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,”, 12/06/13
Source: “Symbolic Eating,”, 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. 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?,”, 4/12/15
Source: “Eating Disorder Treatment is Broken, and Only Abolition Can Fix It,”, 08/30/20
Source: “The Challenges of Going Through Life “Super Morbidly Obese,”, 01/05/18
Image by Junior REIS on Unsplash

GLP-1 Drugs Prompt New Food Offerings

The success of new obesity and diabetes drugs is evident in grocery store aisles. We’ve written before about how the rise of GLP-1 medications is reshaping consumer habits and posing challenges to various sectors of the food and beverage industry.

For one, a Morgan Stanley report predicted that the consumption of sweet and salty snacks could drop by as much as 3% through 2035, causing concern in the food industry. Food companies are reacting accordingly by launching new and reformulated products to cater to the growing number of people using drugs like Novo Nordisk’s Ozempic and Wegovy. Experts believe this trend could significantly alter American diets.

How GLP-1 drugs can lead to nutritional deficiencies

GLP-1 medications, which help reduce hunger and increase feelings of fullness, can lead to nutritional deficiencies because people on these drugs tend to eat less overall. This decreased appetite can result in insufficient intake of essential vitamins, minerals, fiber, and protein.

Specifically, reduced protein intake can lead to muscle loss, while lower consumption of fruits, vegetables, whole grains, beans, seeds, and nuts can limit the intake of important antioxidants, vitamins, and minerals, as well as fiber, which is crucial for blood sugar stabilization, cholesterol management, and digestive health.

To counteract these potential deficiencies, it is important for patients on GLP-1 medications to follow a well-balanced and nutrient-dense eating plan. This includes ensuring adequate intake of macronutrients (proteins for muscle preservation and satiety, carbohydrates for energy and fiber, and fats for vitamin absorption and brain function) and micronutrients (vitamins and minerals). Healthcare professionals recommend tailoring your dietary needs based on personal factors such as age, weight, medical history, and activity levels.

GLP-1-friendly food offerings

Several big food manufacturers stand out. Nestlé, owner of brands like Stouffer’s and DiGiorno Pizza, recently introduced a new line of frozen foods with smaller portions and more protein to counteract muscle loss associated with GLP-1s. This move is seen as a “logical reaction” to the GLP-1 boom, and competitors are expected to follow suit.

The line, called Vital Pursuit, is “high in protein, a good source of fiber, contain[s] essential nutrients, and they are portion-aligned to a weight-loss medication user’s appetite,” the company said. It’s also affordable as it’s sold for $4.99 or less. Items include sandwich melts, pizzas, and bowls with whole grains or protein pasta.

According to Reuters, General Mills is already offering high-protein versions of Annie’s Mac and Cheese and Betty Crocker baking mixes with lower sugar and sodium. And Conagra, which owns brands like Healthy Choice and Slim Jim, is considering smaller-portion frozen foods and sees potential in its protein- and fiber-rich snacks.

Nutrition experts say these new products cater well to GLP-1 users’ needs. These products may also benefit those who stop taking GLP-1s within a year and struggle to maintain weight loss, as well as consumers who are not on GLP-1s but want to reduce calories and sugar or increase protein intake.

A smaller-portion trend

Writer Tina Reed, in her recent article for Axios, reported that Hank Cardello, a former food executive and now a consumer health expert at Georgetown University, suggested that changing perceptions of portion sizes could positively impact American diets. This trend was evident at the recent Sweets & Snacks Expo, where many products were marketed as “minis” or “bites.”

Hank Cardello said:

Once it gets up in that neighborhood, food companies have to pay attention. They have to, otherwise they’re walking away from business. You can’t sell king-size X, Y, and Z to this crowd.

The caveat

Consumers might be misled by marketing claims and assume products labeled for GLP-1 users are inherently “healthy.” Experts emphasize that these drugs should be paired with exercise and a proper diet.

Whether these new products and food trends associated with the increasing use of GLP-1 drugs are here to stay, time will tell. One thing is for sure: Food manufacturers will adapt.

Your responses and feedback are welcome!

Source: “Weight-loss drugs are forcing changes to grocery store offerings,” Axios, 6/4/24
Source: “Changes in food preferences and ingestive behaviors after glucagon-like peptide-1 analog treatment: techniques and opportunities,”, 3/7/24
Source: “Nestlé Launches Frozen Food Line for People Using GLP-1 Drugs,”, 5/27/24
Image by Alan Hardman 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,”, undated
Image by thekirbster/ATTRIBUTION 2.0 GENERIC

Can Web-Based Self-Help Interventions Help With BED?

A recent JAMA Network Open study assessed the effectiveness of web-based self-help interventions in alleviating binge eating disorder (BED). Here are some details, including the findings and the conclusions.

Why BED?

We’ve covered it many times before, but let’s recall that BED is defined as uncontrolled overeating that can lead to obesity, type 2 diabetes, and hypertension. Prolonged BED can reduce the affected person’s quality of life, negatively impact social relationships, and compromise their ability to perform their job well. Without a timely intervention, BED can become chronic and even lead to premature death.

CBT and its barriers

Some studies have demonstrated that cognitive behavioral therapy (CBT) can serve as an effective BED intervention, as well as positively affect the eating disorders bulimia nervosa and anorexia nervosa.

Unfortunately, some people with BED don’t seek in-person psychotherapy because of such barriers as treatment costs, lack of availability, and sociocultural stigma.

This is where web-based cognitive behavioral interventions come in, thanks to their ease of implementation, availability, reduced social stigma, and cost-effectiveness. This avenue has been growing in popularity for these reasons, making BED treatment more accessible.

About the study

The study involved a randomized clinical trial (RCT) to evaluate the effectiveness of a web-based cognitive behavioral self-help intervention for BED. Researchers measured changes in eating disorder symptoms, well-being, co-morbid psychopathology, self-esteem, emotion regulation, and clinical impairment. Weekly symptom monitoring and ecological momentary assessment (EMA) were used to track real-time changes in binge eating.

Participants were recruited from Germany and other German-speaking regions in Europe. Eligible participants were 18-65 years old, owned a smartphone, and were diagnosed with BED according to the DSM-5 criteria. They were randomly assigned to either a control group (waiting list) or a web-based treatment group. Assessments were conducted at baseline, six weeks (mid-treatment), and 12 weeks (post-treatment).

The intervention consisted of six mandatory modules covering psychoeducation, self-monitoring of binge eating, emotion regulation, and interactive exercises. A sequential module-access strategy was employed to engage participants in a personalized manner.

Study findings

The study found significant changes in BED patterns from baseline to 12 weeks in the intervention group. Out of 1,602 patients, 154 met the eligibility criteria and were recruited, with 77 participants in each group. The intervention group reported fewer binge-eating episodes and showed significant improvements in global eating psychopathology and clinical impairment.

Dr. Priyom Bose, Ph.D., discussing the study results, writes:

“The intervention’s efficacy exceeded or was similar to previously documented digital interventions, as well as in-person guided and unguided self-help interventions for BED.

Notably, the levels of improvement observed in the intervention group were consistent with or surpassed those associated with in-person CBT interventions, thus confirming the clinical applicability of web-based cognitive behavioral self-help interventions.”

The study noted that participants’ motivation, attitudes towards online interventions, demographic characteristics, and treatment expectations influenced the positive effects of the web-based intervention.

The bottom line

The study demonstrates that web-based cognitive behavioral self-help interventions can significantly improve the well-being of people with BED, offering a promising alternative to traditional treatments. However, the study had some limitations, including the under-representation of males and older adults, and potential biases due to the self-report design. Future research can address these limitations through methodologies like double-blind designs.

Your responses and feedback are welcome!

Source: “Web-based self-help program proves effective in treating binge eating disorder,”, 5/19/24
Source: “Effectiveness of a Web-Based Cognitive Behavioral Self-Help Intervention for Binge Eating Disorder,” JAMA Network Open, 5/16/24
Image by Glenn Carstens-Peters on Unsplash

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,”, undated
Image by Fabrice Florin/CC BY-SA 2.0

The Support Matrix for Mental Health Diagnostics

The world has a lot to say about binge eating. Sometimes the search for a more precise definition leads off into fascinating side roads.

In its 5th edition, the Diagnostic and Statistical Manual of Mental Disorders decided to file BED, or Binge Eating Disorder, under OSFED, or “Other Specified Feeding or Eating Disorder.” Additionally, BED itself has been broken down into “low frequency and/or limited duration” and “higher frequency and duration;” and then it might be further categorized as mild, moderate, or severe.

Within those parameters, it is still important to understand that not all obese people suffer from BED, nor are all people with BED obese. But they do mostly tend to be moody and anxious.

Classification problems have haunted the field for a long time — not just in the realm of eating disorders, but in everything connected with mental health. To get a grip on this topic, it is apparently necessary to keep track of a lot of initials. For instance, the cluster of letters DSM-ICD. Spelled out, that stands for “Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases.”

A 2016 paper explicated the basis of that school of thought, classified as “an Aristotelian view.” From this angle, mental disorders are seen as “largely discrete entities that are characterized by distinctive signs, symptoms, and natural histories.”

And, as far back as 1989, there had been mumbles and grumbles, an example of which came from psychiatrist R. E. Kendell:

One important possibility is that the discrete clusters of psychiatric symptoms we are trying to delineate do not actually exist.

Then, along came a contrary modality, in fact, a paradigm shift, described as “a Galilean view of psychopathology as the product of dysfunctions in neural circuitry.” This is the RDoC (Research Domain Criteria) initiative, which strives to make sense of what were called the “accumulating anomalies” that troubled professionals when contemplating the older system. Many factors contributed to the restlessness that inspired leaders in the field to call for change.

Remedies made to order

For instance, the authors cited “precision medicine” or “personalized medicine” which translates lab results directly into an individually tailored plan of action. As an example, they mentioned a targeted drug treatment that works for 4% of cystic fibrosis patients, and went on to describe another advance that has “stirred hopes for a similar revolution in psychiatry and clinical psychology.”

Also in the conversation is Oncotype testing, which has revolutionized the treatment of breast cancer by “permitting physicians to move from a ‘one size fits all’ intervention approach to treatment geared to specific genetic profiles.”

They go on to explain the analogy to the Research Domain Criteria:

Rather than base psychiatric diagnosis on presenting signs and symptoms […] RDoC strives to anchor psychiatric classification and diagnosis in a scientifically supported model of neural circuitry. RDoC conceptualizes mental disorders as dysfunctions in brain systems that bear important adaptive implications, such as systems linked to reward responsiveness and threat sensitivity.

Of course, this fundamental declaration branches out into several “crucial assumptions,” some of which are explained in detail. Other experts added depth and breadth to the many dimensions of this expanded worldview.

One was neuroscientist and psychiatrist Thomas R. Insel, who was for more than a decade in charge of the National Institute of Mental Health. Even though in most areas of medicine the public has come to expect a high degree of specificity, he warned, we might as well not anticipate anything of the sort in the field of psychiatric diagnostics.

Because behavioral symptoms are multidetermined (our old friend “multifactorial“), he wrote, “[…] diagnoses based only on presenting complaints are unavoidably heterogeneous in terms of pathophysiology.” Along with this unavoidable truth comes a danger:

[W]hen diagnosis is limited to symptoms, treatments may be limited to symptom relief, precluding cures or preventive interventions.

Your responses and feedback are welcome!

Source: “Clashing Diagnostic Approaches: DSM-ICD versus RDoC,”, 02/03/16
Source: “The NIMH Research Domain Criteria (RDoC) Project: Precision Medicine for Psychiatry,”, 04/01/14
Image by Tatinauk/CC BY-ND 2.0 DEED

Some Binge-Eating Basics

In the dawning days of civilization, there were different kinds of shelters, various food sources, and many ingenious ways to get hold of edible plant and animal products. The inhabitants of this Colorado cliff dwelling ate rice, maize, pine nuts, squash, beans, seeds, berries, nuts, and roots. Vegetables were sun-dried so they would last. Of course, the residents availed themselves of fish and small game, both of which would have been very difficult and labor-intensive to obtain even in the best weather, let alone when the ground was frozen and covered with snow for months on end.

Our source says, “Food was stored in large pits, often sealed in baskets or pottery for protection from insects, animals and moisture.”

But what about people? If binge eating existed then, that would make it one of the most ancient bad habits on Earth. Also, the earlier in human history it happened, the more serious the infraction would have been. In much of North America, early communities had one thing in common. When cold weather set in, sure, the occasional animal could be caught — but there were no guarantees. There was only a certain amount of stored food, and it had to be enough to last through the winter, for everybody.

One binge-eating episode, committed by one individual, could seriously affect the whole settlement. Of course, a factor in the community’s favor was the difficulty of sneaking food. In long-term storage, few casual munchies would be available. By and large, whatever you hoped to eat would need to be shelled, ground, parched, peeled, chopped, pitted, boiled, or in some other way prepared, as a prerequisite to consumption. This would not be easily accomplished on the down-low. In a small, close-knit population, sneaking food would be difficult, if not impossible.

More modern times

We will review (not in the sense of critical judgment, but in the sense of taking another look at) previous Childhood Obesity News posts that mentioned binge eating. For instance, it is a startling fact that some binge eaters don’t even get fat!

Some “make up for” binges by eating very frugally the rest of the time, to find a crude kind of balance and maintain normal weight. This can backfire — and usually does — because the enforced hunger is just as likely to trigger another binge.

How might you know if your consumption is at binge level?

Do you have episodes of eating a lot in a short time frame? Of eating until you are uncomfortably or even painfully stuffed? Does this happen once or twice a week? Do you hide food, or furtively consume it alone? Do you feel embarrassed and ashamed? Does this habit interfere with other aspects of your life? Do you feel like you just can’t stop, as if you are the pawn of some ungovernable force?

Binge-eating seems to run in families, although that could just be the “monkey-see, monkey-do” effect, rather than anything anatomically genetic. When kids grow up watching parents self-medicate with a particular substance, it should come as no surprise if they continue the family tradition.

Another thing about binge eating is how very easy it is for a person to rationalize, justify, defend, self-excuse, self-extenuate, self-validate, and self-vindicate. Even after seeking professional help, this is the sort of problem that a patient can waste a whole lot of time exploring the details of, rather than healing from.

Your responses and feedback are welcome!

Source: “Agriculture and Other Food Sources,”, undated
Image by Boston Public Library/CC BY 2.0 DEED

Will the Cheaper Weight Loss Regimens Replace GLP-1 Drugs?

When patients start on the latest obesity drugs, they often experience reduced food cravings and significant weight loss. However, discontinuing these drugs usually reverses these effects: cravings return, and so does the weight. For instance, within a year of stopping semaglutide — known as Wegovy or Ozempic — people typically regain about two-thirds of the weight they lost. Tirzepatide, marketed as Zepbound or Mounjaro, shows similar patterns. This has led to the medical consensus that these obesity drugs need to be taken indefinitely, perhaps for life.

For pharmaceutical companies selling these blockbuster drugs, collectively known as GLP-1 drugs after the hormone they mimic, this is a lucrative prospect. For patients, who might be paying over $1,000 a month out of pocket, it’s a different story. Most Americans simply can’t afford such ongoing expenses, as a recent article in The Atlantic outlines.

Finding cheaper alternatives

This financial burden has prompted some doctors to get creative, developing regimens that substitute cheaper, though less well-known, alternatives. GLP-1 drugs are highly effective, promoting more rapid weight loss than any other obesity medications currently available.

However, some doctors are exploring whether these drugs need to be used permanently. “What if we use them short-term, for six months to a year, to lose 50 pounds?” asks Sarah Ro, an obesity-medicine doctor and director of the University of North Carolina Physicians Network Weight Management Program. She and other doctors are investigating transitioning patients to older, less expensive drugs for long-term maintenance.

Dr. Ro has already helped hundreds of patients make this switch out of necessity. Many of her patients in rural North Carolina lack insurance coverage for the new obesity drugs and can’t afford them out of pocket. When North Carolina’s state employee health insurance cut off coverage for GLP-1 drugs in April, Ro transitioned her patients to older medications like topiramate, phentermine, metformin, and bupropion/naltrexone, coupled with lifestyle counseling. These alternatives are generally less effective, leading to about half the weight loss of GLP-1 drugs, but are far more affordable, costing as little as $10 a month when prescribed as generics.

Retirees on Medicare lose GLP-1 drug coverage

Jamy Ard, an obesity medicine doctor at Wake Forest University School of Medicine, also had to adjust his approach for patients who lost GLP-1 drug coverage upon retiring and switching to Medicare, which currently does not cover obesity treatments. Doctors like Ard see the need for research on transitioning from GLP-1 drugs to older ones, as many patients will lose coverage at retirement age. “Now I’ve got to figure out, well, how do I treat them?” he said.

Are the alternatives safe?

Long-term data on older drugs are sparse, largely because obesity drugs weren’t profitable enough to justify expensive, long-term studies until recently. Switching from GLP-1 drugs to older medications is largely anecdotal at this point, with varying outcomes. A small minority can maintain their weight with just diet and exercise, while others find the older drugs ineffective. Dr. Ro’s experience suggests that 50% to 60% of her patients have successfully maintained weight loss using older drugs alongside lifestyle changes like cutting out fast food and sugary drinks.

A tailored trial-and-error approach is the way to go

The choice of alternative medication depends on the patient. Different drugs target different biological pathways. For example, the combination of naltrexone and bupropion reduces the pleasure of eating and is particularly effective for emotional eaters. Topiramate makes carbonated drinks unpleasant, which can help soda drinkers. Each drug has different side effects, requiring a tailored approach and sometimes trial and error to find the best fit.

Doctors are also finding that some patients can maintain their weight on lower or less frequent doses of GLP-1 drugs. Lowering the dose doesn’t save money since the pens cost the same regardless of dosage, but extending the time between doses can help stretch supplies.

Stopping completely might be a challenge

Complete discontinuation of obesity medications, GLP-1 or otherwise, is unlikely for most patients. Weight loss triggers compensatory mechanisms in the body, evolved to prevent starvation, making long-term maintenance a constant challenge. Susan Yanovski, co-director of the NIH’s Office of Obesity Research, describes long-term weight maintenance as the “holy grail” of obesity treatment.

The best maintenance strategy — whether it involves GLP-1 drugs, and at what dose — remains an individual question needing further study. “These are really good research questions,” Yanovski said, though they might not align with the pharmaceutical companies’ focus on developing new drugs.

Compounded semaglutide is announced

Hims & Hers company announced last week that it will be selling compounded semaglutide for weight loss at prices significantly lower than Wegovy and Ozempic, addressing a gap in supply. However, it’s important to note that compounded semaglutide is not FDA-approved and undergoes less extensive testing than brand-name drugs.

This compounded GLP-1 drug will be prescribed by physicians through their telehealth platform. Prices start at $79 per month for oral medication kits and $199 per month for injections, much lower than the list prices of Ozempic ($935.77) and Wegovy ($1,349.02).

However, compounded semaglutide differs from FDA-approved drugs like Wegovy and Ozempic in several key ways. Compounded medications do not undergo the rigorous FDA approval process, which ensures safety, efficacy, and quality through extensive testing. This lack of testing can lead to concerns about inconsistent potency, bioavailability, and safety.

Also, these drugs can vary in how they are absorbed and utilized by the body, potentially leading to unpredictable therapeutic outcomes. Safety concerns also arise from the sterility and cleanliness of the compounding process, which might introduce harmful contaminants if not properly managed.

The BrainWeighve app would be an ideal off ramp…

The ability to rechannel displacement into less harmless activities rather than succumbing to urges is behind the behavior modification app, BrainWeighve, currently ramping up for a trial through the University of California Los Angeles (UCLA). The trial focuses on weight loss for obese teens using a self-directed, physician-supervised program withdrawing from one problem food at a time.”

Your responses and feedback are welcome!

Source: “Ozempic Patients Need an Off-Ramp,” The Atlantic, 5/22/24
Source: “Hims & Hers Selling GLP-1 Weight Loss Drugs Like Wegovy for 85% Less: What to Know,”, 5/22/24
Image by Thought Catalog on Unsplash

Binge-Eating Self-Talk

You’re out of balance, and definitely out of control. You want — no, you need — to eat ALL the food. A whole lot of it at once, until it hits the button that says “Enough!” Except, when is that going to happen? And then you coast through a good patch, where you seem to have some semblance of control, and everything just rolls along merrily for a while. Maybe that whole ghastly chapter of your life is over. Maybe you’ve outgrown it, or discovered some more healthy obsession to take its place. For a while, there is a degree of relief. Until…

And you know what? So what. Even at the best of times, the body doesn’t look that great, and maybe it’s time to just stop caring about that. It’s the mind that really matters, and the spirit. There is no real health problem going on, and instead of fretting and beating yourself up about the occasional food orgy maybe you should just sit back and be grateful that you’re not one of the millions of people on earth who are still starving.

Maybe it’s simply time to stop feeling “depressed, disgusted, ashamed, guilty or upset,” to quote the Mayo Clinic’s list of negative emotions. After all, it’s not like you’re vomiting the food up after you eat it. That would be really disgusting, and you’re not there yet. Not even close! You don’t dabble in laxatives, you’re not that far gone. You’re not out there compulsively exercising for six hours every day.

Okay, once in a while you get a little crazy and “put away” a whole bag of groceries, but not in the cupboard. There was that time last week when after about five minutes, you weren’t even hungry anymore, and you kept on eating for — what, two hours? Not quite two hours.

So what? Take a look at the world. People are out there shooting up schoolrooms full of kids, right in front of God and everybody. At least I keep my problems to myself. The door is closed, the shades are down, I’m eating a whole large pizza with breadsticks and dipping sauce on the side, and not hurting another soul. So, all you haters out there, just deal with it.

And what’s the big deal? Once in a while I slip up and eat too much. And okay, it’s been going on for decades, but here I still am, standing upright and able to tell the tale. Thanks for pointing out that my jeans don’t zip up all the way, but you know what? I have others. And if I still need some new ones, with an even bigger waist, I can afford another pair of pants. I got that stuff handled. I’m doing fine at my job, no complaints. Yeah, that one boss keeps looking at me sideways, but he’s retiring next year anyhow.

Anyway, my best friend growing up had monstrous eating orgies. Maybe I caught it from her. And she got over it. At least I think she did. I haven’t seen her in a few years, but I’m sure she’s fine. She did graduate, after all. Oh wait, I wasn’t going to think about how I lost that scholarship anymore. It’s making me think about that bag of chips I stashed in the basement to make it harder to get to. But you know what? Maybe I’ll just take a little walk down there right now. Stairs are good exercise.

I’m taking care of business. Sure, I have stress and maybe a negative self-image, but who doesn’t? None of us are perfect, and at least I’m not out there attacking strangers or dynamiting power stations. I get bored, sometimes I eat too much. At least I don’t drink. Shoot, I know people who should be institutionalized, and I’m nowhere near as crazy. Sure, I have anxiety and depression, who doesn’t? I don’t have insomnia or diabetes or sleep apnea. I’m not socially isolated, I got plenty of friends, and most of them are in worse shape than me…

And blah-blah blah, blahblah blah blah blah blah, and blah, blah-blah, blah-blah blah, blahblah blah blah blah blah, blah, and blah-blah, and blah-blah blah, blahblah blah blah blah blah, blah, blah-blah…..

Your responses and feedback are welcome!

Source: “Binge-Eating Disorder,”, undated
Image by Pat Hartman

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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:


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