Stabilising eating behaviour

The frequency and timing of meals is important as many obese patients describe very erratic or poorly structured diets.14 A common practice is to skip meals or restrain eating in the earlier part of the day, making it difficult to avoid overeating in the latter part of the day. Patients should be assured that having a regular pattern of eating is one of the key strategies people use to help them gain more control over their body weight.15-17 It is interesting to note that in a registry maintained by researchers in America, the majority (78%) of those that have been successful in maintaining a lower body weight for at least one year describe eating breakfast every day or most days.18


More erratic patterns of eating have been observed in patients describing binge eating disorder (BED).

Binge Eating Disorder refers to a particular form of overeating that is associated with obesity. Understanding of the links between obesity and binge eating has improved, and a description of the distinguishing features of BED has been included in the DSM IV. The characteristics of BED are:

  • Eating, in a discrete period of time, an amount of food that is larger than most people would eat during a similar period of time and in similar circumstances.
  • A sense of loss of control

Estimates on the prevalence of binge eating among obese patients vary with suggestions that in specialist obesity clinics this could be as high as 40%. Research comparing obese binge eaters to their non-binging counterparts has shown higher body weights, earlier onset of weight, higher levels of distress and greater dietary disinhibition among those with BED. The best form of treatment for BED has not yet been established but cognitive behavioural therapy (CBT) is a strategy that is commonly applied in psychological treatments.

An eating disorders or local psychology service may provide guidance on which patients would benefit from referral to their service and what treatments are available.
Patients with BED may feel a sense of shame regarding their behaviour and discussions should be handled with sensitivity. Self-help books that outline a clear treatment programme for binge eating can be useful e.g. 'Overcoming Binge Eating' edited by Dr Chris Fairbum.
Monitoring food intake, recording episodes of binge eating, as well as establishing regular mealtimes are all key elements of the treatment.

Night eating syndrome (NES) has also received attention in relation to obesity. NES describes a pattern of: no appetite at breakfast; difficulty with falling asleep or staying asleep; and the majority of calories consumed during the late evening and night. The prevalence of NES is unknown and the degree of overlap with BED is also unclear.