NPR Interview on Binge Eating

Austin Cross (Host):

It’s AirTalk. I’m Austin Cross and this week for Larry Mantle. Thanks so much for staying with us. Let’s turn now to food. Our relationship with it. Food is comfort. For a lot of people. It means connection. It’s also necessary for survival. But our relationship with food, we know it can get complicated with judgments about what we eat, when, how much, and turns out when our relationship with food becomes one that is restrictive or associated with guilt. Disordered eating often follows and binge-eating disorder turns out is the most common eating disorder in the US and it’s usually characterized by consuming unusually large amounts of food in a short amount of time. So I’ll say right now that if you do happen to eat a lot of food, maybe you’re watching TV, you’re eating a bag of chips, it’s not necessarily that. It is unusually large amounts of food, not say a piece of pizza or two pieces of pizza.
It’s maybe a whole pizza or several pizzas in a short amount of time, and people with it often feel unable to stop eating. So we’re going to look at what’s behind this in a minute, but this is where I want to hear from you. I know that this takes a little bit of vulnerability, but this is what we do here on AirTalk. We talk about things so we can understand them a little bit better. If you have a binge-eating disorder, what are some of the things that have helped you manage it? Have you begun to mend your relationship with food? We have a line open for you right now at 866-893-5722. Again, that’s 866-893-5722. If you don’t feel comfortable doing that, of course you can email us at atcomments@laist.com. Again, that’s atcomments@laist.com. Well, starting off our conversation today is Brian Pollack, founder and clinical director at Hilltop Behavioral Health in New Jersey. They specialize in treating anxiety, depression, and eating disorders. Brian, thank you so much for coming on.

Brian Pollack, LCSW, CEDS-S:
Oh, thank you, Austin. I appreciate you inviting me to be on the show.

Austin Cross (Host):
So what is binge-eating disorder and how is it different from what some people may call emotional eating, stress eating?

Brian Pollack, LCSW, CEDS-S:
Sure. Binge-eating, much like you had just outlined, is a relationship with food that often can create an experience where we’re eating more than what person may call normal. Now what is normal? Each person has their own experience of what that is. But when a relationship with food becomes indulgent or over the top to where somebody really feels as though they’ve lost control or they eat to the point where they are uncomfortably full, possibly in pain, physical pain, and then afterwards they’re met with their own experiences of shame, embarrassment, guilt, depression, all these different markers of emotions that make us just feel bad, we find people’s distress starts to increase and then the cycle starts to go because once somebody feels as though they’ve lost control or they’ve eaten too much in our diet minded culture, we will start to try to repair that with restriction.
So we have this balance where with all eating disorders, even binge-eating, which most people are surprised by, there’s a level of restriction or needing to not eat because I ate too much before. Then a cycle goes because much like a pendulum swing, you see somebody restrict and they go all the way to the other side and they find themselves binging.

Austin Cross (Host):
Talking right now with Brian Pollack, founder and clinical director at Hilltop Behavioral Health, which specializes in eating disorders. Of course, if you’d like to share your experience, if you have been diagnosed with binge-eating or if you believe that you might be somebody that falls under this classification, 866-893-5722. If you found a way to manage it, we’d love to hear it. 866-893-5722. Brian, it really surprised me during the research for this conversation because I would not have thought that binge-eating was the number one disorder, eating disorder in the US. And yet I also understand that you work a lot with men. How big of an issue is this among men?

Brian Pollack, LCSW, CEDS-S:
It’s quite a big issue. Over 50% of men who struggle with an eating disorder of some form are struggling with a binge-eating disorder. A lot of times because the social stigmas, the cultural difficulties of men needing to always present being in control or leaders or strong, many different contexts of what it is in our culture to be a man. They don’t come to the forefront and talk about it. We have a society where 28% roughly of boys, adolescent boys, they’re actively dieting and no one’s talking about it. 51% of boys are exercising with the goal of losing weight because they’re not comfortable in their bodies. So this is something that’s growing and growing and growing with the onslaught of pressure coming from our current culture of where our children are getting their information as well as adults and where they’re starting to learn as they go through different developmental and physical changes in their life, how they feel like they need to be taking care of themselves.
Unfortunately, when we struggle with, let’s say comorbidity such as anxiety and depression, where right now about 43% of people who struggle with an eating disorder of some kind, have a comorbidity of a psychiatric diagnosis. What ends up happening is the food component, whether it’s about over control or under control or losing control with something like binge-eating, they have to work through these things. And the food becomes what we call the compensatory behavior, the thing that helps us feel better or even the restriction, the lack of it. So there’s a very large component of our population where we’re really just looking at them, judging them, thinking that they aren’t taking care of themselves or they can’t go to the gym or there’s something not right about them. Then they have to face that when diagnosis wise, they have a comorbidity. Biologically, we’re starting to discover with men and women and all genders, it’s in our DNA. Some of us are just preloaded to struggle with an eating disorder when the going gets tough in our lives.

Austin Cross (Host):
Binge-eating disorder is the most common eating disorder in the United States. I’m talking about it with Brian Pollack, founder and clinical director at Hilltop Behavioral Health, which specializes in eating disorders. I want to invite Alexis Conason into the conversation. She’s a psychologist, founder of Conason Psychological Services in New York City, and author of the “The Diet-Free Revolution: 10 Steps to Free Yourself from the Diet Cycle with Mindful Eating and Radical Self-Acceptance.” Dr. Conason, thank you so much for being here.

Alexis Conason PsyD:
Thanks for having me.

Austin Cross (Host):
So I’m hearing a lot from Brian, and you might have heard some of it too, just what a role are our current culture plays in binge-eating and how it really affects our self-image, how we think of ourselves and who we should be in society. I’m wondering if you can broaden this out for me. Is this a Western culture specific idea? Are we seeing this in other countries and other areas as well? Just how widespread is this? I know it’s clearly number one in the US.

Alexis Conason PsyD:
Yeah, well, certainly we see eating disorders and binge-eating disorder in other cultures as well. There’s actually some research showing that as western ideals are introduced into other cultures, we see a corresponding rise in eating disorders.

Austin Cross (Host):
So is it the media that’s factoring in or is it this idea of diet equals acceptability, lovability? What connections are people making and how are they getting this messaging?

Alexis Conason PsyD:
Well, I think it’s complicated, but certainly dieting plays a huge role. We know that dieting is one of the most predictive variables to the development of an eating disorder. So while not everybody who goes on a diet develops an eating disorder, almost everybody who has an eating disorder does have a history of dieting. So it’s a very high risk behavior to engage in dieting. We do live in a culture where we are constantly bombarded with the messages that smaller is better, that if you’re in a larger body, that’s unacceptable and unhealthy and that we need to do everything we can to try to make ourselves to lose weight and be smaller. That really sets the stage for a epidemic proportions of eating disorders, which is what we’re seeing now in our culture.

Austin Cross (Host):
866-893-5722 is the number if you’d like to share your experience with binge-eating and maybe what’s worked for you. Tricia in Brentwood says, “I’ve been a binge eater. I’ve recovered. I found that I needed self-care and to heal my emotional self and deal with stress properly.” We also heard from Allison in Long Beach who says, “My husband was a binge eater. He was eating his feelings, but he realized he was binging. The only way he was able to regulate it was to take a weight loss drug.” That’s Allison in Long Beach. Alexis, how do we begin to unlearn harmful judgements especially that come as a result of diet culture in society today?

Alexis Conason PsyD:
Yeah, it takes a lot of work to unlearn this, especially many of us have, as Brian was saying earlier, really been raised with these ideals and the narrative that we have to restrict our eating in order to be healthy. So it takes a lot of unlearning to do to be able to come back to the intuitive place that we had almost as children or as babies where we just knew how to feed ourselves and it wasn’t so complicated. But I do think that healing is a process of recognizing where the messages are coming from in diet culture, recognizing the industries that profit off of us feeling bad about ourselves and buying different products and plans and really working oftentimes with a trained mental health professionals specializing in eating disorder to be able to regain a sense of trust in our body and come back home to ourselves where we can start to listen to our hardwired innate wisdom around how to feed ourselves. It’s a very basic skill that we all know on a very deep level, yet we become so disconnected from that.

Austin Cross (Host):
Brian Pollack, I’m wondering if in your practice, if there’s a certain age range that you’re seeing of people who do struggle with binge-eating. Are we seeing it much more among certain groups or certain age groups than others?

Brian Pollack, LCSW, CEDS-S:
I’ve been in practice now for roughly a decade. More people who were calling, I would say were 30 years old and older, maybe some people in their twenties. But as things started to progress particularly with the pandemic, but a little before that, I started getting more and more calls around adolescents and sometimes even children. At Hilltop, we work with individuals from age around 10 or 11 all the way through the lifespan in retirement using different types of intervention models. With binge-eating particularly, it’s an interesting experience because as Alexis was talking about all of the learning we have to undo when you’re younger, there’s a little bit more of an opportunity to challenge the status quo of what’s being internalized throughout their lives. Because there’s this piece of it where children and adolescents are going through an experience where they lose the self embodiment, where they’re comfortable in their body in order to be okay in the world.
When somebody who binge-eats is in a social structure, there’s a lot of anxiety and difficulty because of the social norms and some of the difficulties that could happen in the school environment, which then if families have this dieting mindset or other people aren’t really aware of how to help without utilizing the idea of, “Well, you have to go on a diet,” the pressure mounts. What happens is these kids and these adults, we start acting on our bodies in order to be safe. If you see that our body, now, if you think about the Me Too movement and the Black Lives Matter movement, these are body stories, right? Because the body’s a surface of which we have central rules of hierarchies around. We have to figure out how do we tell our body journey and our body story and unlearn so that we can empower ourselves?
A lot of times that basic experience Alexis is talking about with the food being so intuitive inherent, we think it’s an easy black and white. “Well, if I don’t eat or I do eat, well, here’s one plus one equals.” Then at the same time, the people who are binging, they’ll think, “Okay. Well, two plus two equals four, I don’t like four,” but they can’t stop it. So there’s so many different pieces to this, and you really do need a mental health practitioner because the ages are starting to show up in all different varieties. It’s not just one age bracket of individuals anymore.

Austin Cross (Host):
Dr. Alexis Conason, my last question to you is for people who might be listening in right now who they might suspect that this could be a disorder that they are exhibiting symptoms of, is there a checklist is part one of my question, but then two, if people do check off a number of those boxes, what kind of help they should consider looking for people they should consider reaching out to?

Alexis Conason PsyD:
Yeah, so one thing that I like to emphasize is I think that if you are concerned about your eating, if your eating is causing you distress, if you notice rigid patterns around food or behaviors, those are all signs for seeking help. I think it’s much more about how you’re experiencing eating disorder or disordered eating symptoms. That can be the impetus for seeking treatment more so than checking off the boxes or meeting the criteria for the DSM, because I work with a lot of people who eating causes great distress, but for whatever reason, they don’t meet all the criteria of the DSM, which it doesn’t mean that they don’t deserve treatment for that. So I’d say if you are listening and you’re concerned about your eating, that is reason enough to reach out to a mental health professional and have a call and get some more information about if treatment is something that could be beneficial to you.
Another thing that I want to emphasize for people who are struggling with binge-eating disorder, so often we think about binge-eating disorder as being about the loss of control or being about the binge episode, but there is a strong restriction component that goes into binge-eating as well. So I think that’s something that a lot of people don’t recognize or think about, but it’s really that diet mentality, the rules around food not eating enough during certain portions of the day that set the stage for the binge-eating to occur. So often people who are worried about binge-eating try to treat it by restricting their eating more, trying to follow a diet plan, like one of the callers mentioned even taking weight loss medications to try to reduce their appetite, but actually that can be counterproductive in the treatment of binge-eating disorder. Very often it’s about working through the restriction so that people are letting go of those rules around food, which really contribute to the binge process.

Austin Cross (Host):
That’s Dr. Alexis Conson, psychologist and founder of Conason Psychological Services and author of “The Diet-Free Revolution: 10 Steps to Free Yourself from the Diet Cycle with Mindful Eating and Radical Self-Acceptance.” we also heard from Brian Pollack, founder and clinical director at Hilltop Behavioral Health, which specializes in eating disorders. My thanks to you both for coming on. When we come back, there is a new oral history of emo music. It’s in a new book called, Where Are Your Boys Tonight?” We’re going to talk with their author, Chris Payne. Stick Round. 60 Seconds.