“What is a healthy weight for women and men” is a common question asked by both women and men. But it’s not so simple.
We have known for a long time that restrictive dieting leads to temporary weight loss and more often weight cycling. We sometimes forget the weight cycling itself can be more dangerous than a stable weight, even if this weight is deemed “overweight.” The war on obesity has not worked because it is a war on our bodies.
Most people with Binge Eating Disorder (BED) don’t even know they have it. According to a national survey, just 3% of adults who met the criteria in the prior twelve months were actually diagnosed.
Signs of Binge Eating Disorder
Let’s start with some facts. According to the DSM-V, Binge Eating Disorder is characterized by several behavioral and emotional signs:
- Recurrent episodes of binge eating occurring at least twice a week for six months
- Eating a larger amount of food than normal during a short time frame (any two-hour period)
- Lack of control over eating during the binge episode (e.g., feeling you can’t stop eating or control what or how much you are eating)
Binge eating episodes are associated with three or more of the following:
- Eating until feeling uncomfortably full
- Eating large amounts of food when not physically hungry
- Eating much more rapidly than normal
- Eating alone because you are embarrassed by how much you’re eating
- Feeling disgusted, depressed, or guilty after overeating
- Marked distress regarding binge eating is also present
- Binge eating is not associated with the regular use of inappropriate compensatory behavior (such as purging, excessive exercise, etc.) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa
What is Binge Eating Disorder?
Binge Eating Disorder is a psychiatric disorder and is a red flag for both medical and co-occurring psychological conditions, including but not limited to Major Depression, Post-Traumatic Stress Disorder, Attention Deficit Disorder and other serious mental illnesses. Because it is a serious mental illness, the typical “prescription” to diet to lose weight (a simplistic behavioral recommendation) sets up the BED patient to utter failure since dieting not only sets the person up to rebound, overeat and weight cycle (we will get to that shortly), but also misses the boat as far as helping the person cope with the serious underlying illness with which the person is faced. This is an illness which requires intensive multi-disciplinary treatment, including but not limited t,o a thorough medical and psychological evaluation, psychotherapy, and nutrition management.
Instead of getting serious help for the serious condition they face, individuals with Binge Eating Disorder spend their lives in battle with their body, and are condoned by a society who as a whole are advised to “eat less and exercise more;” with doctors acting as the number one culprit of weight stigmatization. In fact, a dear friend of mine who suffers from Binge Eating Disorder was once told by her psychiatrist, “You are fat every day, so exercise every day.” Does this sound like an invitation toward health?
It is not always easy to convince a person suffering from Binge Eating Disorder that the focus must be on self-love, self-acceptance, and mindfulness (as opposed to weight loss) because they have been indoctrinated with a “no pain, no gain” mentality.
One of the most challenging aspects of treatment lies in the pressure the Binge Eating Disorder patient faces from healthcare providers and society at large to lose weight, because this is at odds with the need to address an underlying restrictive and shame-based mindset which sets the patient up to binge. We have discovered that our Binge Eating Disorder patients are highly restrictive in their thinking about what is allowable with food, similar to the restrictive thinking about food in Anorexia and Bulimia. Accordingly, the Binge Eating Disorder patient may be as fearful as the anorexic about eating carbohydrates or fats when we serve her breakfast in our center. Because they are restrictive in their thinking, the Binge Eating Disorder patient eventually will binge to compensate for the restriction, and in the binges he or she (Binge Eating Disorder Is an equal opportunity disorder; 40% of those with Binge Eating Disorder are men) will consume large amounts of calories without compensating in some way. This is how and why the patient with Binge Eating Disorder may gain weight over the time of their illness. What then happens is when they are told they should lose weight? They go back to restriction, and the cycle of restriction, bingeing and weight gain continues!
Why is Health at Every Size so Controversial?
Will someone please tell me, why is health at every size so controversial? When one asks “what is a healthy weight for women and men,” there is no right answer.
The following was gathered from the HAES website.
Health at Every Size (HAES) is based on the simple premise that the best way to improve health is to honor your body. It supports people in adopting healthy habits for the sake of health and well-being (rather than weight control.) Health at Every Size encourages:
- Accepting and respecting the natural diversity of body sizes and shapes.
- Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
- Finding the joy in moving one’s body and becoming more physically vital.
What is written above seems so simple, reasonable, and validating; but, over the years, in the field of eating disorders, I have noticed adopting this stance is actually controversial.
My daughter was reading an article about prisons in Norway. What is interesting is that they actually treat the prisoners well and provide them with opportunities to have constructive lives and meaningful social interactions. What happens to these prisoners? They start to feel good about themselves and become contributing members of society.
When we treat people well, it brings out the best in them. When we treat ourselves well, it brings out the best in us. A war on ourselves is not likely to bring out the best in ourselves.
Eric Fromm states any art requires concentration, knowledge, respect, and discipline. In this model, we move the focus away from weight loss and toward the art of loving oneself and the art of living. Discipline is not punative, but instead emphasizes the discipline of self-care and living mindfully.
What we find is that this artistic process of mindful living begins to take hold for our clients. It seems to me the ‘Art of Loving’ by Eric Fromm and the principals contained in the Health at Every Size model have a lot in common. Health at Every Size supports adopting health habits for the sake of health and wellbeing. What is not to love about that?
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In order to help the patient with Binge Eating Disorder, we must address the underlying shame around eating (which is reinforced by society who tells them that fat is bad and unhealthy). This shame around eating is intensified beyond what most of us can probably imagine when the person is of a larger size. I often tell my patients that every binge does not start with the binge; binges start with shame and the underlying restriction. So we must help reduce the shame, teach acceptance of the need to eat, (which is akin to teaching the importance of managing our needs), and the skill of mindful eating to our Binge Eating Disorder patients, just like we teach to our other, possibly smaller framed patients. We have to carefully address the underlying restriction, knowing full well that the pressure to lose weight is something the patient is facing throughout each and every day of their life if they have gained weight due to their illness (again, not every Binge Eating Disorder patient is of a larger size).
In addition, another common piece of mis-information, which drives the Binge Eating Disorder patient to binge, is the common belief in our culture that people who are heavier are eating more than the rest of us, and they are eating too much. This, of course, sends the message to the person with Binge Eating Disorder to eat less than they are eating. We have seen, time and time again, that in a 24 hour monitored, controlled setting (with no access to food in between routine meals and snacks), the Binge Eating Disorder patient may lose little to no weight even on a very modest calorie plan and not bingeing. What we have come to understand is that every body is different, and weight loss is not always associated with being on a lower calorie level. There is more and more science becoming available to us to help us understand how and why this may be the case. So the result of good treatment is that the person with Binge Eating Disorder may enter into a period of stable recovery, with overall improved mood, outlook, functioning, and no bingeing or over-eating, and this newly found state of recovery is not associated with weight loss.
So when a well-intentioned person tells a person with Binge Eating Disorder (who may be larger size), that they should eat less because they are eating too much, and that this eating less will make them thinner and also healthier, and the Binge Eating Disorder patient does as s/he is told, yet does not lose weight from the lowered calorie level, and/or ends up with rebound over-eating, this is not helpful to the patient! In addition to the confounding emotional consequences, the patient with Binge Eating Disorder is led to what is perhaps an even more serious medical consequence.
The temporary weight loss sometimes experienced from restriction and dieting, very predictably does not last. The person is likely then to ricochet out of the restriction phase and begins binge. This bingeing can lead to weight gain over time. The “serial dieter” repeatedly goes from restriction to bingeing, and over time may gain more and more weight. This cycle is called weight cycling and can lead to very serious medical/physical (and emotional) consequences. The medical consequences of weight cycling (which can include damage to the heart and cardiovascular system, reduced bone mass, increased risk of gall-stones, physical weakness, and depression and impulsivity) may in fact be more serious and life threatening the consequences of “stable obesity”.
The Binge Eating Disorder patient faces many complicated situations on a daily basis, which can compromise their overall health and well-being. Thankfully, the new DSM-V will address Binge Eating Disorder and with that we can hope that the illness will be treated with the seriousness that is warranted. Eventually, I hope that it will be recognized that placing a Binge Eating Disorder patient on a restrictive diet is not only crazy making, but neglectful of the complex scenario the patient is faced with. I hope that one day, doctors will not be rated as the number two source of weight stigma (second to family members).
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The war on obesity may be as much or more about weight stigmatization as it is about a concern for health but beyond this, the war on obesity may be fueling the Binge Eating Disorder patient to binge and weight cycle. How can this be considered healthful?
Einstein said, “We cannot solve problems by using the same kind of thinking we used when we created them” and my mom used to say to me, “Wendy, the road to hell is paved with good intentions”. I always knew my mom was saying something important to, but when it comes to Binge Eating Disorder and the complicated scenario the patient is faced with, this saying is truer now more than ever.
Are you looking for Binge Eating Disorder recovery? I highly recommend you speak with a medical professional like Amy Boyers today if you struggle with Binge Eating Disorder or other eating disorders. Next time someone asks you “what is a healthy weight for women and men,” tell them there is no right answer!
About Wendy Oliver-Pyatt: Dr. Wendy Oliver-Pyatt is a world-leading expert on treating eating disorders. With more than 20 years of clinical experience, Wendy has developed a unique treatment approach that delves into the underlying issues that place a person at risk for mental health conditions and eating disorders and lead to healing, health and inner peace. Wendy, Mental Health Speaker, Eating Disorder Educator, and Mental Health Advocate, currently delivers keynote speeches for leading organizations on topics such as eating disorders, treating serious mental health issues, and healthful approaches to weight concerns. Contact Wendy for your next keynote!
A note from Amy Boyers:
I would like to thank my good friend Dr. Wendy Oliver Pyatt for sharing her wisdom and passion for all those who struggle with weight and food-related issues.
Get Binge Eating Disorder Recovery in Miami
I’m Dr. Amy Boyers, a Clinical Psychologist in Miami who specializes in eating disorder treatment (all types including anorexia treatment, bulimia treatment, and binge eating treatment) and other long term conditions, including addictions, bipolar, and OCD. I offer personalized and sophisticated eating disorder treatment services, individual and family psychotherapy, family member support and education, in-home meal support, cognitive behavioral therapy, anxiety treatment, depression treatment, and much more.
Have any questions about the eating disorder recovery process? I’d be happy to answer them. Simply reach out to me and I’ll be sure to answer anything you want to know.
I look forward to helping you obtain a brighter tomorrow.