Bellevue doctor: Binge eating disorder can’t be treated alone

Normal binge eating: Drinking beer, snacking on chips, eating hot dogs, maybe some more chips, definitely some sliders, and possibly those stuffed mushrooms over the course of a Sunday football game with friends.

Abnormal binge eating: Waking up and eating three bowls of cereal, making eggs, feeling bad about it, starving yourself all day and repeating the binge when you get home.

According to the National Institute of Mental Health, binge eating disorder is now the most common eating disorder in the U.S. with 2.8 percent of the country’s population experiencing a lifetime prevalence of the disorder.

“Everybody binges at times,” said Dr. Julie Friedman, the executive director of Binge Eating Treatment and Recovery with the Eating Recovery Center in Bellevue. “That’s part of normal eating behavior. But what differentiates normative binge eating from binge eating disorder is binge eating at a frequency of one time a week for three months or more.”

And then there’s the emotional component.

“We see high levels of rumination in these patients where they can’t stop thinking about food, they can’t stop thinking about what they’ve just done and are ruminating about the past in terms of their behaviors and that starts to decrease their quality of life and their productivity,” Friedman said. “At that level, we would say the disorder is associated with pretty significant side effects for patients.”

Friedman helped launch the Binge Eating and Recovery program three years after joining the Eating Recover Center four years ago. She started her career as a health psychologist in a hospital setting – think preoperative psychological evaluations for organ transplants. Through that internship, she became interested in sleep medicine and did a fellowship in that field following her pre-doctoral internship.

“I found that a lot of our patients were high weights and a lot of our patients were basically given the directive: Lost weight,” she said of her patients with sleep issues. “Lose weight and your obstructive sleep apnea or your organic sleep disorder of some sort will get better.”

But her patients continued to come back each month heavier and more miserable. With a new found interest in the phenomenon, Friedman’s sleep medicine fellowship was succeeded by an obesity medicine fellowship. She found her passion.

As Friedman referred patients for eating disorder treatment, she received feedback from those same patients that it wasn’t for them.

“‘This is a bunch of skinny people who are trying to gain weight or people who are really struggling to eat and I can’t relate to that at all’,” Friedman said her patients would say.

Despite the high rate of the disorder, only 38 percent of those with binge eating disorder seek treatment.

Instead of being treated alongside those with eating disorders such as anorexia nervosa or bulimia, Friedman learned patients with binge eating disorder needed their own treatment plan. Through some market research on what was currently available for treatment, Friedman and the Eating Recovery Center designed a plan geared for both high weight patients and those with a loss of control in eating.

Emotional eating, grazing, compulsive over eating, eating in the middle of the night are all undertreated or under addressed behaviors in traditional eating disorder treatments, Friedman said. And because of that gap in services, Friedman found her niche.

“It seems like we’re on the right track in the sense that our patient satisfaction is really through the roof,” she said of program’s 97.4 promoter score.

Friedman said the most common myth about binge eating is that people can treat it themselves. Binge eating is highly biological and genetic and often needs to be approached from a medical, nutritional and exercise or movement standpoint. There’s also individualized and family therapy that plays a factor as well as behavioral modification during treatment.

“There’s a lot of inflammatory stress on the body, there’s a lot of oxidative stress on the body and we know that irrespective of weight status, binge eating disorder really leads people to be more vulnerable to cardiovascular disease and metabolic disease,” Friedman said. “So even in and of itself, without the weight gain that’s associated with binge eating disorder, binge eating can cause some serious health problems.”

Among those physical health problems are also mental: poor body image, obsessing over food, guilt, anxiety and depression.

Friedman recalled a patient whose obsessive thoughts about her favorite ice cream during work caused her to leave work, get the ice cream and microwave it so she could eat it faster.

“There’s this sense that once they start this eating episode that they’ve already kind of blown it,” she said. “So they might as well keep going.”

The Binge Eating Treatment and Recovery program offers several levels of inpatient and outpatient treatment and is covered by insurance. The treatment focuses on non-diet weight management, mental health, dietary support, education, exercise and medical management but mostly focuses on proactive and reactive behavioral modification.

This mean meal planning, eating regularly scheduled meals, identifying food triggers and a plan with how to live with them, and learning how to stop a binge if a patient finds themselves in one.

“Binge eating is a behavior, so we’ve got the ability to modify it just like we can modify or change any other behavior,” Friedman said. “But you need behavioral treatment from somebody who really knows what they’re doing.”

For more information on binge eating or how to get help, visit