Overcoming Binge Eating
Overcoming Binge Eating was written in response to a large number of requests from people suffering from binge eating problems and many similar requests from professionals who specialise in the area. There was a need for a second edition as there have been many advances in our understanding of these problems since I originally wrote the book.
As before, the book is in two sections. Part One is designed to provide a reliable, engaging and comprehensive account of what is known about binge eating problems and their treatment. Part Two is different. It is a self-help programme for people who binge eat. Unlike many self-help programmes it has been extensively tested (15 clinical trials worldwide). It can be used on its own or with support from a professional.
Why does binge eating bring to mind someone that is overweight?
It is logical to assume that people who binge eat must be overweight. This is not the case. Repeated binge eating is seen across the three recognised eating disorders; namely anorexia nervosa (people with anorexia are underweight), bulimia nervosa (most people with bulimia have a normal weight); and binge eating disorder (many people with this "new" eating disorder are overweight). The explanation for this variability in weight lies in whether people are also dieting (and to what extent), making themselves sick or exercising a lot.
Why do people adopt bad eating habits in the first place?
This is not well understood, and it depends which eating disorder the person is suffering from. What is much better understood is why binge eating problems persist. A limited number of processes are involved and these can be reversed. Here are two particularly common ones. Some people's binges are triggered by eating a food that they are trying to avoid or breaking some other dietary rule - eating even a small amount of a "banned" food can lead certain people to feel that they have failed, and their response is to temporarily abandon their attempts to limit their eating. Another common trigger is the occurrence of unpleasant events or emotions. Many people who binge discover that binge eating takes their mind away from difficult thoughts and feelings, and bingeing can also be calming or even soothing, at least in the short-term. Fortunately, processes such as these can be overcome so long as they are directly addressed.
How interlinked is binge eating and body image issues?
Body image issues are common among people with binge eating problems. People with binge eating disorder are typically very dissatisfied with their appearance, and especially those who are overweight. They may avoid their body being seen by others and they may avoid seeing it themselves. In bulimia nervosa and anorexia nervosa, the body image issues are extreme and must be reversed if the person is to overcome their eating problem in a lasting way. These people tend to judge their entire self-worth in terms of their shape and weight and their ability to control them. This is referred to as the "overvaluation of shape and weight". It has many consequences including repeated body checking (which tends to magnify body shape), various forms of body avoidance, and frequent and profound feelings of fatness. All this is described in the book.
Please tell us how a diet can have an impact on our relationship with food?
Common-or-garden dieting is not harmful. It is extreme and persistent dieting that has adverse effects. This is the type of dieting seen in anorexia nervosa and bulimia nervosa. It results in people's lives being dominated by their attempts to restrict their food intake; it can lead to marked under-eating and other nutritional problems; it makes some people prone to binge (as I mentioned earlier); and it interferes with eating with others – indeed, in extreme cases this is impossible.
Why is binge eating so detrimental to someone even if they are not overweight?
Binge eating on its own is not "so detrimental" unless it is very frequent or the binges are extremely large. What is detrimental is its effects on people's self-respect and self-esteem. Repeatedly losing control over eating engenders feelings of shame and self-disgust. It makes people very self-critical.
What are the most common foods that we binge on?
This is interesting. People tend to binge on the foods that they are attempting to avoid. I have noticed over my career that the composition of binges has changed over time according to what diet is currently in fashion and therefore what foods are avoided.
There are important implications here. If one is prone to binge, it is important not to have any totally banned foods or, indeed, any strict rules about eating.
What are the types of binge eating problems?
Binge eating is a problem if it is interfering with a person physically, emotionally or socially. As I mentioned earlier, it occurs in all three of the recognised eating disorders. It is the main feature of bulimia nervosa and binge eating disorder, and it is present in subgroup of people with anorexia nervosa.
How to overcome a binge eating problem depends upon what processes are causing it to persist. These differ from person to person so the starting point is working out why one's binges are happening. Again, all this is explained in the book.
Please can you tell us a bit about your professional background?
I am a psychiatrist and I trained in Oxford and then Edinburgh. I have spent my career in clinical research. I have two areas of expertise. The first is in the development and evaluation of psychological treatments, and the second is in the nature and treatment of eating problems. I have been extremely fortunate in having been funded by the Wellcome Trust who have supported me on a continuous basis for almost 30 years. All the leading evidence-based treatments for adults with eating problems were developed by my team in Oxford and they have been subsequently endorsed by NICE (the National Institute for Health and Clinical Excellence). My career and our work are described in more detail on our website - credo–oxford.com.
Overcoming Binge Eating by Dr Christopher Fairburn is out now, published by Guildford Press, paperback, £12.99