I can't find any non-evasive answers to this question on the internet. Does it actually work or not? Can you just eat a bunch of food and throw it up afterwards and lose weight that way?

Update/Note: I'm specifically asking if you can satiate yourself that way. I realize you will not receive the calories that you expel.

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nim

Nov 06, 2023

70

From having lurked in eating disorder communities where people share photos, I can anecdotally tell you that self-professed bulimics tend on the whole to appear to have substantially more body fat (often even obesity) compared to self-professed anorexics. This could be in part due to the comorbidity of bulimia and binge eating without purging, in people for whom it's predominantly a mental health issue. Of course there's also some sampling bias with who shares their images and measurements, but from what's available, there does seem to be a trend.

If satiety is the primary goal, you can get the same effects with less of the permanent destruction of the oropharynx by consuming high-fiber, low-caloric-density foods. /r/volumeeating on Reddit has plenty of recipes in that vein.

[-]lc6mo20

I can anecdotally tell you that self-professed bulimics tend on the whole to appear to have substantially more body fat (often even obesity) compared to self-professed anorexics

Eh, why would this be surprising? Aren't anorexics defined by their being extremely skinny?

[-]nim6mo102

It wasn't meant to be entirely surprising? Just to contrast the apparent effects of decreased caloric intake vs binge/purge behaviors.

Extreme skinniness is a result of long-term and consistent anorexic behavior. However, if a larger person starts acting anorexic (ie significantly and intentionally undereating), they may encounter health problems from malnutrition, electrolyte imbalances, etc before becoming clinically underweight.

5CronoDAS5mo
You can even have clinically significant symptoms of starvation while obese. http://web.archive.org/web/20230131185217/https://www.nytimes.com/2022/10/18/magazine/anorexia-obesity-eating-disorder.html
3Shankar Sivarajan6mo
I think anorexics are typically defined more by a (pathological) fear of being fat. In practice, of course, that results in them being extremely skinny. I don't think that fact was meant to be surprising, but rather just to point out that not eating in the first place (or exercising intensely to burn off whatever you ate), like anorexics, seems to work better (well, "better") than the bulimics' "binge and purge" approach.

AlphaAndOmega

Nov 06, 2023

72

I'm a doctor, though I haven't had the ?good fortune to treat many bulemics. It's thankfully rarer here in India than in the West, even if I agree with Scott's theory that it's largely social contagion, it's only slowly taking root.

To put it as succinctly as possible, yes, though that's orthogonal to whether or not it's a good idea.

I can't see where the question even arises really, if you're eating a relatively normal amount of food yet vomiting it back up, you're clearly not getting most of the calories, especially since bulemics try and purge themselves as soon as they can instead of timing things.

Weight loss is obviously a sign of bulemia in clinical practise, most of them have a distorted self image/dysmorphia where despite being quite slim or even thin compared to their peers, they perceive themselves as overweight or at least desire further weight loss.

Regular self-induced vomiting has plenty of downsides, including the erosion of teeth enamel from repeated exposure to stomach acids, dyselectrolytemias from both loss of gastric fluids as well as an improper diet, and finally the cardiac strain from a grossly insufficient intake of calories.

If they're within a normal-ish weight range, we usually refer them for therapy or other psychiatric services, but if they drop down to a very low BMI they often need to be admitted for supervised care.

CICO (accounting for absorption) is trivially true, even if our biology makes adhering to it difficult, and I for one am very glad that Ozempic and other GLP-1 agonists are on the market for obesity, not that the typical bulemic should take them for the purposes of losing weight.

TLDR: Yes, and it works too well, hence the associated health risks.

I wonder if the acid blockers (such as Prilosec) used to treat reflux would reduce the physical damage caused by repeated vomiting. Still sounds like a bad idea overall though.

[-]lc6mo10

What I meant was more "does eating a lot of food and throwing it back up satiate you? Is it an effective weight loss technique, setting aside side effects?"

Yes to that too, but the satiety is temporary, you will get ravenously hungry soon enough, and while I can accuse bulemics of many things, a lack of willpower isn't one of them!

In the hypothetical where you, despite lacking the all consuming desire to lose weight they usually possess, manage to emulate them, I expect you'd lose weight too.

jimrandomh

Nov 12, 2023

42

Short answer: No, and trying this does significant damage to people's health.

The prototypical bulimic goes through a cycle where they severely undereat overall, then occasionally experience (what feels from the inside like) a willpower failure which causes them to "binge", eating an enormous amount in a short time. They're then in a state where, if they let digestion run its course, they'd be sick from the excess; so they make themselves vomit, to prevent that.

I believe the "binge" state is actually hypoglycemia (aka low blood sugar), because (as a T1 diabetic), I've experienced it. Most people who talk about blood sugar in relation to appetite have never experienced blood sugar low enough to be actually dangerous; it's very distinctive, and it includes an overpowering compulsion to eat. It also can't be resolved faster than 15 minutes, because eating doesn't raise blood sugar, digesting raises blood sugar; that can lead to consuming thousands of calories of carbs at once (which would be fine if spaced out a little, but is harmful if concentrated into such a narrow time window).

The other important thing about hypoglycemia is that being hypoglycemic is proof that someone's fat cells aren't providing enough energy withdrawals to survive. The binge-eating behavior is a biological safeguard that prevents people from starving themself so much that they literally die.

cobaltcarminechromium

Nov 06, 2023

10

Technically yes, but in practice-probably not. 

It is often said that purging 'doesn't work' in the sense that it doesn't "get rid of the calories" and create a deficit. This doesn't seem necessarily true. 

The logical answer seems to be that if the food isn't fully digested before being purged, the calories aren't retained. This seems to be supported by this University of Pittsburgh study:

https://www.researchgate.net/publication/14705396_Amount_of_calories_retained_after_binge_eating_and_vomiting  

-"In 17 normal weight bulimic patients, there appeared to be a ceiling on the number of calories retained after vomiting. That is, whether or not bulimic patients had small (mean = 1,549 kcal, SD = 505) or large (mean = 3,530 kcal, SD = 438) binges, they retained similar amounts of kilocalories (mean = 1,128, SD = 497, versus mean = 1,209, SD = 574, respectively) after vomiting."

It is suggested that bulimics cannot completely empty their stomachs of the food, so some of it is absorbed, but it is true that some (perhaps most) of it is lost by the act of vomiting. 

Whether this actually satiates you long enough to create a calorie deficit is a different question. Dehydration from vomiting and saliva overproduction as well as a suddenly empty stomach may mean you are hungry again unexpectedly quickly, and any calories lost by the act of purging would just be negated by the urge to replace those calories. Even if binging and purging was done repeatedly in a day, some calories are retained through each cycle so the TDEE could easily be met or surpassed. 

Obviously the negative health effects of self inducing vomiting (markedly heart damage and raised cancer risk, lack of nutrient/vitamin absorption) far outweigh any possible benefit. 


 


 

Iknownothing

Nov 06, 2023

-2-4

Probably much better for health overall to have a bowl of veg and fruit at your table for easy healthy snacking (carrots, cucumber, etc)

6 comments, sorted by Click to highlight new comments since: Today at 2:38 AM

To add some perspective : I suspect some people don't really understand how large the caloric intake can be in boulemia. I routinely see patients eating upwards of 50 000 calories (even saw 100 000 a few times) per day when crisis occur. Things like eating several large peanut butter jars in a row etc

[-]lc6mo53

Jesus. I guess I had a rosier view of the condition. I thought bulemics might binge on the order of, like, two big macs and a fries or something, like normal people.

Na. Although you can see patient having binge that you then understand were just one bigmac, indicating something closer to anorexia.

The suicide rate is about 2% per 10 year which is insanely high. Also it is not uncommon for people with bulemia to have (sometimes severe) deficiencies regardless of their weight.

It might be worth making explicit what you're comparing it to, which is probably eating less in the first place. I.e., your question should be, "Can you sate your hunger by eating a lot, and then 'cheat' by throwing up quickly?"

[-]lc6mo20

Yeah, that's my actual question

In my experience the best way to sate hunger is to have multiple gallon jugs of water lying around and drinking too much water when you feel hungry. I know this is a little off topic, but it's likely a better solution than bulimia.

I have a family member who used to vomit daily. I never noticed any negative effects on him from it, apart from the rapid weight loss; which I guess is the point. I guess the general disgust other people felt around him when he went off to go throw up was a pretty negative effect. Also his weight loss looked unhealthy. He had twig arms, still had a lot of stomach fat, and was generally much more irritable than usual.