November 2005

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Vol. 4, No. 11

How to Help the Volume Eater—The Person with a Binge Eating Disorder 

Possibly disproving my usual preaching that people following our diet always lose weight and become healthier are a few extraordinary people I call “volume eaters.”  They eat very large amounts of McDougall approved foods, and their weight remains stubbornly fixed at a point too high for excellent health—although they all lost initially after giving up the high-fat, high-calorie Western diet.  I can vividly recall several men and a few woman who exemplify this behavior—and I know there are many more out there (in fact, I am guilty of a tinge of this behavior at times myself—“it takes one to know one”).

In my experience, a “big eater” might consume 2 plates filled 2 inches high with salad, potatoes, pasta, beans, and vegetables. The volume eater will put down three to five such plates—often in less than 20 minutes—a pattern repeated for breakfast, lunch and dinner.  Their conveyor belt style of ingesting allows no time for the body and brain to register that they have eaten. By the time their abdomen is noticeably (and sometimes painfully) distended they will have consumed 2,000 calories at a single meal, which could mean 4,000 to 6,000 calories for the day.  In the medical world a person with this pattern of eating is thought to suffer from a binge eating disorder.

Binge eating disorder is characterized by ingestion of very large meals without purging (throwing up) afterwards and is found in a subset of overweight individuals.  These people are different for several reasons.  They have been found to have larger stomachs than the average person of comparable physical size.1 Hormones governing eating and fat storage compound their troubles—they have higher levels of insulin (a hormone which forces fat into the fat cells) and lower levels of appetite suppressing hormones, like ghrelin.1  Volume eaters seem to derive a heightened sense of pleasure from eating, akin to that experienced by drug addicts using heroin.2,3 These “opioid-mediated rewards” play an important role in this form of hedonistic eating behavior.  Thinking back on the people I know who are volume eaters, I would characterize their personalities as “driven,” and by no coincidence all have been financially successful in their individual businesses. 

Possible Solutions

Binge eating disorder is a nearly impossible condition to treat by standard medical care.  Many programs attempt psychological and behavior change with little success.  More drastic treatments with gastric surgery (gastric banding and bypass) and drugs such as the anti-epilepsy medication, topiramate, are also used—unfortunately, the results are poor here too.4 Serious changes in eating behavior are the only real hope for these extreme personalities.

The most successful program for the treatment of people with serious eating disorders is the Kempner Rice Diet.5  This is a diet of rice, fruit, and sugar, plus vitamin and iron supplements, devised by Walter Kempner, MD, of Duke University in the 1940s to treat hypertension. The regular diet consists of about  2,000 calories daily and contains 5 gm or less of fat, about 20 gm of protein, and not more than 150 mg of sodium.  However, the initial diet prescribed for weight loss is even more restricted in calories (400 to 800 per day). In a study of the results published in the Annals of Internal Medicine, one hundred and six massively obese patients were treated as outpatients with the rice/reduction diet, exercise, and motivational enhancement under daily supervision. The average weight loss was 63.9 kg. (141 pounds). Forty-three patients achieved normal weight. Men lost weight at a greater rate than women. Along with the weight loss there were significant reductions in blood pressure, blood sugar, triglycerides, and uric acid levels.  Heart sizes decreased, EKGs improved and blood vessels in the eyes appeared healthier.  (For more information please contact: The Rice Diet Clinic, 3543 Rose of Sharon Road, Durham, NC 27712; Phone: (919) 383-7276 ext. 1; Fax: (919) 309-4695; ricediet@ricediet.com.)

 

From the Bulletin of the Walter Kempner Foundation (June 1972)


What I Have Learned So Far

Volume eaters (people with binge eating disorder) possess strong personalities, are very hard-working, demanding, driven, are not prone to take advice, and are used to being in control of everything around them.  Unfortunately, even though they are strong individuals, they are out of control of their eating behavior—and most of them are well aware of their problem.  In addition to the obvious excess body weight they carry, they can see their health failing—often with diabetes and heart failure. Only when they are imminently faced with death and disability does their powerful drive for self-preservation take over and they attempt to save themselves from their equally strong self-destructive binge eating disorder. 

This is the advice I give to volume eaters: They must slow down their intake and give the food they eat time to register. The stomach needs to tell the brain that food has been consumed.  A pause must be taken so that hormones signaling that calories have been consumed can deliver their messages throughout the body.  In essence, the binge-eater must change from a gorger to a nibbler and a grazer.  In practical terms, they are to consume a medium-size plate of food and then go work on some other project—to return to the dinner table a half-hour later and have another similar-sized plate.  This slowed pattern sends signals of satiety to the brain before over-consumption occurs.

Consumption of all calorie-dense foods must be strongly discouraged.  Therefore, dried fruits, nuts, seeds, avocados, olives, and flour products (especially breads and bagels) are off limits.  And I MEAN off-limits, because a volume eater does not understand “eat only a little bit.” Very calorie-dilute foods, like green and yellow vegetables, are encouraged—especially to be consumed at the beginning of the meals.  But there is a limit to this advice—it is easy to overdo the very low-calorie foods and be unsatisfied.  There must be sufficient starch (potatoes, rice, corn, sweet potatoes, etc.) in the meals to provide a healthy sense of satiety. (See the January 2005 McDougall Newsletter article: Pushing Your Set Point to the Limits – The McDougall Program for Maximum Weight Loss, for more help.)

Exercise is hard for people to fit into their lives and I have found this especially true for driven people who are binge-eaters.  Exercise burns calories and resets the appetite—something these people need desperately.  Since they are typically obsessive in their behaviors, directing some of that energy toward exercise is a big part of the solution.

Obviously, solving the binge eating disorder has not been easy for patients, the medical profession or for me.  However, the stakes are great, so every effort must be made.  Those who fail on the McDougall Program are encouraged to take a long vacation in Durham, North Carolina for a diet of rice and fruit (The Rice Diet)—which should serve as strong motivation to make the McDougall Program work.

References:

1) Geliebter A, Yahav EK, Gluck ME, Hashim SA.  Gastric capacity, test meal intake, and appetitive hormones in binge eating disorder. Physiol Behav. 2004 Jul;81(5):735-40.

2)  de Zwaan M, Mitchell JE. Opiate antagonists and eating behavior in humans: a review. J Clin Pharmacol. 1992 Dec;32(12):1060-72.

3)  Yeomans MR, Gray RW.  Opioid peptides and the control of human ingestive behaviour. Neurosci Biobehav Rev. 2002 Oct;26(6):713-28.

4)  McElroy SL, Shapira NA, Arnold LM, Keck PE, Rosenthal NR, Wu SC, Capece JA, Fazzio L, Hudson JI.  Topiramate in the long-term treatment of binge-eating disorder associated with obesity. J Clin Psychiatry. 2004 Nov;65(11):1463-9.

5)  Kempner W, Newborg BC, Peschel RL, Skyler JS.   Treatment of massive obesity with rice/reduction diet program. An analysis of 106 patients with at least a 45-kg weight loss. Arch Intern Med. 1975 Dec;135(12):1575-84.

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