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Binge Eating Following Weight Loss
Volume One / Number Three
by Warren Huberman, PhD
Does weight loss surgery eliminate or control binge eating? Will my gastric band or gastric bypass stop me from eating such large quantities? These questions are of great concern to folks with a history of binge eating who are pursuing weight loss surgery.
What is a binge and what is binge eating?
Binge eating is a behavior commonly reported by the morbidly obese. Many patients report that a major reason they pursued weight loss surgery was to control their binge eating. The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines a binge as follows:
(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances, and,
(2) 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 they are eating).
Other common elements of binge eating include: eating more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not hungry, eating alone due to feelings of embarrassment and feelings of disgust with oneself, depression, or severe guilt after overeating. It is also common for folks to attempt to conceal their binging because of embarrassment with either what or how much food is being eaten. Common
triggers of binges include: feelings of tension, eating something, being alone, feeling fat, breaking the rules of a diet and food cravings, among others.
Notice that the definition of a binge reference how much food “most people” would eat. It is generally accepted that most Americans eat large or “supersized” portions, so this criterion is vague. Also, there is controversy over the length of the time period that constitutes a binge. We typically think of binging as voracious eating (think of Cookie Monster from Sesame Street), however some people are more of what I would call “grazing bingers.”
These are folks that will consume an excessive amount of food over the course of many hours or an entire day rather than during only two hours. This is why the key element of binge eating is the feeling that one cannot control his behavior.
What a binge is NOT
Binge eating is not an addiction. Binge eating is not evidence of an “addictive” or “compulsive” personality. Many patients make the argument that being morbidly obese is evidence of being “out of control” of their eating, however, this is not binge eating. This loose definition of “out of control,” causes many patients to label themselves as “compulsive eaters” or “food addicts.”
There is scant evidence that binge eating is truly an addiction. There is even less evidence of food addictions or the so-called addictive personality. This is quite a controversial topic and I encourage you to read Binge Eating: Nature, Assessment, and Treatment by Christopher Fairburn, MD. and G.T. Wilson, Ph.D. (1993) for more information.
What can be done to avoid binge eating following
weight loss surgery?
If your binging persists following weight loss surgery, consider undertaking
the following steps. A first step is to monitor certain aspects of your behavior, as well as your weight. Document what you eat, when you eat, and most importantly, what you are thinking and feeling when eating. Learn to identify your emotional, cognitive and behavioral triggers for binging. This will help
you develop alternative strategies for binge eating later on in the change
process. Weigh yourself at most once per week. Daily variations of water levels and other factors make your daily weight an almost useless number and weighing yourself every day can cause you to become obsessed with your weight. When it goes down, you’re ecstatic, when it goes up or is unchanged, you become frustrated and may try to speed things up by skipping meals or starving, which is a big trigger for binging.
Another important step is to get rid of “diet brain.” Diet brain is thinking in black and white terms, where particular foods are categorized as being either good or bad, and self-acceptance is contingent upon whether or not you exhibited restraint during your most recent meal. This absolutist, rule-governed approach to eating is a major trigger for binging. Do not strive for perfect eating. Allow yourself to accept small deviations from your plan. What better way to learn moderation than to actually practice it!
The most critical part of getting rid of diet brain is getting rid of dieting. If you’ve had weight loss surgery, you’re probably a diet expert. You’ve done them all and discovered that in the long run they’re generally not effective. In fact, less than 1% of all people who attempt to lose 50 or more pounds will successfully keep it off for more than five years. It rarely happens, and your inability to be one of the 1% is not a flaw…it’s a part of being a human being. This might explain why the diet industry in the United States is a multi-billion dollar industry. Frustrated dieters, eager to succeed, keep coming back again and again because for most people, the weight lost through conventional diets just does not last more than a few months. Why is it so important to avoid dieting? Dieting involves chronic restriction, restriction inevitably leads to frustration, frustration leads to slips, slips lead to relapse, relapse leads to despair, despair leads to binging and binging leads to weight regain. There you have it! Allow your surgery to do its job helping you lose and control your weight. Incorporate the changes produced by your surgery into a healthy lifestyle modification program. Engage in behaviors that are incompatible with binging. Exercise, socialize and try to make eating a structured, planned behavior.
I know what you’re thinking…I hate structure! I am a fan of structure because it works. One of the most essential strategies to defeat binge eating is to eat three meals per day and perhaps one or two planned snacks. When it comes to eating, don’t “wing it,” plan it! Don’t allow eating to be a casual, mindless behavior. Perhaps, you are one of those folks that have been battling binge eating for years. It is very unlikely that you will be able to eliminate this behavior that you have engaged in possibly thousands of times, without a structured, focused approach. Planned meals and planned snacks is a structured, focused approach.
Another key point is to avoid engaging in other behaviors when you eat. Turn off the television and put down the newspaper. Try to tune in to the feelings and sensations of eating, to better understand and control your behavior. Also, be patient with your weight loss. Never over-restrict yourself to try and speed up the weight loss process. Starvation and meal-skipping are tremendous triggers for binge eating. It is also important that you learn methods of coping with emotional distress other than eating. Anyone who binges can tell you how silly and useless the behavior of binging truly is. No matter what problem you are dealing with, it will not be solved by eating twenty chocolate chip cookies. You may experience a temporary reprieve and a brief feeling of pleasure from the cookies, but the initial problem persists, and it is now compounded by feelings of guilt and self loathing.
Consider learning relaxation strategies, taking a brief walk, listening to music or developing a social network to call upon under such circumstances. Don’t be surprised if your new strategy feels awkward at first…it may take awhile for you to feel comfortable without nibbling on something.
What if I have a slip?
If you have a slip and binge, try to keep it to just one binge. It was bound to happen. Most people find it difficult to stop binge eating cold turkey (no pun intended). Having a binge is a setback, NOT a relapse. This relates to the black and white thinking I was referring to earlier. Eating one chocolate bar is not the same as eating 15 pounds of chocolate. This does not put you “back to square one.” Irrationally telling yourself that you are a failure for having had a slip triggers self-hatred and hopelessness. It is the self-hatred and hopelessness that leads to continued binging that puts you back to square one.
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