Compensating for Binge Eating

Binge Eating and Compensatory Behavior

The act of binge eating can be very upsetting.  In fact, distress about the amount eaten is a piece of what we are looking for when we are assessing binge eating episodes!  To learn more about what binging is from a clinical perspective, please take a look at the first blog post – there’s plenty of great information in there to get a better understanding of that particular difficult behavior.

But we’re not here to discuss binge eating in much more detail.  I’m hoping we can dig more into some of the consequences of binge eating and the problematic responses that we often see as reactions to the amount eaten.  Clinically, we call these compensatory behaviors, and their whole existence is intended to reduce the impact of the amount of food eaten on peoples’ body weight and body shape. 

For something to be considered a binge eating episode, we need to eat an unusually high amount of food, something that people wouldn’t normally eat in similar circumstances.  Oftentimes, these episodes then result in concern that the amount of food eaten will result in a similarly unusual increase in the amount of weight gained as a result.  And here is where compensatory behaviors enter the picture.

Compensatory behaviors, if we take them at face value, should look pretty simple.  They are anything that a person does in response to binge eating that will reduce or eliminate any weight gain as a result of the eating.  However, just like with binge eating, there is a limit to what we would consider to be a clinical issue.  Maybe someone binge eats and takes a longer walk with their dog the next day by a half-mile or so.  Is this an issue?  I’d argue that it isn’t, because it’s not really causing any problems in their lives, nor is it causing any undue distress or possible bodily harm.  However, people rarely stop at a slightly longer dog walk, because the amount eaten causes so much distress that they feel they need to do something much more intense to rid themselves of those extra calories or the possible weight gain of the binge.

So what type of problematic behavior are we interested in?  What type of behavior would be related to an eating disorder diagnosis?  Well, let’s take a look at a few things any eating disorder therapist or researcher will run into.  We may as well start with the more obvious things that we typically see.

• Vomiting.  We all know this one, even if just from popular culture like TV, movies, magazines, or popular websites.  Vomiting to compensate for eating has been the butt of many jokes across many different types of media, which causes even more stigma for people who experience this behavior.  Similar to binge eating, it can be experienced as a compulsion or an urge to vomit that is so strong people have a lot of trouble being able to prevent themselves from vomiting after binges, or vomiting after smaller meals or snacks.

• Fasting.  Anyone who fasts for the express purpose of compensating for binge eating is engaging in a compensatory behavior, and clinically it makes any therapist more concerned.  While fasting itself alone has been shown in some research to have positive health outcomes, and fasting is included in many religious and spiritual rituals across the globe, those studies and rituals are not addressing fasting as a way to compensate for binge eating.  This is a problematic behavior, and is only going to reinforce peoples’ concerns about their body weight and shape, which oftentimes makes disordered eating even more likely in the future.

• Laxatives/Diuretics/Diet Pills.  Look, there are a lot of diet pills and medicines on the market, and recently a lot of them work quite well (I’m looking at you, GLP-1’s).  However, any medicine or medication that someone takes after a binge that is expressly intended to lose weight or prevent weight gain will be considered a clinical problem.  If you’ve been prescribed a GLP-1 by your doctor, fantastic, please take that according to medical instructions!  But if you’re taking laxatives to prevent weight gain or promote weight loss, this is a concerning compensatory behavior and any therapist will want to know it’s happening.

Those are excellent examples of things we as therapists see very often with eating disorders.  However, compensatory behaviors can also be quite subtle, and oftentimes people don’t directly understand that what they’re doing would be considered a compensatory behavior.  I’d be delighted to give you a few examples that I’ve run across.

• Alcohol-induced Vomiting.  After a binge, some people will drink as much as they need to in order to induce vomiting.  There are a lot of reasons people may do so, but the core of this issue will always be about preventing weight gain from the amount eaten.

• Intermittent Fasting.  I know that people may bristle when they read this, particularly if they have used IF successfully, or are engaging in it right now.  I’m not saying that IF is a problem that people need to stop all the time no matter what.  What I am saying is that I’ve often seen IF be implemented only after binge eating starts, or people will only do IF after particularly large meals or high food intake days.  This is where it’s a problem rather than a legitimate strategy for changing your relationship to eating.

• Driven Exercise.  For those of us who exist in the world and engage in regular exercise, or intermittent exercise, or very sporadic exercise, this may seem a bit surprising.  But remember, all compensatory behaviors are about minimizing or removing the impact of eating.  So this isn’t exercise for it’s own sake, or even exercise for weight management in general.  This is driven exercise that is compulsive, or uncontrollable, or very intense, and only in response to binge eating or overeating.  This isn’t 30 minutes on the treadmill, either.  For most people who experience this form of compensatory behavior, it’s more like 2-8 hours of intense exercise, and it really interferes with life and living.

So there we have it!  Compensatory behaviors are an important component of eating disorders that we all need to know a bit about.  And if you have any concerns about your eating, your response to eating, or your concern about your body weight or body shape, you may benefit from reaching out to a therapist who is well-trained in eating disorder assessment and treatment!