Emotional Overeating: Battling the Binge & Stopping the Cycle
 
Michelle is a single mom, struggling to complete the nursing program at COC. In addition to her academic classes, she has a 10-year old daughter and works 30 hrs. per week at Vons. To make matters worse, she is not getting along with one of her teachers, and she is constantly fighting with her ex-husband over child support payments and visitation issues. Prior to nursing school, Michelle was really active and fit, and she followed a very regimented healthy eating plan. Now, however, it has become increasingly difficult for her to find the time to work-out and to eat regular, balanced meals, and this really bothers her. Exhausted, overwhelmed, depressed, and lonely, Michelle often gets home and goes directly to the kitchen. She eats several slices of bread with peanut butter and then polishes off the remaining ½ box of cookies and pint of Ben & Jerry’s ice cream. Later that night, still disgusted with all the junk she has eaten and terrified that it will turn into fat while she sleeps, Michelle goes out for a 2-hour run to burn off the extra calories. She promises herself that she will never let her eating get out of control again. Michelle is suffering from binge eating and purging (with excessive exercise).

Read on to learn…
  • How binge eating (with or without purging) harms your body.
  • What physiological and/or emotional factors trigger your out-of-control eating.
  • What steps you can take to normalize your relationship with food and your body.
Negative Effects of Binge Eating
It’s normal (and healthy) to sometimes eat for emotional reasons. For instance, we may eat certain foods to help us celebrate holidays and other special events. These foods carry deep cultural, religious, or familial meanings; and eating them makes us feel happy. In addition, we may eat certain foods to comfort us in times of sickness or temperature extremes (i.e. chicken noodle soup when we’re sick, hot chocolate when we’re shivering from the cold, and a cool frozen treat when the temperatures are soaring). 

But it is NOT healthy when food becomes our main source of relief when we are feeling stressed, depressed, and overwhelmed; and our eating becomes out of control as we desperately attempt to stuff down all our negative emotions and/or numb all our uncomfortable feelings. Consider all the negative unhealthy effects that may result.

Emotional consequences
Probably the most significant negative health effect that results from this type of eating behavior is the extreme guilt, self-loathing, disgust, anxiety, and depression that may come after the overeating episode. Often, these feelings are so extreme that you feel paralyzed from doing anything (i.e. you can’t study, you can’t work, you can’t participate in activities that used to make you happy). And, you may also isolate yourself from family, friends, and romantic partners--the very people you need most to feel better.

Behavioral consequences
As a result of the extreme guilt and anxiety, you may take desperate measures to get rid of the extra calories you just consumed (i.e. vomiting, using laxatives, diuretics or diet pills, exercising excessively, and/or fasting or very restrictive dieting to compensate). Not only are these measures NOT effective, but they also carry significant health consequences.

Self-induced vomiting does not get rid of all the calories just consumed. In fact, an after-binge vomiting episode retains approximately 1200 of the calories consumed. Much of the weight loss is due to fluid losses, not fat losses. Vomiting can also result in acid/base and electrolyte imbalances in the blood, which can be fatal. And, the stomach acid that comes up with vomiting causes tears in the esophagus, stomach ulcers, gastrointestinal bleeding, and severe tooth decay.

Laxatives act on the large intestine (after food calories have already been absorbed) and cause increased water weight loss through more frequent/watery bowel movements--not fat loss! At most, there is only a 12% reduction in calories consumed. Most calories are already absorbed by the time they reach the large intestine. Over time, you can become dependent on laxatives to have a bowel movement at all. 

Diuretics act on the kidneys and cause increased water weight loss through urination. They have NO effect on food calories or fat loss. They do, however, cause dehydration and electrolyte imbalances (such as low blood potassium levels), which can lead to an irregular heart beat and death.

Over-the-counter diet pills may work to suppress appetite temporarily, increase metabolic rate slightly, and/or induce a laxative effect (which causes fluid, not fat, loss). But, many of these products contain ephedrine or synephrine, which may cause serious problems such as increased blood pressure, arrhythmias (heart rate irregularities), insomnia, nervousness (anxiety), tremors, headaches, seizures, heart attacks, strokes, and even death! While the ads for these products boast impressive results, in reality, their effect on weight loss is relatively minor. There is no magical pill that can shed pounds without some life-long adjustments in eating and activity patterns. Click here for more info about “fat burner” supplements. 

Excessive exercise can cause overuse injuries (like stress fractures), fatigue, sleep disturbances, reduction of sex hormones, and in women, cessation of menses (which contributes to bone loss, osteoporosis, and infertility). Further, too much exercise can actually prevent fitness gains. For example, if you don’t give your muscles adequate time to recover between resistance training sessions, they can’t rebuild and grow. 

Fasting and restrictive eating results in depressed metabolic rate, loss of lean body mass, multiple nutrient deficiencies, constipation, lightheadedness, fatigue, depression, and in women, cessation of menses (which contributes to bone loss, osteoporosis, and infertility). Further, restrictive eating greatly increases your risk for another binge eating episode. 

Physical consequences
Eating large amounts of food very quickly at one time may cause abdominal pain and upset, extremely high blood sugar and insulin levels (which can make you feel dizzy and nauseous), and extreme tiredness (so all you can do is “sleep it off”). Certainly, these physical affects are going to interfere with your studies and your social life.

Further, repeated episodes of binge eating will eventually result in weight gain. If you are underweight due to restrictive eating in the past, the weight gain may be necessary to restore your health. In fact, in this case, the binge eating episodes may be a natural and necessary physiological response to your starvation (and once your weight and eating are restored, you may find that the binge eating stops). However, if you are gaining excessive weight and become obese, you are increasing your risk for a number of medical problems, including high blood pressure, heart disease, gall bladder disease, insulin resistance and type 2 diabetes, joint problems, osteoarthritis, and sleep disorders.

Why can’t I just stop?
You may feel like you should be able to control your eating and that you should have greater self-discipline to stick to your diet. But, it’s not that simple. It’s not your fault! There are many strong physiological and psychological triggers that may be contributing to your binge eating episodes. Discovering what your triggers are is the first step to overcoming them.

Physiological triggers
There are many physiological triggers that may cause you to overeat:

1. Inadequate calorie intake during the day: Whether you are intentionally restricting your intake during the day (for weight control) or unintentionally skipping meals/snacks (due to time constraints), inadequate calories during the day can result in overeating later. NOTE: Many students claim that they don’t feel hungry during the day. This may be because of the stress hormones that are released when your body is starving (which temporarily raise blood sugar and suppress appetite). Or, it may be that you are so preoccupied with what you’re doing that you don’t pay attention to your body’s signals. Or, it could be that your body has simply adapted to functioning with less fuel. In any case, while you may not feel hungry, your body knows when it’s been in a calorie deficit, and it remembers. Be sure to eat every 3-5 hours to avoid getting overly hungry.

2. Excessive exercise: You don’t seem to be restricting your calorie intake. After all, you’re eating just as much as your friends are. But, if you are exercising very intensely (for an hour or more) on most days of the week, your calorie needs are far higher than your friends,’ and your body knows it! Without extra calories on a daily basis to cover your higher daily energy demands, it’s very likely that you will eventually have a binge eating episode.

3. Inadequate protein and/or fat intake with meals or snacks: Protein and fat take longer to be digested and absorbed than carbohydrate, so you feel full longer after you eat them. In addition, both protein and fat trigger the satiety (or fullness) center in your brain, whereas carbohydrate tends to raise levels of hormones and brain chemicals (like insulin and neuropeptide Y, respectively) that are associated with food cravings. If you are just eating carbohydrate rich foods alone at meals and snacks, without some protein and fat along with it, you are more likely to have food cravings (especially for more carbohydrate and sugar) later on in the day. Have you ever heard it said that “the more sugar you eat, the more sugar you want.” It’s true! Of course, not everyone experiences increased sugar cravings and appetite after eating carbohydrate foods alone. And not all carbohydrate foods affect cravings and appetite the same. But, it’s worth considering. How long do you stay full after eating each of the following afternoon snacks?
  Snack Calories Composition
1)
OR
1.5 cup fat free frozen yogurt  About 300 Mostly low fiber carbohydrate (51 g)
2) 1 cup Edamame 
(boiled soybeans)
About 300 Good mix: 30 g protein + 18 g carbohydrate (high fiber) + 16 g fat
1)
OR
4 Snackwell Fat Free Cookies About 200 Mostly low fiber carbohydrate (48 g)
2) 1 slice whole wheat bread with 1 Tbsp. peanut butter About 200 Good mix: 18 g carbohydrate (high fiber) + 8 g fat + 6 g protein
1)
OR
40 small jelly beans About 160 Mostly low fiber carbohydrate (40 g)
2) 1 oz string cheese with 
1 whole apple
About 160 Good mix: 21 g carbohydrate (high fiber) + 8 g protein + 5 g fat
4. Inadequate sleep: Most people need somewhere between 7 and 8 hours of sleep every night. If your body is chronically sleep-deprived, your levels of cortisol (a stress hormone) will be elevated throughout the day. High cortisol levels are associated with increased appetite and increased cravings (especially for sugary or starchy foods). In addition, without adequate rest, you may be more inclined to eat to keep yourself awake.

5. Some disease states and medications: Many medications and some disease states cause increased appetite as a side effect. It's a good idea to discuss any changes in appetite with a qualified health professional so that he/she can rule out medical or pharmacological causes to overeating.

Psychological triggers
While the physiological triggers are relatively easy to manage, the psychological triggers are much more difficult to overcome. These triggers are grounded in deeply held beliefs about food and eating, as well as firmly established learned responses to various situations and emotional states.

1. “Good food-bad food” mentality: When you think of “good foods,” what foods come to mind? Perhaps you think of vegetables, fruits, and very lean protein-rich foods. What about “bad foods?” Everything with fat in it, right? (fried foods, pizza, chips, cookies, and chocolate…) Or maybe it’s anything with too many carbs in it (like bread, pasta, and potatoes). Where did these “good food-bad food” labels come from? Perhaps they came from a recent diet book you read, or from a friend, or from what your parents always told you while you were growing up. It’s true that some foods have a stronger nutritional profile than other foods, but no food is inherently “good” or “bad.” It’s your overall diet that may be good or bad based on how you balance your food choices throughout the day. 

For instance, a diet which consists of only fruits and vegetables is NOT a good diet. The problem is the lack of balance. Fruits and vegetables are excellent sources of fiber, vitamins A and C, folate, and potassium. But, they lack protein, many of the B vitamins, vitamins E and D, calcium, iron, zinc, and the essential fatty acids. Similarly, a diet which consists of only high fat, fast food “value meals” three times a day is not a good diet. This diet would be too high in saturated fat and sodium and terribly lacking in fiber as well as many other important nutrients. On the other hand, if you had one high fat fast food meal at lunch and balanced it out with a high fiber, low fat breakfast and dinner, your overall eating plan would look quite good.

There are two problems with labeling foods in such “black or white” categories. First, there’s no flexibility. It’s all or nothing! “If I eat one piece of cheesecake, I’m a complete failure and I’ve completely blown my diet. So I might as well eat the entire cheesecake now and start over tomorrow.” Second, there’s too much restriction. And, whenever something is off limits or forbidden, we tend to want it more. For instance, children whose parents strictly prohibit them from eating sweets and treats are much more likely to binge on these foods when they are away from their parents (like when they turn 18, move away from home, and start college for the first time).

2. Learned responses to uncomfortable feelings: Throughout our life, we are conditioned to turn to food for security, comfort, and pleasure. As babies, the most powerful comforter when we were distressed was our mother’s milk. As toddlers, we were offered cookies and milk when we fell in the playground and got hurt. Throughout our school years, we were rewarded with sweet treats when we brought home good grades and punished for bad behavior by being sent to our rooms without dessert. It’s little wonder that as college students, food becomes a tranquilizer when we’re anxious and stressed, a mood elevator when we’re depressed, a comforter when we’re lonely, a reward when we’ve had a hard day, and an entertainer when we are bored. We learn to cope with uncomfortable feelings by stuffing them all down with food. Just like cigarettes, alcohol, and drugs, food becomes a temporary relief or escape.

3. Underlying mood, anxiety, or personality disorders
Many people who suffer from binge eating also suffer from one or more other psychiatric problems, such as depression or anxiety disorder. In fact, the binge eating may be an adaptive response to an underlying chemical imbalance in the brain, which is causing the depression or anxiety. For instance, serotonin and cortisol are neurotransmitters (brain chemicals) that affect mood, sleep, and appetite. Low levels of serotonin (or high levels of cortisol) are often associated with depression, anxiety, poor sleep, and increased appetite. People suffering from low serotonin levels (or high cortisol levels) may binge (especially on refined carbohydrates) to temporarily increase serotonin levels and correct the chemical imbalance in the brain. 

Several prescription medications are available to help normalize the balance between serotonin and cortisol. These medications may be required (along with the “Positive Steps Toward Change” below), to correct underlining chemical imbalances in the brain. If you experience extreme feelings of sadness or anxiety, difficulty sleeping, or change in appetite, talk to a clinician or counselor at the Student Health & Wellness Center. There are counseling services and medications available to help.

Positive Steps Towards Change

1. Separate true physiological hunger from emotional hunger. Before you put anything in your mouth, say to yourself, “H.A.L.T.” Then ask yourself, “Why is my desire to eat so high right now? Am I physically Hungry? If not, what’s going on? Am I Anxious or stressed? Lonely or depressed? Tired or bored? Eating is not going to make the underlying feeling go away. It’s just a temporary way to numb yourself and give yourself a false sense of comfort and peace. Take advantage of the caring and confidential counseling services on campus to help you discover the underlying feelings that trigger you to overeat. With help, you can work through these feelings in a healthy way.

2. Learn positive ways of expressing and nurturing your emotional needs without food. If you’re feeling tired, take a nap. If you’re feeling lonely, call a friend. If you’re feeling anxious, go for a walk, meditate, or take a relaxing bubble bath. Create a list of at least 3 things you can do instead of eating when your non-hunger eating cue strikes. It’s not easy to break old patterns, but in time it will get easier. 

3. Plan for success. Remember, restrictive dieting and inadequate calories, protein, or fat intake during the day are certain to trigger a binge later. Learn the basics of good nutrition so that you can fuel your body with the right amount of energy and nutrients for success. After months (or years) of dieting and/or binge eating, you may not know what normal eating looks and feels like. Seek the guidance and support of a Registered Dietitian to help you. And, be sure to check out the Nutrition 101 section of this web site.
4. Honor your cravings, and remember there are no forbidden foods! Low calorie munchies (like baby carrots, rice cakes, and air popped popcorn) are great snacks. BUT, if you’re really craving chocolate, then baby carrots most likely won’t cut it! In fact, you’ll probably wind up eating the entire bag of baby carrots plus some rice cakes and then some popcorn and STILL find yourself bingeing on a bag of Hershey Kisses after all that. You’ll save yourself a lot of time, anguish, and calories, if you just identify what you really, REALLY want when the craving strikes; and then go out and enjoy one small serving. The key is portion control. If you keep an entire box of cookies or pint of ice cream on hand, it might be too easy to overindulge when a craving strikes. If this is the case, it might be better NOT to keep these foods on hand, but to go out to 31 flavors for one scoop of
 
REMEMBER THE 5 D’S
DELAY your response so you can figure out what exactly is tempting you to binge.
DETERMINE what’s going on. Ask yourself, “Why is my desire to eat so high right now? Am I physically hungry? If not, “what do I really want or need?”
DISTRACT yourself for 10 minutes (WAIT).
DISTANCE yourself, physically, from the temptation.
DECIDE how you will handle it.
 - If you’re tired, take a nap. If you’re 
   feeling lonely, call a friend. If you’re 
   feeling anxious, go for a walk or take a 
   bubble bath. 
 - If you’re having a specific food craving, 
   identify what you really want, go get a 
   single portion, and enjoy it without guilt!
ice cream or Mrs. Fields for one big cookie when a craving strikes. If portion control is not a problem for you, you might try keeping a bag of Hershey kisses or mini candy bars in your apartment/house, and eat one daily to satisfy your sweet tooth.
5. Eat slowly, passionately, and without guilt. Your eating style can make a HUGE impact on whether or not you overeat. If you eat standing up in the kitchen, quickly shoveling food into your mouth (directly from its original box or package), anxiously trying to finish before your family or roommate gets home and sees, you are more likely to overeat. On the other hand, if you place a reasonable portion of food (whatever food you want) onto a plate or into a cup, sit down at the dining room table, and eat it slowly, savoring every delicious bite without guilt, you are much more likely to feel satisfied and stop eating after your portion is gone.

6. Know what foods and eating situations trigger a binge. Then work to minimize or avoid them. Here are some examples:
  • Does having a gallon of ice cream in your freezer trigger a binge during finals week. Avoid keeping “trigger foods” in your house. Go out to enjoy one scoop of ice cream when a craving hits.
  • Does passing the coffee shop on the way to class every day trigger an urge to drop in for muffins and pastries? Try walking to class a different way.
  • Does coming home tired and stressed trigger a binge as soon as you walk in the door? Try changing your routine. Rather than going directly home when you’re feeling tired and stressed, go to a relaxing place (a park, the gym, a yoga class). Then treat yourself to a healthy restaurant meal, go to the library or coffee shop to study (if needed), and then go home when you’re ready for bed.
  • Is it hard to stop eating after meals? Try brushing your teeth immediately after each meal or popping a piece of gum or mint in your mouth.
  • Does studying at home trigger a binge? Try studying in the library where food is not around.
7. Enjoy regular physical activity…not because you have to burn calories, but because it feels good and reduces stress. It’s very difficult to stay motivated to do something that is a punishment (i.e. “I have to exercise to punish myself for eating too much.”) On the other hand, it’s easy to make the time for things that make you feel good (i.e. “I always feel so energized and healthy after my morning walk; and it helps me study, work, and sleep better!”) Moderate amounts of fun physical activity can really help fight stress and depression--common triggers for overeating. But, remember, the key is moderate amounts. Too much exercise can be just as damaging to your health as too little. And, excessive exercise can increase your risk of binge eating if you don’t get adequate rest and consume adequate calories on a daily basis to support your heavy training routine. Aim for 3-5 days of enjoyable aerobic activity per week (20-60 minutes per session), along with 2-3 days of enjoyable strengthening activities per week. As is the case for many things, more is not better! More info on physical activity guidelines and tips for fitting fitness into busy college life.

8. Determine what weight is a “healthy weight” for YOU. Each one of us has a healthy weight based on our genetics, muscle mass, and body type. Trying to achieve and/or maintain a weight that is too low for YOU is certain to result in binge eating and disordered behaviors. Sometimes it’s hard to accept the weight that is healthy for you (especially with the media’s ideal body in mind). But, learning to love (or at least accept) your body is key to treating it with the respect and care it deserves. More info about “How Much Should I Weigh?” 

9. Don’t expect to be perfect. Slips in eating are bound to happen, but that doesn’t mean you are a failure! And, it certainly doesn’t mean you’re going to get fat. It takes an extra 3500 calories (above the normal 2000 calories or so you need to eat daily) to gain just 1 pound! You may feel yucky, bloated, and sick after a binge, but you are not going to get fat. It takes days and days of overeating to gain weight and body fat. Think about what you could have done differently to prevent the binge in the future, look at it as a learning opportunity, and then put it behind you and go back to your normal eating and physical activity routine. You may be tempted to restrict your food intake the next day, throw up what you just ate, or go to the gym for hours to burn the extra calories off. But, remember the negative consequences of these behaviors. And, most importantly, remember that they will just propel the vicious cycle of binge eating, rather than stop it. 

10. Listen to your self-talk. That “little voice” in your head is your self-talk. Positive (or negative) self-talk can be very powerful. If you go into an exam thinking “I can do this. I’m totally prepared. I’m going to ace this thing!” you’re far more likely to be successful than if you go in, worrying “I’m not ready for this. I’m going to fail!” In addition to affecting your academic performance, self-talk influences your athletic performance, your ability to overcome personal crises, and your eating and physical activity behaviors. More info on self-talk.
 
Sheri Barke, MPH, RD
COC, Student Health & Wellness Center
Rev. 2005