Understanding Eating Disorders, Binge Eating & Night Eating Syndrome
Eating disorders have existed in one form or another since the beginning of civilization; however it is without question that its presence has increased significantly over the past thirty years. It’s hard to pin point one central causative reason for the increase, but it goes without saying that the social and societal pressures to be thin and in great shape while living in a developed nation where over a third of the population is overweight has been consistently implicated as a cause for the growing number of mostly women with eating disorders. The unstoppable deluge of advertising and marketing cues for women to be supermodel slim and trim doesn’t only affect us here in the United States and Europe but creates an environment ripe for eating disorders even in third world countries where food supplies are scare. In India where it is estimated that almost 60% of the female population is malnourished and where a well rounded body has traditionally been upheld as a nationally accepted ideal, the influx of Western television has brought with it an explosion in the number of young girls with anorexia nervosa- often with fatal consequences.
Here in the United States over eight million people suffer from an eating disorder of some kind with a huge gender bias of seven million women versus one million men. One in 200 American women suffer from anorexia nervosa- the so called slimming disease that can cause suffers to starve themselves to death. A study by the National Association of Anorexia Nervosa & Associated Disorders found that 5 – 10% of anorexics die within 10 years of contracting the disorder and that approximately one fifth of them will die within twenty years. Sadly the mortality rate for anorexia is 12 times higher than the death rates of all causes of death for young females within the ages of 15-24 years old, a sobering statistic, but one that does nothing to stop the presentation of being ultra thin to a fault as an ideal.
Bulimia & Binge Eating- Signs & Symptoms
Binge related eating disorders are even more widespread throughout the American female population- while one in every 200 American women suffers from anorexia, two to three in 100 women suffers from bulimia. Bulimia is an insidious and often silent illness in which a person binges on food or has regular episodes of overeating while feeling a very tangible loss of self control over their eating. The affected person then uses various methods such as vomiting, diet pills or laxative abuse to prevent weight gain. Similar to but not exactly the same as bulimia, binge eating disorder is even more common as people with binge eating disorder often consume large amounts of food while feeling a real loss of control over their eating, but without the recourse to purging methods.While almost everyone overeats at one point or another (usually over the holiday season), some overeat with a regularity that qualifies it as a disorder. While not categorized as a psychiatric condition per se, as with all eating disorders, binge eating comes with the classic cycle of compulsive urges followed by extreme feelings of guilt and powerlessness to stop a re-occurrence. As it is largely undiagnosed, millions are affected but no one can give a precise number as the practice is often shrouded in secrecy and the shame and embarrassment over having so little control over your actions isolate many from ever revealing that they have a problem and getting help.
While bulimia nervosa appears to be of relatively recent origin, binge eating has been a problem for humankind for centuries. Simply eating large amounts of food or being over one’s ideal weight does not mean that someone has a binge eating disorder. Research over the past three decades has conclusively shown that most obese individuals eat relatively normally, (read my post on calories to understand a bit more of how easy it is for us to gain weight) and that the subgroup of obese people with episodic periods of extreme food consumption is relatively small with some sufferers being of normal weight. My experience over the years has been that most people regarded as ideals within the fitness industry do have serious problems with their attitudes towards food, sadly to the point where is can indeed be classed as a disorder.
The criteria for binge eating disorder are:
· Frequent episodes of eating what others would consider an abnormally large amount of food.
· Frequent feelings of being unable to control what or how much is being eaten.
Several or all of these behaviors or feelings:
- Eating much more rapidly than usual.
- Eating until uncomfortably full.
- Eating large amounts of food, even when not physically hungry.
- Eating in isolation out of embarrassment at the quantity of food being eaten.
- Feelings of disgust, depression, or guilt after overeating.
Bulimia & Binge Eating In The Fitness Industry
Both binge eating and bulimia nervosa affects many bodybuilders and fitness models in numbers higher than most would expect. Persons with bulimia regularly purge, fast, or engage in an unhealthy pattern of prolonged strenuous exercise after episodes of binge eating which is a textbook description of the cycle for most competitive physique athletes. The purging process within bulima is usually understood as vomiting but it can also include the use of diuretics (water pills) or laxatives doses to avoid gaining weight after eating- practices that many in the health and fitness circles regularly engage in to maintain ‘the look’.
Fasting is defined as not eating for at least twenty-four hours and many use it as a way of making up for what they see as over the top food consumption (see my article on fasting as a form of weight loss here). Strenuous exercise, in this case, is defined as exercising for more than an hour, but not as a means to better health or self improvement, but as a reactive practice to avoid gaining weight after a period of binging. Purging, fasting, and prolonged strenuous exercise are dangerous ways to attempt weight control and the excessive shape and weight concerns of most competitors in the physique arena are also characteristics of bulimia and or eating disorder of some kind. Issues that may appear benign in someone with rippling abdominals and an ultra tight body, but one that is inevitability self destructive and unsustainable.
The only difference between a physique competitor and someone diagnosed with an eating disorder per se is that the cycle of weight gain, weight loss, extreme dieting, nutrient deprivation and dehydration combined with thousands of hours of daily prolonged strenuous exercise has become almost socially acceptable. Unfortunately the extreme practices of those following this particular lifestyle are seen as ideals for many who aspire to have well muscled and toned bodies just like those of the individuals they see in the pages of the magazines. Unless there is a sense of balance where your overall health is prioritized over the attainment of a transient cosmetic ideal such as being big and muscular or having extremely low body fat levels, the practice falls squarely in the realm of an eating disorder and has no relation to health and fitness whatsoever even though it is portrayed as such in the media.
Night Eating Syndrome- The Other Eating Disorder
There are other eating disorders that can also often go unrecognized as 1.1-1.5% of the U.S. population suffers from another as yet undiagnosed eating disorder called Night Eating Syndrome. Seen as a delay in the daily rhythm of food intake, Night Eating Syndrome is defined by two important points:
The first is hyperphagia- which is an ingestion of over 25% of daily calories after dinner and or waking up to eat at least three times a week.
Usually triggered by feelings of stress, Night Eating Syndrome is a disorder that that many can relate to, albeit in a less extreme form. Characterized by a lack of appetite for breakfast and the consumption of considerable amounts of high calorie, and usually high-carbohydrate snacks and insomnia, the foods eaten during the night time binge are almost always unhealthy.[4,6] After the night binge, the person is usually not hungry in the morning, and breakfast, the most important meal of the day for both optimal performance and appetite regulation is skipped. (Read more about the importance of breakfast for weight loss and appetite regulation here)
The excessive food intake at night also creates a decrease in melatonin, a critical sleep related hormone. The decrease in melatonin contributes to the increased sleep disturbances and insomnia associated with night eating syndrome. Evidence suggests that night eating may be a pathway to obesity as in three studies it preceded the onset of obesity and was a major factor in predicting continued weight gain in female night eaters who were already obese. Not only is night eating a contributor to increased weight gain, but it is also a serious cause of distress for those who feel overpowered by food at night.
Again, it should be kept in mind that most may not have the characteristics of this particular syndrome to the extent that it becomes pathological, but the pattern of almost uncontrollable late night snacking on high carbohydrate and unhealthy foods is a very common issue for many individuals today. While the general population may not be diagnosed as having an eating disorder, most still find the task of controlling their eating habits to be a Sisyphean task. However there are practical and systematic approaches that make the likelihood of success much greater and none of them involve quick fixes. Nothing worth achieving comes quickly, and having control over your eating habits is no exception. It takes practice and patience as lasting achievements stem from a lifetime of dedication. Exercise can go a long way in helping relieve some of the symptoms of depression that eating disorders can bring about, but again balance is the key. That being said, if you have an eating disorder it is always recommended that you first seek professional help.
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Kevin Richardson is an award winning fitness writer, one of the most sought after personal trainers in New York City and the creator of Naturally Intense High Intensity TrainingTM. Get a copy of his free weight loss ebook here.
1. McGivering J. Anorexia takes hold in India. BBC News- 2003
2. Eating Disorder Statistics- South Carolina Dept. of Mental Health
3. Bulimia nervosa; Binge-purge behavior; Eating disorder – bulimia. A.D.A.M. Medical Encyclopedia.
4.Marcus MD. “Binge Eating in Obesity.” In: Fairburn CG, Wilson GT (eds). Binge eating: nature, assessment, and treatment
5. Gordon, Richard A. 2000. Eating Disorders: Anatomy of a Social Epidemic. 2nd ed. Malden, MA: Blackwell Publishers, Ltd.
6. Stunkard AJ. “Eating Patterns and Obesity.” Psychiatric Quarterly, 1959, Vol. 33, pp. 284-295.
7. Stunkard A, Allison K., Lundgren J. Issues for DSM-V: Night Eating Syndrome- Am J Psychiatry 165:424, April 2008
8. Lundgren JD, Newberg A, Allison KC, Wintering N, Ploessl K, Stunkard AJ: 123I-ADAM SPECT imaging of serotonin transporter binding in patients with night eating syndrome: a pilot study. Psychiatry Res
9. Andersen GS, Stunkard AJ, Sørensen TI, Petersen L, Heitmann BL: Night eating and weight change in middle-aged men and women. Int J Obes Relat Metab Disord 2004; 28:1338–1343