By: NutriProCan Dietitans

Binge Eating Disorder explained by a Registered Dietitian

Have you been diagnosed with Binge Eating Disorder (BED)? Or are you worried binge eating may be an issue for you, even if you haven’t been diagnosed? What does it really mean if you ate two rows of Oreos last night? 

Eating Disorders have been diagnosed in approximately 1 million Canadians. The eating disorder that most commonly affects both men and women across the lifespan is BED. This diagnosis is relatively new to the mental health world (added to the DSM-5 in 2013) and the research on BED has been expanding since.

This blog will help you understand what BED is and what it is not (including common misconceptions). It will take you through triggers associated with BED, and provide you with evidence-based information and first steps towards recovery.

What is Binge Eating Disorder?

Binge eating disorder (BED) is characterized by recurrent episodes (at least once a week for 3 months) of eating a large amount of food with a perceived loss of control. Binges often occur in a short period of time, like an evening after work. They can also be spread across an entire day, where every meal feels “out of control” like a binge. Binge eating is usually followed by feelings of guilt and shame afterwards. What sets BED apart from other eating disorders is that there are no additional compensation behaviours involved (i.e. overexercising, purging etc.) to “make up” for a binge.  These compensation behaviours fall into the category of Bulimia-Nervosa, another type of eating disorder.

BED is associated with 3 or more of the following:

• Eating large amounts of food when not feeling physically hungry
• Eating more rapidly than normal
• Eating past fullness until uncomfortable
• Feeling embarrassed by how much one is eating (may eat alone in secrecy)
• Feeling very guilty and shameful after an episode of binge eating

What is the Difference Between Binging and Binge Eating Disorder

Maybe you had a busy day and you didn’t get enough meals and snacks in, so you ate more than normal in the evening due to hunger. This is not a binge; your body needs a large amount of food as it has gone all day without fuel. Alternatively, maybe you had a tough week and engaged in some emotional eating, like eating a pint of ice cream. This is not necessarily a binge either, it may be an occasional exception to your normal eating. Occasional exceptions, whether emotionally driven or not, are a normal part of life. It is not a binge if it did not feel uncontrollable and cause distress afterwards.

Binging usually involves “off-limits foods” and there is a lot of guilt and shame associated with it. There is an intense out-of-control feeling; people may feel like they weren’t even present during the episode. It may look like rummaging through the cupboards and eating everything in sight, unplanned. Other times binges may be planned, for example, ordering a large amount of takeout when not physically hungry and eating it in secrecy. These are just a few examples of what binge episodes could look like. Even if you had a true binge episode, it does not necessarily mean you have BED. The disorder needs to be diagnosed by a doctor or psychologist.

Common Misconceptions Regarding Eating Disorders

One of the most common misconceptions about eating disorders, including BED, is that there is choice involved. Unfortunately, many people struggling with an eating disorder have been asked, “why don’t you just stop”, as if it is a choice they can decide. Eating disorders are not a choice and this messaging can be harmful. There are strong biological components to eating disorders. 

Biological Risk Factors in BED

When you’re restricting through the day (intentional or unintentional) your blood sugars fall very low. These low dips in blood sugar build up a strong biological response in the body that says we need food now! The more you restrict the more you prime your body to have a strong drive for food. Hormonal changes include an increase in hunger hormone, Ghrelin, suppression of satiety hormone, Leptin, and release of Neuropeptide Y, or the ‘carbohydrate craver’, to ensure your body gets what it needs. Glucose, coming from carbohydrates, is our body’s most readily available source of energy; our brains need glucose to function. This is why cravings for carbohydrates and energy-dense foods are so much stronger during these times. Often times following a binge, people will restrict again the next day, as they feel guilty about the binge or they’re still feeling full from the night before. This may cause their hunger cues to be off. However, this restriction once again primes them for another binge. The hormonal changes from food restriction can build over days, meaning another binge may not happen again right away, but it could be building up to occur again later that week. This is the vicious eating disorder cycle. Individuals with BED are particularly sensitive to food restriction and these biological defences are stronger in this population. 

This does NOT mean you have a lack of willpower. This is your body’s defence mechanism kicking in, designed to get you through periods of famine. Our bodies are still functioning off our Caveman biology. That is, historically humans went through periods of feast and periods of famine, where they had to eat in large amounts when food was available to get them through times when food was not available. Our bodies cannot tell the difference between famine and food restriction (intentional or unintentional). That’s why these biological defence mechanisms kick in, to increase the drive for food and keep us alive. There are metabolic changes as well as a result from food restriction. However, both metabolic and hormonal changes can be repaired as you begin normalizing your eating. This is not permanent! 

Psychological Risk Factors in Binge Eating Disorder

Another factor that plays a role in BED is food restraint (not allowing yourself certain foods or feeling guilty when you do have them). Restriction equals attraction, meaning the more we tell ourselves we can’t have something or feel guilty after having it, the more we will want it or risk losing control around it. If we know something is off-limits we are more likely to overindulge in it when we are triggered (i.e. stress) or when it is available to us. 

How Can We Help with Binge Eating?

Working with a registered dietitian (RD) can help you normalize your eating and reduce the biological and psychological risk factors associated with BED. A NutriProCan RD will help you work through any unhelpful thought patterns or beliefs surrounding food. It is our goal to help you feel safe around food again and find enjoyment in eating. One of the most beautiful aspects of recovery is seeing how much it opens your life in all areas and gives you the capacity to do more of what you love. 

First steps in addressing Binge Eating Disorder:

1. Speak to your doctor about getting a formal assessment for BED
2. Seek help from a Registered Dietitian AND Psychologist to:
   1. Breakdown food rules and diet culture
   2. Reconnect with you body’s hunger and fullness cues
   3. Learn to feel safe around all foods again
   4. Address emotional triggers and other mental health aspects with a psychologist 

Note: If you haven’t formally been diagnosed with BED by your doctor but are experiencing some or all of the symptoms mentioned above,  working with an RD (and psychologist) is still recommended to reduce the frequency and severity of your symptoms and build a positive relationship with food.

FAQs

I feel a strong drive towards sugar – if I have one cookie I have to eat the entire box and then I’ll want cookies again the next day, and so on. Do I have BED? And can you help?

This does not necessarily mean you have BED. The drive for sugar could be related to another cause, like low blood sugar. It’s important to be properly assessed for BED by a doctor or psychologist and meet with an RD to see if there are any other explanations related to your other eating behaviours.

I really want to lose weight. Can I work on weight loss while working on BED?

It is not advised to tackle a weight loss goal with any sort of eating disorder in the picture. The priority should be to resolve the eating disorder. When there is a fixation on weight it can actually worsen symptoms. Fortunately, by recovering from BED you are preventing further weight gain associated with binging. After recovery and with normalized eating, your body will settle towards a weight that is natural for you. It is highly encouraged to complete body image work with a psychologist that specializes in this area, following treatment for any eating disorder. 

I’m noticing some of these patterns in my son/daughter. Can you help younger people?

Yes! As NutriProCan RDs we work with many adolescents and their families. There is no age of consent for dietitian services. Consent is based on the client’s mental capacity, not age.

I’m not sure if I have Binge Eating Disorder, but I’m experiencing some of the symptoms described above, can I still seek treatment?

Absolutely! Even if you do not meet all the criteria for BED, you can still be symptomatic and working with a Registered Dietitian and psychologist can help reduce the frequency and severity of your symptoms.