Q & A: Binge Eating Following Dieting

Q: Does binge eating always follow a pattern of prior dieting? (V.K., Boise, ID)

A: In contrast to some previously held notions, more recent research has shown that binge eating doesn’t always follow restricted eating (J Psychosomatic Res 44:367, 1998). In fact, for a substantial proportion of women who binge eat, especially those who meet the criteria for binge eating disorder (BED), binge-eating behavior often starts long before dieting. These researchers uncovered two distinct patterns in the development of binge eating among a group of 106 overweight women between 18 and 55 years of age. The first pattern was an early- onset form, in which binge eating began by early adolescence without prior restrictive intake. The second form begins in early adulthood after a number of years of dieting. The early-onset form, or binge eating before dieting, may be tied to a higher rate of BED (or at least a higher rate of BED by mid-life) and possibly a higher rate of Axis II disorders. Those who started to binge eat before dieting started to diet earlier and more often than those in whom binge eating was preceded by dieting. No differences between the two groups were found in the patterns of weight gain throughout the teenage years or high and low weights in adulthood. This research is consistent with an earlier study in which only 8.7% of 31 binge eating obese patients reported having been on strict diets before they started to binge eat. (Int J Eat Dis 13:25, 1993). At the same time, there are shades of gray. Some degrees of undereating meals, e.g., at breakfast or lunch, without strict dieting per se, may predispose to some exaggerated increases in neuropeptide Y and the nighttime binges that result.

— J.Y.