Regina Bartlett froze when she added the numbers on the piece of paper. They represented the calories she’d consumed that day in the form of pints of Ben & Jerry’s ice cream, dozens of chocolate chip cookies, peanut butter cups, entire pizzas. The total was 38,000.

Bartlett, who is 5 feet 5 inches tall and weighed more than 360 pounds, can recall gaining 125 pounds in a month and a half, eating like that.

“There was twice in my life when I couldn’t be weighed on a scale at all because the scale in the office didn’t get as high as I was,” Bartlett said.

It all started, she said, with an accident 35 years ago, right before Bartlett’s 10^th birthday, when she jumped off a dock and was sucked underwater by currents. In a few seconds, she was pulled from under the dock to the other side of  Wood River, with just a bump in the head, but the sense of helplessness left her with a serious psychological trauma. “I was absolutely terrified, I can still see that scene under water even today,” Bartlett said. Ever since, she has found food a source of comfort.

Bartlett is one of the nearly 30 million Americans who will suffer from eating disorders in their lifetime, according to the National Eating Disorder Association (NEDA). But disordered eating is the manifestation of a deeper mental health issue that has been widely misunderstood by both patients and non-patients, said Michael Devlin, a psychiatrist from Columbia University College of Physicians and Surgeons.

The eating disorder Bartlett had, now classified as binge eating disorder (BED), was first diagnosed in 1999, when it fell into the more general category of “eating disorder not otherwise specified” (EDNOS). According to the National Association of Anorexia Nervosa (ANAD), more than six million American adults suffer from BED in their life time.

Regina Barlett weighed more than 400 pounds in July 2014. She was 250 pounds lighter in Nov. 2017. Photo: Courtesy of Regina Bartlett.

Bartlett blamed herself for her obesity and eating problems. Fearing that she might die young of a sudden heart attack like her grandmother, who had a similar build, Bartlett  tried numerous diets, including three medically supervised diets and a large number of fad diets.

Binging and obesity can be the result of factors beyond anyone’s control, but people, including patients, still tend to think of them as problems of will power or bad choices, Devlin said. “I think the only thing worse than being blamed by society for this problem you have is blaming yourself, buying into that,” he said.

Bartlett was born with microcytic anemia, where the red blood cells are smaller than normal, and she knew the risks of trying many restrictive diets that don’t give her enough vitamins. But from 2001 to 2006, the eagerness to lose weight overpowered everything else.

“I was never fine, I never felt well, I was always tired, everyday thing was so hard when you are carrying that kind of weight,” Bartlett said. “What I wanted was to go to bed 400 pounds and wake up 150 pounds.”

Bartlett also tried the grapefruit diet for a month, where she ate nothing but grapefruit and vitamins. She recalled nearly passing out four times at work.

Bartlett gained back more weight than she lost after almost every diet—for Optifast, a medically supervised liquid diet, she lost more than 100 pounds, only to gain more than 125 pounds back, and for Ideal Protein, a diet high in protein and very low in carbohydrates, those numbers were 75 and 125 pounds.

“The most important thing about a regimen that you use to lose weight is that it has to be one that you don’t mind doing indefinitely. There are many people who have rigorously dropped weight and find that when they regain, they regain to their previous weight, plus,” said Laura Maudene Nelson, a nutritionist at the Columbia University Institute of Human Nutrition.

This can be due to physiological signals the body sends to the brain that encourage people to eat more when fat cells are being depleted, Nelson explained. Another reason for the post-diet gain is the significantly lowered resting energy expenditure—the energy the body consumes when a person is doing nothing—after rapid weight loss.

But a long-term diet was exactly what Bartlett couldn’t do, because she was using binges as a way to regulate her emotions. Whenever she felt anxious, sad, or angry, she would eat to excess. “I would get mad at you but I wouldn’t show it, but man, I would eat the hell of out of that ice cream,” she said.

“In the short run, food is very effective in making someone feel better or distracting their attention, masking what the problem really is,” said Andrea Vazzana, a psychiatrist from NYU Langone Medical Center. Depression, anxiety, low self-esteem and perfectionism have been shown to correlate with eating disorders, but the causal relationship remains unclear, Vazzana added.

Bartlett started looking into the vicious cycle of dieting and binging after reading a book on disordered eating in 2013, and realized that the fundamental issue was emotional — and that her feelings about her body were part of it.  “Everything I tried to do was because I hated my body. I considered it a beast that I prayed everyday was not what it was. Now I take care of my body because I love it,” she said.

But Bartlett can only physically do so much to change—people who engage in regular binges are less able to detect when they are full or hungry, meaning they often have less control over the amount of food they eat, said Vazzana. After extensive research, Bartlett decided to have a gastric bypass surgery, where a patient’s stomach is made much smaller and food bypasses parts of the small intestine.

Four years after the 2014 surgery, living with the attitude of “I eat well because I deserve it,” Bartlett now weighs 175 pounds and works at the Ocean Community YMCA. She has been sharing her experience of losing weight on Facebook and her own website for a few months and has given a talk at TEDxNewport.

Yiwei Xu