Book Review: Overcoming Binge-Eating by Christopher G. Fairburn

 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.