The following article is from:
Psychotherapy Networker July/August 2010
By Judith Matz
Beyond the Diet Mentality
Empowering clients through attuned eating
Q: Many of my clients struggle with food and weight problems. I've helped them look at the emotional issues behind their overeating, but it doesn't always help. What else can you recommend?
A: When I began treating clients with eating problems, I believed that once they understood the emotional triggers behind their overeating, their compulsion to reach for food would decrease—which in turn would lead to weight loss. Instead, I discovered that, although they could resolve issues around depression, anxiety, relationships, work, and self-esteem, conflicts with food and weight usually remained. In the early 1990s, after witnessing the failure of most diet programs, I learned a nondiet approach to treating compulsive eating, one that has enabled me to intervene directly in the diet-and-binge cycle and help my clients make peace with food, their bodies, and themselves.
In our culture, dieting is seen as the primary way to control eating and feel better about one's body. It's often viewed as a means of self-care—the route to happiness, success, and greater self-esteem. Statistics, however, tell us that diets don't work in the long run. Virtually every diet leads to short-term weight loss, but research shows that 95 to 98 percent of dieters will gain back the lost pounds, and about 66 percent of those people will end up heavier than they were before they started dieting. People who diet are eight times as likely to develop an eating disorder, are at higher risk for disease as the result of weight cycling, and have higher rates of depression and lower self-esteem. Thus, while dieting may seem like good self-care, it's actually hazardous to our clients' physical and mental well-being.
The Root Causes of Overeating
According to the nondiet philosophy, the major causes of overeating are deprivation caused by diets and the use of food to manage feelings. When a new client comes to me, she'll often be aware that there's an emotional aspect to her overeating. Most of my clients express deep concern over the weight gain that accompanies their overeating. Most are eager to figure out how to control their food intake. I start by helping them understand how they're translating the language of feelings to the language of food and fat. I explain that, even though it may seem that they're eating because they feel sad, angry, lonely, bored, or even happy, it isn't actually the feeling itself that leads to the desire to eat. Rather, it's the inability to sit with a feeling that triggers the need to reach for food.
Take the case of Julia, who's had a difficult day at work. Her boss just gave her a new assignment, which requires a large commitment of time. She already feels overwhelmed by the work that several other people in the office have asked her to do. However, she doesn't want to undermine her chances for promotion, so she agrees to take the project on.
When Julia arrives home, she heads straight for the kitchen. She eats a bag of potato chips, followed by half a box of cookies. As she eats, she begins to reprimand herself. "You slob! Your stomach is getting so big, and here you are out of control again. No wonder your pants are too tight! No wonder everyone treats you so badly! Look how you treat yourself. You're too fat, and you have to do something about it now! You'd better go back on your diet and get this under control."
Julia has just made a translation from the language of feelings to the language of food and fat. When her boss gave her a new assignment, she felt angry. She believed she was being treated unfairly, but she was unable to speak up for herself. However, it wasn't her anger that led to her overeating: it was her inability to tolerate the anger. Reaching for food at that moment was an attempt to calm herself, because her anger was unacceptable to her. She may have had a clue that she was upset, but she couldn't handle her emotions. Or like other compulsive eaters, she may have found herself eating, but had no idea what was bothering her, or even that something was bothering her.
As I discuss with my clients the process of avoiding feelings through food, I urge them to become compassionate with themselves. When they reach for food to manage feelings, they're trying to help themselves in a time of distress—which is a positive action. Nevertheless, it's the wrong solution to their difficulties, just as rubbing ice cream on a cut knee would be. As they stop castigating themselves, they find that the bingeing decreases. They learn to say to themselves instead, "I'm reaching for food, and I'm not hungry. Something must be bothering me right now, and this is the best way I have to deal with it. I look forward to the day when I no longer need to do that."
Learning Attuned Eating
The next step is for clients to learn how to normalize their eating—a step that must take place for them to be able to end their emotional reliance on food. First, they must stop dieting, since the deprivation caused by eliminating or restricting foods only increases overeating. I'll ask my clients to consider the following question: if you were told that, starting tomorrow, you could no longer eat ice cream, what would you do today? Clients typically say that they'd eat a lot of ice cream today, whether they were hungry for it or not. I encourage them to get rid of the notions of "good" and "bad" foods—a daunting task in our culture!—and learn instead to become attuned eaters.
Attuned eating (also called intuitive, mindful, and normal eating) teaches clients to listen to their internal cues for hunger and satiation. By honoring their hunger, clients become able to "match" what food would feel just right in their bodies at a particular moment. They notice that they're just as off base if they eat a salad when they crave a cookie as they are when they eat a cookie when they're actually hungry for a salad. In this way, they realize that their bodies need a wide variety of foods. They discover that when they eat exactly what they're hungry for when they're hungry, they feel satisfied. This feeling of satisfaction ultimately allows them to stop when they're full.
In using this approach, I make sure that clients understand that this is a process that will take time. The goal isn't to control their eating by deciding that they can now eat only when physically hungry; I explain to them that if they could do that just by hearing these ideas, they wouldn't be compulsive eaters. Rather, their objective is to pay attention to the difference between physical (stomach) hunger and psychological (mouth) hunger.
As clients begin to collect stomach-hunger experiences—eating when hungry, eating exactly what they're hungry for, and stopping when full—they find that this way of eating is much more satisfying, both physically and psychologically, than eating what they "should" eat in response to external rules and then breaking out of all the restraints. They develop a consistent framework for eating what strengthens their internal selves and places them in a strong position to experience feelings that make them uncomfortable. In fact, it's only when clients find that most of their eating is now out of physiological hunger, that they no longer have "forbidden" foods to reprimand themselves about, and that much of their negative dialog about food has been replaced by compassion that they're in a strong position to end their reliance on food to manage emotions.
I help my clients identify what's really bothering them by encouraging them to ask the following question when they notice mouth hunger: "I'm reaching for food, and I'm not physically hungry. I wonder what I might think about or feel if I didn't eat right now." Clients will eventually find that when they try to turn to food for comfort, it no longer works! I refer to this moment as "the good news and the bad news." While my clients no longer eat compulsively, they must deal directly with their issues instead. But, of course, this is really a wonderful step, since clients now feel they're in charge of their eating and can face their real problems. I emphasize that when weight loss occurs, it's a side effect of their new relationship with food and not the main event. I spend time teaching my clients about positive body image and size diversity: that people naturally come in different shapes and sizes. I find it helpful to remind them that even if we all ate the same things and maintained the same exercise program, we wouldn't weigh the same amount.
As clients discover how to cure compulsive eating, rather than control it, they take the first steps along the way to physical, emotional, and spiritual well-being. Energy freed up from a preoccupation with food and weight can be channeled into more productive endeavors, including relationships, work, hobbies, and good self-care. Learning to tune in to needs related to physical hunger leads to an ability to recognize and respond to other kinds of psychological hungers. Taking pleasure in food and one's body leads to a fuller, more satisfying life. These benefits will empower your clients, and they may empower you.