Shifting Body Image and Weight Loss Beliefs During Binge Eating Disorder (BED) Treatment

Three to five million people struggle with binge eating disorder (BED) [3]. Unfortunately, many do not get help and are instead encouraged to try the next diet or to just have more will power. This is simply not true or helpful. 

Emotional eating, family dynamics, dissatisfaction with one’s own shape, dieting, and an internalized body image ideal all may be contributing factors to the development of BED [1].

People of all shapes and sizes struggle with BED. About 20-30% of participates in weight loss programs suffer from BED [1]. These stats indicate that diets and weight loss are not the answer to treating BED, but a more in depth, deeper rooted, emotional work is needed.

What is Binge Eating Disorder (BED)?

The DSM-5 defines BED as someone who has episodes of binge eating where large amounts of food are consumed within a specific time frame [1]. At the same time, a loss of control is experienced related to the amount and quality of food and the ability to stop the binge eating during the episode [1].

Criteria also includes eating quickly, eating until feeling uncomfortably full, eating alone, disgust or guilt towards oneself and one’s body, feeling ashamed, and eating without being hungry [1]. Also, included in the criteria is at least one binge-eating episode per week for at least three months [1]. The number of weekly binge eating episodes is used to determine severity [1].

What is the Motivation for Treatment?

It’s often believed that going to treatment will lead to changes in the shape or size. It should be of concern if the focus of or motivation for eating disorder treatment is to manipulate one’s shape or size.

BED is not treated through dieting or losing weight. The belief that “if I lived in a smaller body, I would be happy,” occurs all too often and is utterly false. 97% of dieters regain everything they have lost and then some within 3 years [3].

Health is often falsely tied to body size, when in reality health can be achieved at any size. Despite the initial motivation coming into treatment the goal should be to shift towards Health at Every Size (HAES).

Shfiting Focus

Shifting Motivation or Focus

What if the focus wasn’t to change the body’s shape or size, but was shifted to the basic principles of HAES [3]:

  • Focus on the quality of day-to-day life experiences
  • Honor varying needs for food and movement as you are able
  • Find sustainable, adaptive ways to take care for the body and mind that allow for imperfection and change
  • Accept the body knows best about weight; when you are taking care of it, your body will find its sustainable natural weight

The goal is to build trust with your body. Bodies will change throughout a lifespan, they will change shape, but this doesn’t mean the value of the body changes.

Related Reading

Change that May Occur During Treatment

When exploring the deep roots of an eating disorder there is often a belief related to good vs. bad foods. The goal during treatment is to find freedom with food, where all foods fit.

When providing the body permission to have desired foods, trust starts to build. This means the body and mind are no longer experiencing or in fear of deprivation.

The trust being built between body and mind supports understanding why behaviors are happening and learning how to interrupt these same behaviors with adaptive coping mechanisms.

When binge eating is interrupted this sometimes means a decrease in energy or calories being eaten, but also may mean redistribution of food or energy throughout the day.

For some weight loss may occur and for others the body may maintain its current weight. The term set-point is often used the describe this as the body returns to its sustainable natural weight [3].

Cognitive Behavioral Therapy (CBT) is currently the best treatment for BED. Despite the positive outcomes psychologically when treating BED, CBT has shown minimal impact on weight [2].

When receiving treatment for BED two things are occurring. One a redistribution of energy intake throughout the day and two changes in distress tolerance and emotions [2].

A study observing treatment for BED with the support of CBT plus dietary counseling resulted in significate reductions in binge eating episodes, psychological distress, and overall diet quality [2].

The Key to Treatment: Repairing the Relationship with Food and Body

Recovery means starting to turn inward, to hear and listen to the body and mind [3]. There is a path that will take time but can support in healing these relationships.

  1. Exploring the roots of BED, what are the factors leading to this disorder?
  2. Bring awareness to the moment, emotions and resulting urges/behaviors
  3. Learning to pause and evaluate what is being searched for or what in needed
  4. Learn to respond to yourself gently with care
  5. Begin to build self-worth outside of physical appearance

Body hatred is not something we are born with, but something that is learned. Society’s thin ideal impacts most, despite actual body size [3]. Making peace with the body is an integral part of recovering from BED [3].

Treatment

Resources:

[1] Lewer, M., Bauer, A., Hartmann, A., & Vocks, S. (2017). Different Facets of Body Image Disturbance in Binge Eating Disorder: A Review. Nutrients, 9(12), 1294. https://doi.org/10.3390/nu9121294

[2] Masheb, R. M., Dorflinger, L. M., Rolls, B. J., Mitchell, D. C., & Grilo, C. M. (2016). Binge abstinence is associated with reduced energy intake after treatment in patients with binge eating disorder and obesity. Obesity, 24(12), 2491–2496. https://doi.org/10.1002/oby.21664

[3] Pershing, A., & Turner, C. (2018). Binge Eating Disorder: The Journey to Recovery and Beyond (1st ed.). Routledge.

Author: Raylene Hungate RDN,LD/N
Page Last Reviewed on February 7, 2022 and Updated By: Jacquelyn Ekern, MS, LPC