Since Sam Ikin was a child his urge to devour food was out of his control. He didn’t want to be fat. “I wanted to look good. But the more I deprived myself of something, the more I craved it,” he says.
In one go, he might end up eating a couple of packets of biscuits or a whole big bag of chips. “You’re not conscious of the quantity that you’re eating, you just want to keep eating. And then once you finish what’s in front of you, you start thinking about what else there is,” he says. He would “come out of it” when he had run out of food, get interrupted or because he had got to the point where he simply could not eat any more.
“It’s something that you would only do when nobody’s around, or in secret when you think nobody can tell that that’s happening.”
Throughout his life, says Ikin, he would hear different versions of the same question: “Why don’t you just stop?”
And yet, he didn’t think he had a problem with food. “I knew I had some sort of psychological problem, but I would never imagine that I could have an eating disorder.”
It took until his early 30s for Sam to receive a diagnosis: he had binge eating disorder, the most common, and perhaps least understood, eating disorder.
‘A binge isn’t a pleasurable experience,’ explains Sam Ikin. Photograph: Matthew Newton/The Guardian
BED is an illness that drives people to consume unusually large amounts of food in one go frequently and consistently over a period of time. Similar to those who suffer from bulimia nervosa, people living with BED feel they can’t stop themselves from eating. But unlike bulimia nervosa, BED is not associated with compensatory behaviour such as excessive exercise, vomiting or taking laxatives. It is not limited to people who are overweight or obese, but is more common in that group.
Ikin says BED is often mistaken for a pleasurable spree, an indulgence. It is associated with laziness, he says, and lack of self-discipline.
“A binge isn’t a pleasurable experience,” he says. “It’s a mindless experience where your hand moves backwards and forwards from your mouth and back to the food. In the end, you feel awful. You look at all the empty packets, all of the evidence, and the first thing that sets in is shame. The shame part is huge.”
He would try to hide it, binge in secret where he could, “try to fit a binge in between going shopping or things like that”. With kids in the house, he would want to eat all the junk food and hide it from them, too.
“Bingeing is awful,” he says.
The disorder has pervaded his whole life, from the day-to-day inconveniences of being overweight to facing societal expectations and judgment. “You can’t fly in aeroplanes comfortably, you can’t buy a suit off the rack, you can’t even go into some shops without being looked at like you’re a leper,” he says.
‘The shame part is huge.’ Photograph: Matthew Newton/The Guardian
In Australia, 47% of all people with an eating disorder have BED, compared with 3% living with anorexia nervosa, 12% with bulimia nervosa and 38% other eating disorders. It is as common in men as it is in women. In total, eating disorders affect around 1 million Australians.
Binge eating was officially recognised as a disorder by the American Psychiatric Association only in 2013 and remains less commonly understood than other eating disorders and under-diagnosed by health professionals. In Australia, less than two in five people with BED access medical care, and the pandemic may have made things even worse.
A challenging diagnosis
“Binge eating is often unrecognised because we can’t say how people may look,” says Dr Jane Miskovic-Wheatley, the research stream lead at the InsideOut Institute at the University of Sydney.
She says most people with BED might be within their normal weight range or overweight, as the majority of the Australian population are.
Historically, the first medical reports about eating disorders described young, white, thin women. This image has stuck in the collective consciousness, leading to biased medical research and diagnostic criteria.
If I’m having a crap day, if I’m very upset, that might trigger a bingeSam Ikin
“It’s pervasive, even among academics and health professionals,” says Dr Deborah Mitchison, an NHMRC research fellow at the Translational Health Research Institute at Western Sydney University. These “historical blindspots” have prevented researchers from learning about how an eating disorder looks in a man or someone with a larger body, she says.
A diagnosis for BED can take years, even decades, and too often, all medical professionals have to offer their patients is a “eat less, exercise more” message, Mitchison says. “That is too simplistic. They actually have a psychological disorder, and it’s not being picked up.”
As with other eating disorders, there are various factors which may lead to someone develop binge eating disorder, ranging from environmental, social and cultural issues to genetics and an individual’s own thoughts and feelings. There are also reported links with depression and anxiety. A review from the Florey Institute and University of Melbourne found there are a range of biological differences between men and women that trigger binge eating, including hormones, stress and neural circuitry.
For Ikin, an episode could be trigged by an urge towards the extremes. “If I’m having a crap day, if I’m very upset, that might trigger a binge. But it also happens sometimes when I’m feeling good, and I can’t explain it,” he says. “You want to augment the emotions that you’re having – whether it’s positive or negative you want to take it to the extreme.”
Covid made things worse
The World Health Organization predicted a mental health pandemic after Covid, and research is increasingly corroborating this prediction.
A survey by the InsideOut Institute released last month revealed an escalation in eating disorder symptoms during the first major Covid wave in Australia and a widespread failure to access treatment.
Sixty-six per cent of respondents reported an increase in binge eating compared with before the pandemic. Other disordered eating behaviours increased starkly too, with 74% of participants reporting increased food restriction.
“The biggest element of the pandemic that had a negative impact on people with lived experience of eating disorders was a change in daily routine,” says Miskovic-Wheatley, who led the study. That included not being able to engage with their family and friends, maintain a balanced lifestyle and access medical care.
The survey unveiled alarmingly low diagnosis and treatment rates, says Miskovic-Wheatley. Despite nearly all responders (96%) reporting experiencing active eating disorder symptoms, only half engaged in treatment.
During the past two years, psychotherapists have been inundated with requests from past and new patients. Waiting times for an appointment have protracted up to 12 months. “Such long lists can be quite off-putting for many people,” says psychologist and PhD student at the InsideOut Institute Sarah Barakat.
Barriers to treatment
Barakat says there are three main barriers people with BED face in accessing treatment.
The most significant is cost. From November 2019, people with eating disorders can access up to 40 psychological sessions with a mental health provider and up to 20 sessions with a dietitian every calendar year with a referral from their GP.
There’s still a high level of stigma and embarrassment around eating behavioursSarah Barakat
But eating disorder specialists’ rates can be high, and the out-of-pocket fee after the Medicare rebate remains unaffordable for most, Barakat says.
Then, there is a geographical barrier. The vast majority of specialist services for eating disorders are concentrated in large metropolitan areas. Access to care in outskirts, rural and remote regions can be inadequate and, in many cases, nonexistent.
The third hurdle is the shame associated with the disorder. “There’s still a high level of stigma and embarrassment around eating behaviours,” says Barakat. “People who have binge eating disorder are much less likely to seek care.”
She says fewer than than 40% of people with BED access professional help. She is now running a randomised control trial to assess the efficacy of a self-help treatment program based on cognitive behaviour therapy and delivered entirely via a digital platform.
She hopes the e-therapy will overcome those barriers, making treatments more affordable and accessible for those who don’t live in the city. “It also offers a step into the treatment world that is not overwhelming or confronting for the patient, who has the opportunity to have more privacy and anonymity.”
Planning his meals scrupulously has helped Sam Ikin cope with his illness. Photograph: Matthew Newton/The Guardian
There is a huge need to talk about binge eating disorder to break the stigma still attached to it, says Ikin. Now in his 40s, he has learned to cope with his illness by planning his meals scrupulously and dissociating food from his emotions with the help of his therapist. “I think I’m on the right track now,” he says.
“People are starting to understand and destigmatise mental illness like depression, anxiety and even OCD, while around eating disorders there is still a lot of stigmas and lack of understanding.
“I used to lie about it all the time,” he says.
Now that he has opened up about his illness, he feels freer to be himself and can benefit from support from his family and friends. “It’s good not to be hiding anymore.”
