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MEDICINE / THE M.D.

Out of control

Binge eaters' inability to stop themselves, often unrecognized as an eating disorder, must be treated differently than anorexia and bulimia.

January 21, 2008|Valerie Ulene | Special to The Times

From time to time, everyone overeats. For some, the enticing menu at a favorite restaurant proves too much to resist (drinks, a couple of appetizers, a rich entree, maybe a sampling of desserts); for others, a special celebration is the downfall (extra helpings from the buffet and a large corner piece of cake with lots of frosting). Beyond a stomachache and perhaps some mild indigestion, these occasional transgressions don't present much of a problem. But, sometimes, overeating can become an overpowering habit.

When it does, consuming a few thousand calories in an hour or two becomes routine. People with this problem -- known as binge eating -- can polish off a large pizza followed by a pint or two of ice cream, chase down a bag of potato chips with a dozen cookies and a liter of soda, or plow through an entire box of crackers and a block of cheese.

Binge eating is not officially recognized as an eating disorder by the American Psychiatric Assn., but it appears to be more common than anorexia and bulimia combined. A recent survey by researchers at Harvard Medical School estimates that, in the United States, roughly 3.5% of women and 2% of men qualify as binge eaters.

The condition is characterized by recurrent episodes (at least twice a week) in which large amounts of food are consumed within a short period of time. Like anorexia and bulimia, binge eating most commonly develops during adolescence or early adulthood. However, many cases of bingeing emerge before puberty, with some people feeling as if their eating has been out of control as long as they can remember.

But binge eating isn't simply about eating too much. "There's a loss of control that goes along with it," says Dr. James Hudson, a professor of psychiatry at Harvard's McLean Hospital. "Once the thought of eating comes to mind, it's all over. They simply have to eat."

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Several possible triggers

No one is certain what triggers binge episodes, but it's not simply hunger. Binge eaters often eat when they're not really hungry and continue to eat until they're uncomfortably full. In some cases, emotions appear to play a role, with people bingeing when they're feeling sad or angry; in others, bingeing seems to be a reaction to attempts to cut back on food.

Whatever drives them to eat, binge eaters are never happy about what they've done. They're left feeling guilty, depressed and outright disgusted with themselves. "Their eating causes them tremendous distress," says Kerri Boutelle, associate professor of pediatrics and psychiatry at UC San Diego. "But they just can't seem to stop it."

In many ways binge eating is similar to bulimia, but binge eaters don't purge or take laxatives after they overeat. "They don't take the extra step of doing something to get rid of the calories," Boutelle says.

That isn't to say that binge eaters don't want to compensate for splurges. "Binge eaters generally wake up in the morning with good intentions," Hudson says. They might eat healthfully most of the day but the resolve usually doesn't last. "There's a pressure that builds up and by evening things fall apart."

Sometimes binge eaters will refrain from bingeing for days, weeks, or even months. But, in the end, "they relapse," Hudson says. "It's a lot like an alcoholic starting to drink again."

Overeating ultimately catches up with most binge eaters. Although some maintain a normal weight, most are grossly overweight. In fact, roughly 30% of people in weight-loss treatment programs are binge eaters, Boutelle says.

Despite binge eating's obvious effect on weight, many people who suffer from it don't realize they have a disorder. Often reluctant or ashamed to talk about it, they simply think of themselves as out-of-control eaters. "People are more hesitant to talk about it than other eating disorders," Hudson says. "Many feel that it reflects on them personally."

Recognition of the condition among physicians is also low. Medical professionals frequently focus on the resulting weight problem rather than its underlying cause.

Increasingly, however, eating disorder experts argue that binge eaters must be approached in a fundamentally different way than other obese individuals. "With binge eating, the impulsivity and loss of control must be addressed," Hudson says. "Otherwise treatment is sure to be ineffective."

Currently, treatment focuses largely on behavioral therapy that addresses the disordered thoughts and behaviors that lead binge eaters to overeat. People are taught to eat in a planned and moderate manner, to avoid foods and environmental cues that trigger binge eating -- and not to give up after slipping up.

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No FDA-approved treatments

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