Written by: Margaret Conte, Dietetic Intern
As a dietetic intern, we learn to
calculate patient needs and how to present our findings to the patient. We
receive training on counseling, but the focus is on nutrition. When it comes to
treating eating disorder patients, in many ways the counseling is far more
important than nutrition. “Overcoming Binge-Eating” gives an intimate look into
the therapy and counseling side of treating binge eating disorders, and I
believe it is a valuable read for all current and future dietitians.
The book is divided into two parts, the first of which discusses the research and what is known about binge eating disorders. Part II is an evidence-based curriculum that can be followed by an individual alone or in conjunction with a therapist. One asset of the book is its readability. An individual need not be a medical professional to understand the information or follow the curriculum.
What is binge eating?
Binge
eating is more recently being recognized as an eating disorder with a
psychological basis, rather than a merely lack of discipline when it comes to
eating. Some people can binge, and it has no effect on their lives. This is
called an indulgence and is a common phenomenon in men and women. When the repeated
practice has a profound impact on a person’s quality of life and health, then
it becomes an eating disorder, and we as dietitians can help with this. The two
hallmarks of a binge are 1) the amount eaten is excessive in the eyes of the
individual and 2) there is a sense of loss of control in the eyes of the
individual.
We are
taught as nutrition students that binges are the result of restriction.
According to Fairburn, the most common foods eaten in a binge are foods the
person is trying to avoid. There is a myth that binges are characterized by
high carbohydrate content, but in reality, the proportion of carbohydrates in a
binge is no different than in ordinary meals. Binges are characterized by the
amount of food rather than the macronutrient composition of the food.
Binges can
cause extreme distress in people. So why would someone subject themselves to
feeling “gross” and “disgusted” over and over? This is important to understand
in order to help someone overcome binge eating. One study interviewed women
with bulimia nervosa who binge and revealed major precipitants of binges:
tension, eating something (anything at all), being alone, craving specific
foods, thinking of food, going home (after school or work), feeling bored and
lonely. Other reasons for binges include undereating and the associated hunger
(especially those who eat little outside of binges), breaking a dietary rule,
and unpleasant emotions.
Binge
eating can be an eating disorder in itself, “binge eating disorder”, or it can
be a component of anorexia nervosa, bulimia nervosa, or eating disorders not
otherwise specified (do not meet the diagnostic criteria for anorexia nervosa,
bulimia nervosa, or binge eating disorder). Many people who binge also diet.
People who binge might think their dieting is in response to the binging, while
in reality the binging may have initially resulted from the dieting, and the
two cyclically encourage one another. The person may also engage in
self-induced vomiting or laxative misuse, which encourages more binging. As we
have learned in class, self-induced vomiting and laxative misuse can cause very
serious health effects.
How can I use this book to help my patients?
Part II is a self-help program for
people who binge. There are many concepts throughout Part II that hark back to
the motivational interviewing and transtheoretical model of change we learned
in counseling classes. It begins with the chapter, “Why Change?” and instructs
the reader to “Start by drawing up a list of the potential advantages of change.
To help you do so, ask yourself the following questions:
If I stop binge eating . . .
• Will I feel better about myself?
• Will it improve my quality of life?
• Will my physical health be enhanced?
• Will others benefit?”
The rest of
Part II outlines steps of the program. Step 1: Starting Well covers
self-monitoring and weekly weighing. Step 2: Regular Eating establishes a
pattern of regular eating and stopping vomiting and misuse of laxatives. Step
3: Alternatives to Binge Eating substitutes alternative activities and
identifies changes in weight. Step 4: Problem Solving addresses problems that
may be coming up. Step 5: Taking Stock reviews progress and decides what else
needs to be tackled. Next there is a diet module which tackles strict dieting and
a body image module that addresses shape concerns, shape checking, shape
avoidance, and feeling fat. The program closes with the section Ending Well,
which discusses maintaining progress and addressing setbacks.
Why is this important?
Because
eating disorders are so complex, it is especially important for the dietitian
to collaborate with other professionals, and understand their own scope of
practice and refer appropriately. I hope this blog post will encourage future
dietitians to read “Overcoming Binge Eating”, because the information I have
written here only scratches the surface of the links between dieting, binge
eating, and eating disorders. We will be better dietitians for understanding
where binging behavior comes from, and how to make recommendations
appropriately for optimal health of body and mind.
