Shame and guilt eating: Tackling binge-eating disorders

Most people occasionally eat too much. They may fill up an extra plate with seconds at a special event, enjoy another piece of pie at a holiday gathering or eat popcorn until stuffed at the movies.

But for some people, overeating becomes excessive. It crosses the line from an occasional indulgence to a binge-eating disorder when overeating feels out of control and happens on a regular basis. It's the most common eating disorder in the U.S.

People with a binge-eating disorder may feel embarrassed about overeating but have a strong, compulsive urge to continue eating. They often eat alone or in secret because they feel ashamed or guilty about their eating.

Binge-eating disorders are different from other eating disorders like bulimia nervosa and anorexia nervosa. Anorexia nervosa is when people severely restrict the amount of food they eat, often to the point of near starvation. When people have bulimia nervosa, they binge on food, but then quickly purge or vomit all of it, or they exercise excessively. A person with a binge-eating disorder may purge or exercise occasionally, but it's not a regular part of their routine and doesn't happen after every food binge.

Who is at the greatest risk for developing a binge-eating disorder?

Binge-eating disorder is more common in women than in men. People of any age can have binge-eating disorder, but it's most common in younger and middle-aged people. The average age when it first occurs is about 25. It can affect people who are underweight, overweight or at an average weight.

Many people who have a binge-eating disorder have a long history of dieting. They have tried and failed many diets and may have poor body image as a result. While dieting, they restrict calories or specific foods for a while, but then are triggered to binge eat. It's also more common in people who have depression, a high level of stress in their lives or use food to cover intense emotions.

How do I know if I have a binge-eating disorder?

Binge-eating disorder mainly is distinguished by a regular occurrence of eating more food than most other people would in a similar situation. Other signs include:

• Eating unusually large amounts of food in a specific amount of time, such as over a two-hour period.
• Feeling that eating behavior is out of control.
• Eating even when full or not hungry.
• Eating rapidly during binge episodes.
• Eating until uncomfortably full.
• Frequently eating alone or in secret..
• Feeling depressed, disgusted, ashamed, guilty or upset about eating.
• Frequently dieting, possibly without weight loss.

People with binge-eating disorders often have become experts at hiding their eating behaviors. They may deny there is an issue or lie about the amount of food they eat.

Binge-eating can lead to obesity, joint problems, heart disease, Type 2 diabetes and sleep apnea. It can be difficult to function in social settings, and the person may isolate or withdraw from others. This can increase anxiety, depression and substance use disorders.

How is binge eating treated?

Overcoming any eating disorder is a challenge because you can't avoid food or social situations that include food during recovery. Your body needs food to survive and thrive. Yet, recovery is possible, and many people overcome binge eating completely.

Treatment needs to address the emotions tied to binge eating, including shame and poor self-image. Relapse is likely until these are tackled, and professional help is usually necessary. A combination of cognitive behavioral therapy and medications, such as antidepressants, can help a person cope with triggers, negative body image and depression. These treatments can regain a sense of control over behaviors and improve stress management skills.

At the same time, a dietitian can work with you to reframe your relationships with food, ensure you are getting the right balance of nutrients, help develop meal plans and offer support for navigating social events that involve food.

Binge-eating disorders are serious, but full recovery is possible with professional treatment. Talk with your health care team if you are concerned about your eating or the eating patterns of a loved one.

Romi Londre is a dietitian in Nutrition in Eau Claire, Wisconsin.