Why are people up in arms about binge eating disorder?

Where do you draw the line between “binging” on Oreos every once in a while and harboring a real disorder? Many people are likely asking themselves that question right now, thanks to a controversial new advertising blitz.

“Binge eating disorder” is the most common eating disorder in America—affecting more people than anorexia or bulimia—but you’d probably never heard of it until recently. Psychiatrists didn’t even officially recognize it as a disorder until 2013. Suddenly, though, it’s everywhere.

Last month, the drug company Shire launched a clever campaign to raise awareness about the disease—and in the process, advertise the hell out of a new drug its selling to treat it. The company even enlisted tennis legend and binge-eating-disorder survivor Monica Seles (who knew?) as its spokesperson.

More awareness is a good thing, but the drug, Vyvanse, is sparking serious backlash since it’s an amphetamine, which is notoriously addiction forming. Here’s what to know about the misunderstood disorder and the controversy swirling around it:

What is binge eating disorder?

Binge eating disorder, also known as B.E.D., affects 3.5 percent of adult women and 2 percent of men, according to the U.S. Department of Health and Human Services, making it the most common eating disorder in America.

The disorder was first defined by psychiatrist Albert Stunkard back in 1959 in the journal Psychiatric Quarterly. However, it didn’t earn a spot in the Diagnostic and Statistical Manual of Mental Disorders until 2013. Its inclusion in the DSM—the bible of psychiatric disorders—and the press it got at the time marked the first step in making it a household name.

Here’s are the most common symptoms of binge eating disorder, according to the HHS. Note that, unlike with bulimia, people with the disorder do not purge after bingeing.

• Regularly eating a large amount of food, nearly uncontrollably, within a short period if time.
• Eating when full, or eating so much one that feels uncomfortably full.
• Experiencing feelings of shame and guilt during periods of uncontrollable eating.

What causes binge eating disorder?

As with most eating disorders, the causes behind binge eating disorder vary from person to person—it’s triggered by a mix of genetic, psychological, emotional, and social factors. It is also associated with anxiety and depression, according to the HHS.

Why has it been making headlines?

The pharmaceutical company Shire recently got FDA approval to sell the drug Vyvanse—originally created to treat ADHD—as a treatment for binge eating disorder. The company has since begun to run ads to spread awareness, in hopes that people will seek out its drug.

The problem is that Vyvanse is an amphetamine, a class of drugs that carry a high risk of abuse and addiction along with potentially dangerous side effects. Last week, The New York Times questioned why the FDA approved the drug as a treatment for binge eating disorder so swiftly. A spokesperson for the FDA told the paper that, since Vyvanse was already deemed safe for ADHD and no other drug existed to treat the disorder, it got priority approval.

The approval has raised particular concern within the medical community, since amphetamines have been used to treat obesity before (they suppress appetite), and the results were disastrous. You might remember hearing about the crash and burn of Fen-Phen in the 90s. The “phen” in Fen-Phen stood for phentermine, a type of amphetamine. The FDA approved the weight-loss drug, then quickly discovered it caused terrible and fatal side effects, including pulmonary hypertension and heart valve problems. Lawsuits were filed and the drug was banned.

Doctors also caution that Shire is behind another highly addictive pharmaceutical drug: Adderall.

How is binge eating disorder treated otherwise?

If you think you might have binge eating disorder, the first step is to reach out to your doctor or a mental health professional. Treatment usually includes counseling, behavior therapy, and if needed, medication such as antidepressants and anticonvulsants (including topiramate, which can also reduce body weight).

During treatment, people with the disorder must also accept that, as with all eating disorders, the illness is chronic and recovery can be a lifelong process, said weight-loss and food addiction specialist Molly Carmel, who runs the eating disorder treatment center Beacon House.

Carmel also told Fusion that understanding the addictive nature of some foods, like sugar, is key. “Studies show that long-standing untreated binge eating disorders progress into substance disorders. So for many struggling with B.E.D., if the sensitivity and/or addiction to sugar is not addressed, it is very hard and almost impossible to put the disease into remission,” she said.

For more information and resources about the disorder and how to get help, visit the websites for the National Eating Disorder Association and Binge Eating Disorder Association.

Taryn Hillin is Fusion’s love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.