New guidelines offer hope for those with binge-eating disorder
Jana Begor, 68, left, who has struggled with her weight for decades, listens to Rebecca Sturges, M. S., in a therapy session in Sacramento, Calif, last month.
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At one time or another, Jana Begor has tried most of the commercially advertised diets, not to mention the grapefruit diet and the cabbage soup diet. She became a vegan. She tried the raw food diet.
Sometimes, she lost weight. And then she regained it.
“I need to learn how to eat,” said Begor, 68, a real estate agent who lives in Calaveras County, Calif. “Why am I not able to control my eating? What is going on that I can’t put my fork down or step away from the refrigerator?
“I start eating, and I don’t stop.”
She was recently diagnosed with binge-eating disorder, a condition involving compulsive, out-of-control episodes of eating followed by deep shame, guilt and depression.
It’s the country’s most prevalent eating disorder, shared by more than 8.5 million Americans: Binge-eating disorder affects more people than do bulimia and anorexia combined, yet experts say it has long been underdiagnosed as a mental health issue.
That’s likely to change this spring, when the new edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5 — the so-called bible of psychiatric treatment — for the first time lists binge-eating disorder as a specific diagnosis.
Unlike most eating disorders, it affects men in large numbers: More than 40 percent of binge eaters are male, according to Harvard University research.
And unlike other eating disorders, it can develop in middle age and beyond, when retirement, care-giving, widowhood and other midlife stresses can trigger eating issues.
Now advocates hope DSM-5 recognition for binge-eating disorder as a treatable behavior pattern will put it on par in the public’s mind with better-known conditions such as anorexia — and open new avenues to insurance coverage.
“Too often, people with binge-eating disorder are referred inaccurately to weight-loss loss programs or clinics,” said Susie Roman, National Eating Disorder Association program director. “What they need is binge-eating disorder treatment.
“Having new insurance coverage standards can be helpful in getting people more access to treatment earlier,” she said.
As it is, binge-eating disorder often falls between the health plan cracks.
California’s mental health parity law requires that insurers cover treatment for anorexia and bulimia as well as seven other conditions, including panic disorder and bipolar disorder.
Although the previous edition of the Diagnostic and Statistical Manual describes binge-eating disorder in an appendix, it’s not a distinct diagnosis — and it’s not included on the parity law list.
As a result, mental health professionals have ended up lumping the condition into a catch-all diagnostic category called “eating disorder not otherwise specified,” which many health plans don’t cover.
“You can have a patient who’s extremely ill, but we have to give them the (catch-all) diagnosis,” said Jennifer Lombardi, executive director of Sacramento’s Summit Eating Disorders and Outreach Program. “That might mean they don’t receive sufficient care.
“From the clinician’s perspective, the change of DSM-5 diagnostic criteria is a very good thing,” she said. “We see patients like this all the time, but there have been gaps in access to treatment and services.”
Research shows that binge-eating disorder accounts for up to 15 percent of cases of extreme obesity and increases the risk of high cholesterol, high blood pressure, heart disease and type 2 diabetes.
Health plans routinely cover those problems, but not the disorder itself.
“I find it fascinating that we don’t look at this from a broader perspective,” said Lombardi.
“Insurance companies will pay for gastric-bypass surgery but not for treatment of binge-eating disorder. We’ve had patients regain the weight after bypass surgery because they struggle to change their relationship with food.”
The new DSM-5 acknowledgment of binge-eating disorder doesn’t guarantee that coverage will follow, according to the California Department of Managed Health Care, which licenses and regulates health plans in the state.
“It really is impossible to predict how the change to the DSM-5 will ultimately impact coverage,” said department spokeswoman Marta Green. “Two things determine what people get coverage for: The mental health parity law and the fact that some plans offer coverage well beyond those parity conditions.
“The inclusion of new diagnoses in the DSM-5 doesn’t necessarily trigger a change in coverage.”
Even so, mental health professionals such as Rebecca Sturges, a Sacramento marriage and family therapist who specializes in binge-eating disorder treatment, consider the new diagnostic criteria a potential game-changer for the condition.
For one thing, she said, people tend to minimize binge-eating disorder by equating it with occasional overeating — consuming too much pie at Easter dinner, for example, or snacking on junk food.
“It’s a different beast from overeating,” said Sturges. “People with binge-eating disorder are feeling something they don’t want to feel, whether that’s mad, sad, angry, bored or stressed, and how they’ve learned to change that feeling is with food.
“Eating is being used like other people use alcohol, drugs, gambling or sex.”
Often, she said, binge eaters are also compulsive spenders, and often, they binge alone, hiding their food addiction from other people. They also tend to be preoccupied with body image and size.
Sturges and other therapists use cognitive behavioral therapy to help patients identify underlying causes for their binge eating and learn new habits.
“People develop behavior patterns that aren’t serving them very well,” she said. “But they can change. They can learn new things.”
Begor, one of Sturges’ clients, is trying. When she married her husband in 1989, she carried 137 pounds on her 5-foot-2 frame, she said.
Then her husband developed throat cancer and she started binge eating to deal with the stress.
He’s been in remission for two decades. But she kept eating, putting on 100 pounds by 2012. Along the way, she developed sleep apnea, high blood pressure and cardiac problems.
“Basically, I eat to fill this empty space, not to feel deprived,” she said. “Eating has been a soothing, safe place, and now it’s becoming a stress.”
With the help of a medical weight-loss center, she lost more than 80 pounds last year — but now, she said, she is regaining the weight and desperate to figure out the emotional underpinnings of her disorder.
“I gained 12 pounds, and now I’m scared to death,” she said. “I need to learn how to eat.”