One out of every 35 adults suffers from binge eating disorder, almost twice the combined rate for anorexia and bulimia. It is characterized by repeated episodes of eating large quantities of food quickly and to the point of discomfort; a feeling of a loss of control during the binge; and guilt following the binge, but without any consistent purging behavior. Up to 40 percent of people trying to lose weight suffer from BED and up to 70 percent of patients with BED are medically obese.

The good news is that BED is highly treatable, particularly with the help of cognitive behavioral therapy: Nearly 80 percent of patients abstain from bingeing after 20 sessions. And, unlike most calorie-restricting diets, the success of CBT holds for many patients over time.

The psychology of addiction in BED patients is still being understood, but I remember, when I was in recovery, thinking how much easier it would be if I could go cold turkey on food. Unfortunately, bingers need their drug to live—which is why they need help modulating the way they think about it and use it. “Imagine telling a coke addict to take three large doses and then two smaller doses per day,” says Tyson—Rivera’s therapist from Texas. “‘Don’t take too much and don’t take too little.’ That is not willpower; that’s torture.”

No diet or exercise plan can fix the disorder: BED lives in the brain. “There does seem to be a difference in the brain of someone with binge eating disorder compared to someone who doesn’t have it,” says Jillian Lampert, the chief strategy officer at the Emily Program, a eating disorder affiliate of the University of Minnesota that provides residential and outpatient care. “They’re interested in food in a different way. If food is very interesting, you’re likely to want more. But then it doesn’t deliver on its promise, so we go back and eat more, because we didn’t get it right. It breeds this cycle where people overeat and feel compelled to overeat. They’re looking for the reward.” The way Lampert explains treatment to her patients is, “Your brain is wired a little differently from some people’s. It’s neither good nor bad, it just is. We can help you to have an owner’s manual and say ‘I remember on page 57 when I’m around this certain set of foods and I’m stressed out, it’s harder for me to make decisions around eating.’”

In therapy, Meginness worked on a strategy called “catching your thoughts,” he says. “When you have a thought, those are just thoughts. It’s what you do after that helps makes those decisions. I can treat it as the truth or treat it as the lie. Am I that hungry? No, I ate, I’m fulfilled. I don’t need to act on that, I can throw [that thought] out and move on.”

In therapy Meginness also addressed the difficulties in his marriage. “I had to prepare myself that when I was released, my wife might not stay with me and the kids. Could I accept that, and continue with recovery? It was really tough. [Friedman] was like, ‘You need to make the choice: Are you going to do this for yourself whether or not you go home to a family?’” Once he decided to pursue treatment no matter what, his wife recognized that he was choosing to treat his disorder. “Actually now we’re in a thriving marriage.”

Body acceptance is also a major part of BED treatment, says Lampert, especially in a culture that prizes the big reveal of “Half Their Size!” features in magazines. Her patients often say, “I don’t feel like I’ll ever be enough, so what’s the point.” But Lampert says, “You can accept your body and delight in what it does while you work on making it feel better. ‘I can take care of myself today: I don’t have to wait until I lose weight.’ Those small wins can accumulate into a mastery of ‘I can do this.’”

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