GLP-1 Drugs and Celebrities

In the old days, meaning the late 60s and early 70s, adherents of the fat acceptance movement could be found at public protests, throwing diet books and pictures of Twiggy into bonfires, as if they were draft cards. Nowadays, Washington Post writer Shane O’Neill suggests, the National Association to Advance Fat Acceptance has mellowed into a group that aspires to influence legislation and end discrimination. Other people with similar feelings have gravitated to the more ambitious and militant Body Positivity movement.

For instance, when activist Virgie Tovar received partnership offers from various weight-loss companies, she notified her Instagram followers, “I don’t want Ozempic.” Tovar is not alone in that sentiment. Many people feel that too many body-positive and fat-positive influencers have transmogrified into advocates for weight loss. Their followers feel betrayed.

The reporter describes the internet talk show, “It’s Bigger Than Me,” produced by pharmaceutical giant Novo Nordisk. Of course, the drug company has a justification:

We are not here to denounce body positivity or detract in any way from the strides we, as a community, have made in inclusivity. The reality is that two truths exist — obesity can impact health, but the discrimination, stigma and shame experienced by people living with obesity for their weight is also very real.

Meanwhile, if there is one thing the average American loves more than weight loss, that other thing is celebrity worship. A shocking number of average folk want — nay, demand — to know which famous people are using the trendy GLP-1 drugs, for how long, and why, or why not.

And how many pounds they have lost, and how often they throw up, or stay home because they are afraid they will throw up. It has also been open season on celebrities who say the wrong thing about other celebrities’ weight-loss drug use, whether they express criticism or approbation — and out there in the zeitgeist, there is no shortage of either.

Men are more rarely heard from

In the spring of last year, Mark Wahlberg put his feelings on the record. The actor is known for his strict fitness regime which includes rising at 2:30 AM for the first of several daily workout sessions. Wahlberg, of course, is not a normal person, having gained and lost large amounts of weight for film roles. He does it all with exercise and correct eating, saying, “You’d be surprised what you can accomplish when you’re willing to do the work.” He does not judge others harshly, but would definitely prefer them to choose the “good old-fashioned way.”

In the recent past, Wonderwall.com has contacted show biz professionals and recorded their Ozempic experiences. Sharon Osbourne reported taking an unnamed weight-loss drug for four months, feeling nauseated through most of it, and losing 30 pounds. Then in September, she appeared on a talk show and confessed “I didn’t want to go this thin” — which, apparently, was under 100 pounds.

Actor and “internet personality” Samantha Jo took Mounjaro, and described how peaceful her inner life had become since the “food noise” quieted down, and she understood for the first time what it was like to be a normal person not constantly besieged by thoughts of eating. Jo also told the public that all the positive attention she had attracted was not always comfortable, although her audience had increased and more advertisers sought her out.

There were resentful thoughts, like, “I wasn’t good enough for you then. And the only thing that has changed about me now is my weight… I don’t see how your weight should indicate how you’re treated or if you’re worthy of respect.”

Writer and editor Samhita Mukhopadhyay stopped using Mounjaro because of the expense, but also has philosophical objections. Namely, prying into the lives of celebrities as if we had the right, is just a “weird witch hunt, and all these discussions only prove how determined humans are to invent “more tools to judge each other with.”

Your responses and feedback are welcome!

Source: “New marketing push by Ozempic and others sparks body-positive backlash,” WashingtonPost.com, 02/14/24
Source: “Mark Wahlberg Is Not A Fan Of The Ozempic Weight Loss Fad,” Yahoo.com, 05/04/23
Source: “Stars Who Have Admitted,” Wonderwall.com 09/22/23
Source: “Rocker’s Famous Wife.,” Wonderwall.com 05/08/23
Source: “Food is one of life’s great pleasures. Will weight-loss drugs end that?,” WashingtonPost.com, 10/02/23
Source: “‘You look great! Ozempic?’ The new minefields of weight-loss etiquette.,” WashingtonPost.com, 06/25/24
Image by Hollywood Branded/ATTRIBUTION 2.0 GENERIC

More Interesting Things About GLP-1 Receptor Agonists

For DiabetesJournals.org, Deborah Hinnen wrote, “Proper patient selection and education can assist in achieving positive treatment outcomes.” The writer is talking about the utility of the GLP-1 drugs in treating diabetes, but the same can be said of their use to fight obesity. Patient selection implies that some people, even if they could greatly benefit from any particular treatment, are just not suited to it for other reasons.

Education is paramount in any case. We hope that the patient will take any words that come directly from the physician’s mouth as gospel, and strive to obey “doctor’s orders” to the best of their understanding and ability.

But during office visits, patients are often not at their psychological best. They are worried about how to rearrange their lives to accommodate the new demands made upon them and their families. They are concerned about expenses, and thinking ahead to the possibility that today’s prescription might not help at all, and there will be rough times in store.

Sometimes they have what we used to quaintly call a “mental block” against absorbing certain items of information. An adult patient will sometimes bring along a friend to pay attention and take notes. For a minor individual, of course, there is a good chance that a parent will be present — which is not guaranteed to be a solution, as the attention span and comprehension depth of a parent or guardian can never be taken for granted, either.

Reinforcements

In an office setting, no matter what the doctor says or forgets to say, in the best-case scenario other staff members will make every effort to assure that the instructions and warnings are understood. They will ask if the patient has any questions, or needs clarification about anything. They might hand out a printed information sheet, or directions to a helpful online resource. Of course, even then, there is no guarantee that the helpful information will be pursued or assimilated.

The “I” word

Of more immediate interest is a recent report with the word “injury” in its title: “Acute Kidney and Liver Injury Associated With Low-Dose Liraglutide in an Obese Adolescent Patient.” This paper originates with four members of the Faculty of Medicine at the Hebrew University of Jerusalem. The complete work is accessible for a fee.

The brief summary version begins by recalling that liraglutide was approved in 2020 for people aged 12 through 18, as an adjunctive therapy for weight management “in combination with a reduced-calorie diet and increased physical activity.” It goes on to say,

Although reports in adults have suggested a link between liraglutide and adverse effects including hepatic injury and acute kidney injury (AKI), these effects have not previously been reported among adolescents treated with liraglutide for weight loss.

The cause for alarm was the experience of a 17-year-old boy afflicted with class III obesity, which is the more recent enlightened term for what used to be called morbid obesity. He had been using liraglutide (at its lowest recommended dose) for three months, and consequently experienced not only significant appetite loss, and weight loss, but a sensation of melancholy. By the standard of the Adverse Drug Reaction Probability Scale, it seemed clear that the liraglutide was also responsible for the injury to his liver and kidneys.

After being off the medication for a month, his kidney issue had settled down and his liver enzymes had reverted to normal, and there was an improvement in his mood. The authors note,

Our report highlights the importance of vigilance in monitoring for these potential adverse effects among adolescents treated for obesity with any dose of liraglutide.

Liraglutide had been approved in 2010 as antidiabetic therapy for adults. A document from that year states that some rodent study results were troubling, but there was no firm evidence of adverse effects on humans. Reports of several different conditions, like pancreatitis, appeared here and there, but in very small numbers, and the evidence to connect the cases with the drug was just not there.

Your responses and feedback are welcome!

Source: “Glucagon-Like Peptide 1 Receptor Agonists for Type 2 Diabetes,” DiabetesJournals.org, 2017
Source: “Acute Kidney and Liver Injury Associated With Low-Dose Liraglutide in an Obese Adolescent Patient,” AAP.org, 06/12/24
Source: “Weighing Risks and Benefits of Liraglutide — The FDA’s Review of a New Antidiabetic Therapy,” NEJM.org, 03/04/10
Image by the healthy blog/Public Domain

Interesting Things About GLP-1 Receptor Agonists

Most of the research on these drugs, over the years, has been performed with an eye to their usefulness in treating Type 2 diabetes. The findings are also, obviously, pertinent to their effects when prescribed for weight loss in non-diabetic patients.

And of course, it is not their effects alone that matter, but what happens when those effects combine with whatever else the patient is already taking? The professional with a prescription pad must be meticulously conscientious in recording a patient’s history, lest something important and potentially threatening slip through the net.

Regarding the currently existing GLP-1 RA meds, there are a few widely recognized contraindications. Except for oral semaglutide, the others are administered by subcutaneous injection. Some concerns do or may apply to all drugs in this class; others are so far known to only be relevant to one of them. Fortunately, many of the potential problems mainly apply to conditions that are relatively quite rare.

A very detailed report originated in 2006 and has been revised 11 times since then, now stating (among other things):

All GLP-1 agonists have been found to cause c-cell tumors in rodent models, but the human relevance has not been determined. All agents except for [two] have a black box warning for risk of thyroid C-cell tumors,

GLP-1 agonists have not been studied in patients with gastroparesis, and all drugs within this class, except for liraglutide and semaglutide, recommend against use in patients with preexisting gastroparesis.

However, their rep is mostly positive:

There is no basis for limiting the duration of treatment for GLP-1 agonists in patients using this medication for chronic weight management if it remains beneficial for weight loss and is not causing intolerable side effects.

Here are some of the caveats and cautions applicable to either the whole class, or various individual drugs. All of them are, of course, contraindicated in patients who are hypersensitive to the particular substance. All should be warned that since the drugs increase the sensation of satiety, it is quite possible that continuing to eat past the point of feeling full can cause nausea and/or vomiting.

Individual drugs are warned against for patients with existing or incipient pancreatitis, gastroparesis or inflammatory bowel disorders, renal disease, or Multiple Endocrine Neoplasia syndrome type 2. Likewise, for those who have a family history of medullary thyroid cancer.

They probably should be avoided for patients who are on tricyclic antidepressants. It should be noted that the GLP-1 receptor agonists, which are therapeutic peptides, could potentially cause the development of drug antibodies.

Another article, titled “Glucagon-like Peptide-1 (GLP-1) Receptor Agonists,” offers a very thorough comparison of the various available meds of this type. For starters, their efficacy and safety “primarily differ by their frequency of administration.” They all delay gastric emptying and increase satiety, and “There is no significant [clinically meaningful] difference in weight loss effect among the agents in the class.”

Here are other details that could be very disappointing, because none of these things match up with what their various manufacturers would have us believe:

Semaglutide is the only GLP-1 receptor agonist that is available as a once-daily oral tablet. Unlike semaglutide injection, the evidence of CV benefit using the oral route has not been definitively established. Compared to placebo, all agents, except albiglutide, significantly reduced weight and increased the risk of hypoglycemia and GI side effects. There were no clinically meaningful differences in weight loss effects, blood pressure reduction, or hypoglycemia risk among the drugs.

Your responses and feedback are welcome!

Source: “Drug Use Criteria: Glucagon-Like Peptide 1 Receptor Agonists,” Texas.gov, October 2022
Source: “Compare and Contrast the Glucagon-Like Peptide-1 Receptor Agonists (GLP1RAs),” NIH.gov, 03/27/23
Source: “Glucagon-like Peptide-1 (GLP-1) Receptor Agonists,” Elsevier.health, 04/11/22
Image by Consumerist Dot Com/ATTRIBUTION 2.0 GENERIC

More Vagus Nerve Knowledge

The previous post listed some activities of the vagus nerve as having to do with…

[…] stomach expansion, stomach contraction, gastric acid release, stomach content release into the small intestine, digestive pancreatic enzyme secretion and the sensations of both hunger and fullness.

Who is in charge of those departments? Who tells the vagus nerve what messages to convey? It now appears that the directives carried from this area of the body originate with the gut microbiome (as differentiated from, for instance, the skin microbiome).

The notion does seem rather radical, and it feels appropriate to resist the idea that just about everything we are, and do, is fundamentally determined by our colonies of gut bugs. Although we may diligently seek help from various treatment modalities, it is very likely that, where mood and behavior are concerned, the little critters are running the show.

Not surprisingly, the same cluster of functions performed by and related to the stomach, is heavily influenced by bariatric surgery, which causes a faction of professionals to wonder: Rather than subject children to the ordeal of surgery, if the same benefits can be achieved by somehow controlling the vagus nerve, why not concentrate on that? How can it be done?

The vagus nerve has been compared to an “information superhighway” that conveys messages from the gut to the brain. It seems that if we could influence the microbiota in regard to the messages they dispatch through the vagus nerve, that might help. It has even been suggested that “probiotic bacteria could be tailored to treat specific psychological diseases.”

This sounds like a great idea when the potential benefit for autistic children, for one example, is considered. They tend to become obese, because that is a side effect of the only drugs that are approved to treat their condition. This is also true of the drugs used against anxiety, epilepsy, and depression. If the body could be induced to manufacture its own meds to deal with those conditions, the results would be pretty spectacular… and apparently, thanks to the efforts of its microscopic tenants, it can.

The gut-brain axis is a thing

For DiscoverMagazine.com, Carla Delgado described how ultra-processed foods can cause inflammation in the gut, as well as in other parts of the body, and how the inflammation connects with mental symptoms of anxiety and depression. This information comes from Dr. Uma Naidoo of Massachusetts General Hospital, who is credentialed as not only a psychiatrist and nutrition specialist but also a professional chef.

Nutritional Psychiatry does not insist that correlation equals causation — however, the evidence against ultra-processed foods is quite damning. By all indications, the brain is tightly bound to the gut microbiome because of the vagus nerve connection, which is compared again to a “fast two-way highway sending signals and chemicals back and forth.” Dr. Naidoo is quoted:

We produce over 90 percent of our body’s serotonin — as well as other neurotransmitters which govern mood — outside the brain, in the gut where our food is digested and broken down into vitamins, minerals and other nutrients. This enables a natural symbiosis between food and the body’s brain chemistry.

Do emotional and mental disorders cause overeating? Obviously. Does overeating cause mental and emotional disorders? Undoubtedly. And right there in the middle of everything, facilitating the two-way communication, is the vagus nerve.

Your responses and feedback are welcome!

Source: “How Ultra-Processed Foods Can Affect Your Mental Health,” DiscoverMagazine.com, 10/24/22
Image by NIH Image Gallery/ATTRIBUTION 2.0 GENERIC

A Vagus Nerve Review

In the past months, the vagus nerve has been showing up quite a lot in the media. Before moving on to consider more recent theories and claims connected with this anatomical feature, it will be useful to recollect some past mentions of it in Childhood Obesity News and other sources. The vagus nerve connects the brain to the heart, lungs, digestive tract, and several other entities.

This quotation from technology writer Aaron Mamiit gives a basic explanation of what the nerve does:

Functions of the vagus nerve involve the enabling of several mechanisms in the human metabolic and gastrointestinal systems, including stomach expansion, stomach contraction, gastric acid release, stomach content release into the small intestine, digestive pancreatic enzyme secretion and the sensations of both hunger and fullness.

Some have gone so far as to call the human gut the “second brain.” It is full of the same neurotransmitters as the brain, and the vagus nerve hooks the brain and gut together as definitively as a pair of conjoined twins. Even if either party objected to such a close and codependent association, they have no choice in the matter.

When the microbiome is out of balance, it can act locally, to cause inflammatory bowel disease complete with pain, vomiting, and diarrhea. Thanks to the vagus nerve, it apparently also has the power to reach all the way up into the brain and cause reactions there, that are the loftier equivalents of pain, vomiting, and diarrhea. It has even been suggested that the “addictive personality” originates not in the mind, but in the intestines.

What’s down there anyway?

The microbiome is made up of several different kinds of organisms. Scientific efforts to sort out the bad from the good became laughable when researchers realized that disease-causing strains can, on occasion, be useful and helpful. Conversely, the most seemingly benign sorts can, under the wrong conditions, damage us.

Our tenants, the gut bugs, can manipulate behavior and mood by altering the neural signals in the vagus nerve. Their tricks include the ability to produce toxins that make us feel bad, and release chemical rewards to make us feel good, and change taste receptors (making certain foods “taste better”). Oh, and release hunger-inducing hormones.

The small intestine is also inhabited by enteroendocrine cells, or EECs, which are important in ways not yet fully comprehended, but we do know they influence obesity. They differentiate into about 15 kinds of cells, and each one only lives from three to five days, so they are constantly being replaced. (Their dead bodies feed the gut bugs.)

The sub-category called L cells makes glucagon-like peptide-1, more familiarly known as GLP-1, which has received a lot of publicity lately. It regulates appetite and consumption by accessing the vagus nerve to influence the brainstem and hypothalamus. Other L cells are responsible for GLP-2, active in the inflammation associated with obesity. The EECs live cheek-by-jowl with the microbiota with whom they interact in ways that are, as yet, not fully comprehended.

Your responses and feedback are welcome!

Source: “Appetite Pacemaker: Here’s How this Weight Loss Implant Works,” TechTimes.com, 01/15/15
Image by Beth Scupham/ATTRIBUTION 2.0 GENERIC

A Birds-Eye View of BED

VeryWellHealth.com started off the current year with an extremely detailed overview of the current state of treatment for Binge Eating Disorder (BED), including a perspective on which approaches are likely to be most effective.

(Bear in mind that simple binge eating does not include behaviors intended to cancel out the inappropriate consumption. If the person pursues a counteractive strategy like vomiting or doing exhaustive exercise, that’s a different disorder.)

Showing thorough professionalism by resisting any temptation toward sensationalism, author Heather Jones did not position the most shocking aspect right up front, but left it for the end:

[E]ating disorder treatment can range from $1,500 to $2,000 a day, depending on whether it’s outpatient or inpatient.

Fortunately, there are more affordable self-help options, to be discussed. Altogether, we are looking at a wide range of possibilities, including psychotherapy, lifestyle changes, and medication. Because eating disorders encompass so many complexities, it is recommended that a person obtain the most specialized help available.

Psychotherapy is the most common treatment, possibly because guilt is one of the most common symptoms driving people to seek help. Nobody wants to live in a perpetual state of self-disgust, and even if psychotherapy cannot immediately end the behavior, the exploration of interior states (such as the tendency toward guilt) will certainly be of overall benefit to the patient.

Branching out

As things stand, a less Freudian method — one that does not delve into the murky past — is widely regarded as the first resort. That is cognitive behavioral therapy (CBT), which Jones explains as “a type of psychotherapy that focuses on disordered or negative thinking patterns.”

Not surprisingly, the description is reminiscent of the expression “stinking thinking,” which originated with another widely used and often effective program, Alcoholics Anonymous. In addition to identifying such aberrations, CBT helps to change the wonky thoughts into positive and productive ones.

Then, there is CBT-E, or Enhanced CBT, which narrows down the general usefulness of the technique to a state of maximal helpfulness for eating disorders. Jones says that a therapist “can tailor the treatment to the specific eating disorder that a person has, as well as the unique factors in a person’s life that are contributing to the disorder.”

Here, as in so many aspects of life, the personal touch is very effective:

In one study, CBT-E had a success rate of about 66% in treating multiple eating disorders. A 2014 study showed that participants with binge eating disorder showed improvement during short-term CBT treatment and continued to improve or were stable during the four years after treatment.

It gets even better, with the added benefit that although CBT-E was formulated for adults, it is very amenable to adaptation for use with younger people. For them, as well as for other generations, there is even more good news, in the form of another variation called CBTgsh, where the three small initials stand for guided self-help.

Furthermore, the author notes that “mental health professionals can provide it even if they do not specialize in eating disorders.” It also comes with a caveat:

[R]esearchers are still unsure about the effectiveness of CBTgsh. Older studies suggested that participants with binge eating disorder had positive results from treatment with CBTgsh and that it may be beneficial for some people.

Still, we can’t have everything, and what we do have is quite a lot.

(To be continued…)

Your responses and feedback are welcome!

Source: “What is the Best Binge Eating Disorder Treatment Approach?,” VeryWellHealth.com, 01/10/24
Image by Eric Van Buskirk/ATTRIBUTION-SHAREALIKE 2.0 GENERIC

Beware the Coax Coach

July 4 and many other holidays share common traits, such as being the occasion of much overconsumption of not only food but other substances that encourage people to drop their inhibitions and do foolish things, like eat until the cows come home.

That ancient colloquialism has deep significance, implying both duration and inevitability. First, cows don’t come home until it is dark, and sometimes not even then. Second, the cows will eventually return home. The point being, holiday celebrations give a lot of people the opportunity to disappoint themselves once again, be shamed by family members and alleged friends, and make promises they will be unable to keep.

Sure, we get off on the neurochemical effects of carbs and fats, but something else is going on at these times, as we become particularly susceptible to this formulation:

Emotional eating is always symbolic eating and among the chief architects of compulsive and binge eating.

To a vulnerable individual, a cake might as well be cocaine. Billi Gordon, Ph.D., had a lot of insights about the particular type of binge eating that occurs during holidays, and even more to say about how people unwittingly aid and abet the harmful behavior.

This is a very flexible talent that allows humans to convince both ourselves and others that, just because some decorations are hanging from the walls, it is perfectly okay to do things that are not good for us. But we can’t help it. Our brains reliably connect symbols with ideas, so when we see festive holiday paraphernalia, the rational mind is no longer in control.

As if things were not bad enough already, Dr. Gordon observed that compulsive eaters are also more prone than some other types of people to experience inappropriate reactions, read social cues inaccurately, misinterpret interpersonal situations, and so forth. It gets worse. There are multiple layers of meaning, with the potential to grow progressively darker. Speaking from personal experience, Dr. Gordon wrote in Psychology Today,

Some badly abused children use chewing and compulsive eating to symbolically destroy the mother, while other abuse survivors use chewing and compulsive eating as a symbolic replacement for maternal love.

Gordon holds that basically everybody is capable of eating to drown and bury feelings. It’s part of our basic equipment. The behavior is potentially in everyone’s repertoire, even if they rarely feel the inclination. Some people manage to sail through life without ever becoming enmeshed in that particular trap.

Other lucky people only respond on rare occasions to the symbolic and emotional lure of eating. A compulsive overeater is one who employs the mechanism far too often, because their emotional center is burdened with far too many cues, both external and internal, that they are unable to either ignore or overcome.

The traps

It is very difficult to resist family members and other close people who urge us to eat more. They do it on their own behalf, as in, “What’s wrong, I didn’t whip the potatoes soft enough for you?” They need to score some kind of point off you, because of their own emotional difficulties. Or, they do it by proxy, as in, “Take some gravy. Don’t hurt your mother’s feelings.” A family gathering is an ideal time for fakers and posers to try and impress the crowd with how much they care.

But even fakers and posers are relatively easy to overcome when compared to coaxers. This individual purports to not care about their own feelings or other people’s feelings. No, no — the coax coach is all about you. “Oh just have one little bite, it won’t hurt you.” They wheedle and tempt and cajole as if they have some personal stake in fattening you up like some kind of sacrificial lamb. Who knows what twisted motives impel people to tempt sober alcoholics and faithful spouses and people who really simply do not want or need “just one little bite.”

The takeaway

The best holiday advice is, “Drive responsibly.”
The next most important holiday advice is, “Don’t listen to a coax coach.”
And for goodness’ sake, please don’t be one.

Your responses and feedback are welcome!

Source: “Christmas Cookie Blue,” PsychologyToday.com, 12/06/13
Source: “Symbolic Eating,” PsychologyToday.com, 11/23/13
Image by Johan Lange/ATTRIBUTION 2.0 GENERIC

Everything You Know About Binge Eating Is Wrong

This post title is facetious, of course. There might even be a world-beating research genius out there, of whom it could be said that everything they know about this stubborn condition is right. Meanwhile, the average person is pretty much in the dark — even the average sufferer of Binge Eating Disorder (BED). They tend to have very little insight into what drives them, or how to bring their self-sabotage to an end. One surprising thing is their ability to eat a whole lot of something they don’t even like… just because…

As Dr. Pretlow and others in the field have pointed out, although a person with BED has preferences and favorites, if the choice is between eating and not eating, they will eat anything. The onset of an “acute emotional upset” can induce a willingness to consume even boring nutritious stuff like apples, or conversely, something dreadfully unhealthful — or even something they normally hate. Stress does this to humans. We feel stressed and seek comfort.

Myproana.com once asked its readers whether they ever binged on foods they didn’t even like. (That address no longer exists and a search query is forwarded to a similar site.)

At any rate, at one point, some anonymous respondents named the shameful causes of their slips. Confessions about what they had eaten included:

— disgusting biscuit
— [low quality] ice cream or chocolate or mayo or stale bread or jam
— all sorts of sausages that I didn’t really like
— a lot of bread stuff I’m never too excited about
— tasteless pre-made supermarket sandwiches
— jelly beans and candy corn. Hate. Tasted like rubber. Ew.
— crappy store-bought icing that tasted like play-doh
— I don’t even have time to recognize the taste.

When the binge mood hits, discrimination, discretion, and discernment go out the door. So does sanity. People recall experiences that inspired such self-realizations as…

— No food is off-limits.
— If I really need to b/p and there’s nothing I like I’ll literally just go with whatever’s going.
— Nothing is safe.
— I’d eat almost anything, even if I didn’t like it, if nothing else was around.
— I’ll eat everything in sight.
— I even started craving certain foods I hated.

One person wrote, “I have no idea why I crave to stuff myself with it when I don’t really like it,” while another said she binged mostly on foods she didn’t like because “it’s a sort of a punishment.”

Binge eating is the ugly stepchild

It seems like the biggest problem should get the most attention — but nooooo! Here is another weird observation made just a few years back:

Services often only cater to anorexics who are severely underweight (which is not the majority of anorexics), despite the fact that only 8% of eating disorder sufferers are anorexic.

The writer Róisín points out how eating disorders that cause people to become fat, despite being “far more prevalent and just as punitive,” are routinely ignored in favor of the ones that lead to glamorous thinness. She goes so far as to say, “Anorexia has a monopoly on eating disorder representation, portrayed with morbid fascination as an exaggerated diet or desirable suffering.” Some activists have a sneaky suspicion that the medical profession does not view overweight patients as legitimate victims who are worthy of resources.

Similarly, in a piece discussing the patients labeled “super morbidly obese,” Dr. Mark Warren wrote,

As a society, we often think of anorexia nervosa when we think of eating disorders. However, it is crucial that we widen our collective perspective to remember that binge eating disorder is a source of tremendous psychological and physical suffering for so many people. Their suffering is all too often overlooked. Increased awareness and understanding are important first steps toward providing effective care to those struggling with this difficult illness.

Your responses and feedback are welcome!

Source: “Do you ever binge on food you don’t like?,” Myproana.com, 4/12/15
Source: “Eating Disorder Treatment is Broken, and Only Abolition Can Fix It,” Medium.com, 08/30/20
Source: “The Challenges of Going Through Life “Super Morbidly Obese,” EmilyProgram.com, 01/05/18
Image by Junior REIS on Unsplash

BED, a Friend, and You

A previous post described the problem. The search for solutions is of course more complicated. Solutions are needed because BED is a disorder that seriously affects the quality of life for millions of humans. An individual who suspects a problem in the self might start by reaching out to a trusted friend, relative, clergy member, or an online community. Even if this is a difficulty not faced by the reader of this page, any one of us might be the trusted friend that someone reaches out to. What then?

Even if we are not experts, and even if we are not sure whether the upset person’s alarm is justified, this much is true: When someone we care about wonders whether their stubborn habit is a problem, the fact that they even suspect a problem is, in and of itself, a problem. The least we can do is validate their autonomy in some way, with verbal reassurances that they are correct to care about potential health conditions that might call for intervention.

Of course, depending on our own position and circumstances, we can offer practical help, like a ride to a clinic, or the money to pay for an appointment. Or we might do a little preliminary research to nudge them into action.

The particulars

For instance, we might sneak a peak at the Mayo Clinic’s very thorough page on binge-eating disorder and garner some facts to pass along. The object here is for the patient to feel more in control, and eventually, to actually be more in control. This sounds boring, but the key to control is the banishment of randomness, and the acquisition of healthy, regular habits.

The patient can probably expect to be dealing with a whole team of experts, including a mental health professional and a sleep disorder specialist (regular habits, remember?). Any large and respected medical institution will offer similar information and advice, along with both standard methods and specialized possibilities.

There will be blood and urine tests, and various other measurements of this and that. The prospective patient will be asked a ton of questions, both objective (“How often are you physically active?”) and subjective (“How often do you think about food?”). As the honest friend who is urging this person to seek help it might, depending on what kind of relationship you two have, be useful to remind them that in order to be effectively helpful, every professional they encounter will need accurate, up-to-date information.

Whoever conducts this interview will want to know about the patient’s typical daily intake of food, and how large the servings tend to be. They will be curious about whether the person tends to eat past the point of discomfort. Does consumption take place even when there is no actual hunger? Have they made previous efforts to lose weight, and of what did those efforts consist of?

Does the person subjectively feel that things are out of control? What about eating secretly, hiding food, lying to family members about what and how much they take in? Is the eating itself the larger concern, or is it the body weight and size? Does the person experience depression, shame or guilt related to eating? Is vomiting ever involved? What about laxatives or pharmaceuticals, prescribed or otherwise?

What’s out there

Speaking of drugs, Vyvanse, or lisdexamfetamine dimesylate (which was developed to alleviate ADHD) has been prescribed to treat moderate-to-severe binge-eating disorder, but it is only approved for adults. Of course as always, before prescribing anything the doctor must be told about any other drugs the patient is already taking, along with any supplements, herbs, etc. The Mayo Clinic page notes that a few other meds (officially approved to control depression and seizures) are sometimes prescribed, but interestingly, makes no mention of the recently fashionable GLP-1 drugs.

There are support groups designed for individuals and for families, and a painfully hesitant person might consider attending a meeting first just to dip a toe into the water. Even more distance can initially be maintained by making the first contact with any such organization online. Of course, there is talk therapy, both individual and group, in several different forms.

Cognitive behavioral therapy is of course mentioned, along with an enhanced variety called CBT-E that is “specifically designed to treat eating disorders.” Other formats are also mentioned:

Integrative cognitive-affective therapy (ICAT). This type of talk therapy may be helpful for adults with binge-eating disorder. This therapy can help you change the emotions and behaviors that trigger binge eating.

Dialectical behavior therapy. This type of talk therapy can help you learn behavioral skills to help you deal with stress, manage your emotions and improve your relationships with others. These skills can lessen the desire to binge eat.

Your responses and feedback are welcome!

Source: “Binge-eating disorder,” MayoClinic.org, undated
Image by thekirbster/ATTRIBUTION 2.0 GENERIC

Binge-Eating Disorder and the Mayo Clinic

Strangely, for such a prevalent disorder, binge eating retains an aura of mystery. Even the esteemed Mayo Clinic can only offer guesses as to its cause. Certain constants are of course observable, including the fact that more women than men are victims. Other genetic factors are also suspected. Whether genetic or purely behavioral in origin, family history is a red flag.

People in their late teens and early 20s are vulnerable, along with those who have adopted the lifestyle variant known as “dieting,” or formalized restrictions imposed either by an outside program or a self-created plan.

Another predisposing condition is some kind of mental health problem, and this is a tough one because it feeds upon itself. The mental health element includes negative self-regard, and this works both ways because when one feels hostile toward oneself, and toward one’s own abilities and accomplishments, the answer always seems to be “Go eat a lot.”

Of course, this offers no alleviation at all, because afterward, the person is assailed by even more self-hate, and rushes to go eat another pile of food. Binge eating is in fact the legendary perpetual-motion machine, tirelessly maintaining itself through endless cycles of cause and effect, which then becomes the next cause, leading to the next effect, and so on into infinity. What can stop such an elegantly designed chain reaction?

A world of triggers

Certain situations will guarantee a binge, and depending on the individual, the trigger may be any size or shape, and wear any disguise. The binge reaction can be set off by an event as traumatic as a romantic breakup. Or it might be based on something as trivial as the habitual pairing of entertainment with eating — the conviction that watching a movie on TV must always be accompanied by a snack session that somehow winds up lasting for an hour and a half.

The trigger can be a certain food, which causes the person to apologetically or facetiously declare, “I’m addicted to chocolate-chip cookies, almost straight from the oven, with the chips still all melty.” Whether or not cookie addiction is recognized by the medical establishment, it becomes a fact in that person’s life.

There are social consequences of course, which include avoiding certain people who might identify the binge pattern and urge the eater to seek help. While social ramifications can be very upsetting, the real trouble starts when the body begins to break down. There is, obviously, weight gain.

But even if the person is not bothered by that, there are also, says the Mayo Clinic, “joint problems, heart disease, type 2 diabetes, gastroesophageal reflux disease (GERD), poor nutrition and some sleep-related breathing disorders.” On the mental side, watch out for depression, anxiety, substance abuse, and even suicidal ideation and behavior.

In the emotional equation, actual bulk is almost irrelevant. No matter what shape the body is in, the average binge-eater is dissatisfied with it.

This condition is defined by compulsion — the conviction of a simple inability to stop eating — and, generally, by excess. It is characterized by periods of resistance, alternating with episodes of simply giving in and letting the disorder have its way. Symptoms vary, but may include:

Eating even when you’re full or not hungry.
Eating very fast during eating binges.
Eating until you’re uncomfortably full.
Often eating alone or in secret.

(To be continued…)

Your responses and feedback are welcome!

Source: “Binge-eating Disorder,” MayoClinic.org, undated
Image by Fabrice Florin/CC BY-SA 2.0

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources