What is overeating

Overeating is a type of problematic eating patterns where you consume an unusually large amount of food ¹⁾, whereas binge eating disorder is defined as overeating while feeling a sense of loss of control ²⁾. Clinically, overeating occurs when energy intake exceeds energy expenditure. Overeating is characterized by eating when not hungry or continuous eating with disregard to physiological cues. Overeating can include patterns of emotional eating and involve a poor sense of hunger and satiety.

Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S. Both overeating and binge eating disorders are common in adolescence ³⁾ and are associated with unhealthy weight gain ⁴⁾ and poorer psychosocial functioning ⁵⁾. Some studies suggest that loss of control while eating is the key construct that uniquely confers distress and impairment beyond the effects of overeating ⁶⁾, while others indicate that the combination of loss of control and overeating is a stronger marker for excess weight status and psychosocial dysfunction ⁷⁾.

Overeating without loss of control was reported by 6.9% of girls and 5.0% of boys, while 9.6% of girls and 6.3% of boys reported overeating with loss of control (binge eating) ⁸⁾. Overall, overeating (with or without loss of control) was positively associated with unhealthy or extreme weight control behaviors, dieting, non-suicidal self-injury, lower body satisfaction and self-esteem, and higher depressive symptoms relative to no overeating ⁹⁾. Among girls, binge eating was associated with unhealthy or extreme weight control behaviors, lower self-esteem, and higher depressive symptoms relative to overeating without loss of control, while in boys, binge eating was associated with greater cigarette usage, lower body satisfaction, and greater depressive symptoms than overeating without loss of control (although cigarette usage was comparable in boys reporting binge eating and no overeating).

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. Some people with eating disorders may also have other mental disorders (such as depression or anxiety) or problems with substance use.

Treatment plans for eating disorders include psychotherapy, medical care and monitoring, nutritional counseling, medications, or a combination of these approaches. Typical treatment goals include restoring adequate nutrition, bringing weight to a healthy level, reducing excessive exercise, and stopping binge-purge and binge-eating behaviors. Complete recovery is possible.

Specific forms of psychotherapy (or “talk therapy”) and cognitive behavioral approaches can be effective for treating specific eating disorders.

Tips for overeaters

• Eat breakfast only when you are hungry. People who eat breakfast are less likely to overeat later in the day.
• Choose whole grains more often. Try whole-wheat breads and pastas, oatmeal, or brown rice.
• Select a mix of colorful vegetables each day. Vegetables of different colors provide different nutrients. Try collards, kale, spinach, squash, sweet potatoes, and tomatoes.
• Have low-fat, low-sugar snacks on hand at home, at work, or on the go to combat hunger and prevent overeating.
• At restaurants, eat only half your meal and take the rest home.
• Visit museums, the zoo, or an aquarium. You and your family can walk for hours and not realize it.
• Take a walk after dinner instead of watching TV.
• Get plenty of sleep.

What are the common types of eating disorders?

Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. If you or someone you know experiences the symptoms listed below, it could be a sign of an eating disorder—call a health provider right away for help.

Anorexia nervosa

People with anorexia nervosa avoid food, severely restrict food, or eat very small quantities of only certain foods. Even when they are dangerously underweight, they may see themselves as overweight. They may also weigh themselves repeatedly.

There are two subtypes of anorexia nervosa: a restrictive subtype and binge-purge subtype.

• Restrictive: People with the restrictive subtype of anorexia nervosa place severe restrictions on the amount and type of food they consume.
• Binge-Purge: People with the binge-purge subtype of anorexia nervosa also place severe restrictions on the amount and type of food they consume. In addition, they may have binge eating and purging behaviors (such as vomiting, use of laxatives and diuretics, etc.).

Anorexia nervosa symptoms

Anorexia nervosa symptoms include:

• Extremely restricted eating and/or intensive and excessive exercise
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Over time, these symptoms may also develop:

• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia and muscle wasting and weakness
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Severe constipation
• Low blood pressure, slowed breathing and pulse
• Damage to the structure and function of the heart
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Infertility
• Brain damage
• Multiorgan failure

Anorexia can be fatal. Anorexia nervosa has the highest mortality (death) rate of any mental disorder. People with anorexia may die from medical conditions and complications associated with starvation; by comparison, people with others eating disorders die of suicide.

Bulimia nervosa

People with bulimia nervosa have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behaviors that compensate for the overeating, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.

Bulimia nervosa symptoms

Symptoms of bulimia nervosa include:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth (a result of exposure to stomach acid)
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from purging
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals), which can lead to stroke or heart attack

Binge-eating disorder

People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese.

Binge-eating disorder symptoms

Symptoms of binge-eating disorder include:

• Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
• Eating fast during binge episodes
• Eating even when full or not hungry
• Eating until uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about eating
• Frequently dieting, possibly without weight loss

Other Specified Feeding or Eating Disorders (OSFED)

Because Other Specified Feeding or Eating Disorders (OSFED) encompasses a wide variety of eating disordered behaviors, any or all of the following symptoms may be present in people with OSFED.

• Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting
• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
• Self-esteem overly related to body image
• Dieting behavior (reducing the amount or types of foods consumed)
• Expresses a need to “burn off” calories taken in
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

Avoidant Restrictive Food Intake Disorder (ARFID)

• Dramatic weight loss
• Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens)
• Fears of choking or vomiting
• No body image disturbance or fear of weight gain

Pica

• The persistent eating, over a period of at least one month, of substances that are not food and do not provide nutritional value
• Typical substances ingested tend to vary with age and availability. They may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice

Rumination disorder

• Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out
• The repeated regurgitation is not due to a medication condition (e.g., gastrointestinal condition).
• The behavior does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, binge eating disorder, or avoidant/restrictive food intake disorder.
• If occurring in the presence of another mental disorder (e.g., intellectual developmental disorder), it is severe enough to warrant independent clinical attention.

Orthorexia

• The term ‘orthorexia’ was coined in 1998 and means an obsession with proper or ‘healthful’ eating. Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being.
• Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
• An increase in concern about the health of ingredients; an inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
• Spending hours per day thinking about what food might be served at upcoming events
• Body image concerns may or may not be present

Overeating causes

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Like women who have eating disorders, men also have a distorted sense of body image.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Researchers are using the latest technology and science to better understand eating disorders.

One approach involves the study of human genes. Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

Overeating can include patterns of emotional eating and involve a poor sense of hunger and satiety. Emotional eating is eating, consciously or unconsciously, as a means of suppressing, numbing and/or soothing emotions such as stress, anger, fear, anxiety, depression, boredom, loneliness. It does not occur exclusively within the context of binge eating but can be a symptom of any of the eating disorders. Emotional eating is the opposite of mindful eating in which the goal is to be focused on what you are eating and doing in the moment, being actively aware of sensations, thoughts and feelings without judging or attempting to change them. Normalized eating patterns entail eating out of physical hunger, and stopping out of fullness or satiety. Individuals with anorexia nervosa oftentimes find it beneficial to utilize distractions while eating because during weight restoration they need to typically eat more food than hunger requires whereas individuals with bulimia nervosa tend to benefit from increasing awareness of hunger and satiety cues, being mindful/aware of how their food tastes and how their bodies react to it. Foods consumed during emotional eating oftentimes entails foods otherwise limited or avoided.

Figure 1. Compulsive overeating neurobiology

Footnotes: Neurobiology of the elements of compulsive overeating. The key systems that underlie the elements of compulsive eating are: (1) the basal ganglia, (2) the extended amygdala, and (3) the prefrontal cortex. The basal ganglia (shown in blue) consist of multiple subcortical nuclei, such as the nucleus accumbens (NAc), which is involved in the rewarding and reinforcing effects of food, and the dorsal striatum, which is involved in instrumental learning and habitual behavior. The basal ganglia contribute to habitual overeating that can arise from maladaptive habit formation processes. The extended amygdala (shown in red) is a basal forebrain composite structure encompassing the central nucleus of the amygdala (CeA), the bed nucleus of the stria terminalis (BNST), and a transition area in the medial and caudal portions of the NAc. The brain stress systems in the extended amygdala mediate overeating to relieve a negative emotional state that emerges from withdrawal processes. Prefronto-cortical regions (shown in green) include the medial prefrontal (mPFC, comprised of dorsolateral (dlPFC) and ventromedial (vmPFC) regions), anterior cingulate (ACC), and orbitofrontal (OFC) cortices; these areas control cognitive functions such as decision-making and response inhibition through interactions with subcortical structures such as the basal ganglia and the extended amygdala. Dysfunctions in the prefrontal cortex (PFC) are hypothesized to underlie overeating despite aversive consequences, reflecting failures in inhibitory control over behavior.

[Source ¹⁰⁾ ]

Elements of compulsive eating behavior

Compulsive eating behavior is posited to be a combination of one or more of the following elements:

1. Habitual overeating,
2. Overeating to relieve a negative emotional state, and
3. Overeating despite aversive consequences.

Moore and colleagues ¹¹⁾ propose that these elements emerge from dysfunctions of brain areas involved in reward learning, emotional processing, and inhibitory control. Although each of these processes involves multiple regions within interconnected circuits, for the purpose of this review, we will focus on three specific key areas implicated in the above discussed elements: the basal ganglia, the extended amygdala, and the prefrontal cortex (PFC). Importantly, they also acknowledge that these elements, although part of a unifying construct, are not mutually exclusive, nor would they all be necessary for the designation of a behavior as compulsive.

Table 1. Diagnostic Criteria for disorders associated with Compulsive Overeating

Disorder	Diagnostic criteria	Reference
Obesity	BMI⩾30 (BMI=body weight (kg)/height (m2))	12)
Binge eating disorder	1. Marked distress regarding binge eating is present	A diagnosis of binge-eating disorder is given when these five criteria are met 13).
	2. Recurrent episodes of binge eating characterized by (1) eating within a 2-h period of time an amount of food larger than what most people would eat in a similar period of time under similar circumstances and (2) a sense of lack of control overeating during the episode
	3. Binge eating episodes are associated with three (or more) of the following cognitive symptoms
	i. Eating much more rapidly than normal
	ii. Eating until feeling uncomfortably full
	iii. Eating large amounts of food when not feeling physically hungry
	iv. Eating alone because of feeling embarrassed about how much one is eating
	v. Feeling disgusted with oneself, depressed, or very guilty afterward
	4. Binge eating occurs, on average, at least once a week for 3 months
	5. Binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (eg, purging) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Food addictiona	Clinically significant impairment or distress AND (2 or more of the following criteria)	A diagnosis is given when impairment or distress is met as well as 2+ other symptoms. A severity classification is given based on the number of criteria. (2–3=mild, 4–5=moderate, and 6+=severe) 14).
	1. Consumed more (larger amount and for a longer period) than planned
	2. Unable to cut down or stop
	3. Great deal of time spent
	4. Important activities given up or reduced
	5. Use despite knowledge of physical/emotional consequences
	6. Tolerance (increase in amount, decrease in effect)
	7. Withdrawal (symptoms, substance taken to relieve withdrawal)
	8. Craving or strong desire
	9. Failure in role obligation
	10. Use despite interpersonal/social consequences
	11. Use in physically hazardous situations

Footnote: (a) Food addiction is not yet accepted as a DSM-V disorder; these criteria were adapted by Gearhardt et al ¹⁵⁾ from the Substance-related and addictive disorders criteria within the DSM-V ¹⁶⁾.

[Source ¹⁷⁾ ]

Table 2. A summary of the features of each element of compulsive eating behavior

Elements of compulsive eating behavior	Neuropsychobiological mechanisms	Characteristic behavior	Most implicated brain area
Habitual overeating	Aberrant reward learning	Inability to reduce eating or seeking behavior following a decrease in food value or contingency	Basal ganglia
Overeating to relieve a negative emotional state	Affective habituation	Eating to cope with decreased sensitivity to reward	Basal ganglia
	Affective withdrawal	Eating to cope with negative affect (eg, anxiety and stress)	Extended amygdala
Overeating despite negative consequences	Decreased inhibitory control	Eating persists in conditions where it would normally be suppressed	Prefrontal cortices

[Source ¹⁸⁾ ]

Overeating symptoms

The following questions to help determine if you have a problem with compulsive overeating:

1. Do I eat when I’m not hungry, or not eat when my body needs nourishment? (Yes / No)
2. Do I go on eating binges for no apparent reason, sometimes eating until I’m stuffed or even feel sick? (Yes / No)
3. Do I have feelings of guilt, shame, or embarrassment about my weight or the way I eat? (Yes / No)
4. Do I eat sensibly in front of others and then make up for it when I am alone? (Yes / No)
5. Is my eating affecting my health or the way I live my life? (Yes / No)
6. When my emotions are intense — whether positive or negative — do I find myself reaching for food? (Yes / No)
7. Do my eating behaviors make me or others unhappy? (Yes / No)
8. Have I ever used laxatives, vomiting, diuretics, excessive exercise, diet pills, shots or other medical interventions (including surgery) to try to control my weight? (Yes / No)
9. Do I fast or severely restrict my food intake to control my weight? (Yes / No)
10. Do I fantasize about how much better life would be if I were a different size or weight? (Yes / No)
11. Do I need to chew or have something in my mouth all the time: food, gum, mints, candies or beverages? (Yes / No)
12. Have I ever eaten food that is burned, frozen or spoiled; from containers in the grocery store; or out of the garbage? (Yes / No)
13. Are there certain foods I can’t stop eating after having the first bite? (Yes / No)
14. Have I lost weight with a diet or “period of control” only to be followed by bouts of uncontrolled eating and/or weight gain? (Yes / No)
15. Do I spend too much time thinking about food, arguing with myself about whether or what to eat, planning the next diet or exercise cure, or counting calories? (Yes / No)

If you answered “yes” to several of these questions, it is possible that you have, or are well on your way to having, a compulsive overeating or overeating problem.

Anorexia nervosa symptoms

• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• Preoccupation with weight, food, calories, fat grams, and dieting. Makes frequent comments about feeling “fat.’
• Resists or is unable to maintain a body weight appropriate for their age, height, and build
• Maintains an excessive, rigid exercise regime – despite weather, fatigue, illness, or injury

Bulimia nervosa symptoms

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
• Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of mouthwash, mints, and gum
• Has calluses on the back of the hands and knuckles from self- induced vomiting
• Dental problems, such as enamel erosion, cavities, discoloration of teeth from vomiting, and tooth sensitivity

Binge eating disorder symptoms

• Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
• Feelings of disgust, depression, or guilt after overeating, and/or feelings of low self-esteem
• Steals or hoards food in strange places
• Creates lifestyle schedules or rituals to make time for binge sessions
• Evidence of binge eating, including the disappearance of large amounts of food in a short time period or a lot of empty wrappers and containers indicating consumption of large amounts of food
• Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
• Eating even when you’re full or not hungry
• Eating fast during binge episodes
• Eating until you’re uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about your eating
• Frequently dieting, possibly without weight loss

Over time, if you eat and drink more calories than your body uses or “burns off,” your body may store the extra energy, leading to weight gain. Many factors may play a part in weight gain.

Common symptoms of an eating disorder

Emotional and behavioral

• In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns
• Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
• Appears uncomfortable eating around others
• Food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
• Skipping meals or taking small portions of food at regular meals
• Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
• Withdrawal from usual friends and activities
• Frequent dieting
• Extreme concern with body size and shape
• Frequent checking in the mirror for perceived flaws in appearance
• Extreme mood swings

Physical

• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
• Dizziness, especially upon standing
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems, such as enamel erosion, cavities, and tooth sensitivity
• Dry skin and hair, and brittle nails
• Swelling around area of salivary glands
• Fine hair on body (lanugo)
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin (in context of eating large amounts of carrots)
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning

Effects of overeating

Extra weight may increase your risk for:

• type 2 diabetes
• heart disease and stroke
• high blood cholesterol
• high blood pressure
• kidney disease
• non-alcoholic fatty liver disease (a fat buildup in the livers of people who drink little or no alcohol)
• problems with pregnancy
• certain cancers

Health risks of being overweight or obese during pregnancy

Extra weight can cause these health problems with pregnancy:

• gestational diabetes (high blood sugar during pregnancy)
• high blood pressure
• increased risk for cesarean section (C-section)

If you are overweight or are experiencing health problems linked to overweight or obesity, ask your health care provider if a modest weight loss would be helpful. A weight loss of 5 to 7 percent of your body weight over 6 months or longer has been shown to improve health.

How to stop overeating

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

• Individual, group, and/or family psychotherapy
• Medical care and monitoring
• Nutritional counseling
• Medications

Paying attention to what, when, how often, and how much you eat can be the first step to helping you eat better.

Eating

• Keep a food diary. To get started, see the sample food diary.
• Make a shopping list and stick to it. Don’t shop when you’re hungry.
• Don’t keep many foods high in fat or sugar in your home.
• Dish up smaller servings. At restaurants, eat only half your meal and take the rest home.
• Eat at the table. Turn off the TV so you don’t overeat.

Behavior

• Be realistic about weight-loss goals. Aim for a slow, modest weight loss.
• Seek support from family and friends.
• Expect setbacks and forgive yourself if you regain a few pounds.
• Add moderately intense or vigorous physical activity to your weight-loss plan. This kind of activity increases your heart rate and makes you break a sweat.
• Examples are brisk walking, swimming, and dancing.

Many people feel stress in their daily lives. Stress can cause you to overeat, feel tired, and not want to do anything. Healthy eating and regular physical activity may help offset the effects of stress.

Try some of these other ideas to help relieve stress and stay on track with improving your health:

• Get plenty of sleep.
• Practice deep breathing while relaxing your muscles one at a time.
• Take a break and go for a walk.
• Add short stretch breaks to your day.
• Try a new hobby or any activity that sparks your interest.
• Surround yourself with people whose company you enjoy.

A balanced eating plan, regular physical activity, and stress relief may help you stay healthy for life.

Table 3. Sample Food Diary

Time	Food	Feelings	How I Can Improve
8 a.m.	Coffee with sugar and cream, oatmeal with low-fat milk and banana	Hungry. Ate my usual breakfast.
11 a.m.	Low-fat yogurt	Stomach starting to rumble.	Adding fresh fruit or whole grains will help keep me from overeating later.
12:30 p.m.	Roast beef and cheese sandwich on whole-wheat bread, potato chips, can of soda	Probably ate more than I was hungry for because of the “lunch deal” the deli offered me.	If I pack my lunch, I won’t be tempted in the lunch line.
2:30 p.m.	1/2 chocolate bar from coworker, large coffee with sugar and cream	Feeling bored, not truly hungry.	A snack like veggie slices with salsa is more nutritious.
7:30 p.m.	Caesar salad, dinner roll, ravioli (didn’t finish the whole serving), 1/2 slice of chocolate cake	Out to dinner with friends, so we all ate big portions! We split dessert, which made me feel healthy.	Next time, I’ll have a salad with low-fat dressing. Sweet, fresh fruit is good as a light dessert.
10:30 p.m.	Decaf herbal tea	Had trouble falling asleep.

Follow a healthy eating plan

These tips may help you stay on track with your plan to eat better:

• Have low-fat, low-sugar snacks on hand. Whether you are at home, at work, or on the go, healthy snacks may help to combat hunger and prevent overeating.
• Select a mix of colorful vegetables each day. Choose dark leafy greens, such as spinach, kale, collards, and mustard greens, and reds and oranges such as carrots, sweet potatoes, red peppers, and tomatoes.
• Eat breakfast every day. People who eat breakfast are less likely to overeat later in the day.
• Choose whole grains more often. Try whole-grain breads and pastas, oatmeal, brown rice, or bulgur.
• Choose fresh fruit more often than fruit juice. Fruit juice has little or no fiber, the calories may be high, and many juices have added sugar.
• Use fats and oils sparingly. Olive, canola, and peanut oils; avocados; nuts and seeds; olives; and fish provide heart-healthy fat as well as vitamins and minerals.
• Limit foods and beverages that are high in sugar.

Eat less of these foods

Some foods have many calories but few of the vitamins, minerals, or fiber your body needs. Added sugars, solid fats, and refined grains pack a lot of calories into food but do not add nutrients. The Government’s dietary guidelines recommend that you limit foods such as these:

• sugar-sweetened drinks and desserts
• foods with butter, shortening, or other fats that are solid at room temperature
• white bread, rice, and pasta that are made from refined grains

Eat more of these nutrient-rich foods

Nutrients—like vitamins, minerals, and dietary fiber—nourish our bodies by giving them what they need to be healthy. The guidelines advise adults to eat the following foods because they are rich in nutrients:

• fruits and vegetables
• whole grains, like oatmeal, whole-wheat bread, and brown rice
• seafood, lean meats, poultry, and eggs
• fat-free or low-fat milk and cheese, or substitutes (like soy or rice milk) that are high in vitamin D and calcium
• beans, nuts, and seeds

Easy snack ideas

• low-fat or fat-free yogurt
• fresh, canned, or dried fruit
• sliced vegetables or baby carrots

Quick breakfast ideas

• oatmeal with low-fat or fat-free milk or a soy-based drink, topped with walnuts and fresh or dried fruit
• a slice of whole-wheat toast with a thin piece of low-fat cheese
• fruit smoothie made with frozen fruit and low-fat yogurt
• high-fiber, low-sugar cereal with a soy-based beverage or fat-free milk

Use a food diary to track what you eat

To keep a food diary, write down all the food you eat in a day. Also write down the time you eat and your feelings at the time. Writing down your feelings may help you identify your eating triggers. For example, you may notice that you sometimes overeat when you are in a big group, simply because everyone around you is eating. The next time you are eating with a big group, be mindful of that trigger and try to limit how much you eat.

How much should I eat?

How much you should eat depends on your genes, sex, age, and how active you are. In general, men need more calories than women do, and younger adults need more calories than adults in midlife and older. At all ages, adults who are more physically active need to eat more calories than those who are less active.

Get active with exercise

According to the Government’s physical activity guidelines, healthy adults should regularly do aerobic and strengthening activities. See the Additional Links section for more information on how to find these guidelines.

Aerobic exercise

Aerobic exercise uses your large muscle groups (chest, legs, and back) to increase your heart rate. This exercise may cause you to breathe harder. You should be able to speak several words in a row while doing aerobic exercises, but you should not be able to have a long chat.

• Aim for at least 150 minutes (2 1/2 hours) each week.

Studies suggest that being fit at midlife may help prevent heart disease and stroke as you get older. To get more health benefits or to lose weight, you may need to do more activity. Aim for 300 minutes (5 hours) a week of moderate activity like walking at a pace of about 4 miles an hour.

Choose aerobic exercises that are fun. People are more likely to be active if they like what they are doing. Getting support from a friend or a family member may also help. Try one of these activities or others you enjoy:

• brisk walking or jogging
• bicycling (with a helmet)
• swimming
• playing basketball or soccer

Benefits of aerobic exercise

Regular aerobic exercise may help you:

• Control weight. Aerobic activity burns calories, which may help you manage your weight.
• Prevent heart disease and stroke. Regular aerobic activity can strengthen your heart muscle and lower your blood pressure. It may also help lower “bad” cholesterol and raise “good” cholesterol.
• Maintain strong bones. Weight-bearing aerobic activities that involve lifting or pushing your own body weight, such as walking, jogging, or dancing, help to maintain strong bones.

Exercise to strengthen muscles

These activities make you push or pull against something, such as gravity, weights, or exercise bands.

• Aim for at least 2 days a week.

Strengthening exercises should focus on working the major muscle groups of the body, such as the chest, back, abdominals, legs, and arms. Allow at least 1 day of rest for your muscles to recover and rebuild before working the same muscle groups.

Try these options:

• Lift weights.
• Use canned food or books as weights.
• Do push-ups or pull-ups.
• Work with resistance bands (large rubber bands).
• Do heavy gardening (digging, lifting, carrying).

Benefits of exercise to strengthen muscles

Doing regular exercises to strengthen your muscles may help you:

• Use more calories. Not only do strengthening exercises burn calories, but having more muscle means you will burn slightly more calories throughout the day—even when you are sitting still.
• Reduce injury. Stronger muscles improve balance and support your joints, lowering the risk of injury.
• Maintain strong bones. Doing strengthening exercises regularly helps build bone and may prevent bone loss as you age.

How do I get started?

You don’t have to be an athlete to benefit from regular physical activity. Even modest amounts of physical activity can improve your health.

If you have been inactive for a while, you may want to start with easier activities, such as walking at a gentle pace. This lets you build up to more intense activity without getting hurt.

Start with small, specific goals, like walking briskly 10 minutes a day, 3 days a week, and build up slowly from there. Keep an activity log to track your progress. You can refer to the sample activity log. As you become more fit, slowly increase your pace, the length of time you are active, and how often you are active.

Try these activities to add more movement to your daily life:

• Choose parking spots that are farther away from where you are going and walk the last few blocks. (Make sure the places you park and walk are well lit.)
• Walk around the inside of a mall in bad weather.
• Rake the leaves, wash the car, or do brisk housecleaning.
• Visit museums or the zoo. Many of these places are free. You and your family can walk for hours and not realize it.
• Take a break from sitting at the computer or TV. Go for a short walk or stretch.
• If your time is limited, do 10 minutes of exercise at a time. Spread these bursts of activity out throughout the day. Every little bit counts!

Table 4. Sample Exercise Log

Date	Activity	Total Time	How I Felt
Mon., Mar. 1	Walking	2 x 15 minutes	I kept a good pace.
	Free weights at home	20 minutes
Tues., Mar. 2	Walking	30 minutes
	Stretching	15 minutes	Stretching felt great.
Wed., Mar. 3	Extra walking at work—used the stairs 3 times	About 20 minutes total	I was busy, so I just tried to move more all day.
	Yoga video at home	20-minute video	Yoga helped me relax.
Thurs., Mar. 4	Walking	15 minutes at lunch and 15 minutes after work	Walking with my coworker was fun and relaxing.
Fri., Mar. 5	Walking	30 minutes at lunch	My coworker and I picked up the pace today!
	Free weights at home	20 minutes
Sat., Mar. 6	Water aerobics class	45 minute class	This class is fun but exhausting.
	Stretching	15 minutes
Sun., Mar. 7	Gardening	60 minutes	A surprisingly good workout.

Psychotherapies

Psychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Medications

Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression.