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FAQs about Binge Eating Disorder and Obesity — What Everyone Needs to Know

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Dr. Genna F. Hymowitz

Today is the first day of National Eating Disorders Awareness Week, so now is a good time to learn more about these abnormal eating behaviors, and how the impact they may have on our health.

In the United States, 20 million women and 10 million men will suffer from an eating disorder at some point in their lives.

Eating disorders are serious, potentially life-threatening illnesses that affect all kinds of people, regardless of gender, ethnicity, size, age, or background. In fact, eating disorders have the highest mortality rate of any mental health concern.

Eating disorders are widely misunderstood illnesses and support options are often inaccessible. As a result, too many people are left feeling helpless, hopeless, and frightened.

Binge eating disorder (BED) is one of the defined eating disorders. Its association with obesity is a major concern.

BED is more common in women than in men. In the United States, about 3.5% of women (5.6 million) and 2% of men (3.1 million) have it.

Here, Genna F. Hymowitz, PhD, assistant professor of psychology, psychiatry, and surgery, and director of the behavioral medicine program, L. Krasner Psychological Center, answers frequently asked questions about BED and obesity. Dr. Hymowitz is a member of the multidisciplinary team of our Bariatric and Metabolic Weight Loss Center.

Q: What is BED — binge eating disorder?

A: BED is a disorder characterized by episodes of eating an objectively large amount of food in a discrete period of time that are accompanied by loss of control of eating and some or all of the following symptoms:

  • Rapid eating
  • Eating until uncomfortably full
  • Feeling guilty or depressed after eating
  • Eating when not physically hungry
  • Eating alone because of embarrassment about the amount eaten
Individuals with BED experience these episodes at least one time a week for at least three months. Although symptoms typically begin in late childhood, early adolescence (ages 11-13), or in young adulthood (ages 25-26), many individuals do not seek treatment until later in life.

At Stony Brook Medicine, we know how best to treat patients with BED and obesity, in terms of
providing care for the whole patient and staging the different treatment options.

Q: What causes BED?

A: A number of factors contribute to the development and maintenance of BED, including genes, the endocrine system, serotonin levels, early family environment, and dietary behaviors.

Although triggers for binge eating episodes vary from person to person, common triggers for binge eating episodes include excessive hunger and negative emotional states, such as stress, or depression.

Q: Who is affected by BED?

A: BED affects up to 7% of individuals in the United States, and occurs in both men and women.

Q: What are BED's risk factors and the problems associated with it?

A: Many, but not all, individuals with BED experience weight and shape concerns, and compared with the general population, individuals with BED are more likely to experience substance abuse, depressive symptoms, and chronic medical conditions, including irritable bowel syndrome, fibromyalgia, insomnia, and metabolic syndrome.

Q: What are the health consequences of BED?

A: BED is also associated with impaired quality of life, higher risk illnesses, higher risk of death, and increased risk for weight gain and development of obesity.

Q: What is the relationship of BED with obesity?

A: Although up to 70% of individuals with BED also experience obesity, only about 8% of individuals with obesity meet criteria for diagnosis of BED.

Individuals with both BED and obesity are more likely to experience more severe obesity and earlier onset of weight difficulties, and to have a greater likelihood of also having depression, substance abuse, and other psychological disorders, such as anxiety.

Here, we not only look carefully to see the person behind every patient, we also understand that
every patient has both physical and psychological dimensions affecting their health.

Q: What is the treatment for BED?

A: There is strong evidence to support the use of cognitive behavioral therapy (CBT) to treat BED. CBT is a skills-based psychological intervention that addresses the patterns of thoughts, feelings, and behaviors that maintain BED symptoms.

Treatment generally involves weekly one-hour sessions and completion of home practice assignments, including self-monitoring, setting up a regular eating schedule, and practice of cognitive techniques and coping strategies discussed in session.

Self-help versions of CBT and other individual psychological interventions, including interpersonal therapy, may also be helpful to address BED.

Additionally, research suggests that some medications can be beneficial for addressing BED, including some stimulant medications, second-generation antidepressants (SSRIs), anticonvulsant medications, and other medications used to address obesity.

Q: How is weight management approached in individuals with BED?

A: Although pharmacological and psychological interventions can address symptoms of BED, many treatments focused on reduction of BED symptoms do not consistently lead to long-term weight loss.

Although individuals with BED can benefit from lifestyle weight loss interventions and bariatric surgery, it is generally recommended that individuals begin to address disordered eating behaviors prior to engaging in additional weight loss interventions.

Q: What is the benefit of seeking treatment for BED and obesity at the Stony Brook Bariatric and Metabolic Weight Loss Center?

A: The benefit is the multidisciplinary care provided at our weight loss center. Here, we not only look carefully to see the person behind every patient, we also understand that every patient has both physical and psychological dimensions affecting their health.

And so, we know how best to treat patients with BED and obesity, in terms of providing care for the whole patient and staging the different treatment options, with emphasis on behavioral transformation.

Learn more about eating disorders. For consultations/appointments with the psychology team and other specialists at our Bariatric and Metabolic Weight Loss Center, please call 631-444-BARI (2274). Watch this video (3:28 min):