Food Addiction: Overcoming Binge Eating with Treatment - Dr. Ralph Carson
In my previous two blog posts, I have explained the basic facts about food addiction and reviewed the scientific research on food addiction. In today’s blog, I explain how to treat food addiction, or as I prefer to call it, treatment of compulsive eating behavior.
All compulsive eaters can learn to manage their behavior with the help of psychotherapy, medical treatment (if necessary), lifestyle management and nutritional intervention.
At ERC, our primary focus at the start of treatment is to stop loss of control eating. Weight loss is not the goal of treatment although we do try to achieve weight stabilization — and some patients will lose weight over time. But, our primary focus is not on weight loss.
We want our patients to understand this: loss of control over food is manageable.
Recovery from binge eating disorder is possible when one learns how to manage stress, incorporate new coping skills into their lives, and change their behavior.
Overcoming food addiction
Before treatment begins, it will be important to determine if you are compulsively overeating, binge eating, emotionally overeating, night eating, or if you have purging behaviors. There is a difference. For example, a compulsive eater experiences a pleasurable and self-soothing response to food. One can have binge eating disorder and be both a compulsive and emotional eater. Yet, another individual may be a binge eater but not a compulsive or emotional eater.
To determine this, we do a comprehensive assessment with each patient. Structured clinical interviews we use may include The Yale Food Addiction Scale (YFAS), developed to recognize those with an abnormal desire for specific foods (Gearhardt, ’08). The YFAS is considered the gold standard in assessing one’s compulsive eating habits.
Before explaining current compulsive eating treatment approaches at Eating Recovery Center, I want to emphasize that there is no one type of overeating treatment that will work for everyone. And, treatment approaches will differ from location to location and between clinical professionals.
Overcoming binge eating
Unlike other addictions, one can’t completely abstain from the thing that they are “addicted” to (food). But, when treating binge eating, abstinence to specific non-essential food items can be useful for a trial period. After the assessment, patients may be initially asked to temporarily abstain from eating their trigger or binge foods.
For many patients with binge eating disorder, however, long-term abstinence is not generally recommended. Any deprivation or rule-governed behavior could potentially heighten anxiety and increase preoccupation with food for many individuals.
When we talk about overcoming food addiction, we talk about moderation in food choices. Moderation may seem difficult — but patients can be trained and supported to recognize that it is possible and works. As an example, one could say to themselves, “it’s OK to have half this dessert; I can eat less than other people; I will demonstrate control; I will switch to only having sweets twice a week; I will choose to have highly palatable foods when I want them.”
We also talk with patients about replacing binge eating with pleasurable and constructive behaviors (socializing, hobbies, reading, games etc.).
Treatment for binge eating disorder
Ideally, someone with compulsive eating habits works with a therapist that is certified as an eating disorders professional and experienced in the binge eating disorder field.
Therapy for compulsive eating can help an individual with numerous personal issues. Those hoping to overcome binge eating may be struggling with one or more of the following issues:
- Lack of self-compassion (filled with guilt and unable to forgive oneself)
- Attachment issues
- History of trauma
- Poor emotional regulation
With counseling, one can learn how to manage lapses and relapses and address interpersonal stressors — factors that can set off binges even after treatment. This obviously creates better long-term outcomes than just eliminating certain trigger foods.
At ERC, we incorporate a number of different types of therapy as we focus on treatment for binge eating disorder:
- Acceptance and commitment therapy (ACT) — ACT teaches us how to create a full and meaningful life in line with our values, changing the things we are capable of changing and accepting those things that we cannot change.
- Cognitive behavioral therapy (CBT) — CBT teaches us how to challenge dysfunctional behaviors and substitute them with constructive modification–habit change. Examples of this in treatment may include: grocery shopping with a list, and trying a normalized amount of a trigger foods in a pre-committed, public setting”. Many times, binge or trigger foods are inappropriately feared and given entirely too much power in their ability to trigger future binge eating episodes.
- Dialectical behavioral therapy (DBT) — Traditional DBT focuses on concrete behavioral skills in four domains: emotional regulation, interpersonal effectiveness, distress tolerance, and mindfulness.
- Exposure Response Prevention (ERP) — ERP helps an individual find out what their fears are, sit with their fears, find out that their fears are fleeting and not as intolerable as initially perceived. ERP teaches you that you can tolerate cravings and urges, building confidence that you do not have to act on them. This is a process that takes practice and patience. This therapeutic CBT practice allows an individual to act out or sit with their fears and realize in doing so those fears will dissipate and be controllable.
- Mindfulness-based practice — Mindfulness increases our ability to listen to ourselves think, switch from reactive to pro-active and work towards self-determined moderation. Most importantly it means staying in the present, not projecting into the future, not reflecting on the past and remaining free of judgment.
- Movement therapy — Finding movement you enjoy can help you increase physical activity throughout the day — and stick with an active life-style for the long-term.
- Sleep Hygiene — In treatment, we teach the importance of sleep. Getting 7 to 9 hours of quality sleep sustains the body’s internal clocks that orchestrate the drive to eat.
In treatment for binge eating disorder, patients can learn to see progress based on moving forward in consistent increments:
- A half-hour binge is not the same as a three-hour binge.
- A three-hundred-calorie binge is an improvement over a three-thousand-calorie binge.
- Giving yourself permission to eat cheesecake in the company of others is not the same as sneaking a quart of ice cream into the basement and eating it until it is empty — even though you are full.
The importance of support in overcoming binge eating
As one learns how to stop overeating and good habits are developed, it is important to have a strong long-term support system. This includes peer support. As you develop your support team, find people you can process things with and confide in. Your peer group support is not just made up of some acquaintances — proper peer group support includes individuals with similar compulsive tendencies that understand what you are going through.
Group therapy for compulsive eating is incredibly beneficial, supporting you in a number of ways, including:
- Providing accountability in treatment
- Increasing your trust of others and in your self
- Validating your experiences in therapy
- Allowing you to practice being honest and authentic in a safe space
- Healing and reducing any feelings of guilt and shame
In addition to peer group support or group therapy, patients would do well to find and maintain at least three other sources of support, such as the following:
1. Someone who is also in treatment and recovery-savvy regarding compulsive eating
2. A therapist, doctor or dietitian that understands BED recovery
3. Two to three people that care about you (friends or family members)
Medications for food addiction
Medications do not cure binge eating, but they can effectively serve to act as a catalyst for healing (speeding up the progress). They can mitigate symptoms and provide insight into how recovery would feel. If recommended, these medications can be administered by medical professionals who have experience with their outcomes and who are integrated with the treatment team.
Surgery for food addiction
Surgery is a popular option for those struggling with excessive weight gain resulting from food addiction. Sometimes, surgery is presented as the only hope for those struggling with weight issues that threaten their health. But, there is a big problem that can follow even the most successful surgery and weight loss: failure or relapse is a real possibility.
Following surgery, the dysfunctional thinking that has led to the compulsive eating habits may still remain.
Patients must accept that food compulsivity is a chronic debilitating disorder that may be accompanied by co-occurring psychological disorders. Surgery rarely addresses these underlying causes and challenges. Too often people opt for changing the body without changing the mind first. This is why therapy is such a crucial component to helping people overcome food addiction.
What defines success in treating food addiction?
After treatment, ideally, a patient will have a healthier relationship with food and increased feelings of self-love and self-acceptance. So, how does one know if they are “cured” of food addiction? Some may argue that one or more of the following factors will be the most important in determining whether treatment was successful or not:
- Maintaining or losing weight
- Being of optimal health
- Reducing medical costs
- Repairing the brain (rewiring neural pathways and establishing alternative brain circuits to create new behavioral responses to stressful events and emotional upheaval)
- Improving quality of life
- Establishing a healthier relationship with food and making healthier food choices
- Increasing activity level
- Becoming more emotionally stable and feeling better about one’s self
- Deepening personal relationships
Binge eating disorder is real and is just now coming into prominence in the eating disorder treatment arena. As a result, researchers and practitioners continue to collaborate on what methods are best suited to produce the best long terms outcomes.
Recovery is a life-long process that focuses on progress — not perfection.
Ralph Carson, RD, PhD, is a nutritionist and exercise physiologist with over 40 years of experience. He is currently Vice President of Science and Innovation for Eating Recovery Centers (ERC). Dr. Carson is an active member on the board of the International Association of Eating Disorder Professionals (iaedp) and author of The Brain Fix: What’s the Matter with Your Gray Matter.
Clinical review by Mara Gustafson, PhD of Eating Recovery Center, Illinois.