I became fascinated with binge eating because my essential problem was the same. Disconnection.
There is a fundamental disconnection deep down that’s the cause of bingeing. For me, I couldn’t feel my body, or make sense of my emotions. I was split. I only lived in my ‘thoughts’ and suffered from an existential loneliness. I covered my pain with food.
I blocked out my anxiety from my conscious mind, and channeled my stress into rigid dietary patterns. My mind wouldn’t stop thinking about food or random numbers about labels like I was going crazy!
So I decided to become a Zen monk. Skipped college graduation, meditatin in the mountains, all that jazz.
Now written over 10 years later, this is my attempt at compiling a bare bones but still comprehensive guide to binge eating and how to heal from binge eating.
Now the PDF version you’re reading is over 8000 words spread over 75 pages with nearly a dozen training videos and interviews snippets.
(This is barebones?!?)
Yes, eating is a complex topic and while I try to keep the solution simple (see section #2) I still want to provide enough info for you to make sense of things yourself.
There are three sections to this guide:
- What is Binge Eating? (11 questions)
- Healing Treatment (8 points)
- Nutrition basics (3 starter tips)
Most sections have a blog post or video for more information.
Click on a bullet point down below to instantly go to the page where the information is provided.
- What Is Binge Eating?
- What Is Binge Eating In General?
- What’s The Clinical Definition Of “Binge Eating Disorder”?
- What’s The Difference Between Overeating and ‘Binge Eating Disorder’?
- Other Binge Eating Signs
- How Often Is Binge Eating Disorder Clinically Diagnosed?
- What Happens To Your Body When You Binge Eat?
- What Factors Cause Binge Eating Disorder?
- What Is The Main Cause Of Overeating?
- How Big Is A Binge And What Do People Eat During Binging?
- Healing Treatment
- Binge Eating Disorder Treatment – Various Treatment Paths
- Cognitive Behavioral Therapy
- Acceptance and Commitment Therapy
- Dialectical Behavioral Therapy
- Intuitive Eating
- Medications For Binge Eating
- Cognitive Behavioral Therapy For Binge Eating – Why I Recommend This Treatment
- The Science Behind Cognitive Behavioral Therapy
- How To Use A Real-time, Before-You-Eat Food Awareness Journal (this is my fundamental technique to end binge eating!)
- Why The CBT Food Awareness Journal Works
- Addressing Concerns About Food Awareness Journal That Many People Share
- General Treatment Tips
- Binge Eating Disorder Treatment – Various Treatment Paths
- Nutrition Basics
- Nutrition 101 – Focus on Timing and Feeling Content First
- The Primary Food Group Guideline
- Two Keys to Meal Prepping
- Concluding Thoughts
1. WHAT IS BINGE EATING?
What Is Binge Eating in General?
Let’s define binge eating first shall we?
In my years of listening to people describe their relationships with food, I’ve noticed a peculiar thing.
Everyone has their own definition of what a binge is.
Some say a binge is where they eat until they are completely and painfully full. Other people say a binge is where they graze throughout the day and feel guilty afterwards.
Have you ever felt confused by the differences between words like emotional eating versus binge eating?
Or compulsive eating versus food addiction?
In this ebook I group all these words together and call them ‘Binge Eating’. As long as you are overeating too much and like you are losing control (or that you HAVE to eat) then we’ll call this binge eating.
There are three main signs of binge eating:
Let’s nail down our definition of binge eating which we’ll use through the post. Binge eating in general (not the official Binge Eating Disorder diagnosis I’ll discuss below) has three characteristics:
- Feel very anxious, like you are losing control OR that you HAVE to eat, usually like you must ‘follow’ a voice or urge.
- Eat an amount of food that feels like too much to you.
- Feel very bad, guilty, disgusted, contemptuous, etc afterwards.
These three characteristics oftentimes (but not always) occur in a well-known pattern known as the Binge Diet Cycle:
For an in depth interview and discussion on this topic, please see when I was interviewed by Dr. Hornaman.
What Is The Clinical Definition Of “Binge Eating Disorder”?
So in this book I talk about ‘Binge Eating’ which includes emotional eating, overeating, stress eating, etc.
But we should also talk about ‘Binge Eating Disorder’ which when you binge eat to a more extreme degree.
Binge Eating Disorder is a clinical diagnosis and is defined by criteria found in the DSM-5.
While the DSM-5 may not mean much to you, please recognize this is the medical community’s ‘bible’, so to speak.
The DSM-5 stands for the Diagnostic and Statistical Manual. It’s a statistical manual of mental disorders that gets revised about once every 15-20 years.
Nothing gets into this ‘bible’ without going through rigorous scientific study.
The DSM-5 is the manual which is used for medical insurance reimbursement and is considered the gold standard in clinical therapy.
Because Binge Eating Disorder is a diagnosis that qualifies for insurance reimbursement, the criteria for having BED are very precise.
To learn more about the DSM-5 read my article here: “What is the DSM-5 Definition of Binge Eating Disorder?”
These two criteria must be present in order to receive a Binge Eating Disorder diagnosis.
- Repeated episodes of Binge Eating, where Binge Eating is defined as:
- Eating a much larger amount of food than normal
- AND feeling a lack of control
- at least 1 day a week for 3 months
In addition to the two criteria above, a Binge Eating Disorder Diagnosis also requires three or more of the following five symptoms:
- Eating rapidly
- Consuming large amounts of food when not hungry
- Eating alone because of embarrassment
- Feeling disgusted with oneself after eating
- Feeling distress when eating
Following so far? First two criteria are mandatory. Then you must have three of the additional five criteria listed above.
Finally, the #8 and final medical criteria of a Binge Eating Disorder diagnosis also requires none of the following behaviors:
- Bulimia nervosa
- Anorexia nervosa
What’s The Difference Between ‘Binge Eating’ and ‘Binge Eating Disorder’?
Oftentimes people who overeat, emotionally eat, and/or binge eat do not meet the strict clinical criteria for Binge Eating Disorder.
For example, here is an index of clinical Binge Eating Disorder severity:
- Mild: 1-3 binge-eating episodes per week
- Moderate: 4-7 binge-eating episodes per week
- Severe: 8-13 binge-eating episodes per week
- Extreme: 14 or more binge-eating episodes per week
But there are many other situations to consider:
- What if you binge every other week and not weekly?
- If you overeat but you don’t think you lose control?
- What if you overeat but don’t feel bad afterwards?
- Or if you binge really heavily one week, but then are normal for two weeks?
In all of these situations, you would not have clinical Binge Eating Disorder (because Binge Eating Disorder criteria is weekly binge eating episodes, with loss of control and guilt) but you would still have an overeating / binge eating problem.
People who do not have Binge Eating Disorder but still suffer from food and eating problems fall somewhere on this Binge Eating Continuum:
Does this make sense?
- ‘Binge Eating’ includes emotional eating and overeating, and is the 3 ‘subthreshold’ options.
- Binge Eating Disorder has 8 specific criteria
Other Binge Eating Signs
The 8 criteria above are used to clinically define Binge Eating Disorder.
However, we all know that eating is on a spectrum with many different behaviors, aka Binge Eating.
Here are other behaviors and signs that are commonly present for all types of Binge Eating, including the disorder:
- Not eating certain foods like carbs, fats or sugars (but then secretly eating them during a binge)
- Obsessively staring in the mirror
- Being afraid to eat with friends, family or in public
- Dieting, yo yo dieting, regaining weight from dieting
- Eating alone oftentimes because of embarrassment or fear that you will lose control
- Feeling depressed, horrified, and guilty about eating
- The disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating large amounts of food consumption.
- Seems awkward eating around others
- Some new practice of food or fad diets, like cutting off whole food groups (no fat, no carbohydrates, no meat, vegetarianism / veganism)
- Feels scared or at risk of eating in public or with others
- Steals or hoards food in strange places
- Creates daily plans or practices to make time for binge sessions
- Having low self-esteem
- Physical Noticeable weight fluctuations, both up and down
- Stomach cramps, other unspecified gastrointestinal complaints (constipation, acid reflux, etc.)
For an in depth post on the signs and symptoms of binge eating disorder, read my article “Here Are The Top Signs And Symptoms Of Binge Eating Disorder“
Long Term Binge Eating Health Complications
How Often Is Binge Eating Disorder Clinically Diagnosed?
Do you know Binge Eating Disorder is more common than breast cancer, HIV, and schizophrenia?
Binge Eating Disorder is also three times more common than Bulimia Nervosa and Anorexia Nervosa combined.
That the official disorder, not the more casual ‘Binge Eating’ term I use in the second section of this ebook, where I talk about solutions to binge eating.
This makes Binge Eating Disorder the most commonly diagnosed eating disorder by far.
The official numbers are staggering. According to a national survey, Overall, around 2.8% of people in the United States will be diagnosed with Binge Eating Disorder in their lifetime.
Specifically about 3.5% of women and 2% of men are diagnosed with Binge Eating Disorder.
That’s close to 9 million people officially diagnosed with BED.
For more info on statistics read my blog article, “Statistics on Binge Eating Disorder | What Is Binge Eating?“
I know 2.8% or 9 million people sounds very precise. Is it really possible to know that 2.8% of Americans will be diagnosed with BED?
2.8% is a precise and accurate number. MediCare, insurance and the precise definition of Binge Eating Disorder make it easy to track the # of people officially diagnosed with BED.
Here is a video on BED statistics:
What Happens To Your Body When You Binge Eat?
There are 3 primary time periods to consider when you binge eat:
For an in depth discussion on what it likes to binge eat and be trapped in your head, see this incredible podcast interview with Gina.
Gina struggled with binge eating, thoughts, and many of the typical symptoms of binge eating disorder. But she never met the criteria for binge eating and remained unknowing for decades.
Finally, after decades of binge eating she entirely stopped and here is her full interview I want to share with you.
Now you see what’s possible!
Ok, let’s resume talking about the changes in your body during a binge attack.
Body Before You Binge Eat
Even before you binge eat, you actually start to lose control.
During this phase, your neocortex starts to get shut down by your limbic brain.
In other words, your ‘thinking’ self gets shut down by your ‘animal’ self. This is also called ‘tunnel vision’.
In tunnel vision you will start to feel like you ‘must’ binge eat. You will start getting powerful cravings. These cravings will feel impossible to ignore.
Your body will begin to tighten and tense up to resist the cravings, but you won’t be able to stop these cravings.
Soon your body will be under so much tension and stress that the only way to release the stress will be to binge eat.
Body During A Binge
While on a binge, your sense of time may be distorted because your ‘thinking’ brain was shut down beforehand.
Oftentimes time will fly by. Hours can pass.
You eat such a large quantity of food, bags upon bags of food. Your memory of what you eat almost gets wiped out.
It’s like life is in a haze.
You’ll become very fatigued, tired, and slow. You may go back several times to eat again. There are sharp pangs of guilt.
Often a thought of ‘self-punishment’ begins to repeat itself, such as:
- I always fail
- Might as well keep eating because I already f*cked up today
- I can’t stop
Many times people will continue overeating as a means of:
- Avoiding their inner critic
Body After A Binge
One of the main “benefits” of a binge is the stupor you go into afterwards.
This stupor is what’s known as ‘escapism’. Your mind is blank, temporarily.
Numb. Coma-like. Essentially you’re high on drugs. Food can be a drug after all.
After you have some time to digest, like any other drug the ‘high’ wears off.
You will feel terrible, both physically from a belly way too stretchedwith food.
Mentally you’ll feel horrible too. The guilt and shame are the worst parts of this whole thing and are the real drivers of long-term damage.
Quick Overeating/Binge Eating Estimate:
45 Million x 30% = 13.5 million people who show signs of binge eating.
Truth be told, we don’t know the precise number of people struggling with overeating in the United States.
We know that 60% or more of the population is overweight at least. How many of these people struggle with food, but haven’t ever gotten a BED diagnosis?
How many times have you heard your friend say they ‘fell off the wagon? Or ‘slipped’ over the weekend?
The vast majority of people who struggle with overeating are not diagnosed with BED and remain ‘uncounted’.
What Factors Cause Binge Eating Disorder?
Much can be said about the general causes of Binge Eating Disorder, yet we do not know what precisely causes BED.
What comes first, the chicken or the egg? We’ll never know. The same is true about what precisely causes binge eating.
We do know that people who binge eat tend to show some common factors.
Please note these same factors are present for eating disorders in general too.
1 – Dieting
Here’s my interview with Melanie, founder of Balancedtx.com and largest group therapy nutrition provider in New York City.
Dieting is the gateway to binge eating. Oftentimes diets promote two unhealthy behaviors which lead to binge eating:
- Skipping meals
- Eating too little
There is a common statistic indicating that 95% of diets fail. Oftentimes when someone fails their diet they say they ‘fell off the wagon’.
And when someone says they ‘fell off the wagon’, what they typically mean is that they had a binge eating episode.
Please note nowadays that many diets no longer call themselves diets. For example, the following are all diets in disguise:
- Low carb
- Many food allergies, for example only 1% of people are actually gluten intolerant
Be careful when dieting because dieting is one of the biggest causes of binge eating.
Here’s the bottom line:
If you eat too little — whether due to skipping meals, removing foods from your diet, or just not eating enough in general — you put yourself at higher risk for binge eating.
For more info read “6 Reasons Why Diets Don’t Work“
2 – Genetics
Genes play a huge role in binge eating.
Boston University School of Medicine researchers published a study showing how they were able to locate a gene responsible for binge eating in mice.
While mice are different from humans, research does show conclusively that many people who struggle with eating have parents who also struggle with eating.
Perhaps you can answer these two questions for yourself:
- Do you struggle with food?
- If so, do you have a parent who struggles with food too?
Research would suggest that if you answer “Yes” to the first question, you’ll probably answer “Yes” to the second question as well, but not all the time.
3 – Negative Body Image
Many people who binge eat have a negative body image. This negative body image motivates the person to diet.
However, remember dieting often leads to binge eating!
Why does a person have a negative body image in the first place?
Our culture with all of its social media, often promotes a body image that is too thin.
For example, it’s estimated that we see between 400-600 body images per day on average. Many of these images are of thin women.
This leaves many women who really are just fine the way they are, with a not-perfectly-thin body, with a negative body image and seeking to lose weight.
But remember, dieting is the most common form of weight loss and it often leads to binge eating!
Many people are actually fine with a bit more fat on their bodies than what the modeling images in the magazines show.
But if you only see images of thin bodies, you’ll think you’re fat and unhealthy, when in reality you’re just fine.
These negative body image thoughts will then drive you to dieting … which has all sorts of negative consequences.
4 – Gender
Women experience Binge Eating Disorder more than men. About 75% of my clients are women. Why is this?
There is science which identifies puberty as a crucial time when many women develop an eating disorder.
This biological reason helps explain why women may experience Binge Eating Disorder at higher rates than men because women in general go through more changes than men during puberty.
But there are other reasons as well. In particular, women have much more societal or cultural pressure placed on them in terms of body image and to look thin.
While men do have body image pressures as well, overall it’s not as intense or all-pervasive as what women experience.
So there’s perhaps a biological component and I would say definitely a cultural component behind the gender discrepancy in eating disorder frequency.
5 – Stress
Many people often rely upon eating to calm themselves down.
Using food to cope with stress is called ‘Emotional Eating’.
However, emotional eating can turn into binge eating if other factors are present.
For example, if a person is under stress, has a history of dieting, and has the genetics for binge eating …
These factors can combine to make emotional eating turn into binge eating.
Finally, alongside other stress problems is trauma, and any form of abuse.
Any type of eating disorder will typically have a significant percentage of people who have experienced trauma.
Stress, including traumatic stress, is a major common factor behind why people binge eat.
If you get stressed and lose your appetite, please see my video which has over 2000 views on the topic.
6 – Depression
Depression and binge eating are difficult to separate.
What comes first? Do people binge because they are depressed? Or does someone become depressed because they’ve binged?
It’s like the chicken and the egg. However, it doesn’t really matter.
According to WebMD, studies have shown that up to 50% of people with binge eating disorder have also been diagnosed for depression.
7 – Social Relationships
Family and other social relationships can greatly influence the chance that someone will become a binge eater, in part by enhancing some of the factors discussed above.
For example, oftentimes a parent will criticize their child’s body, causing the child to have a negative body image.
This child may then turn to dieting out of a mistaken belief that they need to look a certain way to get their parent’s love.
And maybe as a child you saw that your parents handled stress by eating food.
As a child, you could have great parents. However, even if your parents were great, some of their parenting behaviors could still lead to someone binge eating down the line:
- Taught you how to organize information instead of your emotions you could still have a tendency to binge eat
- If your parents were overly strict with you in your education
- Didn’t properly attune to your emotions
Finally, you may have other friends or relationships with people who tend to use food to cope with difficult emotions.
Oftentimes, people will make friends with other people following a diet and then they too become more involved with dieting.
As dieting increases then binge eating follows.
8 – Chemicals
There is incredible stress and guilt associated with binge eating. It might seem strange …
But many people actually “like” binge eating in some ways.
Oftentimes people think that giving up binge eating would mean a loss of something important.
Why is this?
It turns out that binge eating is linked to a release of ‘happy’ chemicals as well.
Oftentimes when people binge eat they are running away from their emotions.
In these cases binge eating can provide a rush of serotonin and dopamine, which can ‘numb’ the person’s emotions.
When numb, a person is no longer in pain. They are temporarily ‘happy’.
While binge eating overall is negative, we cannot forget that powerful chemicals are a major reason why people binge eat.
9 – Low Self-Esteem
Low self-esteem is the final factor.
When a person suffers from low self-esteem they are less likely to care about their well being.
This person might:
- Skip meals
- Not sleep well
- Have less resilience to stress
- Be more easily swayed to diet
Sadly, many people who binge eat think to themselves that their binge eating is a form of punishment.
(It’s interesting how a person can ‘think’ binge eating is a punishment, while chemically speaking their body becomes addicted to the chemicals. You can think one thing and feel the opposite.)
For example, a person with low self-esteem might have a rule to not eat more than 1000 calories per day.
This is extremely low! Not eating enough will cause binge eating.
So eventually this person will end up eating more than 1000 calories.
However, this person may then view their failure to mean they need to binge to ‘punish’ themselves.
This is how an overeating episode turns into a full blown binge in many cases.
What Is The Main Cause Of Overeating?
I just listed 9 factors behind why people binge eat:
- Negative Body Image
- Social Relationships
- Low Self-esteem
While all of these can be important, the main cause of binge eating is dieting.
The reason is simple. Except for genetics, all these factors lead back to dieting.
Now, a person might ‘accidentally’ diet if they are under lots of stress.
For example, in stressful situations a person might skip meals or undereat accidentally. Sometimes people undereat when they are depressed.
Other times the link is more direct. With negative body image and low self esteem, for example, a person could become more likely to diet.
Relationships can also impact a person to have a negative body image and low self-esteem, which again leads back to dieting.
How Big Is A Binge And What Do People Eat During Binging?
75% of binge eating episodes are around 1000 calories consumed.
However, 25% of binge eating episodes are over 2000 calories consumed.
When people overeat, oftentimes the foods binged upon are highly convenient, sugary, and processed.
However there are many instances when the binged foods are normal foods you wouldn’t suspect, like berries, nuts, or protein bars.
While the foods eaten during a binge vary, almost universally the person binges upon foods that they perceive as ‘forbidden’.
In this section I reveal what I believe is the best starting point to heal binge eating.
Binge Eating Disorder Treatment – Various Treatment Paths
The following therapeutic approaches have all passed a high bar of scientific scrutiny:
- Cognitive Behavioral Therapy (CBT): This is where you learn more about the thoughts and emotions that are running in your subconscious mind and start to make changes
- Dialectical Behavior Therapy (DBT): This therapy is for when you “emotionally eat’ all the time. It’s for dealing with intense, stressful emotions.
- Acceptance and Commitment Therapy (ACT): This style involves facing painful emotions and staying flexibly committed to a course of action based on your innermost values.
- Intuitive Eating: This style combines aspects of all the above in a flexible approach. It’s slightly different from CBT, with more of an emphasis on body instead of thinking.
After describing these, I’ll then dive more into Food Awareness Journaling, which is a key part of Cognitive Behavior Therapy.
There is also another well-known treatment for binge eating disorder treatment called Interpersonal Psychotherapy (IPT). For more info about IPT you can read here.
Take a look at this video here where I review the top 10 search results on Google for ‘binge eating disorder treatment’.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is the most well-studied therapy approach.
There is a specific form of CBT, called CBT-E, for eating disorders.
The E stands for ‘enhanced cognitive therapy’ and refers to ‘transdiagnostic’ treatment for eating disorders.
This means CBT-E can be used for different eating disorders such as:
- Bulimia nervosa
- Anorexia nervosa
- Binge eating disorder
CBT-E typically consists of 20 sessions spread across approximately 3-5 months.
This time frame is considered an average length for binge eating disorder treatment across therapy models.
The goals of CBT-E are to educate clients about binge eating disorder and to stop binge eating disorder.
These CBT-E goals tend towards changing a person’s thought patterns.
For more info on CBT, see my article here “Cognitive Behavioral Therapy: Definition and Advantages (For Binge Eating)“
This video talks about Cognitive Behavioral Therapy as a first-line treatment option.
Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) is also used in binge eating disorder treatment.
Here is a video about DBT:
While Cognitive Behavioral Therapy is more of a generalized approach for every person and every type of eating disorder, DBT is very focused on people who also have borderline personality disorder.
A person with borderline personality disorder may have extreme mood swings.
They may feel abandoned or be very emotionally sensitive. They may be impulsive, and have unclear shifting relationships.
DBT is more targeted to help these individuals. DBT tends to lean towards managing stressful emotions, instead of emphasizing changing thought patterns as in CBT.
Acceptance And Commitment Therapy
Acceptance and Commitment Therapy (ACT) and DBT both tend to focus on managing difficult thoughts and feelings.
They both differ from CBT, which focuses more on changing thought and eating patterns themselves.
ACT is different from DBT primarily because it uses a value-based approach to managing difficult feelings.
As mentioned above in the ACCEPT technique, DBT tends to train individuals in using certain tools to handle emotions.
While ACT does greatly emphasize acceptance in its methodology, and while both ACT and DBT emphasize mindfulness …
ACT overall trains individuals to handle difficult thoughts and feelings by identifying their values.
A value is highly individualized, but every person has certain values. This means the value is more important than feeling good.
A person is trained to evaluate their actions based on whether they are acting towards their values, or just trying to feel good.
This can help a person manage their difficult thoughts and feelings by taking a new perspective.
Intuitive Eating, I would say, is a hybrid between all these approaches.
However, Intuitive Eating is slightly different in placing more emphasis on the body in comparison with the other approaches.
In particular, Intuitive Eating includes core principles related to hunger and satisfaction.
Of course, Intuitive Eating also talks about binge eating disorder education, as does CBT, and helps individuals with soothing skills, as does DBT.
Here is an interview that highlights Intuitive Eating!
Medications For Binge Eating
Most people who binge eat or struggle with food will not need medications.
But there are more severe cases where medication may help.
Please note that United States Food and Drug Administration (FDA) has only approved two of these three medications:
- Vyvanse – FDA approved
- Fluoxetine – FDA approved only for bulimia
For more info, please see this post ‘Medication For Binge Eating’.
Cognitive Behavioral Therapy For Binge Eating – An Overview
Let’s now explore Cognitive Behavioral Therapy in more depth.
First I’ll give an overview and then I’ll provide direct links to powerful scientific articles.
Overview: Cognitive Behavioral Therapy (CBT) is the most popular and researched therapy treatment approach for mental struggles like anxiety and depression in the United States.
CBT has been extensively researched for eating disorders as well and is a cornerstone of practical medical advice in treating these disorders.
Here is a powerful, meta-analysis study showing 42% abstinence rates from binge eating after CBT treatment! And these were meta-analysis studies too, the most powerful type of science there exists!
Overall, CBT is very simple and highly effective.
If you want more information on CBT for other eating disorders besides binge eating, see this blog article ‘How To Treat Eating Disorders Of All Types Using Cognitive Behavioral Therapy’.
CBT is based on the idea that your subconscious thoughts lie underneath conscious awareness and control your behavior without you even realizing it.
So while it’s possible for many people who have not been treated or coached on how to overcome eating disorders to still eat mindfully, eat slowly or avoid binging for a short period of time, over the long term they revert back to their subconscious beliefs and self-sabotage.
In The Eating Enlightenment philosophy which I promote on this website (and which you read FAQs about here), we start with CBT because when people try other methods first, they usually totally fall off the wagon because deep down they haven’t uprooted their negative subconscious beliefs about food.
CBT posits that your thoughts, emotions and bodily sensations combine into behavior. Your behavior, in turn, shapes your thoughts, emotions and bodily sensation. It’s all interconnected!
The Science Behind Cognitive Behavioral Therapy
Buddha said to be skeptical and I think you should be skeptical too.
Below are some direct links to compelling scientific articles that demonstrate tremendous proof behind CBT as a methodology to treat binge eating.
For starters, check out this meta-analysis of meta-analysis studies on Cognitive Behavioral Therapy. This paper looked at 269 meta-analyses!
Most therapeutic approaches, even if they are highly effective, have only a few meta-analysis studies, but Cognitive Behavioral Therapy is so simple, popular and effective and has been studied so much that there are over 269 meta-analysis studies!
One meta-analysis study usually combines around 30 normal studies. So this number of studies for CBT is insane!
Want to know the conclusion of over 269 meta-analysis studies on CBT?
“In general, the evidence-base of CBT is very strong.”
Silly scientists, they always speak in such boring language!
To get more specific, here’s a meta-analysis study on CBT and binging that shows that 42% of clients succeeded in abstinence from binges after learning CBT.
42%? Now that’s a bit more exciting to me!
Good news too, this meta-analysis that saw this 42% abstinence rate was specifically about binge eating disorder, which should give you a lot of confidence in this treatment to stop overeating!
Other CBT Components:
- Structured Eating Meal Plan: This is the hallmark of bulimia treatment. 3 meals per day and 3 snacks.
- Bulimia Education: Reading various books about bulimia to understand more about food restriction and why food restriction leads to urges.
- Nutrition: Eating a balance of carbs, fats and proteins at meals and eating enough food in general.
- Get support from family & friends: Isolation is a hallmark of bulimia. While talking to family or close friends can be difficult, it’s worth the tradeoff. Support groups are another option in most evidence-based treatment options as well.
- No skipping meals: Don’t skip your meals and snacks!
- Identify triggers: Study the patterns and situations that leave you feeling vulnerable. By being able to see clearly that XYZ seemingly always precedes a binge, you will find more motivation to avoid these things.
- Journaling: Oftentimes a record of thoughts is a good tool to see triggers. Since weight loss or fear of weight gain can be a trigger but easily missed, a thought journal can help to catch those thoughts.
- Distraction: How do you take your mind off the stress of life? Music? Games? You must have some healthy outlets for yourself!
- Practice compassion: Learning to forgive yourself is highly important. As you work to identify your thoughts, you will also start to hear your inner critic. As you hear your inner critic more, you’ll see how horrible this voice is and you can start practicing a kind inner voice instead.
How To Use A Real-time, Before-You-Eat Food Awareness Journal
A critical component of CBT is keeping a Food Awareness Journal. This journal sometimes reminds people of an old calorie log, but an Awareness Journal is the exact opposite.
I will explain how to keep a Food Awareness Journal in depth right now so that you can get a feel for how treatment in the Cognitive Behavioral Therapy approach might look.
For starters, let’s talk about the two keys to this Food Awareness Journal:
- You journal in the present moment
- You journal before you eat, not afterwards
Here is a video where I keep a CBT food awareness journal for 1 day.
Now what exactly are you journaling? Here is an example template of the Food Awareness Journal with an example entry:
Get a physical copy of the Eating Enlightenment journal, inspired by Cognitive Behavioral Science on Amazon here.
Why The CBT Food Awareness Journal Works
The main benefit of using this food journal is increased awareness. This awareness in turn leads to food cravings naturally decreasing.
Why do food cravings decrease when you journal? There are several reasons:
Delay of Gratification:
By following this simple rule, ‘journal before you eat’, you will be practicing delay of gratification. Sometimes you’ll find that by the time you are finished writing down your craving, you are no longer hungry, or realize how pointless it is to have food at that time!
Awareness of Triggers:
By writing down what you eat before you actually eat the food, you’ll be forced to bring some awareness of your triggers.
For example, many times binge eaters binge at specific times or places or have certain thoughts before a binge.
Therefore, this journal will help you see clearly which triggers and thoughts are impacting you and causing you to binge. As you see the pattern in writing, you will naturally start to avoid these situations and triggers.
This journal will also clearly help you see your food patterns with much, much greater understanding.
Over time you’ll gain incredible awareness into these underlying thoughts, emotions and bodily sensations that drive your eating behaviors.
Plus, you’ll also be able to see how skipping meals, getting really hungry, restricting food and other food intake patterns end up causing negative eating habits at the end of the day.
Finally, there’s no no mention of amounts, serving sizes, or calories! This totally differs from previous food journaling approaches.T
Summary: By writing down your ‘why’ before you eat, you’ll be much better prepared to stop eating before you get too full.
Addressing Concerns About Food Awareness Journal That Many People Share
Now that you have a better understanding of how the Food Awareness Journal works, I know you have a bunch of questions and concerns.
First, here is a video where I talk about resistances that may come up when starting a Cognitive Behavioral Therapy-based treatment program.
Second, I’ve seen many concerns about journaling come up from different clients. In no particular order, I’ll try to address as many of these concerns as I can.
Do I Need To Keep A Food Awareness Journal?
Yes. If you are serious about your quest to stop overeating, then you must.
Now eventually you won’t need the journal. But in the beginning of CBT, a daily food journal is mandatory.
Basically, the specific Food Awareness Journal approach AND the general idea of writing in a journal with pen and paper in real-time are the two main driving forces behind the incredible CBT success rate.
Remember, 42%! That’s 42% of people who go through CBT treatment become abstinent from binge eating afterwards.
I Have Done This Before. It Didn’t Help Then, Why Would It Help Now?
While you likely have recorded calories in a journal, that’s not what we are doing here.
The food awareness journal makes no mention of amounts or calories, and instead places emphasis on time, place and most importantly, feelings, thoughts and noting when you engage in overeating.
By noticing and writing down the conditions when you engage in overeating, in a few short weeks you’ll have a much more clarity about ‘why’ overeating happens for you. This in turn will make it much, much easier to stop overeating.
Furthermore, this is a real-time journal. This is to be done in real time! Not long after, but right before you eat, or immediately after if you happen to engage in overeating.
Won’t The Food Awareness Journal Make Me Even More Preoccupied With Eating Than I Am Already?
It is true that starting to monitor in this way increases preoccupation with thoughts about eating, but this is a constructive and illuminating preoccupation.
Your awareness increases regarding the thoughts and feelings that accompany eating.
It is the beginning of you becoming an expert on your eating problem and starting to understand it. And the preoccupation fades after a few weeks.
Do I Have To Carry The Records Around With Me All The Time?
Yes. This may be difficult under some circumstances but it should be possible.
The day’s record can be stuffed into a pocket or wallet, for example. We have yet to encounter a situation in which recording was truly impossible.
For example, if you are in a social situation, you can use the bathroom to jot down notes.
You can also use the Eating Enlightenment app (coming soon)!
Do I Need To Keep A Food Awareness Journal Forever?
No. Certainly not!
However, a major proficiency must be reached in order to have realistic expectations about abstinence from binging and to stop overeating.
This proficiency is being able to journal, in real time before a binge.
Basically, when a binge urge is growing you must have the awareness and understanding to be able to ‘catch’ yourself in the moment and write down what you are thinking, what you are feeling in your body, and your overall emotional state.
In due time you’ll be able to stop journaling so much as you transition to becoming truly free around food.
General Treatment Tips
As you think about all of these treatments, remember that being successful will involve some very common sense actions. Here are some of these, in the form of “treatment tips.”
- Eat breakfast. Many people suffering from binge-eating disorder skip breakfast. But if you eat breakfast later in the day, you may be less prone to eating higher calorie meals.
- Get enough nutrients for your brain. Just because you may consume a lot through binges doesn’t imply that you eat the kinds of food that provide all the essential nutrients. See section below for more info!
- Stay connected. Self-harm happens in isolation. Don’t get isolated from caring for family members and friends who want to see you getting healthy. Understand that they have a heart for your best interests.
- Become responsible.
- Be easy on yourself. Don’t buy into self-criticism.
- Identify circumstances and internal stories that can cause unhealthy eating behavior, so that you can establish an action plan to address them.
- Look for positive role models that might help to lift your self-esteem. Focus on people that act appropriately, not on those that fit society’s stereotypes (Note, those ultra-thin models or celebrities featured in women’s magazines often do not reflect balanced, natural bodies.)
- Try to find a dependable relative or friend you feel safe sharing your experience with, and who don’t give you unwanted advice.
- Keep a diary of food and mood. An important step in learning how to control binge impulses is identifying personal triggers and symptoms of binge eating. If you keep a CBT Awareness Journal you will do this automatically!
- Practice patience. This can help to increase binging and cause sensitivity while helping to increase self-control and retain self-acceptance.
- Find someone to converse with. Having support is important, whether through a partner, family, friend, binge eating support groups or online.
- Choose healthy foods. A diet consisting of high protein products and healthy fats, regular meals, and whole grains can help satisfy appetite and provide the nutrients required.
- Start working out. Exercise can help increase weight loss, improve body image, reduce symptoms of anxiety and increase mood. Intuitive Eating places an emphasis on movement and finding joy in fitness instead of focusing on weight loss outcomes.
- Get lots of sleep. Sleep deprivation is correlated with an elevated calorie intake and abnormal eating patterns. Having at least 7–8 hours of good sleep per night is suggested.
- Don’t skip medication, treatment sessions or meal times. If you have a meal plan do your best to stick to it and don’t let your overall efforts derail any setbacks.
- Do not diet. Trying to eat will cause further binge events, contributing to a vicious cycle which is difficult to break.
Let’s now switch topics and focus on food.
3. NUTRITION BASICS
Nutrition 101: Focus On TIming and Feeling Content First
Most meal plans hop right into ‘what’ you should eat instead of focusing on important principles first.
For binge eating treatment, it’s vital you don’t worry too much about ‘what’ but instead focus on the important principles:
- Regular Eating
- Not getting too hungry
- Feeling Content
Basically, nutrition in binge eating disorder treatment is extremely basic. It revolves around not getting too hungry and feeling satisfied.
(the above video comes from a “Create Your Safe Eating Structure” course of mine!)
Regular eating is important because allowing yourself to get too hungry is dangerous.
That’s why we shouldn’t let more than 5 hours go by without eating. 5 hours, maximum!
More than 5 hours and you will be too hungry. Why does avoiding getting too hungry matter?
It comes down to survival, and your brain’s ability to take control of your body and make you overeat.
Not so long ago, our ancestors faced two main causes of death.
To prevent starvation, certain “biological laws” evolved that made starvation less likely.
Your brain follows these “biological laws” in order to keep you alive and not dead.
Our ancestors didn’t always have food available, so they evolved to eat a lot when they could, and to be craving food when it wasn’t there.
Here’s the point: you must respect your brain’s ability to “hijack” your body.
In terms of food, if you don’t eat regularly then your brain will hijack control away from you.
Your brain will make you overeat, binge eat, and/or emotionally eat. This is not something you can control!
Don’t Get Too Hungry – Here’s Why
Here’s Abraham Maslow’s “Hierarchy Of Needs”, one of the most famous diagrams of human psychology.
The key words here are: “needs” and “food”. You need food to live.
Without food, you can’t get your other needs met. Food is fuel. Think about it:
Babies are breastfed by their moms several times per day.
Every few hours, babies feed until they are content.
Then they stop eating, and naturally a few hours later they feel like eating again.
And this is similar to why we focus on regular eating first.
If you eat regularly, your brain will not hijack you.
But if you don’t eat regularly, you’ll get TOO hungry AND your brain will be in a panic. And it will make you overeat!
This is why for binge eating or emotional eating struggles, we start with this foundation.
This is why Regular Eating, the timing, not letting more than 5 hours go by, is so important.
Eating To Feel Content – What Does Content Mean Exactly?
One of the useful ways to think about being content is to look at the opposite.
When you are content, you are NOT hungry.
- You think less about food
- Your stomach doesn’t growl
- Your mouth doesn’t salivate
So as you eat regularly … 3-5x per day, not letting more than 5 hours go by without eating, and not snacking …
You’ll know that you are practicing the guideline correctly when – after you finish eating – you think less about food, your stomach doesn’t growl and your mouth doesn’t salivate.
Content can also mean that your belly feels:
- Comfortably full
- Very little to no desire for food
This is our goal: after every meal and snack to feel content and not hungry, satisfied and comfortably full, and that these feelings should last at least two hours.
More on Regular / Content: Eating 3-5x Per Day
Every day, you eat 3-5 times. Even if you binged the night before and want to skip breakfast the next morning……
Don’t skip breakfast that next morning. You should have breakfast even if you binged the night before.
Breakfast, lunch, dinner for sure
Eating regularly three meals, and most likely a snack or two when you get hungry in between meals.
Some days you’ll eat 5x, other times you’ll eat 3x. Each day can be different.
But at a minimum, eat 3-5x per day.
Here is a 3-5x template that works for most people who work 9-5.
(Feel free to modify according to your schedule. And don’t take the time to be exact or perfect. )
- Breakfast ~ 8am
- Lunch ~ 12pm
- Snack ~ 3pm
- Dinner ~ 6pm
- Optional snack ~ 9pm
Here’s another video about the importance of not letting more than 5 hours go by:
Don’t Eat In-Between Meals / Snacks:
When you have multiple snacks (that is, more than 2) throughout the day, you don’t give your body a chance to get hungry, digest food, or feel full.
And without hunger, you can’t have fullness. Yin and yang. We want balance.
We want hunger, so that we can then detect fullness and stop eating before you’re on your 3rd whole pizza and 4th liter of coke and going to bed with cheeks puffed out, waking up with fingers thicker.
Don’t eat in between meals / snacks. Try not to at least.
The Primary Food Groups Guideline:
Nutrition doesn’t need to be too complex. Here are the key principles:
- Fiber, protein and fat are to be eaten breakfast, lunch, and dinner
- For snacks, get two out of the three
Just to be clear, the “Three Primary Food Groups” are:
Fat, proteins, and fiber help you feel content because they digest slower than simple foods like candy – they are the good type of ‘fuel’.
For example, here are two foods groups with approximately the same calories, ‘fiber and protein’ versus candy.
Same amount of calories, but way different amounts of ‘contentedness’!
With the candy, you’ll eat it, but you’ll still be hungry!!
This type of fuel is like fire, it burns hot but burns quickly.
Seriously, how long do you think those Reese’s will keep you comfortably satisfied?
On the other hand, the sweet potatoes, chicken and veggies will make you feel comfortably satisfied!
These fuels are like coal, they burn slow and steady for a long time.
This is why when you don’t eat balanced meals – protein, fiber, and fats – then you won’t feel content afterwards. Because your fuel source is ‘fire’ that burns up quickly!
Then, your odds of binge and emotional eating skyrocket, and you’ll end up eating more overall.
But if you use protein, fiber, and fats as your fuel, you’ll feel content and comfortably full for much longer, and will be able to avoid eating until the next meal!
Here are a few examples of the Primary Food Groups in meals:
- Fiber = porridge
- Protein = yogurt
- Fat = nuts
- Fiber = greens
- Protein = beans
- Fat = olive oil
- Fiber = whole wheat bread
- Protein / fat = peanut butter
- Fiber = brown rice
- Protein = tofu
- Fat = cheese
Here’s an image of specific foods that fall within the three primary food groups:
Common Food Fear: But Isn’t Fat Bad?
Long story short, there are good fats and bad fats.
If you think all fats are bad, you’ll be throwing the baby out with the bathwater.
You absolutely need some ‘good’ fats in your meals and snacks.
These good fats include:
- Olive oil (great addition for salads)
- Cottage cheese
Two Keys To Meal Prepping
- Buy everything at once
- Combine food groups for variety
Buy Everything At Once
This is pretty straightforward. You buy everything at once instead of going to the store every other day.
If you spent one to two hours one day a week buying everything ahead of time, you would actually have more time during the week for other things.
Instead of spending 30 minutes a few times per day going to restaurants or ordering out, buying everything at once saves time.
Then you can actually plan to ensure that you have the food available for Regular Eating and that you can have a variety of combinations of the Three Primary Food Groups!
Combining Food Groups For Variety
If I buy all these ingredients at once at the store, then I can prep different combinations and plan out my week ahead of time.
Let’s look at a few examples:
Here’s how to combine a few different ingredients to create different delicious meals (you may want to add your favorite spices too!) that leads to a feeling of satisfaction, a feeling of being content. Suppose I have the following all on hand:
- Brown rice
- Whole wheat bread
- Ground beef
- Beans (canned)
- Olive oil
- Peanut butter
Then one day I can have:
- Breakfast: bread + eggs + milk
- Lunch: spinach + olive oil / nuts + chicken
- Snack: bread + peanut butter
- Dinner: brown rice + ground beef + beans
Next day I can have:
- Breakfast: oats + nuts + yogurt
- Lunch: brown rice + beef + eggs
- Dinner: beans + veggies w/ olive oil + nuts
- Snack: yogurt + peanut butter
4. CONCLUDING THOUGHTS
Finally, I’d like to wrap up this article by talking about overwhelm.
There’s a ton in this article listed above and you absolutely cannot implement all of it at once!
A very important piece of treatment is working with a professional who can pinpoint where you should focus.
A structured program that can be tailored to your personal needs is essential.
If you’d like to get more information about the 3 month Eating Enlightenment treatment program, visit here.