It's the night of Halloween. The kids are tucked away, their overstuffed bags of candy from trick-or-treating sitting out on the kitchen counter next to the bowl of leftover goodies. For people with the little understood and under-treated condition of binge eating disorder, this is when the pretend frights of the Halloween season can turn into real-life concerns. In the aftermath of trick-or-treating, there can be a house full of candy sitting there, calling out to be eaten.
While many of us will find ourselves overindulging in candy in the upcoming days, and most of us have experienced times when it seems as if a food is literally calling out to us, how do we know if we are suffering from the full-blown disorder? The first step is to realize that binge eating disorder is not a one-time holiday season indulgence. To meet the criteria, one must regularly binge eat, at least one time per week, for at least three months.
In my years of studying this condition and treating patients, the question of how much food has to be consumed to qualify as a diagnosable "binge" is the most difficult to answer, mainly because it depends very much on context: who is doing the eating, what exactly is eaten, and how long it takes to consume the food. As an example, years ago an elderly woman called to be a participant in one of my research studies. When I inquired about what she ate during her last binge episode she was distraught about having eaten a whole container of Ben & Jerry's ice cream by herself. This seemed substantial for an 82-year-old woman of her size and weight, so I followed up with a question about how long it took her to eat that container. Her reply, "One week."
A binge is defined as an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. Thus, a medium-sized pizza might be a binge for a sedentary 48-year-old suburban mom but a post-game snack for a 21-year-old college football player. Some guidelines for quantifying a binge include the consumption of two full meals comprising two or more courses each, or three main courses. How about fruit? Four to five apples depending on the size. And something like brownies? Four or more. Another guideline is that the amount of food must be consumed in a short amount of time (usually about two hours). Thus, eating a pint of ice cream in one week's time doesn't cut it.
The context of the binge, however, is only one factor in determining whether someone has binge eating disorder. There also must be a subjective feeling of loss of control. Individuals with this condition report feeling like they cannot stop eating, or cannot control what or how much they are eating. It is the presence of the "loss of control" that distinguishes plain old overeating from the diagnostic binge episode. Here's another way of describing it. Imagine you are packing snow together and rolling it to make the bottom of a snow man. In the overeating scenario, you are rolling the bottom of your snowman along a flat meadow and it gets larger and larger, but you can stop at any time and decide it is big enough (that is, you are full and have eaten enough). Now let's say you are rolling the bottom of your snowman along hilly terrain and you come to the edge of a slope. As you roll your snowball it gets bigger and bigger, but then you lose control over it as it rolls down the mountainside. That is a binge.
About 3 percent of the population has had binge eating disorder at some point in their lifetime, and that is more than all the other eating disorders combined. While more women suffer from binge eating than men, a greater proportion of men are found among individuals with binge eating disorder compared to anorexia or bulimia, and the disorder is not uncommon in racial/ethnic minorities. However, folks with the disorder oftentimes go undiagnosed and untreated, increasing one's risk for obesity-related diseases, and mood and anxiety difficulties. As if that were not enough, experts also report a greater likelihood of weight gain across the lifespan, and greater difficulty achieving weight loss.
On the upside, binge eating disorder is a very treatable condition with a range of behavioral, medical and self-help interventions. The basis of most treatments involves following a plan of regularly scheduled meals and snacks. If you want to indulge, allow yourself a little bit on a regular basis. And if that trick-or-treat candy is still calling your name see if you can make it last until Thanksgiving or, at a minimum, stretch it out for one week.
If you're struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.