Out of Control: A True Story of Binge Eating
By JANE E. BRODY
Published: February 20, 2007
In 2007, Harvard published a survey finding that binge eating is by far the most common eating disorder, occurring in 1 in 35 adults, or 2.8 percent — almost twice the combined rate for anorexia (0.6 percent) and bulimia (1 percent).
Yet unlike the other two, binge-eating disorder is still not considered a formal diagnosis by the American Psychiatric Association. I’m mystified as to why, and when you read my story you may wonder as well.
It was 1964, I was 23 and working at my first newspaper job in Minneapolis, 1,250 miles from my New York home. My love life was in disarray, my work was boring, my boss was a misogynist. And I, having been raised to associate love and happiness with food, turned to eating for solace.
Of course, I began to gain weight and, of course, I periodically went on various diets to try to lose what I’d gained, only to relapse and regain all I’d lost and then some.
My many failed attempts included the Drinking Man’s Diet, popular at the time, which at least enabled me to stay connected with my hard-partying colleagues.
Before long, desperation set in. When I found myself unable to stop eating once I’d started, I resolved not to eat during the day. Then, after work and out of sight, the bingeing began.
I learned where the few all-night mom-and-pop shops were located so I could pick up the evening’s supply on my way home from work. Then I would spend the night eating nonstop, first something sweet, then something salty, then back to sweet, and so on. A half-gallon of ice cream was only the beginning. I was capable of consuming 3,000 calories at a sitting. Many mornings I awakened to find partly chewed food still in my mouth.
And, as you might expect, because I didn’t purge (never even heard of it then), I got fatter and fatter until I had gained a third more than my normal body weight, even though I was physically active.
My despair was profound, and one night in the midst of a binge I became suicidal. I had lost control of my eating; it was controlling me, and I couldn’t go on living that way.
Fortunately, I was still rational enough to reach out for help, and at 2 a.m. I called a psychologist I knew at his home. His willingness to see me in the morning got me through the night.
Just talking about my behavior and learning from the psychologist that I was not the only person with this problem helped relieve my despair. Still, he was not able to help me stop bingeing. That was something I would have to do on my own.
I finally reached the conclusion that if I kept eating that way, the dreadful foods would end up killing me. And I knew by then that diets were a disaster, something one goes on to go off, only to regain what one has lost. So I decided that if I was going to be fat, at least I was going to be healthy.
An Eating Plan
With my then-limited knowledge of nutrition, I created an eating program for myself: three substantial meals a day with a wholesome snack between meals if I was hungry. No skipping meals allowed. I stripped my apartment of favorite binge foods, though I allowed myself one small treat a day. And I continued with my regular physical activity.
After a month of eating three big meals a day, I had lost seven pounds. And I continued to lose about two pounds a month (as my weight dropped, so did the amount of food I needed to feel satisfied) until two years later I was back to my normal weight.
As I have learned from talking with experts who treat eating disorders, the factors that precipitated my binge eating and the route I took to “cure” myself are strikingly similar to the precipitants among their binge-eating patients and the therapeutic measures used to help them.
It is important for everyone out there with this problem to know that help is available.
While binge eating without purging occurs in 2.8 percent of the adult population, it is much more prevalent, as you might expect, in obese people.
Dr. Katherine Halmi, director of the eating disorders program at the Westchester division of New York Presbyterian Hospital, says 10 percent to 15 percent of the obese population has this problem, and among those who binge without purging, almost 90 percent are obese.
Dr. Halmi, who is also a professor of psychiatry at the Weill Cornell Medical Center in New York, said she had found dieting a frequent “proximal trigger” among people with binge-eating disorder.
Other common risk factors, Dr. Halmi said, include a “personal disaster in a person’s life, like the death of a spouse, losing one’s job, having a serious problem at work, or being left by one’s husband for another woman.”
“People soon learn that binge-eating alleviates anxiety, similar to an addiction,” she said. “There’s psychological reinforcement of the behavior because binge eating makes them feel better at the time, even though they may feel upset afterward for having eaten so much.”
Dr. B. Timothy Walsh, an eating disorders specialist at the New York State Psychiatric Institute at Columbia University Medical Center, says that when compared with equally overweight people who do not binge, binge eaters are more troubled by anxiety and depression.
Getting Help
The main goals of therapy are abstinence from binge eating, and weight loss or weight control, said Cynthia M. Bulik, the distinguished professor of eating disorders in the psychiatry department at the University of North Carolina, Chapel Hill. Dr. Walsh adds that emotional relief is another goal, and that it sometimes results from achieving the other two.
Most popular at the moment is cognitive-behavioral therapy, with or without medication. Since binge eaters have highly irregular eating habits, the behavioral aspect introduces structure to their eating behavior: regular meals, including breakfast, and an afternoon snack if needed.
Dr. Halmi said those in recovery must not go more than four hours without eating, and that their diet should include foods they like.
The cognitive aspect tries to undo the unhealthy notions people have about food and eating, like “I’ve already blown it, so I might as well eat the rest of the ice cream” or “I didn’t eat breakfast, so I can eat more at night.”
“We also help them find more appropriate responses to emotional problems, like using relaxation techniques instead of food to deal with anxiety,” Dr. Bulik said.
The cognitive-behavioral approach, while highly effective in stopping binge eating, is less effective in achieving weight loss, she said.
Thomas Wadden, director of the Center for Weight and Eating Disorders at the University of Pennsylvania, has found that “a behavioral weight control approach” — a structured meal plan that reduces daily intake by 500 to 700 calories but allows a couple hundred calories from foods the person likes — is effective in stopping bingeing and also helps the person lose weight.
“We see an improvement in people’s moods,” Dr. Wadden said, adding that there should also be therapy to deal with relationship issues or self-esteem, if needed.
Medication is also sometimes used with the structured eating plan. Prozac and similar antidepressants and the anticonvulsant drug Topamax have helped some patients gain control of their weight and achieve abstinence from bingeing, Dr. Bulik said, though data are lacking on long-term effectiveness.
As for me, do I still sometimes eat “out of control”? Yes, now and then.
When I feel anxious or upset, I may polish off a dozen innocent-looking cookies or a pint of low-fat ice cream. But this is nothing like it once was. And since 1967, with minor fluctuations, I have stayed at my normal weight.
