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Eating disorders don’t discriminate. They affect people of all ages, appearances, races and religions. Still, when the conversation turns to eating disorders (or disordered eating), we often forget that men struggle, too.

That’s why I was especially interested in speaking with Richard Bedrosian, Ph.D, co-author of this recent study on binge eating in men, published in the International Journal of Eating Disorders. Bedrosian is the Director of Behavioral Health and Solution Development at J&J’s Wellness & Prevention, Inc.

Below, he reveals what we know about binge eating in men, why eating disorders remain under-recognized in this population, what treatments are effective and much more.

Q: Thus far, including your 2012 study in the International Journal of Eating Disorders, what has research revealed about binge eating in men? 

A: Unlike bulimia and anorexia which are much less prevalent among males, binge eating is almost as common among men as it is among females. In our study, which involved participants in an online health risk appraisal, 7.5 percent of men and 11.1 percent of women reported binge eating.

The prevalence of binge eating among men (and women), rises steadily with Body Mass Index, so that it is much more prevalent among obese individuals.

Moreover our research shows that binge eating among men is associated with significant levels of emotional distress, obesity, depression and work productivity impairment, as is the case with females.

As with other eating disorders, people who binge eat are seldom identified or treated.  Treatment outcome studies of binge eating disorders may often exclude males, simply because they are so unlikely to come forward for treatment.

Offering alternative self-management services, such as online digital health coaching programs, may result in more men getting help for binge eating.  For example, nearly 30,000 people have used the Wellness & Prevention digital health coaching program for binge eating: Around 30 percent of the participants have been male.

Q: Why is binge eating under-recognized in men? 

A: In general, eating disorders are typically not often identified or treated, even among females.

We have found that in general the health care system fails to recognize [the] strong association between binge eating and obesity.  Consequently, weight management services may not even be screening for binge eating.

Research on men’s health indicates that men are likely to under-report symptoms of physical and emotional distress across the board.

Men are much less likely to acknowledge or seek help for all behavioral health problems.

There is a perception that eating disorders are “female” disorders.  This may discourage health care providers from inquiring about binge eating.

For male patients, this perception may also add to the stigma associated with the behavior, and make it more difficult for them to admit to having the problem.

Q: What are some of the warning signs that overeating has escalated into binge eating? 

A: The most important distinction between overeating and binge eating is a sense of loss of control.

Below are the proposed research diagnostic criteria for binge eating.  Some of the additional elements that distinguish binge eating from typical overeating include eating until feeling uncomfortably full, eating large amounts of food when not physically hungry, eating much more rapidly than normal, eating alone because you are embarrassed by how much you’re eating, and feeling disgusted, depressed, or guilty after overeating.

A. Recurrent episodes of binge eating. An episode is characterized by:

1. Eating a larger amount of food than normal during a short period of time (within any two-hour period)
2. Lack of control over eating during the binge episode (i.e. the feeling that one cannot stop eating).

B. Binge eating episodes are associated with three or more of the following:

1. Eating until feeling uncomfortably full
2. Eating large amounts of food when not physically hungry
3. Eating much more rapidly than normal
4. Eating alone because you are embarrassed by how much you’re eating
5. Feeling disgusted, depressed, or guilty after overeating

C. Marked distress regarding binge eating is present

D. Binge eating occurs, on average, at least 1 day a week for three months

E. The binge eating is not associated with the regular use of inappropriate compensatory behavior (i.e. purging, excessive exercise, etc.) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

Q: What are the most effective treatments for binge eating? 

A: Much more research needs to be done on all treatments for binge eating, as there are a relatively small number of outcome studies.  Many of the studies have small sample sizes, and importantly for this discussion, may exclude men, often because they cannot recruit enough male participants.

Cognitive-behavioral therapy, offered both individually and in groups, is the treatment with the strongest research support to date.

The use of medications, such as antidepressants, has yielded mixed results in the research. Initial results on the use of appetite suppressants are promising, but more research needs to be done to confirm the effectiveness of these medications.

Other forms of psychotherapy, such as dialectical behavior therapy and interpersonal psychotherapy, have also shown positive results, but the research on them has been limited.

Likewise, combination treatments (e.g., CBT plus medication) have also shown promise in limited research.

Lastly, research is beginning to show that self-help CBT approaches, such as Web-based digital health coaching, can be helpful for binge eating.

Q: Where can men struggling with binge eating find help and support? 

A: Check with your health plan or employee assistance program to find qualified health care professionals who are skilled in assessment and treatment of eating problems.

Look online for reputable resources on binge eating (e.g., National Institute of Mental Health, Binge Eating Disorder Association, National Eating Disorder Association).

Q: Anything else you’d like readers to know about binge eating in men? 

A: This is a common problem, but a treatable one. Screening and treatment for binge eating disorder need to be part of every effort we make to contain the obesity epidemic.

That means that all weight management programs should be asking participants about binge eating behaviors and either providing them with or referring them to the appropriate services for the problem.

[MT: you guys know that I’m going to respectfully disagree here about the obesity epidemic. We don't need to contain it; we need to emphasize having a healthy relationship with food and physical activity for everyone -- and to take the focus away from weight and put it onto health. Plus, there are many “normal-weight” individuals who struggle with binge eating as well. But I totally agree about the importance of screening measures.]

We need to provide alternative forms of self-help or self-management for men who might be reluctant to acknowledge their symptoms or come forward for treatment.

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References

Bedrosian also provided a list of relevant references.

Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007;61:348–358.

Bedrosian RC, Striegel-Moore RH, Wang C. Demographic and clinical characteristics of individuals utilizing an internet-based digital coaching program for recovering from binge eating. Int J Eat Disord 2010.

Striegel-Moore RH, Wilson GT, DeBar L, et al. Cognitive behavioral guided self-help for the treatment of recurrent binge eating. J Consult Clin Psychol 2010;78:312–321.

Striegel-Moore RH, Leslie D, Petrill SA, Garvin V, Rosenheck RA. One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: Evidence from a national database of health insurance claims. Int J Eat Disord 2000;27:381–389.

Striegel-Moore RH, Rosselli F, Perrin N, et al. Gender difference in the prevalence of eating disorder symptoms. Int J Eat Disord 2009;42:471–474.

Brownley KA, Berkman ND, Sedway JA, Lohr KN, Bulik CM. Binge eating disorder treatment: A systematic review of randomized controlled trials. Int J Eat Disord 2007;40: 337–348.

Wilson GT, Wilfley DE, Agras WS, Bryson SW. Psychological treatments of binge eating disorder. Arch Gen Psychiatry 2010;67: 94–101.

Debar LL, Striegel-Moore RH, Wilson GT, et al. Guided self-help treatment for recurrent binge eating: Replication and extension. Psychiatr Serv 2011;62:367–373.

Bedrosian RC, Striegel-Moore RH, Wang C, Schwartz S. Association of Binge Eating with Work Productivity Impairment, Adjusted for Other Health-Risk Factors. J Occup Envir Med in press.

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Thanks so much to Richard Bedrosian for answering my questions.

What would you like to know about binge eating in men? Any questions about the interview? 

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    Last reviewed: 26 Apr 2012