Guilt, shame and fear of gaining weight: The emotional toll that comes from compulsive eating

María Simón, 36, started by ticking off foods on an imaginary list. At 15, she gave up pasta and avocado because her body had developed curves and a “little belly.” And along with the restrictions, the binges also came. Pastries, chocolate donuts and endless packets of cookies that she could eat in an afternoon in complete solitude. “I was in a bad moment with my family, an aunt was dying of cancer,” recalls María, who is an actress.

During that period, everything piled up on her emotionally and that translated into compulsive eating. The binges conditioned every aspect of her life: going out, getting dressed and even drinking coffee (or not drinking it). “I didn’t tell anyone about this until I was 20,” she says while stirring with a spoon the cappuccino she has just ordered in a Madrid café. She doesn’t pick up the cup immediately. She waits before taking the first sip.

Simon suffers from what is known as binge eating disorder (BED), a type of eating disorder that has been recognized since 2013 in the American Psychiatric Association’s manual of mental disorders and that could affect between 2% and 3% of the Spanish population, although there are no clear figures. “I continue to struggle on different levels, but I go through periods. During some periods I have more self-love than during others. I no longer treat myself as badly as I did before,” she says. Globally, it is estimated that BED affects 1.5% of women and 0.3% of men; however, the prevalence of this condition can vary significantly between countries.

Patricia Ruiz, the healthcare director of the Center for Eating Disorders and Mental Health (CITEMA), explains that people with BED are long-term patients. They usually manage to identify this problem in adulthood, between their twenties and thirties. “It is addressed in a multidisciplinary way. It must be worked on with a nutritionist and in psychotherapy. Also with a psychiatrist for possible pharmacological treatment and even with an endocrinologist,” explains Ruiz. According to her, 40% of obesity cases are due to binge eating disorders.

Restrictive eating for long periods of time, such as intermittent fasting or certain types of protein diets, is a key risk factor for this disorder to flare up and develop. “If they have these characteristics, it is easier for them to develop it,” she adds. This is how binge eating came into the life of Olga Alejandre, 29. Diets and weight were a recurring theme in her home while she was growing up, and she even admits that watching the Victoria’s Secret shows affected her. “At that time, everyone was saying that we could get that physique if we trained,” she says via video call.

The kind expression on her face contrasts with the memories that come to mind: “When I was 17, I had to testify against my father in a trial because they were divorced. It was a terrible situation. My mother fell into depression and I was alone at home because my sister had gone off to study in Madrid, so I had to take care of her. It was a combination of things.”

The hamburgers, pizza, sweets and desserts that Alejandre did not eat during the day (because she did not allow herself to) ended up in her mouth in the evenings, a habit she maintained for four years while studying marketing and public relations at university. She did not make herself vomit to counteract what she had ingested. Neither did María Simón, at least not at first.

Unlike bulimia nervosa, this type of eating disorder does not involve compensatory behavior. Rather, the profile of these patients is associated with uncontrolled eating. Most of them are women and to a lesser extent men because there is a stigma attached to talking about the problem.

Belén Silveira, an endocrinologist specializing in eating disorders and obesity, says that people who suffer from this disease do not usually engage in compulsive exercise or throw up after eating. “What they have are other things such as an intense feeling of guilt, discomfort and also a fear of gaining weight,” she says. Silveria and Ruiz agree that these are patients who tend to manage their emotions through food. Anxiety about eating is also a response at the brain level.

A study published in the Journal of Psychiatry & Neuroscience in 2004 warned that people who overeat (and those who suffer from bulimia) tend to have lower serotonin levels than average. In general, eating disorders are the mental illnesses with the highest mortality rate, according to the Spanish Society of Dual Pathology.

Restriction is rooted in culture

Going on a diet only on the weekend is a form of restriction. Avoiding certain types of food from Monday to Friday is also a form of restriction. These are behaviors that are normalized in our routines and ingrained in society. Many people, says the endocrinologist, may have this problem and not recognize it at all. If specialists are not sufficiently skilled in detecting binge eating disorders, it is very easy for them to go unnoticed.

This also happens because advertising, the media and social media promote unrealistic beauty standards. It is common for actresses, for example, to be held to a certain body and weight standard. María Simón felt at the bottom of her game at the beginning of her acting career. “You are neither ugly nor pretty, and, well, how the hell does that help you!” she says. In 2006, she dropped her studies at the School of Dramatic Arts and returned to her parents’ home to receive treatment at the Eating Disorders Unit at the Alicante General Hospital.

The same thing happens in the world of sports. “The first diet I went on was when I was 17. I practiced karate and I started doing it regularly and increasingly professionally. I ended up representing my university,” recalls the journalist Constanza Rodríguez, 30, who is from Santiago de Chile. Like other martial arts, in karate you compete based on body weight, the same as in boxing. “My breasts started to grow,” she says. “I had to stick to a certain number on the scale and that was what mattered. There was a lot of talk about weight, it was something that was on everyone’s lips.”

On one occasion, she was required to lose eight kilos in three weeks to compete. “I didn’t eat, I went out for a run and went to saunas to dehydrate myself,” she says. Rodríguez ended up losing the competition and felt very guilty. No one on her team approached her or encouraged her for the effort she had made.

As a domino effect, the episodes of binge eating began: “I started to eat chocolates and sweets in secret.” She stayed away from sports for two years and did not talk about this problem for a decade. “When you stop being a child and you face a lonely adolescence, it is difficult to learn how to eat,” she says.

Eating disorders are altered eating habits. Viviana Loria Kohen, a professor at the Department of Nutrition and Food Science at the Complutense University of Madrid, says that the role of the nutritionist is fundamental. “They reorganize your diet from an external perspective. In addition, they suggest changes to help the patient,” she says.

Drugs such as Ozempic, which was originally prescribed as a treatment for diabetes, have become popular for their effectiveness in treating obesity, but specialists must take into account the type of patient. “For people, it is very satisfying to suddenly lose their hunger, but when the treatments are suspended or the program ends and the patient moves on to the maintenance phase, the brain responds to this deprivation. There can be serious consequences,” emphasizes Patricia Ruiz.

Silveira and Ruiz stress that dietary restrictions should be avoided and that other aspects should also be investigated in case there are underlying conditions. “These can be blood tests and medical tests. It is common for there to be a history of addictions in the family,” adds the endocrinologist.

Binge eating can trigger increased insulin resistance and increased cardiovascular risk. At the same time, it is important to rule out associated conditions such as sleep apnea. A person may simultaneously have (and not be linked to) undetected hypothyroidism that is also contributing to other problems.

The road to recovery is open

“They asked me if I wanted to be admitted or not. I told them that if they admitted me, it would kill me,” recalls María Simón. She was never discharged from Alicante Hospital because she herself decided that she was fine. “I have to believe in myself and work on food from another angle,” was what she told herself during that period to encourage herself.

Fourteen years have passed since that turning point, during which she went back to school, met her current boyfriend and premiered the play Putos 30, in which she speaks openly about this issue. “It came about because I couldn’t get any agent. They told me I was too funny to be a woman,” she says ironically. For Simón, Olga Alejandre and Constanza Rodríguez, psychological help was important, but they agree on the lack of experts specializing in this problem.

Alejandre also changed her life and went back to school. Now she is a dietician specializing in eating disorders and, together with a team of nutritionists, she helps patients who suffer from this and other types of eating disorders. Rodríguez, for her part, reconciled herself with sports and returned to physical activity.

Simón’s last relapse was in 2023, after she was diagnosed with a herniated disc. “Now they are much smaller [the binges], there are days when I feel like having a snack and I can enjoy it,” she says. She says goodbye and walks towards the door of the cafeteria. She leaves the cappuccino, which she had been drinking since the beginning of the interview, halfway finished.

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