At one time or another, Jana Begor has tried most of the commercially advertised diets, not to mention the grapefruit diet and the cabbage soup diet. She became a vegan. She tried the raw food diet.
Sometimes she lost weight. And then she regained it.
“I need to learn how to eat,” said Begor, 68. “Why am I not able to control my eating? What is going on that I can’t put my fork down or step away from the refrigerator? I start eating, and I don’t stop.”
Begor was recently diagnosed with binge-eating disorder, a condition involving compulsive, out-of-control episodes of eating followed by deep shame, guilt and depression.
It’s the country’s most prevalent eating disorder, shared by more than 8.5 million Americans: It affects more people than do bulimia and anorexia combined, yet experts say it has long been underdiagnosed as a mental health issue.
That’s likely to change this spring, when the new edition of the “Diagnostic and Statistical Manual of Mental Disorders,” or DSM-5 – the so-called bible of psychiatric treatment – for the first time lists binge-eating disorder as a specific diagnosis.
Unlike most eating disorders, it affects men in large numbers: More than 40 percent of binge eaters are male, according to Harvard University research.
And unlike other eating disorders, it can develop in middle age and beyond, when retirement, caregiving, widowhood and other midlife stresses can trigger eating issues.
Now advocates hope DSM-5 recognition for binge-eating disorder as a treatable behavior pattern will put it on par in the public’s mind with better-known conditions such as anorexia – and open new avenues to insurance coverage.
“Too often, people with binge-eating disorder are referred inaccurately to weight-loss programs or clinics,” said Susie Roman, National Eating Disorder Association program director. “What they need is binge-eating disorder treatment. Having new insurance coverage standards can be helpful in getting people more access to treatment earlier.”
As it is, binge-eating disorder often falls between the health plan cracks.
Although the previous edition of the “Diagnostic and Statistical Manual” describes binge-eating disorder in an appendix, it’s not a distinct diagnosis. As a result, mental health professionals have ended up lumping the condition into a catch-all diagnostic category called “eating disorder not otherwise specified,” which many health plans don’t cover.
“You can have a patient who’s extremely ill, but we have to give them the (catch-all) diagnosis,” said Jennifer Lombardi, executive director of Sacramento’s Summit Eating Disorders and Outreach Program. “That might mean they don’t receive sufficient care.”
Links to extreme obesity
Research shows that binge-eating disorder accounts for up to 15 percent of cases of extreme obesity and increases the risk of high cholesterol, high blood pressure, heart disease and Type 2 diabetes. Health plans routinely cover those problems, but not the disorder itself.
Mental health professionals such as Rebecca Sturges, who specializes in binge-eating disorder treatment, consider the new diagnostic criteria a potential game-changer for the condition.
For one thing, she said, people tend to minimize binge-eating disorder by equating it with occasional overeating – consuming too much pie at Easter dinner, for example, or snacking on junk food.
“It’s a different beast from overeating,” Sturges said. “People with binge-eating disorder are feeling something they don’t want to feel, whether that’s mad, sad, angry, bored or stressed, and how they’ve learned to change that feeling is with food. Eating is being used like other people use alcohol, drugs, gambling or sex.”