WHAT IS BINGE EATING: EARLY TREATMENTS

Early treatments focused on warming and comforting the stomach both internally and externally. Medieval medical prescriptions for this problem included the consumption of red wine, hot spices, and fatty, greasy foods. Apparently, fatty foods were prescribed to cause intestinal discomfort to discourage further eating. Other early remedies required all food to be boiled to "jelly" prior to eating. Fortunately, our current treatments are less traumatic, more palatable, and certainly more effective.

It was not until the 1950s that Dr. Albert Stunkard, a renowned obesity expert at the University of Pennsylvania School of Medicine, published the first case report of what he labeled "binge-eating syndrome" in Psychiatric Quarterly. Actually Dr. Stunkard's patient was responsible for naming the disorder when he compared his episodes of excessive overeating to an alcoholic's binge drinking. The patient was a 37-year-old high school teacher who was 5 feet 9 inches tall and weighed 272 pounds. He had been overweight since childhood. He sought treatment because he was being considered for a position as principal and could not pass the required physical exam because of his weight.

He told Dr. Stunkard that eating had become an obsession with him. He thought about food almost all the time. He spoke of his eating in terms of victories and defeats or instances of "I was good" or "I was bad." Being "bad" meant succumbing to temptation, breaking his diet, or going to great lengths to prevent anyone from witnessing his "shameful" acts of eating. His eating pattern was very erratic with few regularly scheduled meals. He often ate out of frustration with day-to-day stresses.

During one binge, he stopped off at a grocery store on the way home from work and proceeded to buy a cake, several pieces of pie, and cookies. He remembers driving through town with one hand on the steering wheel and the other hand stuffing food in his mouth. He ate rapidly, paying little attention to what or how much he was eating. Afterward, he was totally stuffed and uncomfortable. He felt extremely guilty and upset over his behavior.

Unfortunately, little attention was paid to the binge-eating problems described in this case study for the next two decades. Then, in the 1980s, interest in this problem was renewed with the publication of several important studies. (I am pleased to say that the first of these research papers was published in the international journal Addictive Behaviors, of which I am editor in chief.) Throughout the 1990s several major universities and medical schools have launched a concerted effort to find out more about binge eating and its treatment. Based on these studies we now can better define binge eating and the important clinical features associated with it.

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