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March 2018 #obsm Chat: Disordered Eating

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When people discuss dietary issues related to overweight and obesity, the concerns tend to be overeating, making less healthy food choices, skipping meals, or taking in too many liquid non-nutritive calories.  Underlying disordered eating patterns may be missed. However, these patterns need to be addressed to help someone achieve long term weight loss success. Even in the case of bariatric surgery, disordered eating patterns may persist or emerge after the procedure, and this can have a significant negative impact on weight loss outcomes.
 
In the U.S., binge eating disorder is closely associated with obesity and has become the most common form of disordered eating, affecting nearly 3 million people.  Hallmarks of the condition include the rapid consumption of very large amounts of food within a relatively short period of time, a sense of feeling out of control, feeling overly full, and feeling the need to hide the behavior.  Approximately 1.6% of women exhibit binge eating behavior as do 0.8% of men, and there is a relatively even distribution among ethnicities. For bariatric patients, about 25% of candidates have this condition, and though it decreases for many after surgery, it remains an ongoing concern for half of those individuals post-operatively.  Defining a binge after a bariatric procedure is challenging as it may be impossible to eat an objectively large amount of food; loss of control while eating may be the overriding characteristic.
 
Another common disordered eating pattern linked with obesity is grazing, in which individuals snack or nibble in an unplanned and repetitive manner, most typically on carbohydrates, without regard for portions.  For those who diet or have a bariatric procedure, this habit can be insidious and is easy to fall into.  Grazing may also be a form of compulsive overeating.  Night eating syndrome is a newer category which encompasses those who eat a large percentage of their calories in the evening after dinner or wake up in the night to eat again.  Other related eating issues can include eating too quickly, as well as mindless eating or emotional eating in response to stressors.  In these cases, food provides a self-soothing strategy, a reward which brings about short term pleasure in exchange for potential long term disordered eating and weight gain.
 
For many individuals, disordered eating tends to be a more secretive behavior which can lead to hiding food, eating when others aren’t around, and commonly leads to feelings of guilt and shame.   Persons who have struggled with weight may have the added burden of trying to overcome problematic eating styles while also learning to shift nutrition and activity levels.  When someone has had significant weight loss, a return to old, disordered eating habits, particularly when experiencing unexpected stress, can be devastating.  Professionals working in the field of obesity and bariatric surgery have a duty to assess and address these patterns and help individuals to overcome the struggle.
 
Addressing disordered eating among those intent on losing weight is the focus of our next #obsm #obesity tweetchat. We will focus on the following questions:
 
1.    For those familiar with struggles with disordered eating, what circumstances facilitate acknowledging the patterns and seeking help?  What assistance is needed most?
2.    Are providers working in the obesity field aware of disordered eating patterns and making appropriate referrals for treatment?  What education is needed?
3.    After successful weight loss, what specific factors might lead to a return to disordered eating?
4.    As disordered eating is frequently correlated with other mental health and quality of life issues, how does one prioritize treatment?
5.    What successful strategies can be employed to treat disordered eating behaviors which are related to obesity?

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