Binge Eating Disorder and Health at Every Size

Woman joggingThis past weekend, I attended the 2012 Binge Eating Disorders Association (BEDA) national conference. The theme of this year’s conference was, “ Revolution Ahead: Illuminating the Path to Freedom from BED, Emotional Overeating, & Weight Stigma.” I, along with my friend and colleague Clare Stadlen, LCSW, gave a presentation on “Moving From an Addictions Model to an Integrative Approach to Eating Disorders Recovery.” We were one of many workshops and panels on topics relevant to binge eating disorder (BED).

BED is a latecomer to the table of eating disorders officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It is listed as a provisional diagnosis in the DSM-IV and will be a full-fledged diagnosis in the DSM-V. For many years, anorexia nervosa (AN), bulimia nervosa (BN), pica (the ingestion of non-food substances), and eating disorder not otherwise specified (ED-NOS) were the only eating disorders listed in the DSM. Binge eating was relegated to the ED-NOS category, a sort of catchall for eating disordered behaviors that didn’t fit into the AN and BN categories. Binge eating is generally defined as eating a very large amount of food in a relatively short amount of time, accompanied by feeling unable to control the eating and experiencing shame or guilt afterward.

When I found my way to recovery in the late 1970s, I didn’t know I had an eating disorder. I’d never heard the term eating disorder. I thought I was a person who had no willpower, because I couldn’t stick to a diet. When I found help, I was told that I had a disease, called compulsive overeating.

I know now that I had BED, and I believe that binge eating is just one kind of compulsive overeating. I think that there are other forms of compulsive overeating that are yet to be officially classified by the DSM but that are recognized by eating disorders professionals, such as grazing throughout the day or habitually turning to comfort foods when experiencing emotional distress. For my purposes here, I’ll refer to this broader spectrum of compulsive overeating as BED/CO.

Regardless of the style of eating in which a compulsive overeater engages, one thing that often distinguishes someone who has AN or BN from someone with BED/CO is body size. While an individual with AN is underweight and someone with BN is usually in what is considered a normal weight range, individuals with BED/CO are more often than not overweight.

Individuals who suffer from BED/CO often berate themselves for being weak or piggish, because they are unable to conform to the culturally valued conventions of watching and controlling one’s eating and weight. Although there is plenty of evidence out there that a large body can be a healthy body, the prevailing attitudes in our culture are that a large body is unhealthy and that people whose bodies are large should do everything they can to make them smaller.

At the conference, I found a refreshing accord among eating disorder professionals and lay attendees who are advocating against size discrimination and who believe that the vilification of fat and idealization of weight loss are unhealthy and harmful. I took a workshop facilitated by Judith Matz, LCSW, author, along with Ellen Frankel, LCSW, of the “Diet Survivor’s Handbook” (see dietsurvivors.com). At the start of the workshop, Judith said that her passion is to help people focus on “losing the shame, not the weight.” This sentiment was expressed in various forms throughout the conference: there was a “Stop Bad Body Talk” booth offering buttons, posters, and “feeding mind and body” sporks (see changethemessage.com for more information). I picked up “Wellness not Weight “ and “Accept Yourself… Accept Others” bracelets from the ANAD (Anorexia Nervosa and Associated Disorders, see anad.org) table. The Association for Size Diversity and Health (ASDAH, see sizediversityandhealth.org) sponsored an evening Meet and Greet. The “Health at Every Size” philosophy was mentioned often as an underpinning of BEDA’s treatment and recovery philosophy (see haescommunity.org and bedaonline.com).

Let me explain that BEDA and those of us who have or have had or treat BED/CO have nothing against weight loss. Rather, we believe that the valuing and pursuit of weight loss contributes to the development of disordered eating, to discrimination, to bullying of overweight children, and to poor self-image and low self-worth. When weight loss occurs as a “side effect” of changing one’s eating or exercise habits during the healing and recovery process, it’s because of a shift toward eating in service of the body’s nutritional needs rather than for emotional reasons and movement to support well-being rather than to burn calories. But it’s not the goal. The goal is self-acceptance and creating a way of life that supports one’s emotional, psychological, physical, and spiritual health, regardless of weight or size.

Related articles:
Cracking the Code: Understanding the Language of Disordered Eating
If Food Is Love, How Do I Love Myself?
Vulnerability and Eating Disorders

© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Deborah Klinger, MA, LMFT, CEDS, therapist in Durham, North Carolina

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Monique

    Monique

    March 15th, 2012 at 2:42 PM

    I have no problem with advocating for acceptance and self esteem no matter your size. That I am fine with.
    What I am not ok with are the people going around with their heads in the sand saying that they can be just as healthy at 300 pounds as you are at 150 pounds. There is no way in this world that this can be true!
    You can’t tell me that heavier people do not have higher rates of diabetes, heart disease, and high blood pressure.
    I know that there are skinny people who are unhealthy too. I get that. But please stop making the excuse that fat is ok. Is that really what you feel or what you tell yourself to get through the day?

  • Adam

    Adam

    March 15th, 2012 at 4:59 PM

    Think that you are being a little narrow minded Monique. It is possible to be heavy and healthy. Maybe not obese or morbidly obese, but to carry a little extra weight is not always a bad thing. I would be a lot more concerned with helping someone overcome their eating disorder than I would be condemning someone about how much weight they carry around.

  • R.R

    R.R

    March 15th, 2012 at 10:16 PM

    Every person’s body is different, their biology and genetics are different. So it would be stupid to say every should have a smaller body and should rein in weight. Your weight should be fine for your body type that’s it. There is no blanket rule on this simple!

  • turtle

    turtle

    March 16th, 2012 at 4:28 AM

    I have never had a poor relationship with food so I guess I don’t really get where all of this disordered eating stuff comes from. When did food become comfort for some, an enemy for some, but just energy for the rest of us?

  • Juliette

    Juliette

    March 16th, 2012 at 11:22 AM

    it’s hard not to get down on yourself when that is the message that you are constantly receiving everywhere you go. how many magazines have you looked at lately that shows plus size models or how many overweight actors are there on tv and in the movies? the obese have no role models, and we are made to feel guilty for even looking for one. i am always reminded of how much our society is set up to discriminate against me when i go shopping, when i fly on an airplane, or when i basically do anything in public. i want people to look beyond the weight and my size and see the true me, but somehow i have this fear that the weight is always going to work against me.

  • breanna

    breanna

    March 16th, 2012 at 3:00 PM

    @ turtle, you are very lucky cause there are lots of us out there who do struggle with food as an issue every single day.

    There are some days where I have planned each hour around what I was or was not going to eat, I guess kind of like an alcoholic or druggie planning their next drink or hit.

    So yeah for some of us it is a big deal.

  • janice Reeves

    janice Reeves

    March 17th, 2012 at 7:32 AM

    Binge eating- I don’t know how you do that. I feel sick if I overeat even a little bit. I can’t imagine how nauseated you must feel after just stuffing more and more food in, trying to feed something inside that will always be hungry.

    I hope that anyone with an eating disorder can find some way to find peace in their lives, a peace that will let them live and feel normal.

  • J.M.B

    J.M.B

    March 18th, 2012 at 12:10 AM

    My body type is something most people would call ‘large’ but as long as I am healthy that is what matters doesn’t it?

    Everybody is influenced by their genetics,parentage and stuff so how do they expect everybody to fall into their ‘ideal’ category? Every body type can be ideal and healthy in my belief and those that say otherwise are only being unfair to the ‘not ideal’ types.

  • Bennett

    Bennett

    March 18th, 2012 at 5:56 AM

    I don’t villify fat people. They do enough of that on their own. But that does not mean that I want to be that way.

  • Claire

    Claire

    March 19th, 2012 at 3:35 PM

    I know that binge eaters tend to show their damage that they are doing to their bodies on the outside like an anorexic, but not the bulimics who try to hide it. Does binge eating put the same strains on the body as say starving it does?

  • Deborah Klinger, M.A., LMFT, CEDS

    Deborah Klinger, M.A., LMFT, CEDS

    April 5th, 2012 at 10:45 PM

    Thanks, everyone for your comments! I apologize for taking so long to respond.

    Monique, it’s very difficult for people who are significantly overweight to lose weight. Most overweight and obese people have been on diet after diet, have lost and gained hundreds of pounds, have been unable to keep lost weight off, and are often told by health care professional that they need to lose weight for health reasons. They try and can’t. This contributes to a sense of helplessness and failure. What I’m discussing in my article is a shift to a focus on improving health at whatever weight and size one happens to be, rather than a focus on losing weight in order to be healthy. For more information about this, read, “Big Fat Lies: The Truth About Your Weight and Your Health,” by Glenn A. Gaesser.

    Adam, I appreciate your sensitivity. If a person is overweight because of disordered eating, that’s what needs to be addressed, not the weight. Focusing on the factors driving one’s relationship with food and exercise is much more helpful that focusing on weight.

    R.R., I always say that we don’t try to make Saint Bernards look like greyhounds. Some people are greyhounds, and some people are Saint Bernards!

    turtle, disordered eating has been around for a long time. It’s a heartbreaking struggle and you are indeed fortunate not to have experienced it.

    Juliette, you speak eloquently of the difficulties that large-bodied people face. I encourage you to practice deeply accepting yourself (and your body)exactly as you are. Self-acceptance is the antidote to fear of judgment by others.

    breanna, I hope you are getting the help that you need and deserve. Please look into treatment if you’ve not done so already. It can get better.

    Janice, thank you for your kind wishes for those who are suffering.

    Amen, J.M.B!

    Bennett, yes, fat people do villify themselves. I’m glad you don’t. I’m not sure why you said what you did in your last sentence. What does being fat mean to you, that you wouldn’t want to be that way? (That’s a rhetorical question,I’m not expecting you to answer it here :-).)

    Claire, binge eating is far less harmful to the body than starving. Yes, it puts some strain on the body, but nothing compared to the ravages of starvation. Anorexia nervosa is a much more physically dangerous illness than binge eating disorder.

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