OUR THINKING / SPOTLIGHT 01
Obesity and binge eating: exploring what context reveals
Binge eating sits at a complex intersection of biology, psychology and lived experience. In this spotlight, we explore how context shapes the way we understand and respond to it.
01
CONVERSATION 01
Why we’re having this conversation
One thing we’ve noticed working in specialist weight management, bariatric surgery and GLP-1 services is how often obesity and binge eating occur together.
This isn’t just our clinical impression. Research shows that obesity and binge eating frequently co-occur, and that the number of people experiencing both appears to be increasing.
Yet many people living with both conditions seem to encounter difficulties accessing the care they need.
We wonder whether part of the problem is how these conditions are typically organised within healthcare.
In the UK, obesity and binge eating are usually managed by different services, with different referral pathways, eligibility criteria and treatment approaches.
For some people this can mean feeling caught between services—trying to find support for both their weight and their relationship with food, but struggling to find a pathway that addresses both together.
This is a conversation we’ve been having over the past few months, and one we’re continuing to explore together.
Across this Spotlight, Denise, Hannah and I are sharing some of the questions, observations and dilemmas we’ve encountered in clinical practice. We don’t have all the answers, but we hope these conversations might encourage wider discussion about how we can better meet the needs of people living with both obesity and binge eating.
Have you noticed this in your own clinical practice, research or lived experience?
We’d genuinely love to hear your perspective.
02
CONVERSATION 02
Why is integrated care so difficult?
Following on from our previous conversation, we’ve been asking ourselves another question.
Why is it so difficult to provide integrated care for people living with both obesity and binge eating?
One explanation we keep coming back to is the way these two areas of healthcare have developed.
In the UK, obesity is usually managed within physical health services, where clinicians often work within a biopsychosocial framework and recognise binge eating as one of several factors influencing a person’s health and wellbeing.
Binge eating, on the other hand, is most commonly treated within eating disorder services, which usually sit within mental health. Here, understandably, the focus is on understanding and treating binge eating itself.
Neither approach is wrong and both have important strengths.
But because these services have developed separately, they have also developed different ways of understanding the same person.
It also means that many of the dominant psychological models of binge eating have been developed within mental health settings, where the broader context of living with obesity has not always been central to how binge eating is conceptualised.
We find ourselves wondering what happens when we bring that wider context back into the picture.
How might our understanding of binge eating change if we paid more attention to the biological, social and healthcare experiences associated with living with obesity?
We’re interested to hear how others think about this. Does this resonate with your own experience of clinical practice, research or service development?
03
CONVERSATION 03
Caught between services
One consequence of seeing obesity and binge eating as separate conditions is that people living with both can find themselves moving between services without ever receiving truly integrated care.
We see this in clinical practice much more often than we’d like.
A person may be referred to a weight management or bariatric service, where binge eating is identified as something that needs further support before treatment can progress.
They may then be referred elsewhere for help with their binge eating.
But those services are often working within a different clinical context, with different priorities, referral criteria and treatment approaches. Obesity may not be a central focus of the intervention, because that isn’t the service’s remit.
The result can be multiple referrals, repeated assessments and long waits as people try to navigate different parts of the healthcare system.
For many, it feels as though no single service is able to address the whole picture.
We wonder what impact this has on the people living through it.
Repeatedly being told that you don’t quite fit the criteria for one service, or that another service is better placed to help can be frustrating and disheartening. It may also reinforce feelings of shame, self-blame or of being “too complex” for the healthcare system.
Of course, this isn’t the fault of individual clinicians or services. Most are working incredibly hard within limited resources.
It does, however, raise an important question…
If obesity and binge eating so often co-occur, is there a better way of supporting people that reflects the reality of their experience, rather than asking them to navigate two separate systems?
We’re interested to hear whether this is something you’ve encountered in your own clinical practice, research or lived experience.
04
CONVERSATION 04
Conflicting recommendations
One dilemma we’ve been reflecting on is what happens when people receive different recommendations from different parts of the healthcare system.
Imagine someone living with both obesity and binge eating.
A specialist weight management service may be supporting them to improve their health through interventions such as lifestyle support, GLP-1 medication or bariatric surgery.
At the same time, they may seek psychological treatment for binge eating.
Depending on the service they access, they may be encouraged to pause active weight loss efforts while engaging in treatment, with the aim of reducing the focus on weight and dieting.
Both recommendations have a clear clinical rationale.
But from the patient’s perspective, they can feel difficult to reconcile.
Some people describe feeling as though they have to choose between improving their physical health and addressing their relationship with food.
Others wonder whether they have to put one important goal on hold in order to pursue another.
We’ve found ourselves wondering whether this creates a false choice.
For many people living with obesity, concerns about weight aren’t simply about appearance.
They may relate to mobility, pain, physical health, previous healthcare experiences or hopes of being able to do things that currently feel out of reach.
Can we realistically ask people to set all of that aside while working on binge eating?
Or do we need approaches that acknowledge both goals together?
This isn’t an easy question, and we certainly don’t pretend to have the answer.
We’re genuinely interested to hear how clinicians, researchers and people with lived experience think about this.
05
CONVERSATION 05
Do our models reflect the context?
As we’ve reflected on these conversations, we’ve found ourselves asking another question.
What happens if the models we use to understand binge eating don’t fully reflect the context in which many people experience it?
Most of the dominant psychological models of binge eating were developed outside of specialist obesity services.
They have made an enormous contribution to our understanding of binge eating and have helped many people.
But we wonder whether they sometimes leave out parts of the picture for people living with both obesity and binge eating.
For example, they may not always fully consider the impact of:
• living with long-term weight stigma and discrimination
• repeated experiences of dieting and weight regain
• the biological drivers of appetite regulation, genetics and metabolic adaptation
• wider environmental influences, including highly palatable ultra-processed foods
None of these factors make existing models “wrong”.
But if they aren’t part of the formulation, there is a risk that we overemphasise psychological and behavioural explanations while underestimating the wider context in which binge eating develops and persists.
We’re beginning to wonder whether obesity shouldn’t be viewed as a separate issue to consider after binge eating has been addressed, but as part of the context through which binge eating is understood from the very beginning.
What are your thoughts? Does this resonate with your own clinical experience or research?
06
CONVERSATION 06
Weight and shape concern
One idea we’ve found ourselves reflecting on is the concept of weight and shape concern.
Many psychological models of binge eating describe an overvaluation of weight and shape as an important maintaining factor.
But we’ve been wondering whether this looks different for people living with obesity.
If someone has experienced years of weight stigma where they have been told their body is unacceptable…
If they struggled with pain or limited mobility…
If they’ve been treated differently within healthcare and told repeatedly by health care professionals to lose weight…
If they’re worried about developing diabetes or needing joint replacements…
Is concern about weight and shape always an overvaluation?
Or might it sometimes be a realistic and understandable response to lived experience?
That doesn’t mean these concerns aren’t important to address.
But perhaps understanding why weight has become so significant is just as important as recognising that it has become significant.
Context changes meaning.
We’re interested to hear how others think about this. Does the context of living with obesity change the way we understand weight and shape concern?
07
CONVERSATION 07
What role is binge eating playing?
One of the most influential ideas in understanding binge eating is the role of dietary restraint.
For many people, attempts to restrict food can contribute to cycles of deprivation, loss of control and binge eating.
We see this in clinical practice too.
But we’ve also been wondering whether this is sometimes only part of the picture for people living with obesity.
Many people describe binge eating as serving a range of important functions.
Helping them manage overwhelming emotions.
Providing comfort during periods of loneliness or stress.
Creating temporary relief from shame.
Helping them cope with traumatic experiences.
Providing sensory stimulation or regulation.
If binge eating has become protective in these ways, reducing dietary restraint may be necessary—but it may not always be sufficient.
Perhaps the question isn’t simply:
“What is driving the binge eating?”
But also:
“What has binge eating been helping this person to cope with?”
Understanding that broader context may change both our formulation and our intervention.
We’d love to hear how others think about this.
08
CONVERSATION 08
What about biology?
As psychologists, we spend a great deal of time thinking about thoughts, emotions and behaviour. As we should!
But we’ve also found ourselves asking whether discussions about binge eating sometimes underestimate the role of biology.
People living with obesity don’t just bring psychological experiences into the room.
They also bring differences in appetite regulation, genetic vulnerability, hormonal influences, metabolic adaptation following repeated weight loss attempts and differences in hunger, satiety and food reward.
These aren’t simply background variables. They shape people’s day-to-day experience of eating.
Perhaps one of the challenges is that psychology and biology are too often discussed separately.
Yet for the people we work with, they are experienced together.
We’re increasingly wondering whether richer formulations emerge when psychological, biological and social influences are considered alongside one another, rather than in isolation.
What are your thoughts?
09
CONVERSATION 09
The wider environment
When we think about binge eating, we often focus on what is happening within the individual.
Their thoughts. Their emotions. Their behaviours.
But people don’t live in isolation.
They live in environments that continually shape eating behaviour.
Highly palatable ultra-processed foods.
Constant food marketing.
Large portion sizes.
Easy availability.
Stressful lives with little time for rest or meal preparation.
For people already living with biological vulnerability, emotional distress or repeated dieting, these environments can make change incredibly difficult.
This isn’t about removing personal responsibility.
It’s about recognising that behaviour always occurs within a context.
The more we acknowledge that context, the more compassionate—and realistic—our formulations can become.
We wonder whether our conversations about binge eating sometimes underestimate just how powerful the wider environment really is.
10
CONVERSATION 10
What about neurodiversity?
Another factor we’ve found ourselves thinking more about is neurodiversity.
Increasingly, we’re seeing people living with both obesity and binge eating who also have ADHD—or recognise ADHD traits in themselves.
This has led us to ask another question.
How might neurodiversity change the way we understand eating behaviour?
For some people, eating isn’t simply about hunger.
It may also relate to sensory regulation.
Novelty seeking.
Impulsivity.
Reward sensitivity.
Executive functioning.
Emotional regulation.
Routine and predictability.
Food can become a way of regulating a nervous system that experiences the world differently.
That doesn’t mean binge eating is “caused” by ADHD.
Nor does it mean every person with binge eating is neurodivergent.
But perhaps neurodiversity is another piece of context that sometimes deserves greater attention within formulation.
As clinicians, we’ve found that asking about these experiences often opens up conversations that might otherwise be missed.
We’re interested to hear how others are thinking about the relationship between neurodiversity, obesity and binge eating.
11
CONVERSATION 11
Putting it all together
Over the past few weeks we’ve been sharing some of the questions that have emerged from our clinical work.
We’ve talked about fragmented services.
Different treatment recommendations.
Weight stigma.
Protective functions of binge eating.
Biology.
The wider food environment.
None of these ideas, on their own, fully explain binge eating.
But together they begin to paint a richer picture.
One where binge eating is understood not simply as a behaviour to eliminate, but as something that has developed within a particular biological, psychological, social and healthcare context.
For us, this has been one of the biggest shifts in our thinking.
Rather than asking,
“What’s wrong with this person’s eating?”
We’ve increasingly found ourselves asking,
“What context has this eating developed within?”
That small change in perspective has opened up some fascinating conversations.
Over the coming posts we’ll begin sharing more about how these ideas are influencing the way we think about formulation, treatment and service design.
As always, we’d love to hear your reflections and experiences.
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