Tuesday, April 23, 2013

Binge Eating Disorder Awareness & Treatment

What is Binge Eating Disorder?  It's characterized as compulsive overeating while feeling powerless to stop.  This can happen alone or in social settings, and many don't recognize the behavior if it does not result in weight gain.  Binge eaters often eat when they are not hungry, not registering what they are eating or tasting their food. Those who suffer with binge eating disorder often struggle with feelings of guilt, disgust, or depression, worry about the consequences of their episodes, and beat themselves up for their lack of will power or allow it to negatively effect their self esteem. For more information about binge eating disorder, please reference the information available at http://www.helpguide.org/mental/binge_eating_disorder.htm

Behavioral traits of binge eating disorder: 

Inability to stop eating or control what you're eating
Rapidly eating large amounts of food
Eating even when you're full
Hiding or stockpiling food to eat later in secret
Eating normally around others, but gorging when you're alone
Eating continuously throughout the day with no planned mealtimes

Biological and psychological sciences are finally catching up on efforts to concentrate resources on research in binge eating disorder. Overshadowed by decades of focusing on anorexia and bulimia, we now see emerging data on the involvement of opioid, dopamine, and norepinephrine systems' influence on eating behaviors.  While treatment of dopamine and serotonin dysfunction may not completely resolve the influence of adipose tissue-derived hormones,  the improvements derived from healthy lifestyle changes supports the overall success of patients.  Exercise may lead to decrease anxiety and depression symptoms, improving mood and outlook on life. 

There are an increasing number of pharmaceuticals being approved to address binge eating disorder.  As a clinician, I have long resisted the approach to use prescription pharmaceutical to address behavioral issues, it can be a last resort that can make all the difference in the world. I allow snips of my personal struggle here on the blog sometimes, and here it is.  I started a new medication and realized that what I thought was "doing well" mentally, was not in fact doing well.  I realized I needed to address the issue, and I now feel better having discussed it with my doctor and the addition of a new medication. If you exhibit uncontrollable eating behaviors, there are several prescription options that may help you regain control.  These eating behaviors are compulsions, just as anxiety and depression are treated with anti-depressants, so can the dependency developed on food.  Talk to your doctor.  It is important to consider all factors related to the concerning behaviors and move forward with (self) care. 

In recent years, several medications used for other conditions have been approved to be prescribed to assist with weight loss.  Talk to your doctor about what you're currently on, and which of these medications might work for you.  The following are a few of the medications that have or will soon be approved to assist patients with weight loss: Paxil, Zoloft, Topamax, Adderall, and Vyvanse are leading the way.  Another in clinical trials is the drug, Nameda, a drug created to treat Alzheimer's. These are a few of many drugs being used to treat obesity, off-market from their creation. Some are approved by the FDA and some are not. 

Discuss with your doctor, GET A PRESCRIPTION, be responsible and journal the changes you notice in your mood, attitudes and behaviors.  Be responsible for your mental health by keeping a health journal.

I can stress how important it is to be mindful of your own body.  As you start any new regime, journalling can help you and your doctor identify what's working and what's not.  As you might begin to feel more control over your behavior, be empowered to make better choices - changing obsessions and compulsions comes from finding something else that is more health and productive to do with that time.  I find it helpful to stop, put whatever it is I'm eating down, and do something physical -- grab two water bottles and exercise -- build strength in regaining self control.  Record what you did, find new things to do!  I love personal training videos online, and I'm now collecting a catalog of quick videos to do when I need to distract myself from the binge. 

While all the research out there on binge eating disorder recognizes it as a disorder, insurance companies still struggle to accept the worth in covering behavioral issues with counseling. They are quick to prescribe, but psychiatric medication isn't always the best answer. Sometimes, it is simply accepting new realities and developing good self care routines. If you've had weight loss surgery, you now have the added stress of a tinier tummy.  The negative impacts on binging after weight loss surgery can result in dumping, discomfort, convulsions, stretching of your pouch: nevermind the damage it does to your teeth and esophagus.   Realize, it is actually possible to still attempt to eat large amounts of food for the tiny gastric fuel tank, but why?  You are going to cause more harm and be more uncomfortable than you should be.  This nervous, compulsive behavior must be addressed.  

When your surgeon's staff gave you the book and said, "Live by these rules," they weren't suggesting it.  They were requiring it.  If you find you are not living by those rules and you can not help but continue to do harmful things to your body, it might be time to seek further help in recovering from food addiction. We have to find out how to address the compulsive behavior - a WLS patient eating large amounts of food versus normal people eating large amounts are different amounts of food, but even with a smaller portion, we can exhibit the same behaviors - eating too fast, not chewing, making unhealthy food choices.  The key is mindfulness and behavior regulation. You are not in a competition with others to see how fast or much you can eat - it's not a race to the finish, it's a mindful allocation of nutrition. The rules change when you cut your gut, if behaviors stay the same your may push your chances to succeed further  from your reach. 

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