Being overweight is a condition that is still subject to public humiliation as a part of the social norm. It is often thought that it is one’s fault for the size of their body, and that it is entirely within their control to change the size of their body. It’s thought that if one can just “pull themselves up by their bootstraps” and try a little harder that they, too, can torture their bodies into submission to become the size that they desire [insert diet culture here].
Until 2013, it was not acknowledged by the medical/mental health community that being overweight was part of a diagnosable eating disorder, although many of those who struggled with overeating and sought help were categorized into the “unspecified” eating disorder category. Then, in 2013, the DSM-5 was published, which includes Binge Eating Disorder (BED)(see link for criteria and more information) as a diagnosis.
While the DSM-5 acknowledged one diagnosis to characterize overeating as an eating disorder, there are three different categories of overeating: binge eating, compulsive overeating, and grazing. Binge eating consists of eating the amount of food in two meals (doesn’t have to be meal food) in two hours or less. Binge eating is often associated with planned binges where large amounts of food are gathered and food is eaten in one sitting (if binge eating is followed by purging, symptoms cross over into Bulimia). Compulsive overeating has a control flare to it, and can be characterized by needing to finish a certain amount of food – such as a whole box of cereal or three containers of Twinkies. Grazing is when one eats small amounts of food continuously over a long period of time so that they end up overeating but don’t realize it because of how much time passes. I find this is very common with people who are “too busy” to sit down and eat, such as moms, who nibble as they can, but keep coming back for more and eat too much. In my experience, those who have been diagnosed with BED typically have a mix of these types of overeating when they present for treatment, but may only focus on one or two types as treatment progresses. Working with a therapist who has eating disorder-specific knowledge can be helpful to identify these patterns, discover and understand the root of the behavior, and plan and practice to change behaviors.
It may surprise some to know that one of the first questions I often ask my clients is “How were you taught to eat?” This is usually followed by a puzzled look, and some sort of reply that they never really thought of it before. Digging in, however, often they were taught disordered eating as a child, or it was reinforced in some way, or their parents had eating disorders themselves and passed down not only their genes, but also parental teachings and modeling that may have reinforced disordered eating patterns. I certainly don’t encourage anyone to play the “blame game” as far as past experiences go, but rather to just understand why people acted the way they did to the best of your ability, to try to accept it (and forgive it if necessary), and then make a plan for how to move ahead. This is in line with the DBT teachings of “distress tolerance” and specifically “radical acceptance.” For some of my clients, this meant writing letters that can be burned – as a way of letting go and/or sending the message on to someone who has passed.
For those diagnosed with BED, there is always a web of shame and guilt being carried around related to their eating and body. Some have tried any diet or diet program or diet pill that they could get their hands on in an effort to mold their bodies to the desired shape no matter the cost – literally or figuratively. They have been told, and now believe, that they are just not trying hard enough to win at the game of being able to have the “perfect” body. There becomes an acceptable fixation on losing weight, and our “diet culture” is thriving as a result.
The truth is that we don’t get to pick what shape our bodies are. If we are in tune with our bodies, eat when we are hungry, and stop when we are full, and do an amount of “joyful movement” that feels good, your body will even out to be the size that it is supposed to be – or the “set point.” For people diagnosed with BED, this may mean accepting that their body size following treatment may not look like the “goal weight” they came into treatment imagining – which is usually their lowest weight that they were as a teenager or young adult. Many feel a sense of defeat at the task – to accept their “larger” bodies would mean accepting a lifetime of have a “bad” body size that can and likely will impact how others perceive you. However, when one can give over control of the shape of their body back to their body through being in touch with cues such as hunger/fullness, they end the losing struggle of trying to shape one’s body into something it simply isn’t. It’s like setting down the tug of war rope you’ve been battling at for years – there can be a real release of tension if this can be achieved.
One way to work towards alleviating some of the shame and guilt associated with an eating disorder is to be able to put an arm’s length between one’s “authentic” self and their “beast” (eating disorder/mental health concern/trauma, etc.) by being able to characterize behaviors or thoughts from the beast. An example would be “My eating disorder got mad at my husband for showing me a video about a woman with an eating disorder” as opposed to “owning it” – i.e. “I got mad at my husband…” While this causes some of my clients to struggle with their feeling the need to have accountability for their actions, often these thoughts/behaviors are dichotomous for someone with a beast. They are inclined to do/say/think something that, at the same time,their “authentic self” can rationalize against. The internal struggle is very difficult for many, and results in an internal dialogue that can be very “loud” when triggered. One can learn to recognize these thoughts, and then start to fight back against them (see Positive Self-Talk). Eventually, with practice, it becomes easier to fight back against urges, and then they become manageable and less intrusive on one’s life.
If you are reading this and wondering if you or someone you know might have some of the symptoms of Binge Eating Disorder, I would encourage you to get an assessment done. You could contact your insurance to ask about who might be covered for you. It is an incredibly brave step to decide to speak to a professional, but it is the first step to getting help against a difficult condition. Eating disorders can be “vicious” and may require professional support to navigate.
Finally, I would encourage everyone to be more compassionate towards themselves. As some of my RD co-workers preach, use “balance, moderation and variety” in your eating. Avoid strict rules in your eating. Listen to the signals from your body the best you can and respond to them. Understand that no one is a “perfect” eater. The goal is stability, not skinny. Love your body, you only get the one.