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Helping Patients with Binge Eating Disorder Drop the Weight (Mentality)

A woman, who reported she struggles with Binge Eating Disorder, contacted me recently online. She was scheduled to participate in a medical weight-loss program but wondered if she should address her BED first. Unfortunately, this woman is not the only person with BED who has fallen prey to the weight-loss industry.

One of the most challenging things in my work with patients with BED is disavowing them of the diet and weight mentality. Most patients come in with a significant diet history and, despite many failed diet attempts, are intent on losing weight in treatment via the latest diet trends.

I've found through the years that with some patients, getting them to commit to working on their binges, rather than focusing on weight, is a relatively easy switch, while others remain firmly entrenched in a weight-centric mentality. With these patients, I see little-to-no progress. They're they ones that drop out of treatment prematurely when I tell them that their most recent return to Weight Watchers or Jenny Craig is contraindicated with our work. It's a major paradigm shift that's required, and my experience is that patients who are able to think outside the box have an easier time catching on. 
Here are 10 treatment factors I've found that can help bring many patients with BED around to more of a focus on their relationship with food than the current number on the scale.
1) Refuse to set a weight loss goal. Instead, set goals around reducing binge eating and improving the patient's relationship to food.
2) Provide information on the relationship between food restriction and binge eating  (e.g., the diet/binge cycle, the Minnesota Starvation Experiment). Create a timeline of the patient's diet/weight history, noting weight losses followed by inevitable gains. 3) Do not support the patient's participation in eating trends, cleanses, jumpstarts, etc. Focus on what the patient can add to his current "diet," rather than take away.
4) Operate from an intuitive eating perspective and encourage the patient to legalize off-limits foods in a mindful way.
5) Explore the emotional function of binge eating, as well as how an attachment to the diet mentality may trigger binge emotions 6) Provide information on the "Health at Every Size" movement, as well as on the media's inflated damages of obesity; cite meta-analytic studies suggesting that those who are overweight or low-level obese are just as healthy as their "normal"-weight peers.7) Educate the patient on societal and internalized weight stigma and the toll these experiences can take on her physical and mental health.8) Work with the patient on acceptance and self-care of his body as-is.9) Encourage a relationship with movement that is joyful and reinforcing and thus more likely to persist beyond sporadic, diet-centric efforts.
10) Recognize that recovery from an eating disorder might be a bumpy road but that, with persistence and attention to the above factors, is entirely possible.