WebMD Medical News
Daniel J. DeNoon
Louise Chang, MD
Feb. 1, 2007 -- Binge eating disrupts the lives of 3.5% of U.S. women and 2%
of U.S. men for an average of eight years, a new survey shows.
That makes binge eating more widespread than the other two eating disorders,
anorexia nervosa and bulimia nervosa.
Anorexia affects nearly 1% of women and 0.3% of men, the study finds;
bulimia affects 1.5% of women and 0.5% of men.
Yet binge eating disorder isn't currently an official psychiatric
The new finding is likely to change that, say researchers James I. Hudson,
MD, ScD; Harrison Pope Jr., MD; and colleagues at Harvard University and McLean
"These data suggest that binge eating disorder is common -- more common
than the other two eating disorders combined. It is associated with obesity,
and it is persistent," Hudson said in a news conference held to announce
For the study, Hudson and colleagues asked detailed questions about eating
in face-to-face interviews from 2001 to 2003, with a nationally representative
sample of about 3,000 U.S. adults.
They report their findings in the Feb. 1 issue of Biological
No, you don't have binge eating disorder if you mindlessly down a dozen hot
wings, a burger, and a big bag of chips during the Super Bowl. That is
unhealthy overeating, not an eating disorder.
In binge eating, at least twice a week, at times they don't choose -- and
despite feelings of distress and disgust -- binge eaters uncontrollably gorge
themselves on massive quantities of food.
Pope says after interviewing hundreds of people with binge eating disorder
that he heard the same kind of story over and over again.
"Once they start, they go over the cliff. Even though they feel guilty
and disgusted, they can't shut it off," Pope said at the news
"The typical patient tells me, 'I have a normal dinner, and then at 9
o'clock at night I think, well, I'll go down to the kitchen and eat just a
handful of potato chips or a scoop of ice cream. But I just can't stop. I eat
all this sweet stuff, then I want something salty, and before I know it, I have
finished everything in the kitchen,'" Pope recounts.
Food beckons like an irresistible neon sign to a person with binge eating
disorder, says Cynthia M. Bulik, PhD, director of the eating disorders program
at the University of North Carolina at Chapel Hill. Bulik was not involved in
the survey but participated in the news conference.
"A lot of these people will say they are unable to inhibit the urge once
the thought of eating comes into their minds," Bulik said.
"They say that food will beckon to them like neon signs. They are unable
to inhibit the urge to eat once that neon sign goes on. And there is this sense
of distress that occurs when the binge eating occurs," Bulik said.
What causes eating disorders? Some people clearly are at higher risk than
There's strong evidence that certain combinations of genes predispose people
to anorexia and bulimia.
Many people appear to have a genetic predisposition to binge eating
But it's not a simple matter of inheriting an eating-disorder gene.
Genetics, family experience, and environmental triggers all play their
Also, today, there is what Bulik calls a "cultural barrage" of
enticements to binge.
"Eating disorders are classic examples of gene/environment
interactions," Bulik said. "It is more a question of how genetically
liable you are. Some people are more sensitive to this cultural barrage.
"Some can go to the food court in the mall, and they won't even smell
the food or read the signs because they have low genetic liability," she
says. "Whereas for someone with high genetic liability, the food court is a
One woman Bulik treated for binge eating disorder would go to a particular
fast-food restaurant's drive-through window. She'd buy her favorite foods and
uncontrollably gobble them while driving, putting herself and others at
As the woman got better, Bulik gave her an assignment: Go to the
drive-through window, order the food, but get all the way home before
"But on that day they added these hot cinnamon buns to the menu,"
Bulik recalled. "She bought six of them, and could not inhibit the urge to
eat them all in the car. So all the planning in the world can be undone by a
sudden signal that triggers the binge eating."
Unlike people with bulimia -- a closely related eating disorder -- people
with binge eating disorder don't purge by vomiting or laxative abuse.
But Pope said that while the two conditions are distinct, there is a
"My experience after several hundred interviews is that [bulimia and
binge eating] are closely related, and it is not uncommon for a person to morph
from one to the other," he said.
"Some people have pure bulimia and have always purged and are focused on
keeping their weight low," Pope said. "And then there are those in the
intermediate category, who occasionally purge. And particularly there are
people who are older, whose binge eating came on at a later age, who never
thought of purging or just could not get themselves to do it."
Purging, of course, carries its own health risks. But people with binge
eating disorder tend to become morbidly obese.
And as binge eating disorder is now known to be much more common that
previously thought, it is a big part of the obesity epidemic.
The good news is that eating disorders are treatable.
"We are faced with this incredible obesity epidemic," Bulik said.
"We have to ask ourselves what we have in our arsenal to reverse this
"Binge eating is one of those modifiable behavior factors we can focus
on as one tool in our arsenal to combat obesity epidemic," she said.
"This points to a very substantial minority that we can work with to reduce
obesity in a segment of the population."
"There are basically three forms of treatment," Hudson said.
"One is psychological treatment, especially cognitive and behavioral
techniques. This has been effective for binge eating, less so for losing
weight," he said.
"The second is medications, especially topiramate [Topamax] and
sibutramine [Meridia]," Hudson noted.
"And finally, for individuals with severe obesity, there are surgical
procedures, but those are reserved for more severe cases," he said.
In addition to yielding the first hard data on the extent of binge eating
disorder, the survey turned up another surprising finding: Many people with
anorexia have a mild version of the disorder.
"This study shows anorexia is not invariably chronic and severe --
although it often is, and I don't want to suggest it cannot be a devastating
condition," Hudson said. "But for every anorexia case that comes into
the hospital, our data suggests that there are other cases that get better
Hudson said the finding suggests treatment could be improved by finding out
which factors are linked to quickly getting over anorexia, and which factors
are linked to more severe, chronic anorexia.
SOURCES: Hudson, J. Biological Psychiatry, Feb. 1, 2007; vol 61: pp
348-358. News release, McLean Hospital. News conference with James I. Hudson,
MD, ScD, director, psychiatric epidemiology research program, McLean Hospital,
Boston; professor of psychiatry, Harvard Medical School, Boston. Harrison Pope
Jr., MD, director, biological psychiatry laboratory, McLean Hospital. Cynthia
M. Bulik, PhD, professor of eating disorders and nutrition and director, eating
disorders program, University of North Carolina at Chapel Hill.
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