Published: Oct. 17, 2006
Updated: Mar. 26, 2010
It’s triggered by overwhelming feelings of self-loathing, anxiety, desperation, or despair -- and all that seems to soothe them is eating. A large bag of potato chips, a quart of ice cream, an entire package of cookies -- eaten rapidly, one right after another, adding up to thousands of calories.
Binge eating is the most common eating disorder, affecting by some estimates about two million Americans. Excessive eating in secret eases their psychic pain -- for awhile. Then they feel ashamed, guilty, and disgusted with themselves -- and it’s not too long until the destructive cycle is repeated, often several times a week.
We all “pig out” once in awhile, at parties or holiday celebrations. But such behavior is a sad, furtive, out-of-control routine for binge eaters. Unlike bulimics, who purge themselves after excessive eating (a highly unhealthful habit with its own harmful effects), binge eaters retain all those excess calories. As a result, most become overweight or obese. Many have tried dieting programs -- and sometimes ended up eating even more as a result.
“Binge eaters use food to deal with emotional needs,” says Ruth Q. Wolever, PhD, a clinical health psychologist with Duke Integrative Medicine. “It’s calming, soothing, entertaining. It can be a means of escape. Most of the time, bingers don’t even taste what they’re eating -- it just becomes an automatic response to stress.”
Wolever has studied an unusual approach to help binge eaters. She and principal investigator Jean Kristeller, PhD, of Indiana State University conducted an NIH-funded study that explored applications of meditation and mindfulness training as a treatment for binge-eating disorder -- and the technique has shown promising results.
The meditation technique used in the study is adapted from the Buddhist contemplative tradition of vipassana -- "to see things as they really are."
Wolever says that, while the relaxation effects of meditation may help with how food is used emotionally, the most important aspects may be incorporating nonjudgmental awareness into eating and learning to tease apart emotional, physical and cognitive reactivity.
Laboratory research on regulation of eating shows that individuals with eating problems are generally less aware of sensations of hunger and satiety. The mindfulness exercises developed by Wolever and her team are designed to heighten people's awareness of such cues -- to keep their minds focused on the current moment of eating, and nothing else. Individuals practicing the exercises frequently notice changes within a few days of applying them to their eating experiences.
A 1999 pilot study of the approach in 18 obese women found that those who used the approaches reduced bingeing episodes and symptoms of anxiety and depression, while increasing self-acceptance and self-control around food. The research has now been expanded to a larger randomized control study of about 150 men and women.
The results show that those using the mindfulness-based approach reduce their binge eating as much as those that use psychoeducational approaches, from about four times per week to once per week. Participants in the wait-list control did not improve their binge eating.
Furthermore, the participants in the mindfulness group reported feeling more control around food than participants in either the psychoeducation or control group.
Most importantly to Wolever and her team, though, only the mindfulness group improved their metabolism of carbohydrates throughout the study, and this was continued at a four month folow-up. These participants demonstrated better insulin sensitivity when digesting a standard meal. Remarkably, this effect was independent of weightloss. In other words, the mindfulness-based approach shifted metabolism separately from lowering weight.
“Mindfulness really helps not only in identifying hunger and eating triggers, but in helping people to get in touch with physical fullness,” Wolever says. “People often don’t think they’re full until they really feel it. But true satiation comes at a moderate level of intake, when the body has received what it needs. And that’s a very subtle signal.
“Because people with excess weight and eating disorders are subject to prejudice and criticism from others and themselves, learning self-awareness without judgment is extremely powerful,” she adds. “When you pay real, non-judgmental attention to all the micro-steps that occur between the initial urge and the binge-eating behavior, you have a lot more choices about how to respond.
“It’s fascinating: Some realize they don’t even really like the foods they’ve been bingeing on. The experience frees them up to try new behaviors.”
This approach is now being studied in weight loss and weight-loss maintenance, both supported by the NIH's Center for Complementary and Alternative Medicine. While long-term results are still pending, Wolever is optimistic: “In four months, we were able to help people experience a significant decrease in bingeing and metabolism. They got the sense that food didn’t have as much power over them.
“We’re hoping that will ultimately result in longer-lasting change in weight and other indices of physiology.”