Binge Eating Disorder: Shifting Your Perspective with Dr. Key

Thank you so much to Dr. Siobhan Key for being here. I have actually had her on a previous podcast of mine. It was so incredibly educational, informational, and fun to listen to that I wanted to have her back. So can you just start out with telling everybody that doesn't have the privilege of knowing you? Where are you located? How do you help people? Just tell us a little bit. Totally. So, thanks for having me back.

I am Siobhan Key. I'm a family physician and obesity medicine physician practicing in northern British Columbia, Canada, up in the land of bears, my Totally aside, but my friend had a, a moose in her yard charging her dogs this morning, tearing up her lawn. That's where I live. The moose, the moose and the bears roam free around us. And, and I also coach physicians on eating and weight. I've struggled for years and years being a physician.

Feeling like I knew what I should do, and yet finding myself with eating habits, like going through a drive thru, and feeling completely powerless to change it, and not understanding why, with all of my medical knowledge, I couldn't actually change it, and I was so stuck in these habits, and And I even did that while doing obesity medicine, which I think is important to acknowledge in that I was feeling like, okay, I've got this extra knowledge even now, and still I'm like heading for french

fries. What the heck's going on? And so that's what, as I figured it out, and I Start to really understand. Why do we eat the way we do and I found coaching tools that made an incredible difference in my own life and managing my own eating. I do this work because I don't want other physicians to struggle on their own. And in my medical practice, I run out of BC medicine practice to where. I also teach, very similar concepts, to the members in my obesity medicine practice as well.

I just love that you brought all this up. I think everyone needs help. If this is something that you struggle with, no matter where you're at, if you're a physician or not, you need help on it.

And I do like that you shared that, you know, you've had this struggle in the past as well, because I do think that sometimes it humanizes a little bit more, not that everybody needs to struggle with it if they're practicing in this area, but, I just, I just find that it's helpful, sometimes to understand some of the things, I don't know if you, this is a total sidebar, but do you remember when, like a year ago on social media, people started to first start to talk about food noise and some

people were like, What are you talking about? I don't know what that is. And I was there thinking, what do you mean? Does everyone not have a little track sometimes? It's like, what are we going to eat next? Or we just had a donut, but maybe we should have something salty after. Like, I'm like, oh, is that not a thing? And yeah, that's not everybody dealing with that.

So yeah, that just shows that was one example, but the reason I brought you on, I actually have not yet on my podcast talked about binge eating disorder. And this is something that is so incredibly common, affects so many people if they're struggling with their weight potentially.

And so I'm wondering if we can just pick your brain, I want to talk about everything from how does someone even know if it might, might be something that they struggle with, or maybe you want to talk to a doctor about it. And then all the way, maybe if someone either has a diagnosed or thinks, yeah, I might be struggling with this. What are some ways that we could maybe start to work on it again?

We're always going to recommend that you talk to your doctor about this, but this is just 100 percent general informational, right? So can we start with how, what is the definition of binge eating disorder? Rough, rough strokes, right? Not, not perfection. Totally. Like, and I think what you said that it's super common is really important and that binge eating disorder is actually the most common eating disorder. And most people don't know that.

And I don't know about you guys in the States, but in Canada, most of our eating disorder clinics don't actually treat binge eating disorder. They don't help with the very thing that's the most common. Yeah. I know, and it's getting better. Ours, our local one has started to treat binge eating disorder, but it's just an interesting gap.

You and I were just talking about weight bias on my podcast, and I think it's, it's demonstrated like binge eating disorder is behind probably because of the weight bias of thinking people just need to stop eating.

But it's If you have binge eating disorder, if you di, if you identify with binge eating, what it would feel like to you is that you have recurrent episodes of eating where you eat a large amount of food in one sitting, often to the point where you feel physically uncomfortable, sometimes really physically uncomfortable, and the hallmarks of it are you feel really outta control while it's happening. You don't feel like you have a choice. And at the end you have intense negative emotions.

So you feel a lot of guilt, a lot of shame, a lot of failure. Based on your eating. And if that is happening recurrently over and over and over again in your life, it's probably some form of binge eating. Whether or not it's binge eating disorder, or just having episodes of binge eating, depends on how often it happens. And from a lot of the work I do, like for my coaching side, I don't think it really matters that much if we label it a disorder, or we label it binge eating behavior.

I think it matters what you identify with. And the way I think about binge eating is I think it's on a spectrum, and we all have times where we use food to feel better. I think there's some people that, like you said, they have different brains around food, and they're less likely to do that. But, you know, stress eating, emotional eating, are different words for using food to, Try to feel better in some way, and they're probably on the same spectrum as binge eating.

I like that you just laid it all out there. How I would control someone can feel the frequency just, and I I like saying that with the spectrum as well, because I, I think people always get into this thing of, is it diagnosed, is it not? It's like, listen, how's it showing up in your life? Are you distressed about it? Is it causing a problem? Or can you roll right on past? Okay, you overate on pizza and you're fine. There's no problem. Right.

But one of the things, you know, I was talking to Kara Pepper, and we were talking about, or she was talking about, how eating disorders kind of thrive in shame and secrecy. And so what I find is, and I don't know if you see this in your clinic, Almost no one has been screened for it by the time they come to me. No one has even asked them just a few of these type of questions. It was just, oh, you struggle with your weight, here, eat less calories, move more. Absolutely.

And I don't know what your experience in training was, but, when, well, I don't think binge eating disorder existed as a diagnosis when I did my medical school, because I'm old now. But, Even when I was doing obesity medicine, we learned about it, we learned to screen for it. I feel like I didn't learn a lot of what to do about it when people said yes.

And I think in my early years of doing obesity medicine, I felt really uncertain and uncomfortable of Like, if I ask these questions and they say, yes, do I have anything that I can offer them? And so I think there's probably a lot of physicians that have, it's not even on their, radar to think about, does this patient have binge eating disorder? Right. And by the way, I still, I did my obesity medicine boards more recently, same thing.

It's the awareness that exists, awareness to diagnose, not much to do with it.

So what are the types of things that you think through like if someone's listening and they've either been diagnosed by their doctor or they're listening and they're thinking that's really me and and and sidebar I see this show up even when someone's on a glp1 medication when they have an intense sadness that they can't eat more like they they will feel the fullness sensation quicker but they still want to keep going and sometimes then I say wait let's double back did we actually miss binge

eating disorder so If there, if there are lots of challenges on the medication, you're on something, you're still not successful. I just had a patient share with me that they actually plan a binge on day seven. And so I said, look, we need to weigh, rethink what we're doing here. This is not how these medications were intended to be used. Clearly, however, this started, there was something missed, right? So let's say that someone can identify yeah, that is me. I do think this is a struggle.

What types of things do you think through first with them? Yeah, I think first is normalizing. Because like you said, that shame, prevents help. And I think it's fantastic that those patients were able to say to you, I'm having like some binging type urges and, or binging behavior.

Because it, it's something I specifically talk to my patients about, I, I screen them, and if they don't identify with it, they don't think that that's going on for them, I always say that's great, but just so you're aware, if this were to come up, it's something I really want you to come talk to me about, because there's stuff I can do to help you, because otherwise I think it, It gets just hidden and because one of these, the hallmark, part of the definition of binge eating disorder is this

shame. What happens for people that have binge eating is it's isolated and what often is happening for somebody with binge eating is, you know, is a lot of that eating is happening in secret. Like that, that shame and isolation means that You know, the food is purchased on the way home, eaten and thrown away, so their partner isn't aware of what they're doing. Or the binges happen when everybody's out of the house and they're alone, in the house.

Because there's this deep shame that there's something wrong with it. And as much as possible, for those of you listening, if you're identifying, recognize there's nothing wrong with it.

The way I think about binge eating disorder, And binge eating behavior is that at some point your brain recognized food could help you feel better and it used it and it did and I think that's really important to acknowledge is eating in these situations where you have an intense emotion, it does make you feel better and your brain learned that really, really well and Thank you. It's become the kind of the main answer that your brain wants to use when it wants to feel better.

So that intensity of that urge to binge as it's building isn't your brain trying to hurt you or do something bad to you. It's your brain being like, you are really, really uncomfortable right now. There is stuff going on and I want to help you. I want you to feel better. Let's try this. It helped in the past. I think if we can rephrase it like that, it takes some of that shame away.

It makes it easier to look at the behaviors because if, if eating is cloaked in this like really thick layer of shame, you can't even look at it. Like you can't even be curious about it because the shameful stuff we just want to like hide and move on from. And we miss out then on a lot of opportunities to understand what actually really is driving this binging behavior.

I really like what you said about awareness because I think that people often, what I see, they want to jump to weight loss, right? They're like, get me there already. Let this weight be off. And it's like, hold on, hold on. There are some things that need to happen before that. Can you talk a little bit about, once there's awareness there, you've realized, okay, this is something I struggle with. I'm acknowledging that this is maybe potentially really painful to talk about or even to address.

What do you then kind of, steer people in what direction as far as with health? Yeah, so I think, once you recognize there's a binging pattern happening, what I talk to people about is stabilization of their eating. Because the, there's something called a binge restrict cycle. That is often occurring when you've had binge eating. And what that looks like is you have a binge or an overeating episode. And then your brain starts thinking, I can't believe I did that again.

I never should have done that. A lot of negative thoughts making you feel bad. And then the next thoughts are often, Okay, I'm going to do better tomorrow. I need, I'm going to be extra careful tomorrow. Start to have thoughts about trying to compensate for the food you've eaten. Maybe you think you're going to like eat lighter, pack only a little salad. Fast throughout the morning when you don't normally do fasting.

It can show up in lots of ways and that flips you on to the restrict side of that cycle. Restriction feels crummy. It's it feels okay first thing in the morning because we have our our full supply of our decision making capacity and all of our willpower has it hasn't been sapped by the stress of the day. So it feels okay.

So when you wake up you're like it's okay I'll just fast this morning or I can just have that really light little Salad at lunch with that dry little chicken breast to try and compensate. And, but then as you go through your day, that restriction starts to build, the day's stressors start to build, and that pushes you back to the restrict cycle.

So if you're actively binging, and you're like, I need to lose weight, which is super common, then what that ends up doing is your brain pushes harder on that restrict lever. And it generally destabilizes your eating. So you may be restricting, but you also might be binging more. And the outcome is likely going to be that you're not seeing weight loss. Which then is frustrating. Which then often will make you push the restrict lever more. And work harder on that side. And it keeps destabilizing.

When I talk to people who have active binging and we want to work on weight, ultimately the very first step is we have to stabilize this eating, we have to understand what's going on, why this eating is occurring, depending which, which environment I am when I'm working with them, you know, we talk about medication because there are medications that are approved for binge eating, or, if it's just a coaching environment, we really work on like the mindset approach, which I think is very, very

powerful. Cognitive behavioral therapy has very good evidence for treatment of binge eating disorder too. I think some people in the binge eating world would say if you have binge eating, you should never ever try to lose weight. And I don't necessarily believe that. I think if you have a history of binge eating, we have to focus on stability. And then if we're doing something to try to actually lose weight. That eating stability needs to always be the main goal.

And if we do something to try to lose weight and you notice that binges come back and destabilize, then we need to take a step back and be like, okay, why did that happen? What was going on? I, I think another, other messaging that I hear about binge eating disorder that I don't necessarily agree with is if you have binging disorder, you can never restrict anything. Right? Right. Right. Like you, you have to all everything in moderation.

And. And what I know as through coaching and through all the mindset work that I've done is that restriction is not based on the food we eat or the food we say no to. And that's the mistake that when people are looking at it, they think restriction happens when you say no to food. Restriction comes from your thoughts. about the action of saying no to that food. And a really good example of that is, you know, if somebody's vegan, which is, on paper, a very restrictive diet.

There's a lot of things you can't eat if you're vegan. If you really believe in your reasons for being vegan, you probably don't experience restriction when you're making those decisions. Versus when I first started eating low carb and I spent my whole time thinking about bread and how lovely it would be to be able to eat bread, I experienced a lot of restriction because my thoughts when I saying no to those things created the restriction.

So I think this is an important point because I think we have to be really careful when we're talking about these eating behaviors that however we're viewing it. We're empowering the person with the eating behavior and when we say because you've had a history of this eating behavior, you're never allowed to lose weight. You are never allowed to decide that, you know, you need to reduce your carbohydrates because it will always worsen. You're binge eating.

I think that's a really disempowering approach. And that's kind of the medical view of binge eating disorder. And so my view is modifying the medical view with coaching. And I'd be interested to hear your take on it. I love that you brought this up because as you were talking, I was like, there's a difference between mental versus physical restriction. And it's like you said, I'm the same as you. I don't think that because.

This one thing existed in the past that you can never again in certain areas work on things. And it's exactly like you said, the way in which you're thinking about things greatly impacts stuff. And what I was thinking about here is that often it's very loving to, I don't like to use the word restrict, but to maybe not choose certain foods, right? Because You might know it's very sugar and fat packed and when you have it, you just get all the urges and cravings in the world.

Having to deal with those urges and cravings and those thought, those negative thought patterns, that can be overwhelming for someone. And so sometimes I'm really big into, support the physiology first. Sometimes it's really loving to say, I'm going to do these other things because I know my body, just like a car, it functions better on certain things. And now that's going to be different for everyone. So that's why we're not sitting here saying everybody do this, everybody do that.

I think it's about, are you stabilized? Are you liking what you're doing? Do you feel empowered? That's a very different lane than when binge eating disorder is running the show and you feel out of control and you're feeling shame about it. We're almost describing the opposite then. So I agree with you. I, I don't like this approach where people can never get help then just because of something in the past. I think we have very similar philosophies on that. Mm hmm.

And I think, you know, for people listening, not everybody's going to have our philosophy on it. But I think really, if it's if it's your life, really kind of work on what ways of thinking about this really make me feel in in control, because by definition, you've probably spent a lot of years feeling out of control. And part of the treatment, part of managing it is learning how to Bye. Take back that control.

And I think we can, you know, you can do that around the food, but we also can do that just in how you view the fact that you have binge eating behavior. I'm wondering, you know, 'cause us having laid this out and kind of talking through it, are there any practical approaches that you find work? Well, so, for example, I find that. I'm maybe not going to recommend intermittent fasting, right? We might really be focusing more on balanced meals throughout the day. So sometimes I find that.

Sometimes binge eating I'm seeing occur more at night and it's really that they forgot to eat the whole day. They might also have ADHD or other things going on. They just forget to eat.

They're busy And so it's like we need to kind of rework on Distributing things differently throughout the day Maybe even if you're not hungry first thing in the morning or for example, like planning a binge like okay I'm gonna eat XYZ and you just You, because it's a little bit different when you're consciously doing things versus when it's out of control. So I'm wondering, are there any strategies that you have found have worked well for patients? Yeah, totally. Lots. I got lots.

We can fill an hour. The first thing, and I think this This will sound oversimplified maybe, but this is the most important thing, is by opening up and reaching for help when you have binge eating, that in its own is a huge piece of recovery.

Stepping out of that shame because that shame that's part of the disorder holds you in isolation and when you're in isolation, it's really hard to see these patterns and start to feel in control and it's really hard to believe that you could be in control because, you know, for those of you who are listening, who are identifying with this, you know, that out of control feeling is extremely intense. So the first form Practical tip is get, get help.

Binge eating is something that's really difficult to manage on your own. There are books and stuff, but I honestly think one on, one of, like, support with a person who is knowledgeable about binge eating is probably your best bet.

So an obesity medicine physician as for most of the people listening is probably going to be the best place and I would say when you reach out for help, recognize that there are a lot of physicians that will not have training in binge eating disorder and may not even be able to tell you if you have it. So what you might be talking to them about is, could you refer me to somebody who could help me with this? I suspect I have this.

Yes, that the first person might not be the right person and nothing has gone wrong. So then the, I'd say the second practical tip, like I mentioned, the binging isn't truly about the food. The binging is about your brain trying to fix something. Is the way I like to think about it. And any time we spend focusing on the food, often is, I think of it as kind of wasted energy.

Like it's a place if you're about to have a binge or if you're in the middle of the binge and you're just trying to stop eating, everybody listening has had that experience and it takes a ton of energy and generally it's probably not effective. If you're about to binge and you're just trying to not binge, you're probably going to end up having a binge at some point. So it's not the best place to intervene. I like intervening on the restrict side.

Like I said, this binge restrict cycle is a cycle. So we can step out of that circle and break that cycle at any point. Everybody listening has probably tried stepping out on that binge or overeat side and knows that that's not really effective. But if you just, when your brain starts saying the stuff like, Okay, now I need to be extra careful and I'm going to do this and I should never have done that. If you can just answer it with, you know what? All I need to do is get back to my normal.

Or I love it if we can switch from restrict to almost abundance and be like, you know what? I'm just going to focus on eating food that really satisfies me today. Part of my recovery from when I have a binge is I'm going to really just focus on eating enough so I feel very satisfied. It's a very different way of thinking about the food than what you naturally will after a binge. And it ties into what you were saying, Mattea, of Like, that might mean then you eat three meals a day those days.

And even if maybe other times you do fast, after binge might not be the time to be doing it. Right. And, and you can be curious whether fasting is actually a useful tool with you or if it destabilizes eating. So stepping out, number one, reaching for help. Number two, stepping out on the restrict side. It's easier. You don't get as much resistance from your brain about stepping out.

It's still... might not feel comfortable because you're so used to being in that cycle and thinking that tough love is going to fix it. But I can tell you, if you're listening to this, you have tried enough tough love to show yourself that it is not going to fix it. It is not the answer. It's the answer is compassion. But part of this disorder is that you've been kind of taught or internalized something about you don't deserve compassion around this eating and we need to work on that.

So the stepping out of the restriction and then the other piece of that, so number three would be when your brain wants to really hone in on the food. Like, I can't believe I eat that. Why am I always eating this? Work on practicing zooming out. Work on being like, this was not, so if I use my example of like ending up in the drive thru eating french fries is what I struggled with for so long. When I was sitting there focusing on why do I always eat french fries?

Why can't I stop eating french fries? I didn't get very far in it. When I learned to zoom out and be like, oh, here I am eating french fries again. I don't know what was going on. Like, what was today like? What, when did I start thinking about these? What was I... doing when I started to think about them. So you can almost use the binge as like a, a bit of a flag from your brain going, woohoo, something over here that we need to pay attention to.

And you can get curious, but the being just focused on the food, like I shouldn't have eaten that or why did I eat that much? That's not going to actually help you. But being what was I feeling before? I started the binge. When I really started to have those cravings or when I first started to think about maybe having a binge, what was I thinking about? Where was I? What was I doing? How was I feeling? How did I sleep last night? Did I have a fight with my spouse yesterday?

Because sometimes binges, the trigger actually didn't happen today. It might be something that's been bugging you for a couple days and it's built to this point. And really working on speaking kindly to yourself. Because in this, the tough love doesn't allow you to have curiosity. When you're telling yourself that eating itself is wrong, I always say it just kind of builds a brick wall around it. There's no space for understanding why it's there, if it's just this wrong, shameful thing.

All the steps are amazing that you said, and I, the only thing I would add to this is that this takes time. And so again, if you're going in there with an urgency about weight loss or what needs to happen, everything that you just mentioned, that needs to happen on its own timeline. So you getting curious, maybe you're still binging.

But the the win is that you're noticing what's happening and you're getting more familiar with it I know I have a friend that really struggled with this and she Got a lot of help for it and she just talked about this radical period of curiosity where she just really looked at Okay What did I really think about my kids when they did that last night and she just she went She got curious in a way that she had never been before and that helped massively with healing that she just had never done.

So everything you're saying it, it sounds really good. And I want to also provide to people that if you've sought out some of this help and you maybe haven't been as successful as you feel you wanted to be, that maybe seeking someone else out because I don't know about you, but I feel like the approach is very different that everyone takes, right? Like what you're saying intuitively to me sounds amazing, but maybe other people need a different setting. Right?

Do you see people that maybe they've struggled in one setting and then in another they thrive? Oh, yeah, and I would say again, we're talking about binge eating is like this isolated entity, but there's so many things that influence it, right? Like if you have binge eating behavior and you're also significantly depressed or have really severe anxiety, that probably needs to be addressed in order for you to have the space in your mind to be curious.

Like there's often a, a lot of different stuff and I agree with you, like there is no failure in treating this. This is, not a one and done thing. It's not, I've got to do it quick and get to goal. None of those mindsets will help you with this. It's this is something I'm figuring out and I'm probably going to be learning to manage for my life.

I always say for binge eating, I think this is worthwhile talking about too, because often the people with binge eating view it as this like rotten little piece of them. Like it's this, this thing that they want cut out and they would like to leave it behind and never binge again. And that's not actually what recovery from binge eating looks like. I talk in terms of, I think of recovery from binge eating, similar to how we as doctors think about prophylaxis for migraines.

So if somebody has migraines really, really frequently that are making it hard for them to do their life, we can give them medication and help them do different things to manage the migraines. But we're never saying We're gonna get rid of the migraines and you'll never have a migraine again in your life. What we're looking for, and it's the same for binge eating, is we're looking for less.

frequency, meaning you don't have as many binges, less intensity, meaning when they do happen, they're just not as big. Maybe they don't feel as intensely out of control, shorter duration, meaning they don't last as long. So for some people, once a binge starts, it's like a multiple day thing, that's huge success. And then the other piece of it is, I call it distress tolerance, but the idea of something that used to trigger binges doesn't trigger them in the same way anymore.

And all of those are huge, huge successes. But if we hold on to the belief that to, it needs to be cured, it needs to be gone, I need to never binge, you will miss out on seeing that progress that you might be creating already. And And when you can't see the progress you're creating, it kind of holds you in that shame pattern that we've been talking about that makes it really hard to keep progressing.

Yeah, I really like that you brought this up because I, I've heard it described before, like at times it's going to rain. And so what are you going to do when it rains? You might have an umbrella, different strategies during that time, right? So kind of just saying not gone, but does it, do I know how to expect it? Do I know how to work with a little bit more, maybe occurring less frequent, just everything that you were talking about. Yeah. Definitely.

And yes, and I think there's many things, not only binge eating disorder, but many things. I like how you described this, like, we just want to cut it out and remove it. Like, that's the bad part of me. And there are no bad parts. I'm really into IFS, which is internal family systems. It's like different parts are showing up at different times within us. And they're there for a reason. We often, the more we ignore it, the louder it gets, you know?

So just listening to all this, I mean, I have just learned a lot listening to you. And I know that everyone that's listening is going to gain that knowledge as well. How can people find more of you, specifically your podcast, your programs? Can you tell us a little bit how people can find you? Sure. So my podcast is called thriving as a physician, how to lose weight and love your life. So even if you're not a physician listening.

Some of the content's physician specific, but I talk about a lot of this stuff and the mindset stuff, so it's worth checking out. And then, I work with physicians, and my website is Weight Solutions for Physicians, which tells you more about, my programs and how I can help. Love that. And we will make sure that we link it all down below. Thank you so much for having taken this time. Everybody, we're talking on a Friday afternoon. We love you all. We're here.

Yeah. Thank you for having come on today to talk on the podcast. Oh, thanks for having me.