Complusive eating and bingeing differ from overeating

ASK THE EXPERT

Ask The Expert -- Deborah Kauffmann Registered Dietitian

October 20, 2008|By Holly Selby

Just about everyone understands what it's like to eat too many potato chips while watching TV or to reach for that extra serving of pie when already full. But for at least 2 percent to 3 percent of the U.S. population, eating too much or too often is a compulsion and is accompanied by guilt or a feeling of being out of control, says Deborah Kauffmann, a registered dietitian who leads Largely Positive, an adult support group aimed at promoting how to be happy and healthy at your natural weight.

We all overeat at one time or another. How is compulsive eating different from overeating?

It is a repeated pattern of eating without regard to physiological cues. That could mean bingeing, which is defined as eating a large amount of food in a discrete amount of time - typically two hours. And it can be broader than that and can mean constant snacking and eating beyond fullness.

Compulsive eating, an eating disorder, is usually accompanied by a feeling of being out of control, and there are some associated features like intrusive and excessive thoughts about food and weight, secretive eating, feelings of guilt and a sense of shame.

How prevalent is compulsive eating?

It is estimated anywhere from 4 million to 25 million people struggle with binge-eating disorder. The latest national survey of eating disorders published in Biological Psychiatry [February 2007] showed that 3.5 percent of women and 2 percent of men reported having binge-eating disorder at some point in their lives. And since compulsive eating includes more than binge eating, most likely the statistics are higher.

What are the causes of this disorder?

Compulsive eating can be deprivation-driven. Another underlying cause of compulsive eating is emotional eating, which occurs when people use food to calm or center themselves, or cope with feelings.

[Deprivation-driven compulsive eating] can be caused by dieting.

Why might dieting have this effect?

There are several reasons why dieting might result in this eating disorder. One is that when dieting, people often don't take into consideration their bodies' caloric needs, so they are taking in less than their body actually needs.

Another is that when people diet, they often don't take in the right balance of carbohydrates, fat and protein. All three nutrients are important for satiety.

And another thing people do is avoid certain foods that they like, and that can lead to cravings, which will lead to overeating those foods at some point.

If I am overweight, what do you suggest I do to reach a healthy weight?

Eat mindfully. By that I mean being fully present during the experience of eating. Eat mindfully so that when you do eat, you can better judge hunger and fullness. Eat to get more taste and experience the food more fully, and you will get more satisfaction.

You need to know clearly what hunger feels like in your body and know what fullness feels like and eat according to those cues.

Could you talk more about this approach vs. dieting?

Dieting is not the best way to get back to your natural weight. Ninety-five to 98 percent of those who lose weight by dieting will regain the weight in five years.

Dieting uses external cues to guide eating like deciding how many calories you are going to eat. The nondiet approach to weight management is based upon internal cues, such as hunger and fullness. People decide when they are hungry and consider nutritional values while paying [attention] to what tastes and textures they want to eat, so they are eating not only what they need, but also what they actually want.

How is compulsive eating treated?

It is important for people to get nutritional counseling and therapy to treat both deprivation-driven and emotional eating. And sometimes medication can be helpful, like anti-depressants.

What else do you want to tell people about compulsive eating?

There is such a focus now on childhood obesity that my concern is that many well-meaning parents or others may be pushing children into more restrictive eating patterns. This, I think, is going to cause more eating problems for those children. ... People should focus more on healthy lifestyles than weight when thinking about health.

Holly Selby is a former reporter for The Baltimore Sun.

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