Pieter (57) compares it to the urge a smoker can have for a cigarette. “Even if you are not physically hungry at all, just after an evening meal for example, you just have to eat. I got a weird feeling in my stomach, started to tremble and then I was drawn like a magnet to that fridge, like a junkie to a fix.”
And it was never a carrot or a piece of cucumber that he craved. “For example, I ate a whole bag of chips, with dipping sauce, and if I had washed my hands and my eye fell on the liver sausage, I ate half of it without any problems.” Afterwards there was always shame and a feeling of guilt: why had he done that again? “Still, I’ve never had the urge to stick my finger down my throat or anything like that.”
urge to compensate
That is also the main difference between the better-known eating disorders anorexia and bulimia and the binge eating disorder, explains Bernou Melisse, a psychologist at Novarum, a center for eating disorders and obesity. Where those other eating disorders are accompanied by so-called compensatory behavior – vomiting, dieting, laxatives, excessive exercise – this is not the case with the binge eating disorder.
The fact that the binge eating disorder is relatively unknown is partly because it was only included in the ‘psychiatry bible’ DSM-5 as a separate disorder in 2013. Little research has been done yet. It is estimated that about 2 percent of society suffers from binge eating disorder, with an additional 1.5 percent having an eating disorder that is very similar. All in all, it’s much more common than anorexia and bulimia, Melisse says. “We also see that binge eating disorder is much more common in all layers of society. And more often than with anorexia and bulimia, men also suffer from it.”
Pieter is one of those men. He ate almost compulsively. Whatever was in the house had to go. “If my wife had cooked and there was still something in the pan, I couldn’t leave it. That pan had to be empty.” According to Melisse, this soil pressure often occurs in BED patients. And like many other patients, Pieter often ate secretly.
“For example, I did it when my wife was upstairs, while she really knows what’s in the fridge and also fully understood my binge eating. But I was just ashamed. I wish I erased all traces of it before I got home.”
Morbide obesitas
He suffered from it, both physically and mentally. “For as long as I can remember I have had a struggle with food. In the past I exercised a lot and you didn’t see it that way, but as I got older and started exercising less, I gained weight.” So much so that his BMI eventually reached 46 and fell into the morbidly obese category.
He always felt watched and judged. “I didn’t even dare to eat an ice cream when I was out with my family, so to speak, because I was afraid of what people would say about me behind my back. You can’t hide obesity. You stand out when a black dot on a white background, and the stigma is great.”
For Pieter, the low point was the moment when his children spoke to him about his behaviour. “My son and daughter said to me emotionally: ‘Dad, you will die like this. When we have children, they will not have a grandfather, because grandfather ate himself to death.’ That was a bitter realization for me that I was driving down a precipice and not just hitting myself with it.”
A few years ago, Pieter ended up at Novarum, where he started treatment for his disorder. This was possible online: since 2019, the center has been offering an ehealth treatment that they have developed themselves, based on cognitive behavioral therapy. An outcome, especially with the long waiting lists in mental health care – which have only become longer since corona. Novarum has seen a significant increase in the number of people with eating disorders since the corona crisis.
Lockdowns
“We also notice that the people who sign up with us have more severe variants than before,” says Melisse. “It is difficult to say why this is because we have not investigated it ourselves, but what we have seen is that people have more psychological and psychiatric problems, especially due to the many lockdowns.”
With the online treatment many more people can be helped at the same time. And according to Melisse, people with a binge eating disorder benefit from remote therapy. “Several studies seem to show that an ehealth treatment for people with a lot of self-stigma is more effective than, or certainly not inferior to, a regular treatment.” Patients follow an online treatment program with assignments for thirteen weeks at a time that suits them. Once a week they make a live video call with their therapist to discuss what they are encountering.
For Pieter, the therapy made a world of difference. “A tipping point for me was that I learned to accept myself as I was. I had such a negative self-image that I was therefore not motivated to invest time and effort in myself. And just when you do feel good about yourself, the intrinsic motivation to work on yourself.”
“I used to be disgusted by my own reflection and I tried to avoid it as much as possible. When I saw myself with that huge belly, I thought it was terrible. But the therapy has made me realize that I am more than my weight.”
psychological problem
“If I had been disgusting, my wife would not have been with me for so long. It took me a while to realize that, but in the end that has been one of the most important parts for me. I now know that I am fine the way I am, no matter what I weigh.”
Also the realization that a binge eating disorder is not a nutritional problem, but a psychological problem, was an eye opener for Pieter. “I’m someone with quite a strong character and a certain drive, I felt weak that I couldn’t get rid of this. With anorexia and bulimia people recognize that they are diseases, but when you have binge eating, people see you as a weakling without discipline. And I must say: before this therapy I was guilty of that too. When I saw someone with my build eating, I also thought: look at him. Even though I looked the same myself. Now I know what’s behind it, I look at it very differently.”
He will probably never get rid of the urge to binge eat, but he has learned to deal with it. “Now when I feel a binge coming on, I know what to do to avoid giving in to it. For example, I have developed a lot of pleasure in walking and now I go outside for an hour if I get the urge to walk to the fridge I’ve got it under control. You’ll have to do it yourself in the end, but if you don’t get the right tools, you’ll just keep messing around.”
Pieter has even lost weight, although according to Melisse that is explicitly not the goal of the treatment. “If you want to lose weight, you have to eat less than you consume. That in turn increases the chance of binge eating. We do see that people often have a great desire to lose weight, and that wish is allowed, but during therapy you can you don’t live up to that.”
save people’s lives
“We teach people to gain their self-esteem from things other than their figure. You are not your weight or your figure, any more than you are your shoe size. In therapy you also learn to get rid of the binge eating. Then the weight stabilizes and at least you won’t gain more.” Pieter: “I honestly think that we are already saving human lives with this.”
According to Melisse, people with binge eating disorder are often told that they have to lose weight, because otherwise they will develop diabetes or cardiovascular disease. Pieter also ‘cannot count on two hands’ how often he has been told that, he says. While according to Melisse, all kinds of studies show that there is much more health benefit to be gained from binge eating than from losing weight. Binge eating causes much more damage to health than being overweight.
What is binge eating disorder?
Someone with binge eating disorder:
- Eat large amounts of food (on average, at least two packs of something high in calories) in a significantly shorter amount of time than anyone else would
- Can’t think about anything but food at times and is obsessive about it
- Does not show compensatory behavior after a binge (he or she does not diet, vomit, take laxatives, excessive exercise to compensate for the binge eating)
- Do you binge eat at least once a week?
- Has no control over it. The one doesn’t want to eat, but can’t stop
- Feels guilty, ashamed, or disgusted with himself afterwards