The New York Times has an excellent article this week about how pharmaceutical companies bypass doctors to market drugs directly to consumers. The company Shire got Food and Drug Administration approval to sell Vyvanse—an addictive amphetamine that was already prescribed for ADHD—as a treatment for binge-eating disorder last month, and it immediately began spreading the word about the disorder. Shire’s publicity machine is really quite impressive: It hired former tennis pro Monica Seles to go on a media tour to talk about her experience with binge eating, gave tens of thousands of dollars to eating disorder advocacy groups, and secured the domain bingeeatingdisorder.com, which is billed as “A Resource for Understanding B.E.D. in Adults” and encourages patients to be persistent with their doctors if they don’t get their desired diagnosis. Meanwhile, drug abuse experts worry that the drug is being subtly marketed as a treatment for obesity, “despite the fact that, for decades, amphetamines, which suppress the appetite, were widely abused as a treatment for obesity.”
Unfortunately, the Times article not only casts doubt on Vyvanse’s safety and on Shire’s promotional tactics—it also subtly casts doubt on binge-eating disorder as a diagnosis. The online headline, “Shire, Maker of Binge-Eating Drug Vyvanse, First Marketed the Disease,” implies that Shire first manufactured a sham disorder and then manufactured a drug to treat it. This, at least, seems to be the message gleaned by many readers, whose skepticism about the disorder and scare quotes around it abound.
Shire deserves all the scrutiny it’s getting, but binge-eating disorder is a real problem, and it has been since long before Shire began marketing Vyvanse. I know from experience: For several years beginning in my teens and continuing through my early 20s, I had a binge-eating problem. That’s what I always called it, “a binge-eating problem”; at the time binge-eating disorder hadn’t been officially recognized by the DSM. (It finally was in 2013.) Food occupied most of my waking thoughts, and my binge eating distressed me and embarrassed me more than anything else in my life—and it wasn’t because I’d been brainwashed by Big Pharma. If anything, it was because I’d been brainwashed by a sexist, fat-phobic culture.
That’s the story I tell myself now, anyway, as a reasonably well-adjusted adult with a pretty healthy relationship to food. By contrast, when I was 14—the age I started binging—I was lonely and angry at my parents for having just moved our family halfway across the country. I was also several inches taller than most of my classmates and felt grotesquely large; I thought the only reason I didn’t look like the models I saw in Self and Cosmopolitan was that I wasn’t trying hard enough. So I decided to go on a diet, an idea my parents first endorsed as a shift toward healthier eating and then became increasingly concerned about as I became increasingly obsessive about it.
The diet I chose, Body for Life, endorsed the concept of “free days.” Six days out of the week, I restricted the amount and type of food I ate and felt hungry all the time; on the seventh, I ate whatever I wanted. You can see how this kind of either-or framework might encourage binging, and it did—on my “cheat days,” I ate all the foods I missed, in massive quantities, past the point of fullness. I thought it was perfectly OK to do this, even though it made me feel physically uncomfortable and even sick. After all, “cheating” had been endorsed by the impeccably lean, muscular man on the cover of my diet book.
But as time went on, the habit became not OK. I could no longer trust my body’s signals to tell me when and what to eat. I tried different diets, most of them consisting of compulsive calorie counting—I still remember the 30 calories I diligently jotted down in my notebook for every morning’s cup of tea—but the binging recurred every few weeks or days, and it felt increasingly out of control. When it started—usually at night, when I came home after a long day, or sometimes just when I was bored—it felt like an inexorable force, like I was physically incapable of stopping eating, until I got so tired I had to go to bed, shamefaced and vowing to diet the next day and never to binge again. I didn’t tell many people about it, in high school or college; it was mortifying to think that my classmates would know that I had so little willpower when it came to food.
I still don’t totally know why, or how, I stopped binge eating, although I can name a few likely contributing factors. I started seeing a therapist after college, which gave me a safe way to vent my embarrassment and make the connection between my eating habits and my unrealistic expectations for myself in other areas of my life. I started writing about food, which transformed my unhealthy preoccupation with food into a healthier one—once you make a hobby (in my case, thinking about food) your job, it loses a lot of its mystique. I became interested in feminism, which helped me realize how much I’d bought into the widespread cultural message that women only have worth if they’re thin, and then in the fat-acceptance movement, which debunked the moral judgments I’d made about fat. I very gradually let go of the idea that I had to control my eating, which paradoxically made it much easier to control my eating.
Shire stands to profit from binge-eating disorder, and it’s clearly doing its part to spread the word about it—but it didn’t invent it. Binge eating is just one (albeit extreme) way that common attitudes about food and weight manifest themselves. I managed to stop binge eating without medication, but that doesn’t mean I think that medication isn’t a potentially helpful tool for treating the disorder. I know from experience with antidepressants that taking medicine to address the most urgent, distressing symptom of a mental disorder can give you breathing room to deal with the underlying issues. However, I am skeptical that Vyvanse is appropriate for most binge-eating sufferers and am concerned about its potentially addictive properties. (And I think it’s insane that pharmaceutical companies are allowed to market prescription drugs directly to consumers, but that’s a topic for another day.)
Of course, I cannot and don’t want to speak for all people who binge eat, whose stories no doubt vary widely. I offer mine as one tiny case study to legitimize the idea that binge eating is a real thing. Binge-eating disorder is not just a clinical-sounding excuse for obesity—not that obese people need to excuse their bodies to anyone. Binge eating is the source of a lot of anguish for people who do it.