Binge Eating Disorder in Children

Do you find yourself wondering what happened to the box of cookies and that bag of chips you bought just a few days ago? What about the leftover lasagna from last night’s dinner? Have you found candy wrappers or other food items in your child’s room or backpack when you go on a cleaning spree? Is your child is gaining weight rapidly or cycling through periods of weight loss and weight gain? You may simply have a growing child or teenager on your hands, but these could also be signs that your child has a common eating disorder called binge eating disorder, or BED.

Some kids can consume a lot of food, especially during periods of major growth, when they need extra calories and nutrients to support their developing bodies. Many children become particularly hungry during pre-puberty, and it is not unusual for them to gain 20-40 pounds in preparation for this crucial time in their development. Children and teenagers are also frequently engaged in a high level of activity, which may result in increased energy intake. All of these factors can make it challenging to determine whether a child has an underlying problem with their eating behaviors. Plus, children who are binge eating typically hide their behaviors and are ashamed to talk to anyone about what they are doing, not even with their parents.

It’s normal to occasionally turn to food for comfort. Lots of us do. We find ourselves indulging in ice cream when we’re feeling down or going for crunchy and salty potato chips when we’re on a deadline at work. We might enjoy an extra helping of dessert at a holiday celebration. But chances are, you don’t do it on a regular basis and not to the point where you’re uncomfortably full and beating yourself up for days afterward. The difference with binge eaters is that they regularly use food to modulate emotions. For people with binge eating disorder, they may initially feel a brief sense of calm or comfort at the beginning of an episode of binge eating. However, when they do begin to consume the food, they feel as though they have completely lost control over how much they eat, how quickly they eat, and feel an immense amount of distress afterwards.

What Exactly is BED?

To diagnose BED, medical and mental health professionals use the criteria in the Diagnostic and Statistical Manual 5 (the official manual used by mental health professionals). BED is described as:

  • Eating a large quantity of food in a short period of time
  • Eating to cope with negative emotions like sadness, anger or boredom
  • Lack of control with eating
  • Feelings of distress, shame after bingeing
  • The binges take place at least once a week and consistently over a period of 3 months
  • There are no behaviors used to compensate for the binge – vomiting, laxatives, excessive exercise, restricting food outside of episodes of binge eating (if these additional behaviors are present your child may be diagnosed with anorexia nervosa or bulimia nervosa)

Some common signs of binge eating disorder in children:

  • Episodes of eating an objectively large amount of food quickly
  • Eating to cope with stress or negative emotions like sadness, anger or boredom
  • Feeling embarrassed or even disgusted with themselves about how much or what they have eaten
  • Changes in eating behaviors like restricting during meals, avoiding family dinners, secretly eating junk food late at night
  • Not wanting to spend time with friends or participate in activities they used to enjoy

Some less obvious signs your child may have binge eating disorder include:

  • Increased depression, anxiety, irritability
  • Attempts to hide their body by wearing baggy clothes
  • Increased attention to counting calories, fat grams, and carbohydrates
  • Spending more time alone in the bedroom or bathroom
  • Fluctuating between restricting and overeating
  • Making negative comments about their bodies
  • Pre-occupation with weight, calories, nutrition, exercise
  • Eating small amounts in front of others
  • Increased lethargy
  • Going on and off diets

It is important to know that not all children with binge eating disorder are overweight. While binge eating disorder can result in weight gain, this is not always the case – children of all body sizes and shapes can experience BED.

What are the Risk Factors for Developing Binge Eating Disorder?

As with the other eating disorders like anorexia nervosa and bulimia nervosa, BED has genetic, environmental, and individual risk factors. Having a family member with an eating disorder greatly increases a child’s risk of developing an eating disorder.

Schools, doctors, and parents are on high alert to prevent obesity, with weigh-ins and Body Mass Index (BMI) checks starting in elementary school. Instead of being taught moderation, society is setting up children at early ages to think they have done something horribly wrong if they eat a cookie. Children are learning about “good foods” and “bad foods” at very young ages. The “good foods” are typically vegetables, low-fat proteins, whole grains, low- fat dairy and fruit, while the “bad foods” are all those things they enjoy, such as cookies, ice cream, chips, fried foods and sugary drinks. While we can agree the foods in the first group are healthier, the foods in the second are what kids generally love.

I’ve had a number of parents tell me their child came home from school feeling humiliated after being weighed in front of others in gym class, and that’s when they began trying to control their weight, hiding food and bingeing. When you tell children that the foods they love are “bad,” it creates the ideal setup for attempts to restrict those foods, overeating those foods and/or eating those foods in secret and feeling guilt or shame. Asking children to put so much thought into every bite of food they eat is stressful for them. Also, young brains are not as developed as ours, so if you tell them they shouldn’t eat certain foods and they do, these children may end up thinking they are “bad.” Many children who develop BED first begin to diet in an attempt to control weight or body shape. Children are not supposed to be worrying about what they eat or exercise or what they weigh.

Not only does dieting impact hunger and fullness hormones, but it also increases the stress hormone, cortisol. One study on the impact of elevated cortisol demonstrated that increased stress reinforces the value of palatable food – being stressed out actually makes food you already find pleasurable even more enjoyable. Other research has shown that consuming high-fat, sugar-laden foods temporarily reduces your stress level and produces a calming effect. In one study, after putting people through emotional and physical stress, those with the highest cortisol levels chose the foods highest in fat and carbs. It is in this way that stress, environment, dieting, and biology can interact to produce binge eating and eventually BED.

Some additional environmental and individual triggers or risk factors for children who develop BED include:

  • Physical or sexual abuse (which places children at increased risk of developing a variety or mental health disorders)
  • Family conflict or divorce
  • Being overscheduled
  • Social Media
  • Weight stigma, bullying
  • Sports such as dance, gymnastics, cheerleading, wrestling, swimming, or any activity that emphasizes body size, weight, or appearance
  • Health classes that focus on weight and BMI as the primary indicators of nutrition or fitness
  • Moving (to different homes, schools or cities)
  • Academic pressure
  • Dating, emerging sexuality, gender identity issues
  • Culture of instant gratification/technology
  • Technology including diet monitoring, wearable fitness devices, and health trackers
  • History of anxiety and/or depression
  • Difficulty coping with stressful situations
  • Tendency to internalize emotions
  • Perfectionism
  • Children with a larger body type or who develop earlier than their peers
  • Polycystic Ovarian Syndrome (PCOS), which is underdiagnosed in children and teens

What to do if You Suspect Your Child has BED

Eating disorders, especially those involving binge eating, are often accompanied by a great deal of shame. Your child may not be interested in discussing or getting treatment for their problem. However, eating disorders are serious, oftentimes life-threatening illnesses. Without treatment, eating disorders can run a lengthy, even life-long course. So it is imperative that you seek prompt medical and psychological treatment.

If you suspect your child may have binge eating disorder, the best approach is to seek help immediately. Inform your child that you are concerned about their behaviors and that you want to help. Assure them that you love them no matter what and that you are going to support them through this. Be sure to express hope that they can and will get better.

Keep in mind that most doctors have little to no training in eating disorders so it is best to be prepared to advocate for your child. I highly recommend that you have them do a blind weigh and avoid discussing the number or any concerns they might have about weight or health in front of your child. I would ask the pediatrician to gently explain that he/she is going to make a referral to someone who specializes in working with children who have eating problems. Be sure to confirm with the Pediatrician that the therapist has experience working with children who binge eat.

Because there may be medical consequences of eating disorders, a thorough medical exam should be done by your child’s doctor including vitals and blood work. You should also discuss any family history of eating disorders, mental illness, and family medical history.

Some possible medical conditions related to BED are:

  • Hypertension
  • High cholesterol
  • Headaches
  • Gastrointestinal problems such as acid reflux, irritable bowel syndrome, frequent stomach pain, constipation or diarrhea
  • Diabetes
  • Metabolic syndrome
  • Joint pain

Treatment

Ideally, your child will have a team of providers made up of a therapist, a registered dietitian who is familiar with eating disorders, and your doctor. If medication is required for managing mood or anxiety problems, you will also be working with a psychiatrist. Be sure that the team plans to collaborate on your child’s treatment. Helpful treatment approaches include family-based therapy, cognitive behavioral therapy, and interpersonal therapy. Therapy may involve monitoring triggers and establishing a pattern of regular eating, as well as addressing any body image or dissatisfaction, self-concept, mood or anxiety concerns that are also present. It is important to note that weight loss should never be a focus of treatment for BED and will likely only contribute to the cycle of binge eating and weight cycling that your child is struggling with.

Depending on your child’s health status, your child’s doctor, therapist or other provider may recommend a higher level of care such as an intensive outpatient program, partial hospitalization program, residential program or inpatient hospitalization. It is difficult to hear that your child needs more care than you can provide and sometimes parents feel guilty or fearful about sending their loved one to treatment. This is where support for parents can make all the difference. Some communities offer parent support groups and there are also several online options. The center that your child is admitted to might also have educational workshops and parent support groups.

Family members play an important role in recovery from an eating disorder. Whether your child is in outpatient treatment or admitted to a higher level of care, you can expect to meet with a member of your child’s treatment team at least once per week. In some instances, you may be asked to attend every session with each provider. Your child’s team may also invite you to sessions that include you, your child and the entire team. Other members of your family may also be included in some sessions. Keep in mind that most centers offer virtual or phone sessions if you are unable to be there in person. If your child is admitted to a treatment program, the length of stay will depend on how they are progressing with behavior reduction, their medical and mental health status and the team’s determination about readiness to step down to a less intensive environment.

Your treatment team may also recommend some general strategies and habits to incorporate at home to support treatment including:

  • Eating together as a family and without the distraction of technology
  • Implement regularly scheduled meals and snacks while at home
  • Model eating in a way that includes all foods and does not include dieting or food restriction
  • Creating a calm environment around meals
  • Avoiding weight-focused discussion of health, fitness and nutrition
  • Having distracting/fun activities planned for after meals
  • Monitor your child’s social media use to help them avoid triggering sites, bullying
  • Eliminate or reduce activities that create stress for your child
  • Planning fun outdoor activities as a family that don’t revolve around rigorous exercise

Treatment can last a year or longer. I find that the more committed and supportive the family, the better the outcome for the child. It can be challenging to juggle therapy appointments with everything else going on in your life. For your child to get better, it is crucial that you put their recovery on the top of your family’s priority list and keep it there until your treatment team advises differently. Caring for a child with an eating disorder is stressful so it is also important that you take time for yourself.

Full Recovery is Possible

The good news is that with your support and experienced professional help, your child can completely recover from BED. The tools they will learn in therapy will last a lifetime. I have seen entire families heal through the experience of helping their child overcome their struggles with food and their bodies. There is definitely hope.

 

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About The Author:

Beth Riley, MSW, LISW-CP, CEDS is a Licensed Clinical Social Worker, Certified Eating Disorder Specialist and founder of the Riley Wellness Group in Greenville, South Carolina. She is the author of “Break Through Binge Eating.” She is a graduate of Stanford University, received her Master’s Degree in Social Work from the University of South Carolina, and holds a Certificate in Executive Leadership from Cornell University. In addition she is a member of the International Association of Eating Disorder Professionals (IAEDP), the Academy of Eating Disorders, the South Carolina Society for Clinical Social Work, the Alliance for Eating Disorders, and the Carolina Resource Center for Eating Disorders. She has been in the eating disorder field for over 22 years.

References:

Wang, G. J., Volkow, N. D., Logan, J., Pappas, N. R., Wong, C. T., Zhu, W., Netusil, N., & Fowler, J.S. (2001). Brain dopamine and obesity. Lancet, 357, 354– 357. 10.1016/S0140-6736(00)03643-6

Gold eld G.S., Adamo K.B., Rutherford J., Legg, C. (2008). Stress and the relative reinforcing value of food in female binge eaters. Physiology and Behavior, 93(3), 579–587.

Written – 2019