Binge eating disorder (BED) is a serious mental health condition characterised by frequent and excessive eating episodes, that is, consumption of large amounts of food in a shorter period of time, typically <2 hours, which is often accompanied by feelings of loss of control and distress leading to impairment in daily life.
While it’s a prevalent issue in many parts of the world, understanding and addressing BED in India presents unique challenges due to cultural factors and limited awareness.
In India, eating disorders are often stigmatised and seen primarily as physical illness rather than psychiatric illness. According to a 2023 review paper in the Acta Neuropsychologica journal, topics like eating habits and body dissatisfaction are not studied in the Indian context. This cultural perspective can hinder early detection and appropriate treatment. Additionally, the increasing influence of social media on adolescents has contributed to a rise in body dissatisfaction and disordered eating behaviours.
Despite limited research on eating disorders in India, recent studies have highlighted the growing prevalence, particularly among adolescents. Factors such as age, gender, socioeconomic status, family history, and environmental influences have been identified as risk factors for developing BED.
This article aims to shed light on binge eating disorder in India, discussing its prevalence, causes, symptoms, and potential treatment approaches. Let us look into it in detail.
What is a binge eating disorder?
Binge eating disorder (BED) is a serious mental health condition characterised by frequent episodes of excessive eating, often accompanied by feelings of guilt or shame.
Individuals with BED struggle to control their eating, even when they’re full, and often binge eat at least once a week for several months. Binge eating disorder was first identified by psychiatrist Albert Stunkard in 1959. In the paper titled “Eating Patterns and Obesity,” Albert describes an eating pattern associated with consuming large amounts of food at irregular intervals.
According to the American Psychiatric Association, EDs are associated with distressing thoughts and emotions and can affect people of all body types. Several types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder (AFRID), other specified feeding and eating disorders, and pica and rumination disorder.
While it’s often compared to bulimia nervosa, BED differs in that individuals with BED typically do not engage in purging or other compensatory behaviours after binge eating.
The prevalence of eating disorders, including BED, has been on the rise globally. According to a study published in the American Journal of Clinical Nutrition, the global rate doubled from 3.4% to 7.8% between 2000 and 2018.
Now that we have understood what binge-eating disorder is, let us look at how we can identify if it is actually BED or not.
What are the signs and symptoms of a binge eating disorder?
People with binge-eating disorder may have the following signs or symptoms:.
- Eating more food regularly than most people.
- Eating beyond the point of discomfort and satisfaction.
- Eating too fast to notice how much you’re eating or how it feels.
- Eating large amounts of food when you’re not hungry or after recently finishing a meal.
- Eating in response to emotional stress (emotional eating).
- Avoiding social eating and eating in secret.
- Hoarding food in hidden places to access later.
- Obsessive thinking about food and specific food cravings.
- Frequent dieting, which may cause weight fluctuations or no weight loss.
- Guilt, remorse, shame, and self-esteem issues related to binge eating.
People with Binge Eating Disorder do not attempt to compensate for their binge eating and are likely not to go for dietary restrictions, fasting, exercise, or self-induced vomiting.
What causes the urge to binge-eat?
There can be various reasons for binge eating, including:
- Genetics: BED can run into families. If any of your family members have it, you are more likely to do so. Your genes may affect the brain functions that control appetite or mood. Though your brain may have the odds, other things trigger BED. Research shows that a low level of serotonin (a natural body chemical that controls your mood) plays a role in compulsive eating.
- Depression: If you are suffering from depression, you are more likely to suffer from a binge eating disorder. Other factors, such as loneliness or trouble managing emotions, can also contribute to binge eating.
- Low self-esteem: People with low self-esteem might not be happy with the way they look. This gives them a negative body image or causes body dissatisfaction. This low self-esteem can cause binge eating. Further, with the feeling of guilt or shame, they overeat.
- Stress and anxiety: During stress, the body releases cortisol. If cortisol levels are elevated for a long period of time, such as during repeated and constant stressors, this can lead to increased food consumption. So, people who are binge eaters are more likely to overeat when they are stressed or anxious.
Who is at risk of binge-eating disorder?
People of any age group or income level can be at risk for binge eating, though it is most prevalent in women. Let us look at some data on binge eating.
A new study revealed that women with PCOS may have a higher risk of developing BED. This study was led by Laura Cooney, an associate professor at the University of Wisconsin. She is the first to confirm the increased risk of specific eating disorders among women with PCOS.
A finding from the University of Houston Department of Health and Human Performance revealed a significant association between a lower number of positive childhood experiences, a higher binge-eating disorder and low intuitive eating. Positive childhood experiences include positive interactions with parents and caregivers, feelings of relational and internal safety, enjoyment of a pleasurable and predictable quality of life, and support from sources outside the family. This further indicates the need for a supportive environment.
Another study examining eating disorders (EDs) in Indian adolescents found that EDs are present in India and affect both boys and girls. This concludes that individuals of every age, gender, profession, or income level might get affected by Binge eating disorder.
Binge eating and Medical Professionals
A study conducted in 2017 among medical students at the American University of Beirut in Lebanon (AUB) aimed to evaluate the prevalence and possible factors associated with eating disorders. Here are the key findings:
- Eating disorders are common among Lebanese medical students, with approximately 17–19% showing signs of at-risk behaviour.
- Females are more likely to be diagnosed with eating disorders than men.
- Despite the high prevalence, many students with eating disorders do not seek professional help due to stigma and other factors.
The study highlights the importance of implementing prevention programs and providing adequate support for medical students struggling with eating disorders.
Another study conducted on UK doctors shows that occupational distress and job factors increase the odds of doctors using substances, having sleep problems, presenting with frequent symptoms of ill health and binge-eating.
What risk factors are associated with binge-eating disorders?
Social and developmental risk factors include the following:
- Conduct problems
- Childhood obesity
- Family weight concerns and eating problems
- Parenting problems and family conflict
- Parental psychopathology
- Physical or sexual abuse
- Childhood loss of control eating, which may be considered a prodrome in adults as well.
Psychological risk factors associated with binge eating disorder include Premorbid negative affectivity and Perfectionism.
Biological risk factors include:
- Substance abuse: The excessive and harmful use of alcohol or drugs.
- DRD2 polymorphisms: Genetic variations in the dopamine receptor D2 gene that may influence how sensitive a person is to rewards.
- OPRM1 polymorphisms: Genetic variations in the mu-opioid receptor gene that may also influence reward sensitivity.
- 5-HTT polymorphisms: Genetic variations in the serotonin transporter gene that have mixed evidence for their involvement in binge eating.
- MC4R polymorphisms: Genetic variations in the melanocortin receptor 4 gene that also have mixed evidence for their involvement in binge eating.
- Alterations in Gut Microbiome: Changes in the balance of bacteria in the digestive system.
- Alterations in Cortical Connectivity: Changes in how different areas of the brain communicate with each other.
Consequences of Binge Eating
The long-term consequences of binge eating include:
- Obesity
- High blood pressure
- Heart disease
- Diabetes
- Other obesity-related diseases
- Stress and anxiety
- Insomnia
- Depression or even suicidal thoughts
- Substance use disorder (SUD)
- Body dysmorphic disorder (BDD).
Tips to recover from a binge eating disorder
- Develop a healthy relationship with food. Recovery from any addiction is challenging, especially when it comes to food or eating. You cannot completely avoid or replace it. But you can develop a healthy relationship with your food by following healthy choices and prioritising your nutritional needs over your emotional needs.
- Break the vicious cycle of binge eating. The cycle includes feeling deprived, having an overwhelming urge to eat, binge eating, feeling out of control or ashamed, and again eating to cover that up.
- Avoid junk food. It is more tempting, but it is not a healthy choice. Replace your unhealthy junk food with fruits or vegetables.
- Make a schedule and eat regularly. Do not wait until you are starving, as it might lead to binge eating later.
- Do not avoid healthy fat. It is a saying that all fat is bad but this is not so. Include healthy fats in your diet that will make you feel full for a long period of time. You can check the difference between good fat and bad fat and opt for better and healthier choices.
- Getting bored and eating unhealthy foods is very common. Identify such a pattern. Take a moment to find out what triggered the urge. Write down what you ate when you were stressed, how you felt after eating, and whether it could be avoided. Now that you have identified the pattern, replace that unhealthy snacking with a walk, reading, or taking time for your hobby.
- Practice mindful eating. Slow down, eat less, and enjoy the taste.
- Avoid eating without any distractions like watching television or reading.
- You can support yourself with healthy lifestyle habits such as exercising regularly, getting enough sleep, indulging yourself in social activities and connecting with others, and practicing relaxation strategies to manage stress.
Tips to help someone with binge eating
- The longer it takes to diagnose eating disorders, the more challenging they become to treat. Encourage your loved ones to seek help and get proper treatment.
- Don’t be judgmental while listening to them. Make sure you support them.
- Avoid insulting them and lecturing them about their eating habits. They already feel troubled, and making them feel anxious will overstress them, which ultimately will make the situation worse.
- Help them make healthier choices by getting a good routine.
Expert Opinion
Being a professional psychiatrist, encountering people with Binge eating disorder is not uncommon in India. Despite being surrounded by a stigma of eating disorders, it is difficult to encourage people to get professional help. BED can often require extensive psychiatric treatment, including medications like SSRIs and psychotherapy like cognitive behavioural therapy.
EDs are often associated with co-morbid psychiatric disorders like obsessive-compulsive disorders (OCD), depression, and anxiety disorders, which require urgent management. Therefore, it is necessary to do a detailed evaluation of the BED as early as possible and the appropriate intervention required to prevent long-term consequences and improve the quality of life.
Takeaway
Since binge eaters often try to hide their eating habits and eat in secret, it is difficult for their family and friends to identify the warning signs. If you notice your loved one eating a lot more than usual, hiding food, or throwing away empty food wrappers, they might have a problem with overeating.
Talk to them about your concerns, even if they get upset at first. They might be embarrassed or ashamed, but they may also appreciate your help. Remember, you can’t force them to get better, but you can be there for them and offer your support.
In conclusion, by raising awareness and understanding of this condition, we can work towards reducing stigma, improving early detection, and providing effective support for individuals struggling with BED in India.
Dr. Riya Gupta (MBBS, MD, DNB)
Dr. Riya is an experienced and empathetic Psychiatrist, who brings a deep commitment to understanding and treating mental health disorders with compassion and expertise. Her approach is characterised by a patient-centred focus, where she prioritizes developing personalized treatment plans that cater to each individual's unique needs and circumstances.
Dr. Riya Gupta (MBBS, MD, DNB)
Dr. Riya is an experienced and empathetic Psychiatrist, who brings a deep commitment to understanding and treating mental health disorders with compassion and expertise. Her approach is characterised by a patient-centred focus, where she prioritizes developing personalized treatment plans that cater to each individual's unique needs and circumstances.
