James I. Hudson, the study’s lead investigator and the director of the Biological Psychiatry Laboratory at the Harvard-affiliated McLean Hospital, spoke to NEWSWEEK’s Samantha Henig about the surprise findings in this study and what the results tell us about body image and the growing obesity epidemic. Excerpts:
NEWSWEEK: Your survey found that binge eating is a much more common disorder than anorexia or bulimia. If that’s the case, why don’t we hear more about binge eating? James I. Hudson: Up until recently we have not had as much scientific study of binge-eating disorder, so while people have suspected it might be more of a problem than we thought, there’s been little hard data. There is also a greater stigma attached to binge eating than to anorexia nervosa or bulimia nervosa, so people are less likely to admit to the problem. I’ve worked with people who have talked to me much more easily about problems they’ve had with drug abuse, depression or trauma, but when it comes to talking about losing control of their eating they break down in tears.
What constitutes a binge? When I’m having a bad day and decide to drown my sorrows in a box of cookies, is that a binge? A binge has two features. One is eating an abnormally large amount of food in a short period of time—the typical binge would be 1,500 calories or so. There is also a sense of loss of control of the eating. It’s not sufficient just to eat a large amount; one has to feel that they’re out of control.
Can you give me a typical binge menu? Usually it’s highly caloric, easily ingested foods. It might be a sleeve of saltine cookies or a pint of ice cream or six donuts. There is no set number of calories or amount of food that makes it a binge, but it has to be a large amount of food relative to the circumstances. For example, if you’ve already eaten dinner and then you go back for a second dinner.
When I took health class in high school, our discussions about anorexia and bulimia usually focused on how we should be comfortable with our looks. Should the same educational approach be taken to address binge eating? Here is the rub with binge-eating disorder: the people with it do gain weight and gain weight to an unhealthy degree. They often have both the problem of body dissatisfaction and the problem of obesity. Cultural factors just make them more miserable and more hopeless, but they probably would be gaining weight and to some extent having trouble controlling their eating, even if it weren’t for the emphasis on thinness in our society.
So what can be done to prevent binge eating? The first thing is to help individuals self-identify if they seem to have a problem with loss of control of eating. Once you identify that group, unfortunately there’s no simple way to say “get control of your eating”—if they could, they would.
At what age do people typically develop the disorder? What’s remarkable is how many people with the problem have said that almost as early as they remember—age 6 or 8—they have had problems with out-of-control eating. That’s far earlier than anyone develops bulimia nervosa or anorexia nervosa. Then there’s another group of people who have had not that much of a struggle with binge eating or their weight, but then in their 30s or 40s it becomes very difficult for them to control their eating.
The study also found that struggles with anorexia seemed to pass more quickly—after 1.7 years, on average—compared to about 8 years for bulimia and binge eating. This is one of the surprising findings of this study. I don’t think for a minute that this should diminish our impression that anorexia nervosa can still be a serious illness—it does have the highest mortality rate of any psychological disorder—but there are cases where it seems to come and go without treatment. These findings are a call to try to determine what distinguishes the short-lived cases from those that go on to have these devastating consequences.
Binge eating is not currently listed as a disorder in the most recent edition of the Diagnostic and Statistic Manual of Mental Disorders. Should it be? The reasons for including it are that it’s common (more common than anorexia nervosa and bulimia nervosa combined), it’s associated with severe obesity so it has important health consequences, and it appears to be chronic and persistent. Taken together, that suggests it’s a major public-health problem and also suggests that we now know enough about it that we should include it in the next edition.
If it is included in the next edition, what will that change? It opens the door for greater recognition of the condition and will lead to improved treatment and access to treatment. Right now, in order to get treatment for a condition, for many insurance carriers, it has to be a recognized disorder. That’s a barrier for people with binge-eating disorder because there’s no official diagnosis.
What do you hope to come out of these results? The obesity epidemic is a major problem for society these days, and what we have here is a behavioral abnormality that contributes to the obesity epidemic. Better understanding binge eating may offer us an avenue to treat or prevent obesity.
