The day after she graduated college in May 2011, Monaco stepped on the scale for the first time in years.
Her legs trembled when she saw the number: 240. She had gained more than 100 pounds in two years. She sat down at the kitchen table with her mom, and together they cried.
A new balance
Until DSM-5 -- the latest version of the psychiatric diagnostic manual -- was released this month, binge eating wasn't an official eating disorder. Many who have it simply think they are gluttons who lack self-control, says Marsha Hudnall, a registered dietitian and co-owner of the Green Mountain weight loss retreat in Vermont.
The disorder is characterized by frequent episodes of overeating in a short periods of time. People with the disorder feel out of control during binges and are often disgusted with themselves afterward. The usually eat alone because they're uncomfortable consuming so much in front of others.
It's estimated that 3.5% of women and 2% of men in the United States have the disorder, but Hudnall says experts believe it's "extremely underdiagnosed."
Doctors used treat the disorder by putting patients on a diet. They now know "that is absolutely the wrong thing to do," Hudnall said.
"Many people who have binge-eating disorder, they're eating food to cope with their feelings. If you try to take away food without giving them something else to cope, you're stranding that person. And you make them feel guilty when they go back to the one strategy they know."
Monaco went to Green Mountain in the summer of 2011. She chose the retreat because it focused on helping women have a healthy relationship with food rather than focusing solely on losing weight.
The first priority at the retreat, Hudnall says, is to get patients to eat regular, small meals that are based on the government's MyPlate guidelines. Many people who binge go long periods of time in between without eating to try to save calories, which can lead to more binge eating later on.
The next step is therapy, where the patients learn other strategies for coping with their emotions.
For Monaco, that meant writing. She purged her emotions into a journal and tried to forgive herself for using food to cope. She bonded with other women at the retreat who were all just "trying to get to a happy place."
"For the first time, I was not alone," she remembered. "I was not sitting alone in my car or in room somewhere or in a bathroom stall, eating. ... This place really acknowledged that we're all real people with real problems."
Four weeks later, Monaco left with a better understanding of her disorder. She knew that she couldn't go back to the same environment that had led her to this pain, so she packed up and moved cross-country to live near her brother in California.
A happy place
Monaco hasn't had a binge in two years. Since leaving Green Mountain, she's lost 70 pounds.
She lives with her new boyfriend and another roommate, a significant step in her recovery. She no longer feels the urge to eat mass quantities of pasta; food is fun now, though she still struggles with certain types. Pizza, for instance, scares her, since it was a binge eating trigger.
"It's kind of like seeing an ex-boyfriend and not being sure how to handle that situation," she explained. "I get a whole slew of emotions that run through my body: I want to devour you. I need to stay away from you. I want you in my life."
She keeps healthy snacks like baby carrots and cottage cheese on hand but allows herself gummy bears when she wants them. She's back at the gym but has made it into an activity she does with her boyfriend rather than an obsession.
Monaco is also writing for Green Mountain's blog, FitWoman.com, in hopes of reaching out to other women who are struggling.
"My goal is to just feel better," she said. "I'm hoping that with this story and with my blog ... I'm hoping that what I've gone through is really going to make a difference in somebody else's life."
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