Modern Metabolic Health with Dr. Lindsay Ogle, MD

Understanding Binge Eating Disorder

• Lindsay Ogle, MD

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We unpack how to recognize binge eating disorder and why it differs from overeating or emotional eating. We share a compassionate, team-based roadmap that blends therapy, nutrition, and medication options to improve metabolic and mental health.

• Medical definition of binge eating clarified
• Distinction between holiday overeating, emotional eating, and binge episodes
• Prevalence and why it often goes undiagnosed at any weight
• Genetic, psychological, and environmental contributors
• Myths debunked about willpower, weight, and gender
• Complications including depression, anxiety, and metabolic disease
• Treatment model using CBT, dietitian support, and non-restrictive plans
• FDA-approved and off-label medications, side effects, and monitoring
• Long-term goals focused on remission and relapse prevention

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SPEAKER_00:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Olde, board certified family medicine and obesity medicine physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatment. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. And even though it is very common, it often goes undiagnosed and therefore untreated. And millions of people are suffering because of this. Today I'm going to talk about this common condition, how it is diagnosed, and how it can be managed so people can be treated and live healthier and better lives. So, just how common is binge eating disorder? Some studies estimate that 2 to 3% of the population meet criteria for binge eating disorder. Symptoms of binge eating disorder can overlap with emotional eating and just overeating in general. In medicine, we use the DSM criteria to diagnose mental health conditions and eating disorders like binge eating syndrome. And currently we are following the DSM 5 criteria, and there are three parts of this criteria for binge eating disorder. The first is that binge episodes have to occur at least once a week for a period of at least three months. Episodes have to accompany three of the following to be considered a binge episode. One is eating much more rapidly than normal. Two is eating to the point of feeling uncomfortably full. Three, eating large amounts when not physiologically hungry. So eating for a reason other than hunger. And then five, feeling guilty or embarrassed or disgusted after these episodes. Binge eating episodes are not accompanied by compensatory methods such as over-exercising or restricting or purging afterwards. If that is happening, that would classify someone as having bulimia. As I mentioned, there can be some overlap or perceived overlap of binge eating disorder with emotional eating or just overeating. So, for an example, say during the holidays, we just went through Thanksgiving and Christmas and New Year's, and oftentimes we celebrate those occasions with getting together with friends and family, holiday parties. Often there is a lot of food involved, and many times people eat more than they typically do during this holiday period. But this is done in the setting of that celebration, and oftentimes people may feel uncomfortably full, maybe they even feel a little bit guilty, but it's not an ongoing habitual behavior. It is typically limited to that period of time. Another example is emotional eating. So many of us occasionally, when we're under stress or we're feeling down, or maybe we're celebrating, we turn to food to help cope with those emotions. And a lot of that is cultural. We often, you know, allow kids to celebrate getting good grades or an accomplishment, say winning a sporting event by taking them for pizza or ice cream. And again, while that is eating not when physiologically hungry, this does not classify as binge eating disorder because it does not meet that criteria that was that we reviewed earlier. Binge eating disorder is multifactorial in its underlying cause, meaning that there are a lot of factors that contribute to the development. It is thought to have a genetic underlying component. So a family history of an eating disorder can increase your risk of having binge eating disorder, but it does not mean that you will definitely have this condition. There are many psychological factors that can lead to the development of binge eating disorder. And there are often comorbid mental health conditions like depression, anxiety, PTSD, history of trauma. And there are definitely environmental influences, whether that is cultural or experiences in childhood or habits that develop with routines at school or at home. These can all play a part in the development of binge eating disorder. I want to go through three common myths of binge eating disorder. The first is that this condition is just a lack of willpower. And that is absolutely not the case. Binge eating disorder is a complex disorder that involves biologic, psychologic, and environmental factors. Anyone that I've talked to that has binge eating disorder, if they could stop and control their condition, they would do it. It can be difficult to treat and often requires a team-based approach to manage this condition. Myth number two, everyone with binge eating disorder is overweight. That is not the case. Binge eating disorder can affect anybody and any weight category. Many times these patients have a normal weight and therefore it often goes undiagnosed from their provider. These patients appear healthy and so it is presumed that they are eating in a healthy manner. Patients can be overweight, but they don't have to to have a binge eating disorder. And myth number three is that binge eating disorder affects women only. While it is more common in women, it can affect men as well. It is important to diagnose and treat binge eating disorder because if it goes undiagnosed, it can lead to several complications. This can range from the development of depression and anxiety to metabolic conditions like diabetes, PCOS, cardiovascular disease. The earlier it is identified and treated, the better. As I mentioned before, treatment is multifactorial and often team-based. There is a component of cognitive behavioral therapy. Working with a coach or a psychologist is extremely helpful in binge eating disorder. Also, working with a dietician who specializes in eating disorders is extremely helpful. We want to avoid restrictive diets and binge eating disorder because restriction can lead to binging. And so we want to focus on having enough food early on in the day because binges tend to happen in the evening time and making sure that we're eating feeling foods like protein and fiber. And so a dietitian will help focus on those foods, help you plan meals ahead of time. And then with that cognitive behavioral therapy that you're using with your therapist and your coach, the combination of that along with the dietitian plan is extremely powerful. If those approaches are not enough, there are FDA-approved medications that can help treat binge eating disorder. The first is Les dexamphetamine, which is generic for bivands. This is most commonly prescribed for ADHD, but is FDA approved for binge eating disorder. This is a controlled substance, it's a stimulant, and so not everybody can tolerate these medications. Common side effects include increased anxiety, insomnia, increased heart rate or palpitations. It can lead to weight loss because of the decreased appetite that comes along with it. So weight is something that we definitely want to monitor while on this medication. Certraline, which is generic for Zolof, is an SSRI that we sometimes also use to treat depression and anxiety. This is also FDA approved for the treatment of binge eating disorder and is extremely helpful if somebody also has depression and anxiety because it can treat those as well. Some off-label medications include taupiramates and naltrexone, and the GLP1 agonist are newer medications like semaglutide and trazepatide are being studied for this indication. It's important to speak with a doctor who has experience in treating binge eating disorder, and this can be a primary care doctor like a family physician or an obesity medicine physician or an eating disorder specialist or psychiatrist who can really help you navigate what option may be the best for you. Some people may be able to effectively cure their binge eating disorder with the above treatments, but for most people this is a lifelong condition, and with the treatment it can be improved or put into remission, or they have less frequent or less severe binges. And that is really the goal long term. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.