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Eating Disorders
Overcoming Resistance in Binge Eating Disorder Treatment
Binge eaters have often tried every diet in the book
Posted June 18, 2012
Just as patients with anorexia and bulimia can be treatment-resistant, those with binge eating disorder may face a number of obstacles as they work to change their attitudes and behaviors around food, body image and health. In treating binge eating disorders in residential treatment at The Ranch, I’ve worked with clinicians on various strategies to overcome the most common points of resistance, which include:
Diet Thinking and Food Confusion
It is not unusual for individuals struggling with binge eating disorder to have tried every diet in the book. From low-fat and low-calorie to meal replacement and low-carb, some people become attached to one particular diet and believe it’s the “right” way to maintain a healthy weight. During treatment, they may be resistant to recommendations for healthy eating because of their prior beliefs and/or experiences.
Food confusion is best handled with simple guidelines that are easy to understand and follow, such as the time-tested wisdom of eating more fruits, vegetables and whole grains and the “plate method” of filling half the plate with vegetables, one-quarter with lean meant and one-quarter with starch. Any issues with weight should only be addressed after bingeing is no longer a problem and without dieting.
In binge eating treatment, patients can develop a healthy mindset around food and restore the joy of eating well by embracing the following principles:
• No food is bad food.
• Deprivation affects the body and spirit.
• Variety is the antithesis of diet thinking.
• Judgments about what you eat are counterproductive.
Stress perpetuates the cycle of binge eating, and can affect sleep and mood, increase cortisol, and trigger emotional eating. Resistance in this area can be reduced using integrative stress management techniques, such as acupuncture, massage, nutraceuticals, art therapy and yoga, among others. Simple breathwork techniques, guided imagery and progressive muscle relaxation are additional natural stress relievers. Other skills that can be useful to combat binge eating are the dialectical behavior skills of distraction, mindfulness (taking a period of reflection before eating and being present and attentive to what you are eating), and teaching the patient how to self-soothe without using food (through music, aromatherapy or similar approaches).
Thin Ideal
Like much of the rest of our society, binge eaters are exposed to the message that to be desirable and worthy, they must be thin. As a result, they may have difficulty accepting or feeling good about themselves even if they’ve reached a healthy weight.
In treatment, we encourage patients to develop a deeper relationship with their bodies and to look at their bodies with a sense of gratitude and awe. Instead of focusing only on how their bodies look, we ask patients to recognize that their bodies continue to work for them despite surviving endless pains, joys and losses. As we go about our normal lives, sometimes overeating, avoiding exercise, or possibly undergoing surgery, child birth, grief/loss, abuse or trauma, our bodies are taken along for the ride – and yet our hearts keep ticking and our lungs keep breathing.
While most people learn to pay attention to their thoughts and emotions, there is also a lot to gain by listening to our bodies, which have their own wisdom and guidance for us. The body tells us when we are hungry or tired, but it also sends cues when we are in danger (e.g., when the hairs on the back of the neck stand up) and tells us who to get close to and who to stay away from when we first meet someone. Although we don’t always listen to it, this form of intuition can be a powerful guiding system in our lives.
Resistance to Exercise
People with binge eating disorder may have a deeply entrenched negative view of exercise. In some cases, exercise has been painful, embarrassing or boring in the past, and they are reluctant to commit to a regular fitness routine.
Some of the guiding principles that help overcome resistance to exercise are:
• Focus on moving the body, not just exercise to lose weight.
• No exercise is better than another.
• Experiment with different types of exercise until you find one you enjoy.
Gentle approaches like yoga have been shown to reduce many insulin resistance syndrome factors, such as glucose tolerance, insulin sensitivity, lipid profiles, blood pressure and stress. Studies also suggest that the practice of yoga promotes self-awareness, reduces feelings of depression and anxiety, and improves self-image.
Lack of Self-Care
The belief that everyone else’s needs come first can be an obstacle to binge eating disorder recovery. In addition to affecting the individual’s diet and sleep patterns, lack of self-care causes spiritual deprivation.
There are a number of daily practices that nourish the spirit, including gratitude, awe and forgiveness. Clinicians can also work with their patients to find new inspiration to care for themselves, such as modeling healthy behavior for their children or reducing the health risks that would affect not only themselves but also their families.
Managing Relapses
Relapse is a common part of eating disorder recovery. Some of the principles that aid in relapse prevention are:
• Avoid global thinking.
• Recognize that avoiding the scale is a relapse risk.
• Have U-turn foods in mind and available.
• Vow to never skip meals even when you overeat.
• Have an accountability partner or buddy.
Success is measured not by avoidance of relapse but by how quickly the individual returns to their recovery program.
A Partnership Approach
Resistance cannot be overcome with blame, dieting, unrealistic expectations or lack of encouragement. Two common practices – encouraging dieting and focusing on the number on the scale as the only indicator of good health and well-being – only exacerbate the struggles of those with binge eating disorder.
Instead, we serve our patients best by setting realistic expectations, providing support and encouragement, reinforcing simple instructions over time, and offering feedback that health is the most important goal. Forming a partnership with your patients is the best gift you can give them to help them become healthier. They need to feel, “We’re in this together.”
Carolyn Ross, M.D., specializes in Integrative Medicine and developed the eating disorder treatment program at The Ranch in Tennessee. You can follow Dr. Ross on Twitter.
