An old idiom says that the best way to a man’s heart is through his stomach. But always succumbing to the stomach can take the heart to the brink of exhaustion.
For Graham Boettcher ’95 GRD ’06, the result of his binge eating was an enlarged left ventricle — his heart was working too hard.
“I would polish off a pint of ice cream, sometimes a quart depending on my mood,” Boettcher said. “It was this feeling that I had to have the entire bag of potato chips or not just one slice of pizza, but eight. It usually wasn’t junk food, either. I always cooked good food.”
Binge eating has been a problem for Boettcher for as long as he can remember. Three years ago, Boettcher weighed in at 445 pounds. Now he has lost over 250 pounds as a result of a gastric bypass surgery. For many Americans like Boettcher, lifelong dieting and an uphill battle with weight loss is a reality.
American Dietetic Association research now suggests that many more people suffer from binge eating disorder than previously believed. The disorder is defined by the American Dietetic Association as consuming a large amount of food in a short period of time and feeling out of control.
“I would definitely say that I was a binge eater based on emotion,” Boettcher said. “All the ups, all the downs, every feeling and event was punctuated by uncontrolled bouts of eating.”
The sensations Boettcher felt when he ate compulsively are representative of the feelings that pulse through the mind of a binge eater during episodes of uncontrollable eating. Feelings such as loneliness and boredom cause binge eaters to eat, said Boettcher and Robin Masheb, a psychiatry professor at the Yale School of Medicine.
Masheb said a binge eater will consume superfluous quantities of food to regain a feeling of being in control. The binge eater typically will eat beyond satisfaction and continue until the last slice or crumbs are gone — what Masheb calls an all-or-nothing mechanism.
Different theories exist as to the true cause of binge eating, and many point to insecurity.
Feeding the hungry heart — eating as a form of solace or protection — is not an uncommon notion, even for people who do not suffer from binge eating. Countless romantic comedies have been made depicting a heartbroken lover eating frosting out of the container or ice cream out of the carton.
“We do not always necessarily diagnose someone who is binge eating as binge eating disorder, per se,” Lorraine Siggins, the director of University Health Services Mental Hygiene Department said. “A clinician must look at the whole picture and analyze what it is that makes the individual go on eating binges. In some cases it very well might be loneliness. You have to ask yourself if depression is part of that patient’s picture.”
Treatment options are varied and differ on a case-to-case basis. But Boettcher, Masheb and Siggins all said counseling should be an integral part of recovery.
“People need to realize that you cannot tell a binge eater to stop eating and to do exercise just like you couldn’t tell an anorexic, ‘Here, have a sandwich,” Boettcher said. “You need help from the psychological point.”
Masheb’s current research with psychiatry colleague Carlos Grilo attempted to treat binge eating the same way physicians remedy depression, with the little pill that seems to have put all of America back on its feet: fluoxetine, better known as Prozac to the general public. It is now prescribed for a variety of health concerns, not just traditional depression. The Food and Drug Administration has approved its use for obsessive-compulsive disorder, bulimia nervosa and — under a version with the trade name Serafem — for premenstrual dysphorbic disorder.
“We found in our study that while the fluoxetine treatment was not more effective than the placebo, what seemed to help the patients in our study was the use of cognitive behavioral therapy,” Masheb said.
Cognitive behavioral therapy is a multistage process. It examines the patient’s behavior, which includes keeping food records and setting weekly goals for patients. The primary step includes what Masheb calls “meal patterning,” when the patient learns to have three meals every day with two snacks alternating between meals.
“The meals should be at consistent times and should not be in a car, not while moving either, but just sitting down at a table,” Masheb said. “Where people eat their meals says something about their eating patterns. Whether they eat in their car too often … can tell us something about the root of their problem.”
The next step, the cognitive therapy, helps the patient to analyze his or her thoughts — to automatically have a handful of potato chips, not the entire bag. The last step is relapse prevention, which ensures that the patient will not revert to old ways.
Masheb said her future research will not include medication to determine behavioral therapy’s effectiveness.
What works for one individual does not necessarily work for another, and Siggins said that is why the initial assessment of the patient’s particular concerns with food is so important.
“We have to get to the root of the problem, so we can develop the most effective treatment, whether it is group therapy, one-on-one counseling or medication,” Siggins said.
In cases like Boettcher’s, the most effective solution to the problem was gastric bypass surgery. The procedure alters the digestive process and creates a narrow passage from the upper to the lower parts of the stomach, reducing the amount of food the stomach can hold. Celebrities Al Roker and Carnie Wilson, who was a band member of the popular 1990s band Wilson Philips and is the daughter of Beach Boy Brian Wilson, have of late popularized the surgery.
“I don’t restrict myself completely,” Boettcher said. “I know I can have one piece of candy or one slice of pizza, and I don’t make nachos or eat ice cream by the pint anymore.”
Boettcher’s heart is back to normal size, and his death sentence is removed. When he was 21, Boettcher, now 32, was not expected to live past the age of 30.
UHS mental-hygiene specialists report that eating disorders are a common problem among not only the Yale student population but among many college-aged students.
The UHS approach to helping a student combat an eating disorder is multifaceted. A social worker, a nutritionist and a mental health specialist are all involved in waging the war on food.
Siggins also said the Yale student body has issues with food in general. She said eating issues among students are often too quickly labeled as anorexia, bulimia or compulsive eating, when eating disorders typically overlap all three.
“I think it is definitely a large group of students here that suffer from some eating disorder,” said Kimberly Bandman, social worker at the Mental Hygiene Division of UHS. “That’s why when they come in here, whether they are overeating or under-eating, we all work together to help them understand what it is that is triggering their eating issue.”