When you think of an eating disorder, chances are you picture a young girl with anorexia, or possibly bulimia.
You're not alone. Those conditions are most commonly portrayed in TV and film — and research shows the media usually depicts both as mostly affecting white women under 30.
However, binge eating disorder is a far more common condition — but is rarely talked about and is mostly misunderstood.
The condition also seems to be on the rise: the frequency of binge eating behavior in South Australia, for example, increased more than five-fold between 1995 and 2015.
All ages, all genders, all body sizes
Binge eating disorder is believed to be the most common eating disorder in Australia and the US. Forty-seven percent of all people with eating disorders have binge eating disorder. It has a lifetime prevalence of 4.5 percent of females and 3 percent of males.
It involves frequent episodes of consuming unusually large quantities of food in a short period of time, accompanied by a sense of loss of control. Unlike in bulimia, the binge isn't followed by purging or compensatory behaviors such as excessive exercise.
These episodes are very different from typical overeating. They're driven by an intense, repetitive compulsion to overeat, and are often followed by feelings of shame, guilt and distress.
Binge eating disorder can significantly impair people's lives. People with the disorder are often very secretive about their eating habits and eat alone.
The average age of onset for the condition is 25 — but people of all ages, genders, body shapes and sizes, sexual orientations and ethnic backgrounds can be affected. No-one is immune.
Food insecurity and other causes
We don't know the exact causes, but it is believed to be a complex interaction of biological, psychological, social and environmental factors.
Eating disorders are genetic, and we are still determining genetic profiles that may predispose people towards developing binge eating disorder.
Psychologically, several factors increase susceptibility. They include low self-esteem, heightened negative emotions, rigid thinking styles, conflict avoidance, and impulsive or obsessive behaviors.
Cultural influences can also play a role. The idolization of thinner, toned or muscular bodies, coupled with the normalization of dieting, foster an environment where people's self-worth is commonly linked with their physical appearance. This can induce feelings of shame in those who do not conform, which increases the risk of eating disorders.
Food insecurity is another factor. People who have experienced unstable access to food, whether in childhood or later life — due to financial hardship or homelessness, for example — may develop a survival-driven response, leading to binge eating when food becomes available.
This behavior is seen in children who hoard or binge after periods of food deprivation, and it can persist into adulthood, increasing the risk of binge eating disorder.
More barriers to treatment than other disorders
People with binge eating disorder face significant barriers to accessing appropriate treatment — more so than other eating disorders and particularly compared to other mental health conditions.
In general, there are not enough health professionals to deliver eating disorder-specific treatment, particularly in more remote areas of Australia. The cost of treatment can also be very high in our currently very challenging economic climate.
There tends to a longer delay for seeking treatment after onset. What's more, only 19 to 36 percent people with binge eating disorder ever seek treatment.
Stigma, shame and fear of judgment often prevents people with binge eating disorder from accessing treatment.
Weight stigma — the discrimination or stereotyping based on a person's weight — further compounds this issue. This stigma is most prevalent among people with higher body weight, leading to increased body dissatisfaction and potentially contributing to the development of binge eating disorder.
Treatment: from therapy to medication
Treatment will usually involve multidisciplinary treatment including psychological and dietary treatment, sometimes in conjunction with medication.
Enhanced cognitive behavioral therapy is effective in changing unhelpful thoughts and behaviors for some people. Certain other forms of psychotherapy or ‘talk therapy,' such as Interpersonal Therapy and Dialectical Behavioural Therapy, may also be helpful.
Dietary approaches generally focus on trying to regulate eating behaviors and improve the person's relationship with food.
There has been an increase in online support options for psychological and dietary approaches including some that are more self-directed. However, it is always preferable to have a team of health professionals involved to guide people, even if treatment is delivered entirely online.
The only Therapeutic Goods Administration-approved medication for binge eating disorder in Australia in adults is lisdexamfetamine (marketed under the brand name Vyvanse), which was originally discovered to treat attention-deficit/hyperactivity disorder.
Some people have found this medication to be very helpful in reducing binge eating episodes but others experience substantial side effects including nausea, headaches, anxiety, insomnia, so they discontinue the medication. Clearly, we need more targeted drug discovery for binge eating disorder.
Some recent small studies have suggested that GLP-1 receptor agonists — the same class of medications as Ozempic (semaglutide) — can reduce binge eating behaviors — but more large-scale studies are definitely needed before this class of medications can be determined as safe and effective for use.
While binge eating disorder is often overlooked, it remains to be seen whether with time and increased awareness there will be stronger investment in improving prevention, accessibility and treatments for this too-often forgotten but very common eating disorder.
(Associate Professor Gemma Sharp is the Head of the Body Image & Eating Disorders Research Program and Senior Clinical Psychologist in the Department of Neuroscience at Monash University. Gabby Lubieniecki is a Credentialed Eating Disorder Clinician and a lived experience advocate and researcher. This article was originally published under Creative Commons by 360info)
