By Kari Johnson, RD, CD, Rogers Memorial Hospital
The average person may think that eating three pieces of pumpkin pie at Thanksgiving qualifies as a binge, but binge eating disorder (BED) is much more serious than that. According to the National Eating Disorders Association, BED is the most common eating disorder in the U.S., affecting 3.5% of women, 2% of men and up to 1.6% of adolescents .
A very important development in BED is the fact that it is now listed as an official eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which will increase awareness and help make it easier for patients to get treatment.
The Effects of Binge Eating Disorder
As lead dietitian at Rogers Memorial Hospital, I see the effects of binge eating disorder on a regular basis:
- Co-morbid health concerns (obesity, cardiac concerns, hypercholesterolemia, and hyperglycemia)
- A feeling of being out of control
It’s the job of our team at Rogers to discover the reasons leading to an individual’s bingeing so we can effectively treat them.
According to the National Eating Disorders Association (NEDA), the key diagnostic features of BED are:
- Recurrent and persistent episodes of binge eating
- Binge eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal
- Eating until uncomfortably full
- Eating large amounts of food when not physically hungry
- Eating alone because of being embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty after overeating
- Marked distress regarding binge eating
- Absence of regular compensatory behaviors (such as purging)
The Reasons and Triggers for BED
There are many reasons for someone turning to BED, but my past several patients had a history of verbal, physical or emotional abuse, or a combination thereof.
Patients who have experienced trauma describe their binges as “stuffing themselves as a way to stuff their emotions deep inside.” One of my patients was so exhausted of being abused physically they tried to “gain weight to make themselves so unattractive that maybe then they would be left alone.”
Sometimes my job as a dietitian is more about communication. I often ask questions and listen to patients to uncover their triggers for bingeing. Because BED may have started in childhood, I ask patients about their relationship with food while growing up. For instance, were they always urged to clean their plate? Was there chaos at the dinner table?
Other questions can include:
- Can you tell me about your average daily consumption?
- When is the last time you felt out of control?
- What was going on to provoke the binge?
It may sound contradictory, but dieting often plays a big part in BED. People who restrict food intake can easily set themselves up for a binge because they are starving themselves.
I want my patients to work on their relationship with food and eventually learn to listen to their bodies, and that’s why learning hunger and fullness cues are really important. So I don’t just prescribe a meal plan – I explain how and why I’m asking them to eat in a certain way.
Goals For Management of BED
The goal is to normalize a person’s interaction with food. At Rogers, our patients with a history of BED eat three meals and three snacks at the same time each day. They also eat the same amount of food each day, as determined by a dietitian.
To our patients, it may feel like they’re eating all the time, but it helps rejuvenate their bodies. The meal plans provide structure as we don’t want anyone to feel overly full, but we also don’t want them to be so hungry that they set themselves up for a binge.
We use the following analogy between food and fuel to teach patients why it’s important to find balance in their eating:
Regular, Structured Meals
If you throw a wheelbarrow of wood on a fire, it will burn very fast, but burn out quickly. It you put a log or two on the fire every couple of hours, the fire will last longer. Likewise, if you eat regular, structured amounts to fuel your body throughout the day, your metabolism will even out and your blood sugar will stabilize. (Often a person who binges has blood sugar levels that fluctuate drastically.)
Weighing, But For Changes, Not Numbers
While we do weigh our patients on a regular basis, we don’t focus on the number on the scale. We only share the number if it is therapeutically appropriate as we don’t want anyone to obsess over a number. Instead, we talk about where their bodies should be, how losing weight could improve co-morbidities by resulting in less heart stress and stabilizing blood sugar levels.
Patients stay at Rogers for different lengths of time. If they have a history of trauma, we want them to resolve as many of those emotions as possible while they are here, and we equip them with appropriate coping skills. We want to prepare them to deal with situations that could be overwhelming and trigger a binge, such as certain social events or even encountering someone who resembles a past abuser.
Our job doesn’t end when our patients leave campus. We create a solid plan for discharge. We coordinate their next level of care by finding a dietitian in their area who is comfortable working with eating disorders as well as providing all of the necessary information to create appropriate goals for the next level of care.
What Does Success Look Like?
When someone asks me what success looks like in my job, I think about the patient who arrived needing the aid of a cane along with type II diabetes and sleep apnea. By the time she left four months later, she had lost weight, which led to a more sound sleep schedule, and no longer needed diabetes medication. Having developed so much faith in the fact that she could control eating, she left her cane behind as a souvenir for the treatment team.
“We help patients build trust in themselves and feel confident they can handle their emotions without resorting to binge eating. Most important, patients learn that they were never the problem – they are the answer.”
That’s success. We help patients build trust in themselves and feel confident they can handle their emotions without resorting to binge eating. Most important, patients learn that they were never the problem – they are the answer.
ABOUT THE AUTHOR:
Kari started with Rogers Memorial Hospital as a registered dietitian in the Eating Disorder Center in 2004. She contributed numerous group and individual nutrition therapy sessions along with many grocery store tours, meal outings, cooking groups and all-house therapeutic outings during her four years at EDC.
As Rogers continued to grow she took on the role of the primary dietitian and developed the nutritional components of various programs including eating disorders, OCD and anxiety, and addiction.
Kari has had the chance to “share the health,” by presenting at local and regional levels for a
number of events throughout the years. Some of these include the Madison Networking Group, the Wisconsin Dietetic Association, Mount Mary College and UW Stout.
Rogers Memorial Hospital is a key corporation of Rogers Behavioral Health System, which also includes: Rogers Memorial Hospital Foundation, Inc.; Rogers Partners in Behavioral Health, LLC; Rogers Center for Research and Training; and Rogers InHealth. The hospital has become nationally recognized for its specialized residential treatment services and affiliations with academic institutions and teaching hospitals in the area.
Rogers Memorial Hospital is currently Wisconsin’s largest not-for-profit, private behavioral health hospital, providing adults, children and adolescents with depression and mood disorders treatment, eating disorders treatment, addiction treatment, obsessive-compulsive and anxiety disorders treatment, posttraumatic stress disorder, as well as caring for a variety of other child and adolescent mental health concerns. For more information, please visit www.rogershospital.org.
REFERENCES: Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry. 2011;68(7):714–723.