Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states
An important article appeared in the February 20 Science Section of the New York Times about treatment for binge eating. Some of the most prominent psychiatrists in the field of eating disorders were interviewed for the article including Dr. Katherine Halmi, director of the eating disorder program at the Westchester division of New York Presbyterian Hospital. The information in the article is important because it is useful for anyone who is struggling with weight issues whether or not they binge. Many of the things discussed in the article can be tried by anyone who wants to gain control if their eating life, especially those who over eat with or without bingeing.
Excuses for Not Eating:
One of the things I have noticed in working with people over the years is that too many of us have disordered and disorganized eating habits. Dr. Halmi and other distinguished psychiatrists in the field mention the importance of developing a meal plan if you are someone who binges. This meal plan must include eating three regular meals each day with a snack in between. Many of the people I have worked with have thousands of excuses for why they cannot eat breakfast or lunch. If they do have lunch it is in the form of grabbing a cookie or chips while they are "on the run." Very often these people eat nothing until the late afternoon or early evening and are famished by that time. These are the perfect conditions that result in binge eating or over eating and gaining weight.
How To Eat:
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The simple fact is that people must sit down and have a breakfast, lunch and dinner each day and at a fixed time. Eating while "running" to work or being "on the run" is a very unsatisfying way to eat. Ultimately, everyone who does this runs the risk of over eating or bingeing and gaining weight.
In addition to three meals per day Dr. Halmi points out that those who binge or are in recovery should not go for more than four hours without eating. In my opinion, this is important for anyone who is over weight or obese. Waiting too long between meals increase hunger and the likelihood of over eating later during the day or evening. This is why it is important for those who binge to have a snack between meals and not allow hungry feelings to mount.
One young eating disordered person recently told me, in reference to her having many hours between meals, that she enjoys the challenge of feeling hungry and not eating because she feels in control when she does not give in to the impulse to eat. However, she pays the price in the evening when she binges. What is interesting when she binges is that she does not feel hungry and cannot understand why she eats so much? The answer is that, in the complex neurological hormonal relationship between brain and stomach, the wish to eat demands satisfaction even when the individual is not aware of hunger. This is also why diets fail.
What to Eat:
Dr. Halmi also recommends that, as part of gain control over one’s eating life, that the daily diet includes things that people enjoy eating. If there is a wish for a piece of candy at work, then it is alright to have a small piece rather than denying one’s self. The problem for eating disordered people is that if they have that one piece of candy or bit of ice cream they then tell themselves that they have lost control, have failed and might as well eat all the candy and ice cream. This is not true and, rather than open the flood gates to bingeing, just allow one’s that small indulgence and go no further.
For those who cannot get control of their eating it is important to seek professional help. All the experts cited in the article agreed that help is available in the form of Cognitive-Behavioral therapy with or without medication, depending on the individual case. In addition, treatment will include meal plans, perhaps with the help of a nutritionist who works with the therapist and psychiatrist with careful monitoring of everything eaten and a record of thoughts during each eating session.
Of special note in the article is that most of the people with binge eating disorder and weight problems have great difficulty coping with their feelings of anxiety and depression. One expert pointed out that people quickly discover that over-eating and bingeing temporarily relieves anxiety and depression. In this way, the bingeing behavior becomes positively reinforced. It is a well know fact that most of us will sometimes over indulge in over-eating of "comfort foods." What is really meant by this is that eating feels incredibly soothing, much like what is experienced in any addiction. This is why Cognitive-Behavioral Therapy is an excellent tool to help people test these ways of thinking and replace them with more realistic thoughts and plans about how to handle stressful situations.
The New York Times is available online at: http://www.nytimes.com
Then do a search for February 20, 2007. The title of the article is: "Out of Control: A True Story of Binge Eating" by Jane E. Brody.
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