In his new book, Queer Eye star Jonathan Van Ness wrote about his experiences binge-eating junk food. The grooming expert also recently told “The ‘Allure’ Podcast” that he had “eating disorders, weird relationship with food, for sure” stemming from the lack of conversation around male body image and “unrealistic beauty expectations.” Binge eating disorder (BED) is one of the most common eating disorders, experts say, but it’s also one of the most misunderstood conditions. But, celebrities like Van Ness openly discussing their struggles with the disorder is helping to raise awareness about BED. The lack of understanding of binge eating disorder is rooted in “weight stigma,” says Chevese Turner, chief policy and strategy officer at the National Eating Disorders Association. Unlike other eating disorders, where people may be dangerously underweight, people with BED may be considered at a healthy weight, be overweight or have fluctuating weight. “We tend to as a community, as a culture, look at people who are in higher weight bodies as having no control: They’re disgusting. They don’t take care of themselves,” she says. “It’s just one myth on top of the other. That allows for a disconnect in terms of this is a serious mental health disorder that’s going on.” Along with the weight stigma, Turner says most eating disorder conversations center on anorexia nervosa, because it can be life-threatening, but so can all eating disorders. “We haven’t done a good job of really elevating the other disorders to allow the general public to understand that they, too, are very critical in terms of people’s health, and people die from all eating disorders,” she explains. Read on for more information on exactly what a binge eating disorder is, how common it is, risks, and more.
What is binge eating disorder?
Binge eating disorder is a serious mental health condition where individuals engage in recurrent instances of eating large quantities of food in a short period of time, often eating very quickly and until they feel discomfort, according to NEDA. The binge eating often brings feelings of loss of control, stress, guilt or shame. “What we know about binge eating disorder, along with the rapid eating and the objectively large amount of foods, and the negative feelings that go along with that is that there is actually a lot of restriction that happens,” says Turner, who has been open about her own struggles with BED. Eating disorders are complex, and the symptoms for different conditions sometimes overlap, which can make fully understanding the disorders difficult. For example, restricting foods, commonly associated with anorexia or orthorexia, is also a BED symptom. Turner says with binge eating disorder, there’s a cycle of restriction, bingeing and then restricting again to counteract the binge, leading to a “negative feedback loop.” BED also differs from bulimia, where purging behaviors, like self-induced vomiting and using laxatives, follow the binge. People with binge eating disorder don’t always engage in purging.
How common is binge eating disorder?
Binge eating disorder is more than three times more common than anorexia and bulimia combined, and 40% of those with the disorder are male. Despite its prevalence, BED has been studied less frequently than other eating disorders, Turner says. It was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Much of the BED research has centered on helping people with the condition lose weight, “even though we know that pursuit of weight loss actually is what keeps people in this disorder many times,” Turner says. Restriction as part of treatment can entrench the eating disorder, especially when patients are using food to deal with their feelings and restricting food to compensate for the binge. Eating disorder advocates believe weight stigma is the underlying reason for the lack of research dollars being devoted to BED. “We’re all enmeshed into this diet culture that is a part of our overall culture, and we know that weight sigma is pervasive, that it is ingrained into everything we do,” Turner says. “We make assumptions about people based on their size.”
Who’s at risk for binge eating disorder?
Research has shown a link between binge eating disorder and trauma, including post-traumatic stress disorder (PTSD). Binge eating is seen as a way to dissociate. “There’s that time when you’re bingeing that you’re stepping out of your life, you’re stepping out of yourself, and you’re focused on something else or you’re not focused at all, really,” Turner says. “You’re just sort of timelessly eating, and it’s about escape, really.” Other risk factors include body dissatisfaction, weight stigma, fat shaming and a desire to be thin, according to NEDA. Yasi Ansari, a registered dietitian nutritionist and national media spokesperson for the Academy of Nutrition and Dietetics, says a history of trauma, difficulty coping with negative experiences and life transitions are risk factors she’s seen in her patients with BED. “For some, it is a coping mechanism to manage emotional distress, therefore it’s important to understand where the drive to use food for comfort is coming from,” Ansari says. People may also experience binge eating after a history of restrictive eating patterns, she says, whether it’s an anorexia diagnosis or someone who avoids certain food groups. Someone’s eating binges may be carb heavy, for example, if they have a history of embracing a low-carb diet.
Weight stigma and fat shaming also play a role
Ansari emphasizes that weight and appearance are not part of the diagnostic criteria for binge eating disorder. “People often assume that binge eating disorder occurs in clients with larger bodies however it can take place in people with lower body weights, as well,” she says. About two-thirds of individuals diagnosed with BED are identified as obese, but people of all body types can have the condition. Weight stigma is a driving force for many eating disorder behaviors, Turner says, adding that research shows that weight bias and stigma impact quality health care, and people of different sizes are treated differently by their family members, co-workers and others. All of this contributes to the trauma. “If you’re walking out into the world every day in a body size that is deemed wrong, deemed immoral, deemed to be utilizing more resources and health care than others, is disgusting and all the words that we put with fat, that takes a toll on the person’s physical and mental health,” Turner says. “To some extent, we have to accept where we are and be able to move on and take care of ourselves in the best way we can.” Weight shaming and trying to force people to lose weight is a breeding ground for binge eating disorder. Three out 10 patients seeking weight loss treatments, like bariatric surgery, show signs of BED.
How is binge eating disorder treated?
BED treatment should focus on the individual’s mental health condition and trauma, Turner says. Finding a clinician who specializes in binge eating disorder is key, and the NEDA helpline 1-800-931-2237 can connect individuals with local clinicians. Cognitive behavior therapy (CBT), which aims to modify beliefs and attitudes about weight and appearance, is a common treatment for most eating disorders, including BED. However, Turner says the therapy is not always “trauma-informed,” a must for treating binge eating disorder. “We really advocate for utilization of trauma-informed therapies and trauma as a factor, and then learning ways to deliver CBT and other forms of therapy in a way that is not weight stigmatizing,” she says. “Addressing the weight stigmatism is a very critical part of what is done in treatment, as well.” Treatment also may include a nutrition component, as long as the intervention doesn’t focus on dieting, Turner says. Dietitians can help patients, once they’re medically stable, understand their hunger and fullness cues, Ansari says. Nutrition counseling also helps patients develop consistent eating habits to reduce bingeing episodes and avoid skipping meals, helping them understand that “this is part of their recovery process towards normalized eating.” Find out how screenwriter Marti Noxon turned her personal eating disorder battle into a movie.
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Chevese Turner, chief policy and strategy officer at the National Eating Disorders Association
