Chewing and Spitting Eating Disorder

chewing and spitting eating disorder

New Kid on the Eating Disorder Block

Chewing up food and then spitting it out seems like a good deal if you are worried about your weight. In theory, you get to enjoy the taste of highly palatable (sweet, salty, fatty and carby) foods without suffering the consequences of over-eating or eating junk food. That is the theory, but not the reality. You can still gain weight and suffer the consequences of eating polluted food, without actually swallowing it.

This relatively new phenomenon is gaining momentum among those who already have an eating disorder and among those who do not, but may end up with one if they continue the behavior. The question is whether chewing and spitting is a form or bingeing, restricting or purging or all three. It is similar to bingeing because it involves larger than intended quantities of high-calorie foods. It also shares elements of restrictive eating because the food is not actually consumed. Finally, it is a form of purging as the individual “gets rid of the food” and in theory escapes weight gain. The problem is that professionals are having a devil of a time classifying it.

Chewing and Spitting in the DSM-5

The diagnostic and statistical manual (DSM-5) initially characterized chewing and spitting as an alternative to purging. Therefore, the behavior was primarily studied in individuals with bulimia. Before that it was listed as a potential symptom of eating disorder not otherwise specified (EDNOS). The diagnosis of EDNOS was recently replaced with the category of other specified feeding and eating disorder(OSFED.) Currently, the DSM-5 does not list chewing and spitting under any single disorder because the behavior may occur across other eating disorder diagnoses including patients diagnosed with anorexia nervosa, bulimia nervosa, or other specified eating disorders.

Causes

Over the years I have resisted the urge to classify the causes of eating disorders as I have found that they come in all sizes and shapes (no pun intended) and for a plethora of reasons. Today, for example, we are seeing COVID-ED, or eating disorders that began indirectly because of COVID-19. That said, a preoccupation with body image and a desire for control are commonly associated with eating disorders, like chewing and spitting. The chewing and spitting, which is a fairly recent phenomenon, appears to have arisen as a way of cheating the system, much like purging was intended to do. The specific “cause” is a fear of gaining weight and/or a desire to lose weight while still enjoying foods that the individual is often addicted to eating.

Backfire

Unfortunately, just as those who purge eventually realize that they are not preventing weight gain, so too do those who chew and spit (C&S). Most bulimics as well as C&S’ers are often slightly overweight. There is a reason for that, the body does not react well to purging and in an effort to counteract the purging changes the metabolic processes in order to protect the body by holding on to the calories. What a kick in the butt for the bulimic or bulimarexic individual. Same for the C&S group.

What Are The Medical Consequences

While it might seem like a relatively benign habit when compared to other disordered behaviors like vomiting, the physical consequences of chewing and spitting can be serious. Some of the health effects of chewing and spitting include:

  • Dental problems: Cavities and gum disease result when teeth are exposed to frequent contact with sugary foods.
  • Stomach issues: The production of stomach acid is triggered by chewing but then no food is made available for digestion. This could potentially lead to ulcers or acid reflux.
  • Weight gain: This is a surprising side-effect of chewing and spitting behavior which researchers are baffled to explain. 

My theory is that because chewing is the first stage of digestion, and one which raises blood sugar levels, what happens after is not of consequence.  In other words, as soon as you begin chewing saliva is released.  It is the first digestive enzyme.  That raises your blood sugar levels and that is all it takes to store fat.  That’s right, you do not have to swallow the food, higher blood sugar causes the storage of fat.

Saliva contains special enzymes that help digest the starches in your food. An enzyme called amylase breaks down starches (complex carbohydrates) into sugars, which your body can more easily absorb and store as fat and lipase which breaks down fats. 

During digestion, insulin stimulates muscle, fat, and liver cells to absorb glucose. The cells either use this glucose for energy or convert it into fat for long-term storage. (1)


When I explain to my patients who chew and spit that they are going to gain weight, they usually can stop on the dime.  The whole point was to enjoy highly palatable foods without gaining weight and when they realize that that is not going to happen it is a no-brainer for most of them.  I just had a patient who stopped spitting a month ago after I explained this to her, and she said that it was like a light bulb going on in her head.  Since she stopped, she has lost 1 to 2 pounds a week.  

Diagnosis and Treatment 

Make no mistake, C&S is an eating disorder no matter how we classify it, and it has significant implications for your health.  It interferes with metabolism, raises blood sugar levels, and results in weight gain. It is very important to seek psychological and if necessary medical help.

Advice for Family Members 

Because C&S is often a symptom of other forms of eating disorder, it is important to act and get your loved one help.

References
1.  Medical News Today, What to know about insulin and weight gain, May 2019


Dr. Renae Norton specializes in the treatment of eating disorders. Located in Cincinnati, Ohio. Call 513-205-6543 to schedule an appointment or fill out our online contact form for someone to call you to discuss your concerns. Tele-therapy sessions available. Individual and family sessions also available.

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Materials contained on this site are made available solely for educational purposes and as part of an effort to raise general awareness of the psychological treatments available to individuals with health issues. These materials are not intended to be, and are not a substitute for, direct professional medical or psychological care based on your individual condition and circumstances.  Dr. J. Renae Norton does not diagnose or treat medical conditions. While this site may contain descriptions of pharmacological, psychiatric and psychological treatments, such descriptions and any related materials should not be used to diagnose or treat a mental health problem without consulting a qualified mental health care provider.  You are advised to consult your medical health provider about your personal questions or concerns.