What Doesn’t Work in Treating BED
“People with BED may turn to weight management programs,” Matz said. In fact, about 30 percent of people who seek these interventions have BED. But food restrictions actually promote binge eating, she said.
Unfortunately, many professionals think weight loss is essential for recovery for individuals at higher weights. “This is a dangerous concept because the very behaviors that are prescribed for weight loss in those with BED are ‘diagnosed’ in eating disorders that do not involve higher weights,” Turner said.
“For example, individuals with BED are encouraged to count calories, limit food groups (sugar and fat particularly), and restrict food intake with no regard for hunger or satiety.”
The weight-loss approach only fuels feelings of failure and shame, perpetuating the cycle of “self-loathing, defeat, and further eating disorder behaviors,” said Turner, who described below what this feels like:
Having BED means living in a constant state of anxiety and yearning for something that is seemingly forever elusive. Imagine having a stomachache that never goes away. You get up daily and hope that today will be the day that your stomach feels normal again.
You are determined that you are going to find the cause, but each time you go to the doctor, she tells you that it is your fault you have this pain and that you just need to follow the very specific but easy directions she will provide to you. You go home and are determined to implement the doctor’s recommendations perfectly.
After some time, you realize that you are following the doctor’s orders to a “T,” but nothing has changed. Your stomach continues to hurt and you find you are more distressed than ever because you know that everyone around you is assuming that you are not following the recommendations. You are confident that you are the only one who is suffering like this and there is a major defect in your character that is propelling the stomach problems and your ability to control them.
You decide that you are going to isolate and keep everyone away because you do not deserve friends or love. You and your stomach pain are together forever — it’s all you have.
What Does Work for Treating BED
There are different treatment modalities, including cognitive-behavioral therapy, dialectical behavior therapy, internal family systems and trauma therapy, which have shown benefit for BED, Pershing said. The key is that the “client feels validated, taken seriously and respected.”
It’s important for treatment to target the emotional and behavioral aspects of BED, Matz said.
Clients learn the underlying emotional reasons they turn to food along with coping strategies to use when they’re emotionally distressed. They also learn to relinquish dieting and restrictive behaviors around food, which only perpetuate binge eating, she said.
It’s also important to have a multidisciplinary team, which ideally includes “a therapist, nutritionist, non-shaming physician, and a psychiatrist (particularly if there are co-morbid struggles, such as depression, anxiety, attention deficit hyperactivity disorder, obsessive compulsive disorder or substance abuse),” Lawson said.
She recommended seeing a registered dietitian who is well-versed in intuitive eating, which focuses on reconnecting to your body and your natural sense of hunger and fullness. This is in stark contrast, she said, to society’s belief that people with BED “can’t trust themselves, need to diet and rely on external numbers and messages.”
When you learn to trust your body, this trust spills over into other parts of your life. You become more confident in using your voice with others, setting boundaries and pursuing meaningful goals, Lawson said. “It all takes practice and none of it is easy, but food is the metaphor, not the problem, per se.”
People with BED commonly have physical issues, such as polycystic ovary syndrome (PCOS), hypothyroidism, low vitamin D, sleep apnea and inflammation, Lawson said. This is why having a physician on your team is helpful.
Health At Every Size
The Health At Every Size (HAES) framework is “increasingly recognized as an important component of treating BED,” Matz said. HAES focuses on “physical, emotional and spiritual health, and well-being rather than weight.”
Instead of using thinness as a path to health, happiness and success, HAES helps people with BED focus on the direct behaviors that foster all three, without the harmful consequences that come from pursuing weight loss, she said. (When people turn to diets to lose weight, they usually experience a boost in binge eating in the short term and weight gain in the long term, she added.)
Learn more about HAES here.
Finding Weight-Neutral Professionals
Lawson stressed the importance of advocating for yourself and shopping for your treatment team or program. She suggested conducting a brief phone interview to get an idea about a practitioner’s approach and understanding of BED. Ask how frequently they’ve worked with people who have BED and their views on weight loss for recovery, she said.
The key is to find professionals who can help you “focus on health and , rather than a goal of a specific weight or shape,” Pershing said. Also, clinicians must do their own work to heal any eating disorder or body image issues and biases about weight, she said.
If you can’t find a qualified clinician in your area, consider phone coaching, Matz said. (For instance, Ellen Shuman is an Emotional and Binge Eating Recovery Coach and has an online community for people with BED.)
Unfortunately, it’s also hard to find a non-shaming physician who will work on your health issues without focusing on weight loss as a remedy, Lawson said. She suggested asking around. Ask your therapist or nutritionist for names of doctors they like to work with. “Good reputations get around!”
When looking for a nutritionist who specializes in intuitive eating, start by searching online for “intuitive eating” and your location, Lawson said.