There are people who, in a short interval, ingest a relatively large amount of food. I mean, sometimes the portion itself isn’t even that huge, but the subject sees it as excessive.
In other words, there are people who seem to eat more in less time, compared to other people in the same situation – and who suffer a lot, because the feeling is that they have no control. Anger, guilt and low self-esteem come on the menu for dessert.
This is one way of beginning to define binge eating, described as early as 1959, but which at the beginning was closely associated with bulimia—when people, so to speak, hit a big plate and vomit soon after.
It wasn’t until less than ten years ago, in 2013, that binge eating disorder, or BED, was recognized as a completely separate problem. It is said that, of the eating disorders in adults, it is the most common: 2% to 4% of humanity have it. Under.
Don’t ask me why, but the prevalence is higher in Brazil, according to a survey by the WHO (World Health Organization). In a sample of 2,942 people from São Paulo, 4.7% experienced episodes of binge eating disorder throughout their lives; 1.8% of them, in the last twelve months.
But, if it is to talk about numbers, I was amazed by the ones I saw in the presentation by psychiatrist Luiz Henrique Junqueira Dieckmann during EndoDEBATE 2022, an event that, last week, brought together more than 3,000 doctors to discuss issues related to diabetes and the syndrome metabolic.
“In a study called VALIDATE, involving more than 22,000 adults, 344 individuals perfectly met the criteria for ACT. However, only 11 of them, or 3.2%, had received this diagnosis,” he said. It is worrying.
The risk of ignoring the disorder
And that’s how it is in all the scientific research out there: less than 5% of those who have TCA know their condition. The rest remain distressed and sick, ignoring their diagnosis.
But, from episode to episode, TCA can raise blood pressure, cholesterol, triglycerides and blood glucose, damages that usually arise even among those who don’t gain as much weight.
The disorder also creates a sense of inadequacy that undermines confidence to work and disrupts social or family life. At least, that’s what six out of ten people with TCA report.
It’s not always how we imagine
“Not every person with TCA is the one who attacks a whole cake in the middle of the night”, Luiz Dieckmann explains to me later. “It could be that individual who decided to be vegan and who, in the episodes of TCA, devours a picanha, feeling defeated afterwards.” Or even those who, despite being thin, have diabetes and indulge in sweets.
Former preceptor of the postgraduate course in psychiatry at Unifesp (Federal University of São Paulo) and ahead of the BIPP, acronym for Brazilian Institute of Practical Pharmacology, a community dedicated to the teaching of neurosciences to health professionals, he adds that there are patients with TCA without being overweight.
However, about 25% of people who are overweight have TCA. Therefore, this mental health issue deserves attention in dealing with the obesity epidemic.
Criteria for catching TCA
In addition to eating too much too quickly and losing control, psychiatrists detect this disorder when a person meets at least three of five criteria.
The first one is eating too fast. Another is to consume food to the point of feeling sick, with a very full belly and, if in doubt, wanting to unbutton your clothes.
A third is to eat large amounts of food without being hungry, with the eye bigger than the mouth, as they say.
“It also lights up the alert if the person reports that, embarrassed, he feeds alone or hidden, because he already foresees comments about the amount on his plate”, explains Dieckmann. “Often, she helps herself to cold food from the fridge to be quick and not get caught in the jump.” The last criterion is feeling disgusted, depressed, regretful after the binge.
What does gravity suggest?
Doctors assess the frequency of episodes. “Of course, no one here is talking about stepping into the jackfruit once in a while, which everyone occasionally does while traveling, visiting that special restaurant or at a party,” Dieckmann says.
At TCA, episodes are regular. When they recur one to three times a week, the case is considered mild. “And then, we do not consider medication, but multidisciplinary follow-up, with psychologists and nutritionists, among other professionals, to strengthen self-control and promote changes in lifestyle.”
The condition is considered moderate, requiring medication, when there are four to seven episodes per week. Severe, when repeated eight to thirteen times a week, and extreme, fourteen or more in this period.
Association with ADHD
Studies show that almost 80% of people with BED don’t have just that — as if that weren’t enough. “We can classify psychiatric diseases and name them, creating diagnostic criteria, but our brain doesn’t respect this limit”, says Dieckmann. “Those who present with BD often also suffer from mood disorders, such as depression or anxiety, or have other conditions in which there is difficulty controlling impulses, such as attention deficit hyperactivity disorder, ADHD. This association, by the way, is not is rare.”
The reason is simple: The neural circuits and neurotransmitters behind symptoms are shared across these problems. Hence the importance of recognizing everything that is going on. “Or at the time of treatment, if by chance we only look at the food issue or, often, only think about weight loss, we hunt vampires and leave aside Count Dracula”, warns the psychiatrist.
Often, it is necessary to combine medications. Today, there is a specific drug approved for TCA, lisdexamfetamine — an amphetamine molecule linked to an amino acid that would slow its absorption and thus avoid old side effects. “The drug is effective and safe, but some patients do not need to be treated with it or only with it”, says the doctor.
In the brain
It is the brain region of the hypothalamus that controls our desire to eat. However, in the world for which our bodies were designed in ancient times, food consumption would be tailored to the needs of energy and nutrients at any given moment, thanks to information provided by hormones such as insulin, the ghrelin behind hunger and leptin, which triggers satiety.
The brain, of course, also captures sensory information that is able to activate its reward system, where a neurotransmitter called dopamine reigns. It is the promise of the prize that encourages the head to look for food.
“If I’m in front of a gnocchi, when I smell it or even remember the taste, I start to salivate with desire”, exemplifies Dieckmann. “However, there are regions of my brain that tell me to wait for that reward or else stop eating after an adequate intake, deactivating my impulse to chase more pleasure.”
Among these regions is the prefrontal cortex, just behind our forehead. It is he, specifically, who is also involved in ADHD. “That’s why people with attention deficit hyperactivity disorder can’t delay a reward very long,” says the psychiatrist. “In the evolution of species, it was great to have people like that, who came out of the cave to hunt and who took food to others, even when they were in danger, because they couldn’t bear the idea of waiting a while without satisfying the desire to eat.”
These days, those who feel hungry do not need to hunt. On the contrary, it is easy to find food formulated to increasingly trigger the reward system. But you know that story that the higher the higher the fall?
Dieckmann makes the comparison with the coca leaf, which the Andean peoples chew: “No one gets addicted to it. But the paste made from the leaf releases more dopamine. The powder, rubbed on the mucosa or aspirated, triggers even more dopamine and much more quickly. Then, at the same speed, that neurotransmitter drops, creating in the individual a great need to feel it rise again.”
Where the psychiatrist wants to go: In the brain, everything in nature tends to make dopamine rise slowly and fall slowly, keeping our reward system in a comfort zone.
“Ultra-processed food, however, has a combination that we don’t usually find naturally: a lot of sugar and a lot of fat at the same time”, he notes. In fact, very sweet fruits are not fatty. While an avocado, which has fat, is not as sweet, for example.
“There’s no way to compete: this combo launches dopamine high and compulsion goes with it”, notes the psychiatrist. This is why no one with TCA stuffs themselves with salad. Food as it exists in nature will never put dopamine in a rocket ship.
Alone, of course, ultra-processed does not cause TCA. But its presence doesn’t make life easier for those who suffer from this compulsion, and sometimes they don’t even discuss it with the doctor, swallowing the anguish dry and barely digesting the health problems that the eating disorder can cause them.