Binge Eating: Back From the Brink

Feb. 7, 2007 — -- A study just published in the journal Biological Psychiatry suggests that binge eating is the most common eating disorder in the United States, affecting roughly 3.5 percent of women and 2 percent of men.

Binge eating disorder is defined by the World Health Organization as bouts of uncontrolled eating, well past the point of being full, that occur at least twice a week on average.

The condition is a public health concern because BED is associated with an increased risk of severe obesity -- a body mass index of 40 or above -- as well as the complications associated with it, including diabetes, heart disease, increased cancer risk and stroke.

The new study grabbed national headlines partly because it was novel in providing an overview of population patterns for eating disorders and partly because the findings were something of a surprise.

Anorexia nervosa and bulimia tend to get much more attention than BED, but these eating disorders are considerably less common. Anorexia, while severe enough to be life threatening at times, usually lasts two years or less, while BED lasts eight years on average.

Binge Eating Widely Accepted

What intrigues me most about BED is how nearly normal it is. Whereas starving oneself, as in anorexia, or inducing vomiting, as in bulimia, is clearly abnormal behavior that most people would not even consider, overeating is another matter. We all do it at times, and on such occasions as Thanksgiving and last weekend's Super Bowl, it is virtually expected.

Nor does binge eating appear to be a uniquely human tendency. Other species may binge far more often than we do. Predators, uncertain when they will make their next kill, tend to gorge themselves after a successful hunt. In an environment of uncertain access to calories, gorging -- a close cousin to bingeing, if not the same thing -- would favor survival.

Many human behaviors and characteristics vary over the expanse of the famous bell curve. The bell curve is a graph to show how traits vary over a range, with most clustering near the middle, or average, for the group, and relatively fewer far above or far below the group average. The shape of the graph looks like a bell.

Up to a point, having a trait well above or below the population average is still considered normal. Beyond that point, the trait is considered abnormal, often defined as a disorder.

BED differs from normal, acceptable and even expected behavior simply by degree. And it may relate to a deep-seated tendency programmed into the genes of many species, including ours.

This characterization of BED makes me think of another common disorder, attention deficit hyperactivity disorder, or ADHD. All of us get distracted and restless at times, kids especially. Here, too, what passes as normal behavior becomes abnormal when it goes to extremes.

Whereas some children would have ADHD in almost any environment, others are doubtless pushed from the normal part of the bell curve by the pressures of a modern environment that limits physical activity and imposes multimedia distractions. The greater those pressures, the larger the population pushed past normal limits into a disorder, and the more common the condition becomes.

The prevalence of eating disorders, like the prevalence of ADHD, appears to be rising over time. The study just published suggests that the more recently people were born, the more likely they are to suffer an eating disorder at some time in their lives.

Is It Our Nature to Binge?

Since human nature, our moods and our genes are all pretty much the same today as they were 10, 50, or 150 years ago, changes in the prevalence of conditions tend to be linked to changes in the environment.

More tasty food is constantly and abundantly available to us all than ever before in history. Emotional needs may be changing little over time, but the availability of food as a means to address those needs is changing a lot. Any tendency to overeat is doubtless aggravated by the proliferating opportunities for doing so.

The processing of food may be contributing as well. Often, food processing packs more calories into ever smaller volumes; to appreciate the effect, just imagine trying to binge on apples.

And flavor enhancers -- from sugar and salt to monosodium glutamate and others listed simply as "artificial flavors"-- may stimulate the appetite center in ways we find hard to resist or control.

Tips to Avoid Binge Eating

Binge eating disorder deserves more attention, and those afflicted will often warrant psychological treatment. Changes to the food supply are likely warranted as well.

But a few simple strategies may offer protection to those in the at-risk part of the bell curve but not yet over the line.

Don't ever starve yourself. Most binges are preceded by relative deprivation. Instead, make a habit of loading an insulated snack pack with nutritious foods -- such as fresh fruit, fresh vegetables, dried fruit, nuts and seeds, whole grain cereals, nonfat yogurt -- to take with you everywhere, every day.

Eat something nutritious whenever hungry, and you may pre-empt any tendency to binge. Make fruits and vegetables a prominent part of your diet. They are nutritious, filling and low in calories.

Look at food labels, and choose items in every category with short ingredient lists. These will tend to be less processed foods, less likely to overstimulate your appetite center. Fill your home with nutritious foods, and both the tendency to binge, and the harm of doing so, will subside.

To the extent possible, make eating a social activity. There are many potential benefits to a family meal, and bingeing is almost invariably done in private.

And finally, make a realistic assessment of your emotional needs, and try to address them with something other than food. Loneliness, depression, anxiety, and low self-esteem can all contribute to bingeing, but all can be addressed in more productive, less harmful ways. That process begins with an honest appraisal -- and seeking help.

Some of you reading this may have BED; others may be on the brink. Don't be ashamed. The new information about how common and important binge eating disorder is tells us we're in this together. Our job now is to help ourselves, and one another, avoid this growing hazard.

Dr. David Katz is director of the Prevention Research Center at the Yale University School of Medicine and medical contributor to ABC News. Visit his Web site at www.davidkatzmd.com.