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Binge Eating Disorder- The cycle that continues to feed itself

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Binge Eating Disorder- The cycle that continues to feed itself

By: Annyck Besso, MS, RD

“I woke up the next morning, in distress, telling myself that I needed to have more control over my eating and then everything would be ok.”  This sentence or a similar one may sound familiar to several individuals. In a society that places a great deal of importance on weight loss and healthy eating, most people believe that the problem is related to their “lack of control," rather than something greater. 


What is Binge Eating Disorder?: 
Binge Eating Disorder (BED) was first recognized as an eating disorder in the DSM V, which was published in 2013 (APA, 2017). The diagnostic criteria for BED include, but are not limited to, the perception of loss of control while eating a larger quantity of foods than considered “normal” in a specific period of time in addition to extreme feelings of guilt and shame afterwards.  While diagnostic criteria for BED does not include compensation following a binge (e.g., vomiting, laxative use).

Figure 1- Common nutritional and emotional pattern that arises in many patients with BED

Figure 1- Common nutritional and emotional pattern that arises in many patients with BED

Restriction and the Binge Cycle:
People with BED often report that they try to make up for the behavior the following day through restrictive eating. This restrictive eating behavior can present itself in several forms, such as using food rules to eat “healthier,” avoiding certain foods or limiting oneself to a certain amount of calories. Sometimes just the idea that tomorrow will be different can keep the binge cycle going. 


The goal of your dietitian is to target restrictive eating, which normally perpetuates the cycle of feeling overly hungry then bingeing. Messages from social media often seem to condition us to believe that we can control what our bodies want and what they should look like. This battle can have dire consequences on our physical health, our mood and our emotional well-being.

 
Sandra’s Story

One example is a client who I will name Sandra. Sandra has always had a very difficult relationship with her body,  creating  food rules to try to control her weight and shape. For years, she attempted several diets, which worked initially, but then she ended up heavier and more demoralized after each one. She became confused as she was following her food rules and eating “healthy,”but was unable to lose any weight. Often, Sandra would come home from a long day of work and describe “zoning out” and eating whatever “forbidden foods” she could find over a period of an hour. When she would finally “snap out of it,” she was filled with feelings of guilt, shame and loathing for herself. She would reassure herself by saying that this was the last time and that she was going to get things under control the following day; she would get rid of all the junk food in her house and start anew. 


While this may seem like a good strategy, this is exactly what I would NOT recommend a client to do. Food rules typically perpetuate the cycle of loss of control(led?) eating. It is not a lack of control that leads to bingeing; it is instead primarily the emotional relationship people have with food and their body (amongst other reasons). 


Treatment Goals:
Stopping the cycle: after a binge, do not try to “get back on track”. 
Reconnecting with your body: try asking yourself how hungry you feel before a meal and how satisfied you feel after a meal. Try to let your body guide your food choices, rather than deciding what it should be having. 


Accepting all foods: there is no such thing as a good food or bad food. All foods are good and serve different purposes in our lives. Eliminating a food or food group simply makes it novel and more interesting which leads us to become preoccupied with the food. 


Eliminating mindless eating: if you eat at your desk, in front of the TV or in the car, this one is for you. Take time to just EAT and taste the food you’re putting in your mouth. It will feel much more satisfying. 


Please note the strategies above are NOT as simple as they may seem. If you can identify with this article or know someone who has an emotional relationship with food, it may be beneficial for them or for you to talk with a Registered Dietitian. Please don’t hesitate to reach out.  
 
 
References:
American Psychiatric Association. (2017). DSM History. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm on June 19th, 2017. 


Binge Eating Disorder Association. (2016). Characteristics of BED. Retrieved from https://bedaonline.com/understanding-binge-eating-disorder/symptoms/ on June 19th, 2017. 
 
 

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The Downside of Missed Periods

 
Sam Tryon, MS, RD

Sam Tryon, MS, RD

 

For some, the idea of not having their period might be cause for celebration.  No cramps, bloating or having to worry about keeping tampons or pads on hand; awesome right?! Unfortunately, not getting your period could be cause for concern.*

If you are 16 years old and have not yet started your period or if you have missed at least 3, you could be diagnosed with amenorrhea.1 Amenorrhea can be caused by a variety of factors including genetic abnormalities, gland problems, and certain gynecological conditions.1  Amenorrhea may also be due to what you eat and how active you are.

The roles of nutrition and activity

Low energy availability is one cause of amenorrhea.  Energy availability is a measure of the energy left for bodily functions (i.e. heart beating, digestion, breathing) after subtracting for energy used during exercise and other activities of daily living (i.e. vacuuming, walking to work, gardening).  Low energy availability means that there is not enough energy for body functions and exercise.

Low energy availability can be a result of not taking in enough fuel (A.K.A. not eating enough) and/or using too much energy for exercise.  Among other effects, the lack of energy left for bodily functions leads to decreased production of gonadotropin-releasing hormone, a hormone important in reproduction, which causes decreased production of estrogen and progesterone and disruption of the menstrual cycle.2

Amenorrhea and Bone Health

Both low energy availability and reproductive hormone changes have negative impacts on bone density.  In addition to not having the available energy and nutrients to maintain bone mass, lack of estrogen is associated with bone loss.  In a healthy body, our bones are constantly being broken down to release minerals like calcium and then rebuilt.  Without estrogen, there is increased breakdown without rebuilding which leads to decreased bone density.  This can progress to osteopenia and osteoporosis, putting a person at risk for fractures.  

Studies have found that up to 95% of people with Anorexia Nervosa have osteopenia and as many as 40% have the more severe osteoporosis.3 Weight gain is associated with return of menstruation and possible reversal of at least some bone loss.

Amenorrhea and bone loss are especially concerning in adolescents as peak bone mass is reached during this time. Bone loss from low energy availability during this stage of life may prevent patients from reaching a normal peak bone mass. This can put them at increased risk for fractures later in life.

Next Steps

If you have missed 3 or more periods, an appointment with your general physician can help to determine the cause of amenorrhea.  They may recommend a bone density test to look for possible bone loss.  

If the cause is found to be nutrition related, a dietitian can help you change your diet to make sure you are taking in enough energy to fuel your body. Amenorrhea can occur with or without disordered eating and a dietitian can also help assess for any disordered eating behaviors.  If disordered eating is a problem, a therapist may be added to the team to best tackle these concerns and get you back to the activities you love.  

*The content of this article is for informational purposes only and does not constitute medical advice, professional diagnosis, or treatment.  See your healthcare provider before making any healthcare decisions or with any questions you have regarding a medical condition.  

References:

  1. Amenorrhea. Eunice Kennedy Shriver National Institute for Child Health and Human Development; [accessed 2017 May 31]. https://www.nichd.nih.gov/health/topics/amenorrhea/Pages/default.aspx

  2. Mallinson, R and De Souza, M. Current perspectives on the etiology and manifestation of the “silent” component of the Female Athlete Triad. Int J Womens Health. 2014; 6: 451–467

  3. Mehler, P and MacKenzie, T. Treatment of Osteopenia and Osteoporosis in Anorexia Nervosa: A Systematic Review of the Literature. Int J Eat Disord. 2009; 42: 195-201

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NEDA Walk, Washington, DC: April 2, 2017

Alexa, Charlie (with Daria!), Joanna, and Rebecca 

Alexa, Charlie (with Daria!), Joanna, and Rebecca 

Alexa, Charlie (with Daria!), Joanna, and Rebecca

Alexa, Charlie (with Daria!), Joanna, and Rebecca

Evelyn and Alexa- Our WONDERFUL intake staff! 

Evelyn and Alexa- Our WONDERFUL intake staff! 

Rebecca and Alexa

Rebecca and Alexa

Evelyn and Joanna

Evelyn and Joanna

Joanna Marino, PhD giving a keynote speech at the DC NEDA walk!

Joanna Marino, PhD giving a keynote speech at the DC NEDA walk!

Alexa ;)

Alexa ;)

Our booth at the walk

Our booth at the walk

Joanna Marino, PhD giving a keynote speech at the NEDA walk

Joanna Marino, PhD giving a keynote speech at the NEDA walk

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