Bingeing most common eating disorder

By KRISTI EATON

VIEW ON HEALTH

Chevese Turner was 5 or 6 years old when she had her first episode of binge eating.

Even then, she knew it was odd that she gobbled an entire box of ice cream cones without any ice cream. She couldn't figure out why she did it, only that she immediately felt better afterward. Eating the cones plain without the ice cream had everything to do with her state of mind at the time and nothing to do with the nourishment or pleasure most associate with food.

As she grew older she continued to binge. Unlike bulimics who binge and purge through vomiting, starving, exercising, laxative abuse or other means, Turner could not make herself do that. "For years, I tried to become bulimic. I just couldn't do it," she says.

There were times where she would restrict her food intake, she says, which would inevitably lead to another episode of binge eating. So she gained weight. Along with the weight, she gained a sense of shame. She became obsessed with what her body looked like and tried every diet imaginable. Drugs and alcohol numbed her pain a bit, but her real drug of choice was food.

"In my 20s, I was still struggling with weight," she says. "I was convinced if I lost weight all my problems would disappear."

She watched as her mother suffered from undiagnosed anorexia, always checking her image in the mirror and restricting food to herself and the family. Her mother, now 62, began bingeing herself.

"It was a household with lots of dysfunction and lots going on that no one understood and knew what was going on," recalls Turner, 43.

She entered a weight-management program and lost weight, only to regain it while in college because, she says, she did not address the underlying problems causing her binge eating.

It wasn't until the late 1990s, while she was in her 30s that Turner sought treatment for binge eating disorder, which was just beginning to be talked about at the time.

Today, binge eating disorder is the most common eating disorder in the United States -- more common than anorexia and bulimia combined. Approximately 1 to 5 percent of the general population has binge eating disorder, according to the National Eating Disorders Association. Women are slightly more likely than men to suffer from the condition -- about 60 percent of those affected are female. The average age of onset of the disorder is in young adulthood, usually in the 20s, which is slightly later in life than those diagnosed with anorexia or bulimia, according to the Binge Eating Disorder Association. There have been an increasing number of children with BED, however.

PROPOSED CHANGES TO BINGE EATING DISORDER

Individuals who are of normal weight, overweight or obese can have binge eating disorder, says Dr. James M. Greenblatt, medical director of Eating Disorders Services at Walden Behavioral Care in Waltham, Mass. The main behavioral symptom is that they have no ability to control how much they eat. Just having a weight problem does not mean someone has binge eating disorder, or BED.

"Binge eating disorder is the very rapid consumption of large amounts of food and calories with no internal mechanism to turn off the appetite, so they continue to feel hungry," he says, adding that people with BED do not get the same feeling of fullness or satiety in the brain that most people do after eating a meal.

Turner, who founded the Binge Eating Disorder Association in 2008, says she is regularly asked about the difference between BED and simply overeating and being overweight.

"The first question will be, 'I tend to overeat at Christmas and Thanksgiving, and when I overeat I get depressed.' Does everybody that overeats have binge eating disorder?" she says.

Much like the question of what is the difference between dieting and anorexia and bulimia, Turner says BED is more than simply eating too much food.

"There are genetic underpinnings, there's a high rate of heredity in families," she says. "The way these play out can be life threatening. This is a serious mental health condition often coupled with other mental health conditions. It's not unusual to find obsessive compulsive disorder, attention deficit disorder and schizophrenia in people with binge eating disorder."

That doesn't mean, however, that many obese patients don't have BED. Studies show that up to 5 percent of obese patients and 30 percent of patients participating in weight loss programs meet the criteria for binge eating disorder.

Binge eating disorder first appeared in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1994. Under the current DSM-IV, it is categorized under the umbrella term "eating disorders not otherwise specified," or EDNOS for short. EDNOS includes a wide variety of disordered eating patterns. It's often used for people who meet many of the symptoms of anorexia or bulimia but not all. For example, a woman who meets all of the symptoms for anorexia, but still menstruates regularly -- a criteria for an anorexia diagnosis -- would be diagnosed with an eating disorder not otherwise specified.

Proposed changes in the upcoming DSM-V, to be released in May 2013, would categorize BED as a specific eating disorder. The proposed criteria require that episodes of binge eating -- the consumption of unusually large amounts of food, accompanied by a sense of loss of control and strong feelings of embarrassment and guilt -- occur a minimum of once a week over the last three months for a diagnosis.

"It is important that clinicians and the public be aware that there are substantial differences between an eating disorder such as binge eating disorder and the common phenomenon of overeating," says B. Timothy Walsh, chair of the DSM-V Eating Disorders Work Group, in a press release. "While overeating is a challenge for many Americans, recurrent binge eating is much less common and far more severe and is associated with significant physical and psychological problems."

Turner, as part of the Binge Eating Disorder Association, has been commenting on the proposed DSM changes to the criteria.

She says: "We say it's about time. The studies weren't there the last time when it was revised so there wasn't enough (research) to take it out of EDNOS, but the studies are there now ... We did some comments as did other groups. We're very, very happy it's going to be there."

She adds that she imagines the definition will be tweaked throughout the years, but the important thing is people will now be able to afford treatment for the disorder.

Because it has not been officially listed in the DSM in its own category, many insurance companies will not cover treatment for BED, Greenblatt, says, adding that with the proposed changes, companies will be more willing to reimburse patients for treatment costs.

Greenblatt says the people most in need of treatment will hopefully have a shot at getting help.

"As a treatment center, it's been very frustrating because people present to the program with very disordered eating, and they can't control it and are sometimes quite depressed and suicidal," he says.

Jennifer Lombardi feels the same way. As the director of admissions at Summit Eating Disorders and Outreach Program in Sacramento, Calif., she has been admitting patients for 10 years. One of the most frustrating aspects of her profession, she says, is that the people who want help are unable to afford it due to constraints by insurance companies.

She says many states, including Nevada, have parity laws, meaning many insurance companies view certain mental health conditions as medical-based. And since medical coverage tends to be more comprehensive, eating disorders like anorexia and bulimia, which fall under the parity diagnosis, are able to get more exhaustive treatment under medical-based coverage. Unfortunately, as long as binge eating disorder falls under the category of eating disorder not otherwise specified, it will not fall under the parity-diagnosis law, Lombardi says.

As an example, Lombardi notes that if a woman struggling with anorexia were to come to Summit Outreach and was diagnosed with the disease, her insurance company would more than likely cover 90 to 100 percent of her treatment costs, regardless of the type of coverage she had. But less than 50 percent of patients who have binge eating disorder are able to get coverage for any sort of treatment, whether it be residential, partial-patient or out-patient treatment, she says. Depending on the intensity and length of treatment, the cost to get help for an eating disorder can range in price from a few thousand dollars to tens of thousands or more.

"Oftentimes, patients are having to pay out of pocket, which can be fairly costly," says Lombardi. "Someone who struggles with binge eating disorder, that is just as life threatening as anorexia or bulimia. In our culture, we talk a lot about the obesity epidemic, particularly among children and teenagers. But if you are trying to get treatment, you will be hard pressed."

FOOD ADDICTION: LIKE ALCOHOL OR DRUG ADDICTION

Michael Prager was lucky. He was able to get treatment and change his life even before the term binge eating disorder became known.

Prager, from Arlington, Mass., went to an eating disorder hospital in New York for nine weeks in 1991, where he was able to get the help he needed.

Rehab, he says, was a chance for him to see he wasn't alone and there were other people dealing with the same issues and behaviors he was. Money was not an issue, as his hospital was paid for by the medical system. Prager knew he had to take the opportunity presented to him at that time: His job was held for him, his mortgage was going to be paid, he was just going to be able to leave and seek the treatment he needed. "I knew that I kind of had this opportunity that doesn't come around very often, so I didn't know what I was coming for specifically, but I know I damn well better get it," says Prager.

Up to that point, says the 53-year-old Prager, he was an angry person, both at himself and others. Food became a reward for him, but also a way to abuse himself. It didn't matter what type of food; he just wanted a lot of it, he says.

"The volume was every bit as important to me. It definitely served something to me," he says, recalling one instance where he left work angry and headed to three nearby fast food restaurants connected to each other and proceeded to eat a meal at each one, never leaving his car.

Food consumed his life, says Prager. It stunted his social growth and development so much that he didn't have his first girlfriend until he was 36, after he sought treatment and dealt with his issues. At 42 he got married and became a father.

Prager, a former editor at the Boston Globe, has written a memoir, "Fat Boy Thin Man," about his obese adolescence, his stint in rehab and the changed man he has become. He argues that all food addictions, whether it's anorexia or binge eating disorder, should be treated as a disease, so, similar to drug and alcohol abuse, insurance companies will cover treatment costs.

Many people abuse food, but don't realize it, says Pantazis of Cranbrook, British Columbia, Canada. It's not black and white like drug or alcohol abuse. "Food is an acceptable substance," she says. "Injecting drugs or getting drunk? 'OK, there's a problem there.' But people don't make the connection."

Like Turner and Prager, Pantazis' relationship with food became strained as a child. Her mother, she says, didn't show affection. Instead, she showed love and affection through food, "so you learn at a very young age, when you're hurting, you have food and you'll feel better," says Pantazis, 47.

Lombardi says she has seen an increase in children being assessed for binge eating disorders and related disorders. She is assessing children as young as 7 years old. Part of the increase stems from the recent focus on obesity in children and how policies are being implemented. Eating for children has become very black and white in today's world, she says, adding that, for example, she wouldn't put chips in her child's lunch every day but also wouldn't make them eat rice cakes every day either. But many parents are doing one or the other, with the parents focusing on enrolling their kids in weight loss programs and physical activities the kids may have no desire to participate in, which makes the activities seem like they are a chore or punishment.

TREATMENT

Depending on the type of disorder, about 1/3 of sufferers will switch from one to another, says Lombardi. "If you look at the underlying biological factors for anyone with any type of eating disorder, you will they are the same."

That's what happened to Turner's mother. After suffering from anorexia for years, she became a binge eater and at age 62, sought treatment for BED.

As someone involved in the binge eating disorder community, Turner says one phenomenon of concern is an individual with binge eating disorder opting for laparoscopic weight loss surgery or gastric bypass to lose the weight and slipping into anorexia. The two disorders, BED and anorexia, span the spectrum of eating, but the root causes are still the same.

"That tells us pretty clearly that all the same underpinnings are there. It's just how it is manifested," says Turner.

But while most insurance companies do not cover treatment for binge eating disorder, many are increasingly covering weight loss surgery, Lombardi notes, making it hard for people suffering from the disorder to pass up the quick-fix surgery.

Insurance companies, she adds, tend to be short sighted, paying for an expensive surgery but not for long-term treatment.

However, for those people who are able to afford treatment, there are many options available. In fact, treatment for binge eating disorder tends to be more successful than anorexia and bulimia, Greenblatt says.

"The first step is looking to see if there is an underlying depression or psychiatric illness and understanding nutritional deficiencies. Some are going on diets and are not getting nourishment and binge," he says.

When Lombardi assesses a potential patient and what treatment would best suit their needs, she considers three things: the medical issues and how severe the disorder is; the potential nutrition deficiencies occurring; and the emotional and psychological factors, such as how isolated they are and how the disorder is affecting their relationships.

Medications and cognitive behavioral therapy has been found to work well, Greenblatt says, although there is not much hard data on long-term recovery rates.