When overeating takes control of your life

SINGAPORE — Seeking solace in comfort food is not an uncommon phenomenon, especially in times of stress. But what happens when emotional eating crosses the line?

For one recovering binge-eater, who wishes to be known as Ms Loh, using food to cope with stress and anger caused her weight to double from 60kg to almost 120kg within two years.

Her first few binge-eating episodes occurred during her teenage years. With no one to confide in when facing an upsetting personal matter, she turned to food, gorging on snacks until she felt physically sick.

“No one was willing to listen to me without passing judgment, and I felt very angry. Binge-eating was a shield to my anger. It took away my anguish for a short while. After each session, I would feel too uncomfortable and bloated to feel angry,” said Ms Loh, who is in her late thirties and currently holding an administrative job.

As her binges became more frequent and intense, Ms Loh began spending every cent she had to finance her eating habits. She would upsize her rice portion when she could not afford to pay for extra ingredients, and use the loose change her mother had left on the table to pay for extras like pizza delivery.

Ms Loh is one of the about 20 patients the Singapore General Hospital (SGH) saw from 2011 to 2015 for binge-eating disorder, where individuals compulsively consume a larger-than-normal amount of food repeatedly and experience loss of control during a bingeing episode.

For binge eating to qualify as a disorder, the episodes have to also occur often — at least once a week for three months, said Dr Victor Kwok, head and consultant of the Department of Psychiatry at Sengkang Health.

MOST UNDER-DETECTED EATING DISORDER

While eating disorders such as anorexia and bulimia have been widely publicised, there is little awareness about binge-eating disorder as symptoms tend to come across as gluttony.

According to Dr Lee Huei Yen, head and senior consultant at SGH’s Department of Psychiatry, overseas studies suggest that binge-eating disorder is twice as common as anorexia and bulimia, yet it is the most under-detected among the three eating disorders. Unlike the former two eating disorders, where women sufferers outnumber men, binge eating affects both genders equally, said Dr Kwok. SGH, which runs an eating disorders programme that saw about 160 to 200 eating disorder cases each year between 2012 and 2015, saw an annual average of four patients with binge-eating disorder during that period. “Although binge-eating disorder is a lot more common than anorexia or bulimia, the small number (that SGH’s eating disorders clinic sees) is not surprising. Most people may not think of it as an eating disorder, and may attribute it to a bad habit of overeating,” said Dr Lee.

The lack of awareness could also be because binge-eating disorder was classified as an official eating disorder fairly recently — in 2013, in the fifth edition of the Diagnostic and Statistical Manual by the American Psychiatric Association.

“In the past, it fell into the category of ‘Eating disorder not otherwise specified’. Patients would probably seek help from weight management or obesity clinics rather than an eating disorder clinic,” said Dr Lee.

What spurs a person to binge eat? The doctors said its exact cause is unknown, but it is likely to be a combination of factors.

Researchers have found genetic mutations that appear to cause food addiction, and eating disorders can run in families, indicating that they may be inherited, said Dr Lee. Biological causes such as low levels of the brain chemical serotonin may also play a role in compulsive eating.

Binge-eating disorder is linked to other psychiatric conditions. Nearly half of all patients with the eating disorder are depressed or have a history of depression, said Dr Lee. Some studies suggest that up to 60 per cent may have anxiety disorders, added Dr Kwok.

According to Dr Lee, binge eating may also be a learned behaviour in response to stress; patients often come from families that overeat or put an unnatural emphasis on food.

“For example, food may be used as a reward or to soothe/comfort. Children who are exposed to frequent critical comments about their bodies and weight are also vulnerable, as are those who have been sexually abused in childhood,” she said.

NOT A CASE OF GLUTTONY

Although the eating disorder is highly treatable, stigma can prevent people from seeking help. A common misconception is that binge eaters overeat due to gluttony, or that they “live to eat”.

But unlike most people who overindulge, binge eaters rarely enjoy the pleasure that eating brings. Patients often associate a binge-eating episode with significant distress, said SGH’s Dr Lee. They may experience discomfort from feeling extremely full as well as feelings of guilt, depression or disgust after an episode.

Dr Lee said binge eaters are typically embarrassed and ashamed of their eating habits, so they often try to hide their symptoms and eat alone or in secret. Other symptoms include hiding or stockpiling food to consume later.

Guilt, not pleasure and satiation, was what Ms Loh felt after a binge eating frenzy. Her excessive weight also took a toll on her self-esteem.

“I would feel guilty for hurting my body and upsetting my mum, but I think (my compulsive eating) is not a lack of self-control, but a cover-up for my emotions,” she said.

Her condition was discovered after she sought medical attention for bipolar disorder around 2004. Bipolar disorder is a mental condition marked by alternating periods of depression and elation.

As with other eating disorders, binge eating can take a toll on one’s physical health. About half of all binge eaters are overweight, which may in turn lead to medical issues such as diabetes and hypertension, said Dr Kwok.

A new study published in The International Journal of Eating Disorders last September linked binge eating to more than 40 health conditions including endocrine, respiratory and gastrointestinal diseases.

With treatment, the prognosis for this group of patients tends to be “somewhat better” than those with anorexia or bulimia, said Dr Lee.

Studies show that with treatment, more than two-thirds (70 per cent) of binge eaters would “do well” and no longer meet the criteria for binge eating disorder at the five-year mark, she said. About 20 per cent would achieve partial remission. Treatment, which may take several months to years, includes psychological therapy and medications such as antidepressants and anticonvulsants, which have been shown to be effective in treating the disorder, said Dr Lee.

At the same time, patients are encouraged to make lifestyle changes and undergo dietary rehabilitation, which teaches strategies such as eating three proper meals, keeping a food diary, as well as avoiding dieting, getting too hungry, and food temptation.

With treatment, Ms Loh’s days of compulsive eating are now a thing of the past, but she continues to struggle with her weight. Currently tipping the scales at 113kg, she is on follow-ups with a psychiatrist and a psychologist to prevent a relapse.

“Due to prolonged binge eating, I need to eat a lot to feel full and satisfied. Although I don’t binge eat now, I need to work hard to prevent my weight from going up. If given a choice, I think most ladies would like to look fit and lean,” said Ms Loh, who is considering bariatric surgery to lose weight.

“To anyone who is binge eating to hide any painful emotions, I’d suggest seeking treatment. It is okay to ask for help.”

Learn more about eating disorders and the dangers of over-exercising at a public forum organised by the Singapore General Hospital.

Date: Feb 25, Saturday

Time: 9.30am to 11.30am

Venue: Academia, Level 1 Seminar Room L1-S1 (opposite SGH Block 7)

Fee/ Registration: Free entry. Registration is required. Call 6576 2644 from Tuesdays to Fridays (9am to 5pm) or email your full name, contact number to ed.publicforum [at] sgh.com.sg.