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Binge eating

Introduction

Binge eating is an eating disorder where a person feels compelled to overeat on a regular basis.

People who binge eat consume very large quantities of food over a short period of time and they often eat even when they are not hungry. Binges are often planned and can involve the person buying "special binge foods".

Binge eating usually takes place in private with the person feeling that they have no control over their eating. They will often have feelings of guilt or disgust after binge eating. These feelings highlight underlying psychological issues, such as:

  • depression – feelings of extreme sadness that last for a long time
  • anxiety – a feeling of unease, such as worry or fear, that can range from mild to severe

Depression and anxiety may be both a cause and an effect of binge eating.

Binge eating is a mental health condition, but it is also triggered by the effect that the binge eating cycle has on the body (see box, below left, for more information about the binge eating cycle).

See Binge eating – Causes for more information.

Who is affected by binge eating?

Anyone can be affected by binge eating. Unlike anorexia where more women than men are affected, binge eating affects men and women equally. The condition tends to be more common in older adults than in younger people.

Binge eating and bulimia

People who binge eat and those with bulimia (another type of eating disorder) often eat until they are uncomfortably full. People with bulimia then purge (flush out) the food they have eaten by making themselves vomit or by taking laxatives (medicine to help empty the bowels).

Unlike those with bulimia, people who binge eat do not purge themselves to control their weight. Therefore, binge eating can cause weight gain, which can lead to obesity (see below), which is where a person has too much body fat for their sex and height).

See the topic about Bulimia for more information about the condition.

Binge eating and obesity

Binge eating is often associated with obesity, where someone is very overweight with a body mass index (BMI) of 30 or over. Obesity is a serious health problem that can lead to a number of serious chronic (long-term) health conditions such as:

Being obese can also shorten your life expectancy. For example, the life expectancy of obese adults who are over the age of 40 can be shortened by six or seven years. 

See Binge eating – Symptoms for details of other health conditions that are related to obesity and the Obesity topic.

Outlook

Binge eating is a treatable condition, and a number of different treatment options are available. For example, treatments include:

  • a self-help programme
  • psychological therapy, such as cognitive behavioural therapy (CBT)
  • a type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs)

See Binge eating – Treatment for more information.

The binge eating cycle

People who binge eat often display a particular pattern of behaviour known as the binge eating cycle. The binge eating cycle (described below) is difficult to break.

  • Binge eating leads to a surge in blood sugar which causes the pancreas to produce insulin (a hormone that helps to break down fat and carbohydrate in the body).
  • The insulin causes blood sugar levels to fall rapidly, resulting in a false message being sent to the brain that more food is needed to top up glucose levels.
  • This results in cravings for sugary foods to provide a quick glucose fix, so the person eats large quantities of food even when they are not hungry.
  • Eating large amounts of sugary foods leads to a rapid increase in blood sugar levels and the production of insulin, causing the cycle to begin again.
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Symptoms

The Weight gain is the main symptom of binge eating. Many people with the disorder are already overweight.  If you are carrying too much weight you are vulnerable to other health problems that are associated with obesity, including:

  • high cholesterol – high levels of cholesterol in your blood increases your riskheart disease and stroke 
  • high blood pressure– this also increases your risk of cardiovascular conditions such as stroke or heart disease
  • diabetes – a chronic (long-term) condition caused by too much glucose (sugar) in the blood
  • asthma – where the lung airways become inflamed
  • osteoarthritis – a condition that causes pain and swelling in the joints
  • chronic back pain
  • heart disease – where the heart’s blood supply is blocked by a build-up of fatty substances in the coronary arteries (the main blood vessels of the heart)

See the topic about Obesity for more information.

Other physical symptoms

In addition to the serious health conditions described above, binge eating can also have a number of other physical effects on the body as a result of fluctuating blood sugar levels. These include:

  • sugar cravings
  • stomach pains
  • intolerance to heat and cold
  • headaches

Psychological effects

People who binge eat are unable to comprehend why they cannot control their body’s sugar cravings, and become trapped in a cycle of bingeing - guilt - restraint - bingeing.

They blame themselves for their weakness, which reduces their self-esteem even further. As a result, binge eating may cause the following psychological problems:

See Binge eating – Causes for more information about the role that depression, stress and anxiety play in binge eating.

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Causes

There is no one cause for binge eating. However, like most eating disorders, it is seen as a way of coping with feelings of unhappiness and depression.

Depression

It is estimated that about 50% of people who binge eat have been depressed at some point in their life. However, it is not clear whether depression causes binge eating or whether binge eating causes depression.

See the topic about Depression for more information about the condition.

Stress and anxiety

Stress is another common trigger of eating disorders. Stressful events, such as moving house, job, or school, or the death of a friend or relative, can sometimes cause someone to binge eat.

Eating disorders are a physical display of the difficulties a person may be experiencing in their personal life. Those who binge eat  are often ashamed at the volume of food they consume, and may also feel that their lack of control around food mirrors the lack of control they have over their personal lives.

Research has suggested that there are other factors or emotions that may bring on an episode of binge eating, including:

  • anger
  • boredom
  • worry or anxiety
  • sadness
  • low self-esteem

There are also specific behaviours that are more common in people with a binge eating disorder. These include:

  • impulsive behaviour – acting quickly without thinking about the consequences
  • alcohol misuse – regularly drinking more than the recommended daily amount of alcohol
  • avoiding discussing feelings and emotions openly
  • not feeling responsible for yourself or your actions

Trying to lose weight

The social pressure of trying to achieve a slim body shape may sometimes cause a person to binge eat.People who binge eat may be unable to achieve their desired body shape. This can result in a sense of inadequacy, causing them to overeat and to feel guilty afterwards.

It is not known whether dieting and binge eating are related. However, some people binge eat after:

  • skipping meals
  • not consuming enough food each day
  • avoiding certain foods

These are unhealthy methods of trying to lose weight and alter body shape and they increase a person's risk of binge eating.

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Diagnosis

If you think that you have a binge eating problem, visit your GP. They will be able to diagnose the condition and refer you to a specialist, such as a psychiatrist, psychologist or dietitian. See Binge eating – Treatment for more information.

In diagnosing binge eating, your GP will ask you about your eating habits and look for three or more of the following signs:

  • You eat much faster than normal during a binge.
  • You eat until you feel uncomfortably full.
  • You eat a large amount of food when you are not hungry.
  • You eat alone or secretly due to embarrassment about the amount of food you are consuming.
  • You have feelings of guilt, shame, or disgust after binge eating. 

People who regularly eat in this way are likely to be diagnosed as having a binge eating disorder.

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Treatment

It is important that you seek medical advice if you feel you have a binge eating disorder. Your  GP will assess you, and advise the best course of treatment for you.

The National Institute for Health and Clinical Excellence (NICE) recommends the following treatments for eating disorders:

  •  a self-help programme, under the supervision of healthcare professionals
  •  psychological therapy
  • a selective serotonin reuptake inhibitor (SSRI) anti-depressant (in some cases) 

These are described in more detail below.

Self-help programme

A self-help programme is an important part of the treatment process for binge eating. It will look at ways that you can break the binge eating cycle so that you can successfully tackle your binge eating disorder. The programme will be carried out with the support and encouragement of healthcare professionals.

Psychological therapy

People who binge eat are encouraged to stop relying on the cycle of bingeing and guilt as a way of dealing with their emotional problems.

It is possible to make a full recovery from binge eating by using certain types of psychological therapy such as:

  • cognitive behavioural therapy for binge eating disorder (CBT-BED) – a specially adapted type of CBT that involves talking to a therapist and working out new ways of thinking about situations, feelings and food
  • psychotherapy – regular sessions with a therapist to help you understand what makes you anxious and accept your strengths and weaknesses
  • an adapted form of dialectal behaviour therapy (DBT) – you discuss all aspects of your binge eating disorder with a therapist. DBT has been used effectively to treat other mental health disorders, such as borderline personality disorder.
  • diet and nutritional advice

See the topics about Cognitive behavourial therapy and Psychotherapy for more information about these psychological therapies.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a type of medication that can help to reduce binge eating.

SSRIs boost levels of a substance called serotonin. When serotonin is released in the brain, it helps to lift your mood. NICE recommends the use of SSRIs to help reduce binge eating, but the long-term effects of the treatment are unknown.

Known side effects of SSRIs include:

  • nausea (feeling sick)
  • blurred vision
  • diarrhoea or constipation
  • dizziness
  • dry mouth
  • feeling agitated or shaky
  • insomnia (difficulty sleeping) or feeling very sleepy
  • loss of appetite
  • sweating
  • low sex drive

See the topic about andidepressants for more about  Selective serotonin reuptake inhibitors (SSRIs) for more information.

Losing weight

Although there are a number of psychological treatments available to treat binge eating, they will have a limited effect on your body weight.

However, underlying psychological issues need to be dealt with first if weight loss is to be successful and long-lasting.

If you are overweight, you should follow a weight-loss plan that is drawn up by a healthcare professional, such as your GP or a dietitian (a food and nutrition specialist). The plan may involve:

  • eating food that is high in complex carbohydrates, such as brown rice, wholemeal bread and cereal, lentils and potatoes
  • eating little and often

See the topic about Diet for more information about maintaining a healthy diet.

Dieting risk

Dieting as a means of treating binge eating should be avoided because it may make the problem worse.

If you are overweight or obese, your GP or a dietitian will be able to draw up a weight-loss plan for you to follow.

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Prevention

It is important to understand the effect of low blood sugar levels on the body, and the food cravings that it causes.

Binge eating can be reduced and prevented if you adopt healthy eating habits and receive realistic advice about food. For example: 

  • Keep a food diary, to highlight when you binge and the types of food you are eating that trigger a rapid and false sense of hunger.
  • Avoid eating sugary foods, as eating quality carbohydrates (see below) will provide a slow and sustained energy release throughout the day.
  • Eat little and often, and include complex carbohydrates, such as brown rice, wholemeal bread and cereal, lentils and potatoes to help keep you feeling full.
  • Cut out alcohol and caffeine, as well as sugary foods will help prevent the "yo-yo effect" on your body's blood sugar levels.
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Nice guidelines

Guidance for people affected by eating disorders 

The term "eating disorder" covers conditions such as:

  • anorexia nervosa
  • bulimia nervosa
  • binge eating

These mental health disorders usually develop over time, sometimes over years, and often at a point when life brings fear and insecurity.

The National Institute for Health and Clinical Excellence (NICE) has issued guidance to the NHS about eating disorders. Although the guidance is mainly intended for people with eating disorders, it may also be useful for family members and those who care for people with eating disorders.

The guidance aims to improve the care and treatment provided in the health service and looks at different areas of diagnosis, treatment, care and self-help. The guidance includes:

  • advice for carers of someone with an eating disorder
  • what you can expect from the NHS if you have an eating disorder

It also includes information about the support and treatment you can receive if you have:

  • anorexia nervosa
  • bulimia nervosa
  • another type of eating disorder, including binge eating disorder

For further information, you can download the NICE guidelines on eating disorders.

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