Hyperphagia (binge eating): why and what to do?

Do you think you might be affected by hyperphagia, eating in large quantities at times without really wanting to, and without necessarily being overweight, but without making yourself vomit (bulimia)?

As someone who has been affected by this phenomenon myself, I’d like to take a look at what we know today about this syndrome worldwide.

♻️ Last update: August 12, 2024.
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

How do you know if you really have binge eating disorder?

Binge eating is an eating disorder in which a person overeats and feels unable to control his or her eating behavior. It’s not just a matter of overeating once in a while ; it’s a recurring habit that can affect your physical and emotional well-being.

The symptoms

Here are a few signs and symptoms that could indicate you’re suffering from hyperphagia:

1. you tend to eat very large quantities of food in a short space of time, even when you’re not hungry;
2. you often feel unable to stop eating, even though you know you’ve already eaten enough;
3. after overeating, you may feel guilty, ashamed or disgusted with yourself;
4. you may have a tendency to eat in secret;
5. You may start strict diets, but stop them abruptly because of overeating, alternating between periods of severe restriction and overeating;
6. you may experience nausea, digestive discomfort or significant weight gain.

Often, attacks occur more in the evening or at night(nocturnal hyperphagia) than in the morning or at midday. Not least because of hormonal fluctuations according to the time of day.

Binge eating test: Binge Eating Scale

Some doctors ask you to fill in a questionnaire called the Binge Eating Scale to diagnose hyperphagia.

You answer 16 questions by ticking 1 of the 2/3 possible answers for each question.

You then receive a score between 0 and 3 for each question, or between 0 and 2 for each item.

A score of 18 or more indicates hyperphagia. 46 is the maximum possible score.

Take the test!

I suggest you take the test by filling in the form below. You’ll get your score, which you can then discuss with your GP, for example.

1. Check the statement that best applies to you

I don’t feel self-conscious about my weight or body size when I’m with others.
I’m concerned about my physical appearance in relation to others, but in general I’m not disappointed in myself.
I am self-conscious about my appearance and weight.
I’m very self-conscious about my weight and frequently feel ashamed of myself and disgusted. I try to avoid social contact because of this embarrassment.

2. Tick the statement that best describes you

I have no trouble eating slowly and properly.
Although I seem to swallow food quickly, I don’t end up feeling full from overeating.
Sometimes I tend to eat quickly and then feel uncomfortable about being too full.
I have a habit of swallowing my food without really chewing it. When this happens, I often feel stuffed because I’ve eaten too much.

3. Tick the statement that best describes you

I feel able to control my cravings for food when I want to.
I feel I have less control over my eating habits than most people.
I feel absolutely helpless when it comes to controlling my cravings.
Because I feel helpless to control my eating, I’m really hopeless at trying to control myself.

4. Tick the statement that best describes you

I don’t usually eat when I’m bored.
I sometimes eat when I’m bored, but often I’m able to keep myself busy and stop thinking about food.
I’m used to eating when I’m bored, but sometimes I can do another activity to keep food out of my thoughts.
I have a great habit of eating when I’m bored. Nothing seems to help me break this habit.

5. Tick the statement that best describes you

I’m usually hungry when I eat something.
Sometimes I eat impulsively even though I’m not really hungry.
I usually eat foods I don’t really like to satisfy my cravings even when I’m not hungry.
Even if I’m not hungry, I have a feeling of hunger in my mouth that only seems to be satisfied by eating food, such as a sandwich, that fills my mouth. Sometimes, after eating to satisfy this feeling of hunger, I spit out the food so as not to gain weight.

6. Tick the statement that best describes you

I don’t feel guilty or disgusted with myself after eating.
After eating too much, I sometimes feel guilty or disgusted.
Most of the time, I feel a deep sense of guilt or disgust after eating too much.

7. Tick the statement that best describes you

I never totally lose control of my diet, even after periods of overeating.
Sometimes I eat a food that’s forbidden by the diet; I feel like I’m banishing it from my memory and I eat even more.
Frequently, when I overeat during the diet, I say to myself: “I’ve just deviated from the diet, why not continue? When that happens, I eat even more.
I’m used to starting a strict diet, but I interrupt it by continuing to overeat. My life seems to be either “feast” or “famine”.

8. Tick the statement that best describes you

I rarely eat so much food that I feel too full afterwards.
Usually, about once a month, I eat so much food that I feel too full afterwards.
I regularly have periods during the month when I eat very large quantities of food, either at meals or outside of meals.
I eat so much food that I frequently feel really unwell after meals and sometimes even nauseous.

9. Tick the statement that best describes you

My calorie intake doesn’t usually go very high or very low.
Sometimes, after eating too much, I try to reduce my calorie intake to the point of eating nothing to compensate for the excess.
I usually eat a lot in the evening. It seems to me that most of the time I’m not hungry in the morning, but I eat a lot in the evening.
There have been periods of several weeks in my adult life when I’ve gone almost totally without food. These followed periods of overeating. I seem to alternate between “feast” and “famine”.

10 Tick the statement that best describes you

Most of the time, I’m able to stop when I want to. I know when “enough is enough”.
Quite often, I have an irresistible urge to eat that I can’t seem to control.
Frequently, I have irresistible cravings for large quantities of food that I can’t seem to control, but at other times I manage to control these eating urges.
I feel unable to control my food cravings. I’m afraid I won’t be able to voluntarily stop eating.

11 Tick the statement that best describes you

I have no problem stopping eating when I feel full.
Most of the time I can stop eating when I’m no longer hungry, but sometimes I eat too much, to the point of feeling too full.
I find it hard to stop eating once I’ve started, and more often than not I feel completely full after eating a meal.
As I find it difficult to stop eating when I want to, I sometimes make myself vomit to stop feeling too full.

12 Tick the statement that best describes you

I seem to eat as much when I’m with others (family, social meals) as when I’m alone.
Occasionally, when I’m with other people, I don’t eat as much as I’d like because I’m embarrassed by my eating habits.
Frequently, I eat only small quantities of food when I’m with other people, because I’m so embarrassed by the way I eat.
I’m so ashamed of overeating that I choose times when no one can see me to eat large quantities of food. I feel like a “sneak eater”.

13 Tick the statement that best describes you

I eat three meals a day and occasionally have a snack between meals.
I eat three meals a day, but often have a snack between meals.
When I have heavy snacks between meals, I usually skip meals.
There are times when I feel like I’m constantly eating without having a real meal planned.

14 Check the statement that best describes you

I don’t think much about trying to control my food cravings.
Sometimes I feel preoccupied with trying to control my binge eating.
I feel like I frequently spend a lot of time thinking about how much I’ve eaten or how much I’ve tried not to eat.
I feel like I spend most of my time thinking about what I do or don’t eat. I feel like I’m constantly resisting not eating.

15 Tick the statement that best describes you

I don’t think much about food.
I crave food but it only lasts for short periods.
Some days I can’t think about anything but food.
Most of my day seems to be taken up with thoughts about food. I feel like I live to eat.

16 Tick the statement that best describes you

I know most of the time if I’m hungry or not. I eat the right portion of food to satisfy my hunger.
Occasionally, I’m not sure whether I’m hungry or not. At these times, it’s hard for me to know how much food I need to satisfy my hunger.
Even though I should know how many calories I should be eating, I have no idea what a normal serving size is for me.


function calculateScore() { var totalScore = 0; // Loop through all questions (assume q1 to q16) for (var i = 1; i <= 16; i++) { var question = document.querySelector('input[name="q' + i + '"]:checked'); if (question) { totalScore += parseInt(question.value); } } // Display the score document.getElementById('result').innerText = "Votre score est : " + totalScore; // Prevent form submission return false; }

Personal note: I played the game myself and got a score of 20! Not surprising, since I’ve been affected by binge eating since I was about 15, but I’ve never had a bad experience of it.

Why you suffer: the causes

Studies on twins and families have shown that hyperphagia tends to occur more frequently in certain families, suggesting that there is a genetic component.

Approximately 39% to 57% of the variations in predisposition to develop this syndrome could be explained by genetic factors.

Here are the other identified risk factors. This doesn’t necessarily mean that this is what’s causing your hyperphagia, but simply that these problems are more common in people with hyperphagia than in the general population.

• Childhood obesity
• Loss of dietary control during childhood
• Perfectionism
• Behavioral problems
• Substance abuse
• Family concerns about weight and eating disorders
• Family conflicts and parenting problems
• Parental psychopathology
• Physical and sexual abuse
• Impaired mental health
• Distorted perception of body image
• Altered intestinal microbiota

Source: Giel 2022; Iqbal 2022

Personal note: I personally don’t tick any of these criteria, except for parental psychopathology and parenting problems.

How long does it last?

The average duration of hyperphagia in adults is 14 to 16 years. Irrespective of treatment.

Source: Giel 2022

Personal note: I’m blowing away the average, I’ve had this for 20 years 🙂

How can hyperphagia be treated?

Let’s take a look at what you can do if you want to stop binge eating, or limit the frequency of binges.

Here are the 2 main types of treatment based on international recommendations and clinical studies evaluating their benefit/risk ratio:

• cognitive-behavioural therapies, with psychologists in particular;
• certain medications : second-generation antidepressants, anticonvulsants such as topiramate, stimulants such as lisdexamfetamine, or anti-obesity drugs such as orlistat.

Source: Giel 2022

Personal note: I’ve never really put anything in place to eradicate my hyperphagia. I’ve always told myself that as long as it didn’t have a direct visible impact on my weight, mental or physical health, it was just something I had to deal with. However, about once a year, I write down everything I eat for a few days on an app, which has a radical effect: I eat less!

Natural” treatment: psychotherapies

A large synthesis of studies examined 81 studies including 7,515 participants.

Most of the participants were women with an average age in their forties and an average body mass index (BMI) above 35 kg/m². On average, they had been hyperphaphic for 18 years and had undergone around 16 weeks of therapy (4 months).

The results showed that psychotherapies had moderate effects: they reduced seizures, improved eating disorder symptoms and mood, compared to those on the waiting list.

Improvements were generally maintained at the 6- and 12-month follow-ups, and half the people managed to stop having seizures.

However, there was no significant improvement in BMI.

Who best fits this approach?

• those with a reduction in seizures in the first few weeks
• those who are not addicted to substances such as alcohol or tobacco;
• younger people ;
• those with a lower BMI;
• those with good social functioning before the disorder.

Two comments:

• it seems that treatment is mainly given to people whose hyperphagia has an impact on their BMI. For it is these people who are at greater risk to their health;
• most studies are not conducted in France. In France, psychologists and psychotherapists do not necessarily practice cognitive-behavioral therapy, even though it is the most tried and tested.

Medication

Here are the results from the main synthesis of studies comparing the efficacy of different bulimia medications: people treated with lisdexamfetamine versus second-generation antidepressants had fewer seizures.

Most studies lack long-term follow-up. Available data on second-generation antidepressants suggest that the reduction in binge-eating symptoms is no longer significant after 3 to 6 months of follow-up.

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!