online conference transcript

Transcript from Online Conference with: Dr. Steven Crawford on Compulsive Overeating

Bob M is the moderator.

BEGINNING

Bob M: Good evening everyone. Our topic tonight is "Compulsive Overeating". Our guest is Dr. Steve Crawford, Associate Director of the Center for Eating Disorders at St. Joseph's Medical Center. Good evening Dr. Crawford and welcome to the Concerned Counseling website. I'd like to start off by having you tell us a bit more about your expertise.

Dr. Crawford: Good evening, Bob. I have worked with patients with eating disorders for ten years. I currently manage the inpatient and day treatment programs at the Center for Eating Disorders and assist patients with initial consultations to design an individualized treatment plan.

Bob M: Can you explain the difference between compulsive overeating and obesity?

Dr. Crawford: Obesity is a medical term. It simply means being more than 20% above the upper limit for age and height. Compulsive overeating is a behavior. It refers to a pattern of eating that is frequent and usually in response to uncomfortable emotions. It is similar to other eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder.

Bob M: How does one figure out if their eating patterns have become a problem...in terms of binge eating?

Dr. Crawford: People that binge eat are usually aware that their eating pattern is a problem. They experience extreme feelings of embarrassment, guilt and depression with their eating. Binge eating disorder is when someone is binge eating at least two days per week for 6 months. It is different from bulimia in that patients do not attempt to counteract the effects of the binge...that is they do not induce vomiting, use laxatives, compulsively exercise etc.

Bob M: How does one change the behaviors then that are associated with compulsive overeating?

Dr. Crawford: It is helpful for individuals to begin to identify their particular "triggers', that is events in their life that usually result in them binge eating. Once identified people can begin to work on new ways to deal with these triggers or stress.

Bob M: When you say "triggers", what kinds of things can initiate binge eating?

Dr. Crawford: Trigger generally refer to events that the person experiences as stressful. These can be both positive and negative. Examples are: doing poorly on a test, having problems at work, or getting a promotion. Day to day events such as rush hour can also be a trigger. In working with patients, we try to help them begin to differentiate between physical, real, hunger and emotional hunger.

Bob M: What then are the most effective treatments for binge eating?

Dr. Crawford: Treatment for binge eating consists of several components: We provide patients with nutritional counseling to begin to understand their eating pattern and work towards healthy eating patterns. Therapy is also an important component, both with group and individual therapy. Groups help patients to not feel so isolated and begin to work on self acceptance. Individual therapy allows patients to explore the use of food for psychological stress. Also, we evaluate if any of the antidepressants would be beneficial in decreasing the impulses to binge eat.

Bob M: Is the treatment done on an inpatient or out-patient basis, for the most part?

Dr. Crawford: Generally treatment for this population is done on an outpatient basis. Patients may get admitted to the inpatient or day treatment unit if they have a severe depression or they have medical problems that are in need of immediate attention.

Bob M: Besides the anti-depressants, are there any other medications that are being used or are on the horizon to control binge eating?

Dr. Crawford: There are currently a host of new diet pills that are now being marketed or are on the horizon. The newest agent is Meridia. This medication, however, is not one that I consider to be known to be effective over the long term and its safety is questionable. 4 out of 5 of the FDA advisory board members actually voted against having Meridia approved. It was allowed on the market because of the demand for these drugs. Meridia is known to cause elevation of blood pressure.

Bob M: Here are some audience questions, Dr. Crawford:

frcnb: How can diet pills be helpful to those who eat when not hungry?

Dr. Crawford: I do not think diet pills are helpful. They are temporary solutions that do not work long term. It is more helpful for individuals to learn coping mechanisms that will allow them to not eat when they are not hungry.

withattitud2: How common is it that one binges, then follows with starvation patterns?

Dr. Crawford: This is not uncommon. People frequently feel uncomfortable after binge eating. They can feel extremely guilty and attempt fasting. This actually is considered to be more of a bulimic pattern than just binge eating.

Bob M: For those just joining us, our guest is Dr. Steve Crawford, of the Center for Eating Disorders at St. Joseph's Medical Center. We are talking about compulsive overeating and taking questions from the audience.