Recognizing, Treating, and Coping with Binge Eating Disorder

Binge eating disorder (BED) is the most common, but least understood, eating disorder in the United States. Intuitive eating and Health at Every Size® may be helpful tools for those in recovery, but public understanding of these concepts is limited. 

NEDA hosted a special presentation, supported by Shire, to enhance public understanding of these topics. Presenters Lisa DuBreuil, LICSW, Matt Joseph Diaz, and Marci Evans, MS, CEDRD-S, cPT spoke about the personal and clinical aspects of BED; recognizing, treating, coping with, and recovering from BED; the principles behind intuitive eating; and the importance of the Health at Every Size® movement. 

Lisa DuBreuil, LICSW is a clinical social worker, psychotherapist, and fat activist. She reviewed information on binge eating disorder, Health at Every Size®, and weight stigma.

• Binge Eating Disorder became a distinct diagnosis in 2013. It frequently co-occurs with other conditions, including mood disorders and addictions. The diagnostic criteria for BED are somewhat broad and subjective, but there is no easy, straightforward checklist of symptoms for any eating disorder. The bottom line is that when eating behaviors cause you stress, or when you feel a loss of control around eating, it’s time to get help. Check out NEDA’s resources for more on BED risk factors, warning signs, and health consequences.
• Diverse communities struggle with BED, just as with any other eating disorder. There is a strong need for more research on binge eating disorder—of the research that has been done, the majority focuses on straight, young, white women, which does not represent the diverse communities affected. This includes size diversity—just as it’s impossible to tell if someone is struggling with anorexia or bulimia by looking at the size of their body, people struggling with BED come in all shapes and sizes. Unfortunately, narrow views about weight and eating disorders can lead to patients who don’t have the expected eating disorder “look” being denied appropriate care.
• BED treatment may include a number of different therapeutic methods, and a treatment team that includes a nutritionist. Medical/psychiatric support and support groups may also be helpful. Lisa stressed that weight-inclusive treatment is essential for those dealing with BED. 
• Health at Every Size® (HAES) is a movement that prioritizes weight inclusivity and respectful care, regardless of body size. Health enhancement and balanced living are encouraged, within a framework that does not equate body size with health. While this may be a controversial viewpoint within our weight-centric society, valuing individual health beyond weight allows us to move past a one-size-fits-all view of bodies. 
• Weight stigma—shaming or judging individuals for their weight or shape—has no place in any environment, least of all a therapeutic one. Those living in larger bodies should receive the same quality healthcare as any other person. Moreover, the perpetuation of weight stigma may contribute to negative psychological states and poor health outcomes. Clinicians, in particular, should look at their office space to ensure that it’s welcoming to individuals of all shapes and sizes, considering comfortable seating and office décor that reinforces weight-inclusive messaging.
• Language around eating disorders and weight is vitally important. Lisa discussed how she uses the word “fat”—not as an insult, but simply as a factual descriptor that doesn’t carry any negative meaning. Lisa stressed that it is her choice to do this, and there are people in larger bodies who choose not to use or embrace that word. In general, listening to the words that people use to describe themselves is the best route; it is vital to respect the word choices and labels that people establish for themselves. 

Matt Joseph Diaz is a writer, public speaker and social media activist tackling the issues of body image and self love. Matt discussed his own experience with binge eating disorder and body image, offering a personal perspective on struggling with BED. 

• Struggling with BED can be a lonely, isolating experience, compounded by the fact that it can also emerge out of lonely and isolating experiences. In Matt’s case, struggling with BED was accompanied by weight gain, weight shaming, and a general emphasis on weight as the root cause of his problems—with the binge eating disorder not properly addressed until after he had struggled through years of a weight-based approach.
• Weight loss may be part of a holistic recovery, but it should not be the focus. Matt spoke about losing weight, but holding onto unhappy and unhealthy views of his body—and how if his attitude towards himself, rather than his size and shape, had been the focus, he could have reclaimed years spent shaming himself for his body.
• Body positivity is a promise to love your body in all of its forms. It’s often represented in an overly rosy or aspirational way, as though it’s a final destination that can be achieved through positive thinking. Your relationship with your body will be like any other relationship—highs and lows, ups and downs, good days and bad. Body positivity is a journey, not a finish line. 

Marci Evans, MS, CEDRD-S, cPT is a self-proclaimed Food and Body Imager Healer™. She is a Certified Eating Disorder Registered Dietitian and Supervisor, certified Intuitive Eating Counselor and Certified ACSM personal trainer. She shared information on intuitive eating.

• Intuitive eating principles include eating for physical rather than emotional reasons; relying on internal hunger and satiety cues; and unconditional permission to eat with attunement.
• Weight loss should never be a goal of intuitive eating. While intuitive eating is correlated with a lower BMI, placing an emphasis on weight loss is in opposition to the principles of intuitive eating, which value listening to one’s body and fueling it accordingly. This includes your own internal “food police” thoughts—take note of when you experience those thoughts, and actively disinvite them from the conversation.
• Flexibility is essential to successful intuitive eating. While the basic principle is to eat according to your body’s hunger cues, rather than its emotional ones, sometimes there is an emotional component to eating that’s not necessarily unhealthy. As an example, Marci described going to a nice restaurant on her birthday, and enjoying a slice of cake even though she wasn’t physically hungry—it was a joyful experience, and one that she entered knowingly and without regret; rigidity and deprivation are not part of intuitive eating, and are counterproductive to its goals. 
• Satisfaction from eating is important, and helps us to appreciate and enjoy food for what it is. Eating foods that are considered ‘healthy’ but are not satisfying to you may not be a fulfilling experience, and could lead to later bingeing. Don’t discount the role of satisfaction or ignore your body’s natural response to various foods.
• Respect your body by treating it well. This will look different for everyone—whether it’s expanding your wardrobe, upgrading your pillow, going for a hike, or resting when you’re sick, there are many ways (unrelated to food!) to show your body love. Intentionally engaging with your body in respectful, loving ways can help to reinforce the positive relationship you are developing with food and your body.

Developing a positive relationship with your body is an ongoing process, and cultural obsession with weight as the ultimate arbiter of health can complicate an already challenging process. For people struggling with binge eating disorder, a potentially devastating condition that lacks public understanding, the conflicting messaging around health, weight, and food can become a barrier to recovery. 

There is no one ‘right’ approach for those struggling, but emphasizing weight and creating rigid rules around food can be counterproductive to developing a loving and sustainable relationship with your body. The principles behind intuitive eating and Health at Every Size® may be helpful not only to those who have struggled with BED, but to anyone who is working on their relationship with food and their body.

Thanks to Lisa DuBreuil, Matt Joseph Diaz, and Marci Evans for their engaging presentations, and to Shire for making the event possible.