What is a binge episode? What isn't?

When is eating large enough to be a binge?

Binge eating is complicated.  It seems like it shouldn’t be, because it’s just “eating a lot of food” in most peoples’ minds.  However, I hope that in other blog posts you’ve seen that the process of diagnosing binge eating is quite a bit more complicated than that.  After all, scientists and doctors love to have a clear-cut answer!  I think of it like getting your blood levels checked at the doctor – they have strict cutoffs for what is considered high, normal, and low blood pressure, cholesterol, heart rate, and everything else you can imagine.

We do the same thing for binge eating!  We want to have a clear cutoff for what is considered a binge and what is not.  Unfortunately for everyone, eating is so varied!  How many radishes do I need to eat for it to be considered a binge?  How much pizza?  How many glasses of orange juice?  It’s tough to nail down exactly where the line should be.  And it’s even more complicated than that, because how many people just eat plain radishes?  No, you’ll probably eat them chopped up on a salad.  Do we consider a thin crust veggie pizza the same way we think of a double sausage double cheese deep dish?  Absolutely not.

To help us with this, the researchers and doctors behind the Diagnostic and Statistical Manual (DSM) have come up with a line that’s pretty important, and is the only guidance they give on amount eaten.  For something to be a binge, people need to eat (and I’m paraphrasing here, because I’m not sure I can legally use their words) “an objectively large amount of food compared to what would normally be eaten in similar circumstances, within a specific amount of time”.  Let’s break that down!

Specific Amount of Time:  Binges don’t only happen in one sitting.  People will start and stop, pause, start again, maybe get some more food or cook something else, and come back and eat more.  Sometimes it’s a few different sittings across time, but there can’t be any breaks that are too long between moments of eating.  If someone happens to be a big snacker across 4 or 5 hours in the evenings, that is less likely to be a binge than someone who will eat two lunches and a snack back-to-back without much of a break.

Amount Normally Eaten in Similar Circumstances:  Most people eating lunch will have a sandwich and a snack/dessert, or a salad with something on the side, or a slice or two of a large pizza, or a burger and small fries, or a few small tacos.  You can see a lot of variability in there!  We are looking for what happens for most people, on average.  Holidays or celebrations are different circumstances, and follow their own rules, so we don’t typically worry about those unless they’re fitting in to a larger, problematic pattern.

Objectively Large:  Here’s where it gets pretty tough.  You can tell from the “normally eaten” rules that there is some wiggle room here.  But in general, we’re looking for an amount of food that’s notably and significantly higher than what people would eat on average.

So the big wrinkle is obvious.  What do we consider to be “objectively large”?  Well, lets say it’s for supper on a weeknight, and it’s for a male in their 30’s who is not an athlete.  Here are a few quick ideas of cutoffs.

• A sleeve of Oreo cookies (about 1/5 of a family pack of oreos)

• An entire frozen thin crust pizza (Jack’s, Red Baron)

• 4 slices (of 8) on a large normal crust delivery pizza (Papa Johns, Dominos, Pizza Hut)

• 4 bell peppers

• 2 meal plates of mashed potatoes, gravy, 3 slices of ham, side of sweet corn and green beans

You can see that this isn’t looking at calories, fat content, sugar content, or any thing of those sorts.  This is asking “what would a person like this eat under these circumstances,” and creating a (kind of arbitrary) cutoff.

I know this isn’t completely simple, and there is some wiggle room in where the cutoffs and guidelines are.  That’s just the way this works!  We have to have diagnoses that are flexible enough to consider the different amounts people will eat at different stages of life – someone at age 18 and an athlete will eat very differently from a person who doesn’t exercise in their 50’s.  However, hopefully you can see that we are looking for eating patterns that are higher compared to what would be normally expected, and occur in a somewhat close time period to one another.