While eating disorders claim the most fatalities of any mental illness, doctors receive zero to one hour of training on them throughout their entire medical career.
They learn even less about binge eating disorder (BED) — the most common ED in the United States.
To be fair, the disorder wasn't formally recognized until it entered the DSM-5 three years ago. It defines BED as "recurrent episodes of binge eating," which include:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Though 3.5% of American women and 2% of men will struggle with BED at some point in their lives, many never seek treatment because they see themselves as "failed dieters" rather than people with a serious health condition.
In fact, 30 to 40% of people seeking weight loss treatments can be clinically diagnosed with binge eating disorder. But all too often, doctors don't know that.
If you or someone you care about might be struggling with BED, here's what you need to know:
Binge eating disorder is not the same as bulimia.
Ashley Solomon, a licensed clinical psychologist and director of Eating Recovery Center of Ohio, told Revelist that BED isn't the same as bulimia, which includes both binging and purging food.
"The difference between BED and bulimia, for example, is that in bulimia, following the episode, there’s some kind of compensatory behavior," She said. "So, self-induced vomiting, use of laxatives, things like that. In BED, you don’t see that necessarily. It’s really about binge episodes that are occurring repeatedly at least once a week for a period of three months."
That said, many people who have struggled with anorexia or bulimia can develop BED as they grow out of the other disorders.
"I see a lot of people that, as a teenager, struggled with anorexia or bulimia, and have developed BED later in life," Solomon added.
Some people are more likely to develop BED than others. It's science.
"Like all eating disorders, we think that people tend to have a biological predisposition to these disorders," Solomon told Revelist. "Genetics and biology load the gun, and environment pulls the trigger."
Though anyone can develop BED at any age, it's most common that people start experiencing symptoms in their 20s. Many simultaneously struggle with mental health conditions like anxiety, depression, or OCD.
"A lot of people will treat binge eating as a kind of medication," Solomon said. "Many, many people with BED have a comorbid mental health condition, so they're dealing with something else as well."
"Sometimes, binge eating is a way of dealing with that," she added.
There's no single explanation why someone develops BED.
But "transitional periods" in person's life (e.g. college, moving, marriage) can certainly trigger the harmful habits, Solomon said.
"Penny," a 26-year-old from Michigan, told Revelist she started noticing symptoms at a difficult point in her life two years ago.
"I was under a lot of stress at the time and dealing with a full school load and work," she said. "I was also dealing with the end of a relationship and the loss of a family member."
She relied on food to self-soothe, and binged two to five times a week.
"I would often order a lot of food and find myself eating all of it even though I was very full or not very hungry," Penny said. "I was always ashamed of what I was eating because I knew it was bad for me."
She said she'd wait until later in the evening to eat at home when her family would go to bed, "so they wouldn't judge me for the food I ate."
Dieting can fuel binge eating disorder.
"We’ll see a person who is really unhappy with their bodies and attempt to go on all kinds of diets and restrict what they’re eating, and then as a result of that, they’re more likely to binge," Solomon told Revelist.
"If they go the whole day without eating enough, they set themselves up to binge. So sometimes the root is this vicious cycle of dieting."
But because doctors aren't trained to look for BED, they assume their patients aren't "trying hard enough" to be healthy.
"[People with BED] may just see themselves as 'failed dieters,' that’s really common," Solomon said. "They’ll go to the doctor and say, ‘There’s something wrong with me. I just can’t stay on a diet, and my weight just keeps going up. And I don’t have any willpower.'"
The doctor will likely suggest treatments that don't address the disordered eating practices.
"A lot of doctors and physicians will look at somebody who might have someone come into their office who’s in a higher weight body, and they’ll never ask them about their eating habits," Solomon said.
"They’ll tell them to go on a diet, or to manage their weight. But [some of] these people have an eating disorder — they don’t need a prescription for a weight loss pill."
Fatphobia in and out of the medical community makes it hard for those struggling to realize they have a problem.
"[BED] is misunderstood because often when you're heavier and you're seen eating unhealthy, you're just seen as lazy and not willing to help yourself out," Penny, who still struggles with binge eating episodes, told Revelist. "People don't realize your mental health effects you too."
Solomon says weight stigma causes people with BED to silently suffer.
"We don’t give as much attention or concern to conditions that people who are in higher weight bodies struggle with," she said.
If you're struggling with BED, know you're not alone.
Groups like NEDA and BEDA are working hard to get federal bills passed that would guarantee more eating disorder training for health professionals and educators.
"This is a prime time for mental health legislation and eating disorder legislation," Solomon told Revelist. "There’s Helping Families in Mental Health Crisis Act and then there’s a senate bill that’s a companion to that. We’re hoping that in this session, that those will get passed."
In the meantime, she recommends checking out BEDA for more ways to find treatment options.
