Emotional eating

Eating is such a basic need, like breathing. Hungry? Thirsty? Eat and drink. But for some people trauma, illness or medication blurs the way that they relate to food. What should be simple sustenance turns into a dangerous cycle threatening their quality of life, self-esteem and health. Read some of the questions most frequently asked of the Eating Disorders and Obesity Expert, and find answers.

Q: Do I have a bad relationship with food?

I'm 23, female, 1.75m tall and I weigh between 55- 56kgs (it doesn't fluctuate higher or less).  I've been obsessed with food for years but I don't starve or binge.

I feel bad for eating, even if it's just a bowl of cereal. I have an office job but walk for at least an hour a day. I bring as little food to work as possible, but then get hungry at night (I do eat breakfast and my lunch), so sometimes I eat a big meal at night.  I have no control when it comes to treats.  I feel terrible for doing this but then I don't have the energy to exercise some more. Do I have an unhealthy attitude towards food? What can I do about it?

A: In short, I have to say that your short description does paint a rather unhealthy picture. For one thing, you are slightly underweight, and should be weighing closer to 60 kilograms for someone of your height (and age).

Your weight should also fluctuate a little more that one kilogram, especially if you are menstruating regularly. Are you menstruating regularly, as this is an important indication that your body is producing sufficient oestrogen?

 You say that you don’t starve, yet you appear obsessively preoccupied with eating small quantities of food which is an unhealthy sign. Your getting hungry at night might be due to a lack of sufficient calorie intake during the day. This might also be what accounts for your feeling out of control when it comes to treats (which I assume are refined carbohydrates).

I suggest you consider two steps: First, I would advise you to see a registered dietician and have your current eating habits reviewed and probably revised. You should try to eat three equivalently sized meals (breakfast, lunch and evening meal) though the day, with a small snack between each meal and one before bedtime.

Given your questionable attitude to food (and likely your body), I suggest you consider seeing a psychologist, preferably one who has some experience in working with clients who suffer eating disorders. I am not sure whether you live in a large city or whether you come from a smaller town, but Cape Town, Johannesburg, and Durban all have specialists. You can email me for a specialist if you wish. Professional treatment is expensive, so make use of your medical aid if you have one and budget for what you can afford. However, please do something to change your current picture, as it will very unlikely change for the better on its own. I hope this helps.

Q: Food

I have an obsession with food think of it every minute of every day, I am on medication for bi-polar disorder. How do I change my mindset without consulting a dietician – I don't like them? I really pick up weight easily. It used to be the reverse when I trained at the gym. I had obsession with food then too –I just refused to eat it. Now I cannot leave food alone. I need to lose 15kg – I will go to the gym, but I'm just worried about my food thing. I am 27 years old.

A: I assume that you are seeing a psychiatrist for the management of your medication for bipolar disorder. For this, I assume that you are on at least one mood stabiliser. Without mentioning any trade names, some of the anticonvulsants (which are used for mood stability) have an effect in decreasing appetite, and your psychiatrist may want to consider this.

Although I do not, as a rule, condone the use of appetite suppressants, I would condone your choice of bipolar meds be that of one that decreases your appetite over one that may increase it. That aside, you need to consider that part of your bipolar management is looking your "bipolar" relationship with food.

In your question, you mention how you are now constantly obsessed about food, while before you used to refuse it. It seems that your relationship with food even reflects opposites. Are you in therapy, as this needs to be explored?

You also need to look as to why you are so anti dieticians, as having someone guide you sensibly in eating moderately and healthily would be very helpful for you. What have your previous dietetic experiences been that have so soured your opinion about dieticians? With regards to exercise, this also needs to be done moderately. I wish you best in your way forward.

Q:  My 8-year-old is overweight

Please advise the best route to go - my daughter is 8 years old and weighs 57 kg. It's a living nightmare, please help.  Someone said I should give her an appetite suppressant.

A: Please do not follow the advice anyone regarding gimmicks and have your young daughter already fall into the dreadful habit of taking appetite suppressants or trying special diets.

 Although your daughter is likely overweight (you did not provide me with her height), I suggest you first consult a registered dietician yourself and gain some solid and sensible advice on how to provide your daughter with a well-structure, well-balanced and moderated diet with a good balance of food groups.

Your daughter should not feel that she is on a special diet unlike those of her peers, but enjoy good wholesome food and get good moderate exercise. Should she not respond favourably to this intervention, you will then need to consider a medical cause for her elevated weight and consult with an endocrinologist/paediatrician. But, first things first, get her into a balanced, healthy lifestyle. No tricks, no short cuts. No gimmicks! OK?

Q:  Emotional eater

Please help - where do I start? I am 20kg's overweight and an emotional eater.  If I'm sad I eat, if I'm happy I eat. And I never feel full, it's like I'm constantly craving something that I can't put my finger on. The weight has piled on and I'm now considered clinically obese.

What can I do? I hate myself...

A: You appear to have already identified that you eat in response to emotions rather than following "tummy" hunger or appetite.

What is interesting is that you eat on the full spectrum of emotions, whether they are comfortable (happy) or uncomfortable (sad). Most people (and professionals) talk of positive and negative emotions, but I like to think of all emotions as holding a benefit, because they convey a message. For instance, when you are feeling sad, you are likely expressing a loss, or when you are anxious you are likely reflecting a danger that is real or imaginary.

Depression suggests an emptiness, while anger signifies violation of some sort. These are some examples of some uncomfortable feelings, and serve as clues towards bringing about necessary change to a situation. Comfortable feelings like happiness, joy or excitement we hold onto, but are incapable of sustaining.

What you need to do is try and first identify the difference between your different hungers: are you emotionally hungry, in which case you need to listen to the feeling and possibly respond to an uncomfortable feeling by changing something (e.g., responding to danger by protecting yourself) or are you "tummy" hungry, in which case you body needs nourishment and you need to eat your meal or snack.

Try eating a good, regular and moderate diet and you will not be too easily confused between the two. When patients come into treatment, I almost always make use of the dieticians on my team to help them with the design of an individualised meal plan. With that in place, the therapy can focus more easily on identifying emotional hunger and learning how to more healthily deal with, and express feelings.

Q: Binge eating

I used to think that perhaps I am an emotional overeater, but I have realised that I overeat regardless of the emotional state I am in. It's like my brain can't register that I'm full and I will eat till I'm actually nauseous.

I suppose I need to lose about 40kgs (120kg, 1.68m) but I lack the motivation. Sugar, bloodpressure, cholesterol are all normal - FOR NOW!! (bp actually on the low side).  I just enjoy food tremendously and can't see myself eating salads for the rest of my life. Yet I don't want to be the mom that cannot swim with my son because I'm too self-conscious about my body.

I remember when I gave birth that I lost so much of weight in hospital due to the fact that I was getting 3 balanced meals a day and, even though the portions were small, I never felt hungry. Everyone complained about the food but I just loved it - I suppose it was because the choice wasn't left up to me.

I simply cannot afford to go and see a dietician due to financial constraints. Most of our meals consist of mince with some kind of a starch (potatoes/rice/pasta).

A: You seem to realize that there are no particular feelings that trigger your overeating, but it’s nevertheless clear that you do not eat in response to your physical appetite. What you describe, though, sounds more like binge-eating, as you eat quantities that result in you actually feeling nauseous.

Amongst other things, your weight is a serious health concern and you are extremely lucky that you have not yet developed a type II diabetes, or another medical complication associated with your obese state.

It is just a matter of time, for that is inevitable. What I hope, for your sake, is that you do not only respond with a healthy plan of action once you have developed a serious physical complication. You say that you are not in a position to consult with a dietician, but I would suggest you a least post a question with the DietDoc in order to prepare yourself for a shift in eating lifestyle.

You responded well to a sensible plan when in hospital years ago, and you would likely respond favourably again, but you need to act now, before your morbidly obese status devastates you in every arena of your life.

You will certainly not need to (and shouldn’t) eat salads all day long. As I advise continually on this forum, get yourself an individualized, moderated and balanced dietary plan that will help you to lose weight gently. Even at your weight, there are physical exercises you can do to assist in your weight loss and improved physical health.

You get plenty of carbohydrate, but you will need to integrate plenty of protein into your diet as well. Also, try to become more aware of how you are feeling emotionally. Although you say that you overeat on all feelings, I suspect that certain uncomfortable feelings are more provocative than others in leading you to overeating. Perhaps start with keeping a diary of what you eat and how you feel to see if there is any link.

Q: Overweight quadriplegic

I've been an incomplete quad since '99. Although I try my best I cannot seem to lose weight, but I'm slowly gaining. I'm 1,68m (when I measured myself before my accident) and weighing in at a whopping 110kg. I feel like a beached whale stuck in a wheelchair and very aware of myself. Needless to say, my self-esteem has taken a heavy knock and I feel extremely depressed.

I am on anti-depressants, but the fact that I struggle with my weight and not capable of exercising, makes me feel hopeless. I suffer from very high blood pressure due to the weight, but my cholesterol and sugar levels are fine. Do I qualify for any gastric bypass or anything like that? And if so, will my medical aid pay for this? I am female.

A: Thanks for your question. If you still weight 110kg, you almost fall into the morbidly obese weight category, which is the weight minimum requirement to qualify for bariatric surgery.

However, with a Body Mass Index between 35 and 40 (99 kilograms and 112 kilograms for your height), you would still qualify because of your hypertension, a medical complication associated with your weight condition.

If you are looking to qualify for surgery through a Centre of Excellence (which I strongly recommend), then you will also need to qualify on a number of other domains, including your depression being stabilised. It's fine that you are on an antidepressant, provided your mood is relatively stable and your psychological health is good.

If you become a candidate for surgery, your pre-surgical work-up will likely require you to address your mood state associated with your weight condition and life circumstances. Being a quad will not disqualify you. I suggest you go to the Chrysalis Clinic website and ask for Sr. Gill Gibson, the programme coordinator. The website is chrysalisclinic.co.za. If you are not living in Cape Town, Chrysalis Clinic can always recommend you to another reputable centre closer to you.

Q:  Can you help?

I have been following a healthy eating plan, which is a huge achievement for me. But it is not easy, now that I am not bingeing, instead of being happy, I'm sad because I have nothing except an intense, overwhelming, longing for something other than food. When I look at food, I actually feel nauseated (a first for me!) and a fear starts building up inside.

A: Yes, it is a great achievement that you are following your meal plan. Well done on that!

The fact that it leaves you feeling sad is quite normal, as you are no longer pushing your feelings down with food, which has been serving as your "addictive" behaviour.

I suggest that you learn to work creatively with your feelings. As I have mentioned so often in response to other questions before this one, the feeling "sadness" always indicates a loss of some sort. Try to explore what your losses are (other than your eating disorder) and try to resolve such losses. Try to work creatively with all your feelings, both comfortable and uncomfortable.

Be careful to not cross-addict, that is, turn your destructive behaviour across to something like excessive alcolhol or drugs, or even piling yourself under loads of work. Excessive shopping (retail therapy) very often becomes a cross addiction to watch out for. The emptiness in your life that the eating disorder was hiding still needs to be replaced by something healthy. Work creatively towards living a full and healthy lifestyle. Are you in therapy, as this would be helpful in guiding you towards replacing your eating disorder with a new and more meaningful lifestyle?

Q: I eat to cope

What a relief to be able to voice our problems on this forum.

I'm a 59yr old female. I never struggled with my weight until after the birth of 2 multi-handicapped babies. I know I'm an emotional eater - I eat when I'm happy, sad or for any reason in between.

I'm seeing a dietician and a psychologist. I've done a lot of introspection and realized that I am probably still mourning the loss of not having "normal" children. I love our children just as much as I would have loved any normal child, but I probably mourn over lost life expectancies any parent has – I realise that our children will never be in a position to be there for us when we are old, I will never have the privilege of being a grandmother.

Our children's health is deteriorating and it's a huge financial burden to us. I don't feel depressed and function very well, sleep well - I only eat too much. My therapist is so proud of me because I have actually pinpointed my problem on my own.

My problem still remains - although I know what makes me happy or sad, I still need food! How do I shut my mouth? I try to have water first, then get up for coffee and still, the thought of food never leaves me. I eat according to my prescribed plan, and I feel good about it, but nevertheless, it just does not come naturally.

This is taking so much energy and increasing my emotional burden even more. I stick to the eating plan for 5 days and then cheat for 2 days. It's back to the salt mines on Mondays. I feel I'm a complete failure. Is there any hope for me?   

A: I really admire that you have chosen to face your challenges rather than hide away. It is very courageous that you have persisted with therapy and continue seeing a dietician in order to resolve your destructive relationship with food.

Even though you love your children unconditionally, it is very understandable that their handicaps have posed many challenges at so many levels. Yet you have faced those challenges and moved forward. It is now time for you to look to yourself and try to engage in an unconditionally loving and nurturing relationship with yourself.

Instead of focusing on trying to lose weight, try and place the emphasis on establishing and maintaining a moderated, balanced and healthy relationship with food. If you can do that, your emotions might not get diluted by food, but have the opportunity to find more appropriate expression in healthy intimate friendships.

Try starting a daily journal to acknowledge your feelings, and perhaps make a connection between your emotional feelings and your eating habits. Your therapist and dietician might need to collaborate in assisting you here.

My patients always find it helpful to learn that it is easier to focus on establishing a healthy relationship with food, rather than focusing on trying to lose weight. If you eat healthily and maintain a creative and fulfilling lifestyle, losing weight (if it’s appropriate for your body to do so) will be an automatic by-product/side-effect.

Please persist with your professional help, and talk to your therapist about some helpful groups that might be available in your area as an adjunct source of support.

In recovery

"I don't think I really have a question, but I do have a story to tell and I think this is a great forum to do tell it in.

This is all part of my recovery from a 16-year-long battle with anorexia. I'm now 28 years old. I decided (with the help and advice of my psychiatrist) to get the treatment that I so needed since childhood. I went to Crescent Clinic for 21 days and had the most positive experience of my life. It was extremely challenging and there were many tears, but it was worth it.

I was there - desperate, stuck and totally consumed by my eating disorder. It literally took over my life. It stole my friends away from me. In addition, I'd developed other addictions (caffeine, alcohol - been clean a year now, etc.). I have spent so much money on medical expenses, I wish I could take it all back but I can't. I can just try to tell sufferers that they do not need to feel ashamed and that they can get help.

I left the clinic and a week later I was diagnosed with Coeliac Disease (gluten is basically toxic to my body). This is after I became safe and comfortable with my meal plan. I now have to change my lifestyle again because I cannot eat anything with gluten (or lactose because my body cannot break it down anymore as a result of the Coeliac Disease). This is not going to become a way for me to abuse my body. It is not going to become self-detructive. I've learned to become kind to myself.

Although I have two illnesses - anorexia and Coeliac Disease, I am at peace with both. I thank God everyday I am alive. I thank God that I have been blessed with healthy food choices and that I am able to now eat 6 times a day.

If you are suffering from an eating disorder - it's NEVER too late to get help! You're NEVER too deep! I was at the peak of my career, a newly-wed and had no intention of letting this secret out, but I realised it was slowly killing me. It will kill you too. Just take the leap and get help. It will lead to great things - you will actually learn about who you really are and begin to really trust and love yourself again."

If you have any questions, please write in to the Eating Disorders and Obesity expert for professional advice.

Read more:

Psychiatry: drug-food interactions

Obesity, eating disorders and depression

(Joanne Hart, Health24, November 2010)