meant to replace the guidance of a doctor, a therapist trained in eating disorders or dietitians trained in eating disorders.
Fortunately, many people can overcome binge eating through some guided self-help assuming they are willing to put in the work.
I should note right off the bat that if you are someone who is trying to lose fat AND you also struggle with binge eating, it is in your best interest to reduce the frequency of binge eating or eliminate it before you try to lose fat.
This may seem somewhat counterintuitive.
One of the biggest issues with binge eating is the fact that things such as calorie tracking and intermittent fasting protocols can actually trigger binge eating episodes. In addition, having a list of demonized/forbidden foods can also trigger binge behavior.
While an individual is working through the process of binge eating, they may have to accept the fact that weight may or may not reduce during that process: it may remain stable, it may drop and it may go up.
Let me discuss some common behaviors exhibited by those who struggle with binge eating and some of the drawbacks of those behaviors.
I’m going to do my best to exercise some respect and sensitivity with this next section as this part may contain more triggering subject matter.
There are a handful of types of eating disorders someone could potentially fall under. The most common are:
–bulimia nervosa
–anorexia nervosa
–binge eating disorder
–eating disorder not otherwise specified (ED-NOS: which may include mixed eating disorders or night eating syndrome)
We know that with any of these individuals a degree of guilt and shame surrounds the behavior. This can result in something of a cyclical pattern of behavior that may look like:
Feelings of guilt/shame->loss of control->binge eat->extreme form of dieting->repeat.
Why someone binges can be multi-factorial and may include:
Shame around current weight/physique
Difficulty in relationships
Difficulty coping with stressful circumstances
Fear of failure
Fear of success
What constitutes an extreme form of dieting?
This can include:
Self-induced vomiting
Laxative/Diuretic Abuse/Misuse
Overexercising/Chronic Exercising
Fluid Manipulation
Self induced vomiting (SIV) appears to be most common in bulimia nervosa and, to a lesser extent with anorexia nervosa. For some, it is the belief that utilizing this tactic will remove the calories from the food(s) they binged on. However, when this has been studied in labs, only about 50% of the calories have been removed from the system. Said differently, if the binge was upwards of 2000 calories, roughly 1000 are removed through the process. This is not the only reason why this may be used. For some, they have binged to such a great degree of discomfort, that SIV serves to release the tension of that discomfort.
Laxative and diuretic misuse can be done on its own or in combination with SIV. There is a similar misconception around laxatives (as with SIV) that calories are being removed from the system with their use but this is not accurate. Food absorption happens higher in the digestive system while laxatives work lower in the digestive system. Diuretics have no effect on calorie absorption, they simply deplete fluid from the system. Some people feel the need to continue their binge patterns with the use of SIV or laxatives/diuretics because they believe they have cleansed their system. This can actually lead to larger binges later on.
Extreme exercising is exhibited more in individuals with anorexia nervosa and can be categorized when exercising has a tendency to take over one’s life. This can also manifest in a way where someone may not consume a meal until they have sufficiently “burned off” the calories of that meal ahead of time.
Fluid manipulation can take form by using high fluid intake to induce vomiting or to register that enough vomiting has occurred when there is no more color coming up. Again, this is with the belief that the system has been “cleaned”. Another area may be purposefully not drinking enough water as dehydration may show up as a loss of weight (not fat) on the scale.
To reiterate, shame and guilt may be significant reasons why we don’t hear more about binge patterns. It’s also worth noting that strict dieting can trigger binges, men may be less likely to report binge behaviors than women, some people feel that binge behavior helps them manage other stressful circumstances better and some believe that the behavior can resolve itself without help.
Now, I’ll break down the four different types of eating disorders related to binge eating.
-Bulimia Nervosa
-Anorexia Nervosa
-Binge Eating Disorder
-Eating Disorder Not Otherwise Specified (ED-NOS: specifically mixed eating disorders and night eating syndrome)
As a reminder, this is not meant to diagnose. A doctor would need to oversee that diagnosis. If you believe you suffer from any of these disorders, you are encouraged to get medical advice if you feel it’s needed. For the purposes of this post, it’s simply for information and potentially for the reader to use as guided self-help.
Bulimia Nervosa
With bulimia nervosa, a person has to exhibit 3 of 4 of the criteria listed. One of these must be absent.
The criteria:
1) The individual must have frequent objective binges (consuming genuinely large amounts of food) with a feeling of a “loss of control”. All persons with bulimia binge eat.
2)The individual must utilize at least one form of extreme dieting (as referenced above).
3) The individual must have an over evaluation of their body size and shape, characterized by primary judgement of their physique beyond simply “unhappiness”.
4) The individual must not have anorexia nervosa.
It may come as a surprise to some that many people who suffer with bulimia would be considered a healthy weight and size. In approximately a quarter of cases, an individual may start with anorexia nervosa and transition to bulimia nervosa. It is more common in women than in men. Also, some may eat very little outside of their binges (comparable to those with anorexia). By the time someone gets help with this, they may have already been struggling for 5-10 years.
Anorexia Nervosa
Two conditions must be met:
1) A BMI somewhere between or under 17.5-18.5
2) Evidence of overvaluation of body size and shape. Many fear becoming overweight or getting fat and despite their current size, they may already view themselves as overweight.
It is more common in women than in men. They achieve their weight by both eating too little and possibly exercising too much. Roughly 1/3 still have binges however they are considered subjective binges (smaller in size).
Binge Eating Disorder
This is characterized by those who do struggle with binge eating but do not exhibit forms of compensatory behaviors like the aforementioned extreme dieting measures. Considerations in diagnosis may include (adapted from Dr. Jake Linardon):
1) Eating more rapidly than normal
2) Eating to the point of discomfort
3) Consuming more than normal even when not hungry
4) Eating alone associated with feelings of embarrassment
5) Feelings of disgust, depression or guilt after binge eating
6) Marked distress associated with binge eating episodes
Where many who have bulimia nervosa are of a healthy weight, most who struggle with binge eating disorder are overweight or considered obese. More men appear to be affected compared to the previous two (1/3 men to approx 2/3 women).
ED-NOS (Eating Disorder Not Otherwise Specified)
Lastly, there are eating disorders not otherwise specified which are defined by similar features as bulimia nervosa, anorexia nervosa, and binge eating disorder without meeting all of the criteria (also called subthreshold). Mixed eating disorders could have features of all three. Night eating syndrome is classified as those episodes which only occur at night (or after waking up from sleeping at night) and are smaller in size than actual binges. The individual may not feel the same “loss of control” as those who suffer with binge eating in the other disorders.
Next, I want to start tackling what an individual can do to reduce and hopefully eliminate binges in their lives.
A few reminders:
-Some people will need medical help. Self-help or even guided self-help with a coach may not be enough for severe cases.
-Strict dieting, aggressive deficits, “forbidden” foods, and diets that remove food groups are all capable of triggering binge behavior. Calorie counting and macro counting are contraindicated practices for binge eating behavior.
-Accept the possibility that in order to overcome binge eating, an individual is advised to temporarily abstain from conscious dieting practices so they can get a better handle on all of the circumstances that are currently contributing to binges.
The first protocol would be to start monitoring food intake. This is not the same as calorie tracking. This is writing down the times you eat, what you eat, if any extreme form of dieting came after you ate (self-induced vomiting, laxative or diuretic use) and how you felt in general.
Monitoring is a short-term plan. That being said, you may find that you are monitoring for several weeks/months to develop awareness of trends and patterns of behavior. Dichotomous thinking and looking at foods as good/bad and right/wrong also fosters binge behavior.
Monitoring allows you to take an objective look at food intake without judgment. It is a skill to practice. It is very much likely that you will still experience binges with the long-term goal that they are reduced in size and frequency.
Questions you are seeking to answer through monitoring will include:
-What’s eaten during a binge?
-Do binges include “forbidden” foods?
-When do the binges happen?
-Is there a trigger for binges?
-Is there an emotion connected to binges?
-Are the binges a form of coping or a form of punishment?
Within the scope of monitoring, remember this is not to judge. It is to have documentation of events with candor and honesty. It will not be easy and it will likely be a lengthy process. Persevere all the same if you are determined to end the behavior. Review the previous week’s monitoring and go back through the questions listed above to see if patterns can be found.
It’s Dr. Fairburn’s advice that weigh-ins should be once a week to follow the trends of monitoring. Your weight may reduce, it may remain stable and it may go up. Monitoring is not synonymous with dieting. At each weekly weigh-in, review the previous week’s information and go back through the questions listed above to see if patterns can be found.
When you have developed the consistency of monitoring and recognizing patterns you can move to the next stage of establishing a regular eating schedule.
This means, not going lengthy spans of time without food (except while sleeping). In execution, this will look like: Breakfast, Morning Snack, Lunch, Afternoon Snack, and Dinner.
Remember that experiencing the discomfort of hunger is what can lead to binges. This is why strict dieting and intermittent fasting tend to backfire on those who struggle with binge eating. Of note, the ability to discern the signals of hunger and fullness can be distorted in those who are working through these patterns. Once a regular eating pattern has been established a more intuitive approach may be easier to adopt.
Set a schedule based on your current lifestyle (work, family, commutes, etc) and build your five times of eating into the schedule. You’ll be working to keep the eating schedule consistent with the understanding that perfection is not necessary. You are simply trying to get the body and mind on a schedule of regular eating to prevent future binges.
It is assumed that you are no longer using extreme forms of dieting after eating. To the best of your ability, do not eat in between your scheduled meals.
If you have a chaotic schedule, this may take time to implement. Do the best you can at focusing on consistency, planning ahead, and having food available so that you can eat when you are scheduled to do so.
You will still be monitoring intake so that you can continue to ask the same questions referenced above. Even though you are developing a consistent eating schedule, you may still have negative feelings (physical and/or emotional) around food that should be accounted for in your monitoring efforts. Stay candid, stay honest, and resist the urge to judge yourself.
Lastly, there are some other areas that would be in consideration for a long-term view for the individual struggling with binge eating.
Something that is a common thread when it comes to dietary practices is developing new coping mechanisms. For many people who struggle with binge eating, it can serve as the cope for when life is stressful, boring, tense or sad.
In taking that long-term view of health, new coping mechanisms will need to be developed and nurtured.
This may be in finding a new hobby or in reclaiming an old one. You’ll want something that serves as an active option (going for a walk, going for a hike, calling a friend, playing an instrument, etc.) Watching television is seen as a passive coping mechanism and will likely not accomplish the same goal.
Whatever you choose, make a list of viable alternatives because the urge to binge will still come. Remember that, for many people, binge patterns have been a part of their lives for many years and it will take time to not only accept that the urge to binge will come but that, like many urges, it will pass as well.
Finding alternative ways to occupy your body and your mind will help reduce the length of urges and the frequency in which they occur. If binge patterns are apparent because of challenges related to work, family, relationships or a trama informed response, working with a therapist can be crucial in this process.
It will help to find things that actually seem enjoyable and realistic to do. So, if you’re not an outdoor person and you think that hiking will be an option, it may not be a good fit. You may want to align with an activity that is more appealing and still effective at working through the urge to binge.
Throughout this time of exploring and implementing these activities, you’ll continue to monitor intake, addressing any areas of vulnerability or areas of opportunity to improve on, as well as keeping an eye on the trends of body weight through weekly weigh-ins.
Recognize that due to the fact that urges to binge will still come, you’re looking to develop insight into when you feel urges, what may be triggering the urges, learning how to spot problematic areas and having a plan for how to work through them. It’s an evolving process. Much like one would problem solve for a business, there are areas of opportunity, a plan to overcome obstacles and implementing those plans to see what works, what doesn’t and how to modify as you go.
Take the time to review what’s working in your problem solving process. How can things be improved? What could be done differently if a course of action didn’t go as planned? Practice forgiveness in ways that remind you of the progress you’ve made as you now have qualitative and quantitative data to show that binge eating has likely been reduced in your life.
It’s also at this point where you may want to experiment with re-introducing “forbidden” foods back into the diet. If you find this to be overwhelming at first, try only adding one or two foods at a time to assess your psychological readiness around them. It’s important to remind that the introduction of these foods still has the potential to trigger a binge so you’re aiming to introduce the ones you feel least likely will cause that outcome.
As with every step of the solutions for binge eating, expect some resistance, expect to still have moments when you struggle. This is part of the process and still is a very important step to tackle and develop confidence with.
Issues may still arise with the overvaluation of body image and size, since, as previously stated, this process is not designed specifically for the outcome of weight loss even though some may lose weight while working through these steps.
Also, it is still entirely possible that additional help is needed. You may still need the help of a therapist and/or a doctor to continue this process.
Strict/aggressive dieting is too risky of a scenario for those who have a history of binge eating. This is information I wish I knew more about throughout my career as it would have helped me better serve my clients and not attempt things that are popular in diet culture such as “food challenges” where certain foods/food groups are eliminated for the purposes of fat loss.
Should the individual who has struggled with binge eating still elect to lose fat after they have worked through these steps, a more conservative (less aggressive) diet approach may be suggested. Exercise for the purpose of holistic health and not as punishment can still be a part of a well-rounded plan.
Should you want more in-depth information on what I’ve written here, I highly recommend the book “Overcoming Binge Eating” by Dr. Christopher G. Fairburn where much of this information has been adapted from. Dr. Jake Linardon (www.breakbingeeating.com) has excellent information as well. If you prefer to take in information via podcasts, Georgie Fear, RD has a great show called “Breaking Up With Binge Eating”. In addition, I took knowledge from my work coaching nutrition for clients and my coursework with Mac-Nutrition Uni.
For my fellow coaches, especially those who also coach nutrition, be mindful of how certain dietary tips and practices can be triggering for those who struggle with binge eating. What works for one does not work for another. This is one of the reasons why diets don’t serve everyone equally.
