What You'll Learn
- How does binge eating develop in children and teenagers?
- What is loss of control eating?
- How can we help kids with binge-eating or loss of control eating?
Binge eating — consuming an unusually large amount of food in a short period of time — was classified as an eating disorder in 2013. It is usually diagnosed in teenagers and young adults, but children can also develop binge eating.
One of the characteristics of binge eating is that the person feels they have lost control of their eating. They feel they can’t stop eating. And this loss of control (LOC) eating sometimes develops in children (as young as eight years old) who will later develop full-blown binge-eating disorder (BED). So identifying and treating children with LOC eating could be an important way to prevent adult BED and weight gain.
Adults with BED usually report that their eating binges are triggered by negative feelings, but kids generally don’t. Instead they describe feeling zoned out. And rather than intending or planning to binge, they tend to do it when an opportunity arises, such as after school when parents aren’t home or are otherwise occupied. BED is often diagnosed in teenagers who are looking for weight loss treatment, who may not even realize they have an eating disorder.
Most of the research on BED has been done in adults with the disorder, but experts are adapting adult treatments for adolescents and children. Two kinds of therapy are being used to help kids with binge eating.
In cognitive behavioral therapy (CBT) kids learn to change their eating habits to prioritize regular meals and healthy foods. They also work on self-regulation and impulse-control skills.
In interpersonal therapy (IPT), kids get help improving relationships that may be troubling them, triggering binge eating episodes.
Binge eating, which involves consuming an unusually large amount of food in a short time, has long been associated with weight problems and psychological distress. But it’s only since 2013 that repeated binge eating has been classified as an eating disorder. Binge-eating disorder is usually first diagnosed in teenagers or young adults, but it can also occur in children.
It’s not just the unusual amount of food eaten that defines binge eating. People with the disorder also report feeling a loss of control while eating. And when it comes to children and adolescents who struggle with binge eating, experts say it’s more useful to focus on the “loss of control” experience than the amount of food consumed in an eating binge.
That’s in part because when you’re talking about kids, it’s hard to be clear what “large amount” means — it varies for different ages, genders and developmental stages, explains Marian Tanofsky-Kraff, PhD, a researcher of binge eating in youth and a professor at the Uniformed Services University School of Medicine. “If you have a 14-year-old boy going through a burst of puberty, he could easily eat a whole pizza. Is that large?” asks Dr. Tanofsky-Kraff. “What about an eight-year-old girl who’s eating four slices of pizza? Is that too much?”
But it’s also important to focus on the loss of control (LOC) experience because it’s a behavior that often appears in kids before they have developed full-blown binge-eating disorder (BED). Kids who have episodes of LOC eating — regardless of the amount eaten — have been shown to be at higher risk for developing BED and adult obesity. So interventions that treat LOC eating in kids may be an important way to prevent BED.
Kids and binge-eating disorder
Most young people who are diagnosed with BED are identified because they are seeking treatment for obesity, explains Andrea Goldschmidt, PhD, an associate professor of psychiatry at the University of Pittsburgh School of Medicine whose research focuses on LOC. They often don’t know they have an eating disorder.
“When I ask kids and their families where they want to start, often times it will be weight loss,” Dr. Goldschmidt says. “And we have to help them understand that the thing they need to work on before they can lose the weight is managing their binge eating.”
Binge-eating disorder is rarely flagged by pediatricians and other doctors. That is in part because doctors don’t think of eating disorders when they see a patient at an above average or higher weight, notes Dr. Tanofsky-Kraff. But more broadly, doctors often avoid talking to kids about their weight, for fear of undermining their self-esteem.
Drs. Goldschmidt and Tanofsky-Kraff report seeing LOC eating in kids as young as eight years old. And they’ve seen kids with the full-blown BED as young as 12 or 13.
Diagnosing binge-eating disorder
The primary symptoms of BED are recurring episodes of binge eating. Those episodes are defined by eating more food than most people would consume in a discrete period of time — for instance, within a 2-hour period — and a sense of lack of control over eating during the episode. A person with BED feels unable to stop.
The episodes may also be characterized by:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed or very guilty afterward
For a BED diagnosis, these episodes must occur at least once a week, have continued for 3 months, and be causing serious distress. Individuals with the disorder are typically ashamed of their eating problems and often eat in secret to hide their symptoms.
How are kids different from adults with BED?
While adults who have BED tend to say their episodes are triggered by negative feelings, younger kids generally don’t connect them to feeling bad. That may be because they’re not able to articulate their feelings, Dr. Tanofsky-Kraff notes. “A lot of children talk about feeling like they’re zoning out or paralyzed. They describe a sort of numbing out when they’re eating. We’re not 100 percent sure why, but we think part of it is because they’re using food to cope, to deal with aversive feelings.”
Unlike adults with the disorder, kids don’t tend to plan for binges. Instead, the episodes happen when there is an opportunity.
Often kids report that they don’t eat regularly during the school day. “I will often hear that they don’t want to bring a packed lunch and say the food at school is gross, so they’re coming home from school very hungry,” explains Dr. Tanofsky-Kraff. “Maybe nobody else is home, or their parents are busy doing something else. Those after-school hours can be the prime risk period for loss-of-control eating.”
Who is at risk for binge-eating disorder?
Like other eating disorders, girls are more likely to develop BED than boys. And the disorder is highly heritable.
Young people who have been engaging in unhealthy dieting to lose weight are also at higher risk for BED. They restrict their eating so much that they become famished, and they feel deprived. Then they end up overeating and feeling out of control later.
Research led by Dr. Tanofsky-Kraff published in American Psychologist proposes that there are several factors that, combined, may increase the development of BED and high weight among youth who report LOC eating behaviors. They are:
- Negative mood: experiencing depression, anxiety, stress or interpersonal difficulties
- Responsiveness to foods: being particularly sensitive to food as rewarding
- Executive functioning issues: poor impulse control and self-regulation skills
Research has also found that a greater percentage of kids with ADHD have recurring LOC incidents than kids without ADHD.
Treatment for binge-eating disorder
Treatment for BED has been studied more in adults than teenagers. For adults, several forms of therapy have been shown to be effective.
- Cognitive behavior therapy (CBT): CBT is the most studied and well-established form of therapy for BED. CBT works with patients to normalize eating patterns, develop self-control and modify negative views of themselves in order to reduce binge eating.
- Interpersonal psychotherapy (IPT): IPT focuses on improving interpersonal skills to foster healthy relationships and a positive self-image, and helps individuals manage negative feelings without turning to food.
- Dialectical behavior therapy (DBT): DBT focuses on improving emotional regulation skills to avoid using binge eating as a way of responding to painful emotional experience.
There are three kinds of medicine that have been found to help reduce BED in adults, sometimes in conjunction with therapy:
- Stimulant medications developed for ADHD, which may reduce impulsiveness (Vyvanse is FDA-approved for BED in adults).
- Antidepressants, including SSRIs, which may reduce binges by boosting mood.
- Anti-seizure drugs like Topamax, which help stabilize mood and reduce impulse control problems.
Drs. Goldschmidt and Tanofsky-Kraff are both involved in adapting adult treatments for use with teenagers. They emphasize that there is not yet enough research to establish a gold standard treatment for kids with the disorder.
CBT for binge eating in teenagers
Dr. Goldschmidt uses CBT to help young people reset their eating habits to reduce extreme dieting and prioritize regular eating and flexibility with respect to food choices. There is also a big focus on helping kids improve their self-regulation around eating, and strengthening self-regulation skills in general.
Dr. Goldschmidt sees promise in web-based interventions for teenagers, given how much they are online already, and because issues like access and stigma might limit their willingness to engage in face-to-face therapy. In her work, she uses smartphones to collect data on how kids are feeling and what they’re doing, including eating. It’s called “ecological momentary assessment.”
“We ping them throughout the day, or they respond to surveys at the time that they have an eating episode,” Dr. Goldschmidt explains, “and they’re answering a series of questions about where they are, who they are with, how they are feeling, and what they are doing.”
This allows clinicians to offer guidance in real time. “We can identify the momentary factors, as they’re occurring, that are going to trigger a binge-eating episode, and we can intervene in the moment to tell them, ‘It looks like you’re heading into a party with your friends. Let’s think about the ways that you’re going to avoid overeating at the buffet table,’” Dr. Goldschmidt adds.
Once patterns are established, Dr. Goldschmidt says, teens can be sent periodic reminders for high-risk situations, or when they’re likely to be experiencing a trigger, to remind them to practice skills they have learned. Dr. Goldschmidt calls this technology-based treatment “CBT augmented by self-regulation interventions.”
IPT for binge eating in teenagers
Dr. Tanofsky-Kraff advocates using IPT, which is focused on helping the child to understand relationship issues that may make them turn to overeating.
Kids who are binge eating are usually struggling with relationships, she says. You might assume that their biggest concerns would be friendships and acceptance by peers, she adds, but it’s usually stressors with their parents. “We did a study where we looked at all the problem areas to see what was it that was prompting their loss of control episodes, and it was most frequently difficulties with their parents.”
IPT helps kids focus on interpersonal issues that are related to their eating. “For instance,” she notes, “if every day when you come home from school you’re having a battle with your mom, you feel badly, and you use food to cope.”
Dr. Tanofsky-Kraff stresses that IPT improves not only kids’ eating habits but also their lives. “It goes deeper, to what is promoting the loss of control. It also improves relationships and mood symptoms, and loss of control is highly comorbid with things like anxiety and depression.”
Dr. Goldschmidt notes the importance of developing scalable interventions that could be used to get care to kids who may have poor access to mental health professionals. “We know that binge eating affects kids who are under-resourced, maybe come from minority populations, like racial and ethnic minority youth, and don’t have adequate insurance coverage.”
She sees hope in the use of technology like smartphones that could enable short-term treatment that targets the eating behaviors and starts to address the mechanisms, though she recognizes that this kind of treatment “is not going to cover all of the bases in terms of what’s underlying the eating disorder.”