Obesity has reached epidemic proportions with 3.8 million people weighing over 300 lbs. and approximately 65% of Americans are overweight. Childhood obesity has more than tripled in two decades. The average adult female weighs 163lbs. The Center for Disease Control reports that in 2006 only four states had a prevalence of obesity less than 20%. One in four children is overweight.
Clearly the statistics indicate a dramatic increase in obesity in the United States, but the trend is true for all developed countries. The causes of obesity are many—some complex and others simple, such as, living sedentary lifestyles.
Jessica struggled with her weight for more than two decades. At times, she had felt in control but for the most part she experienced her eating and weight problem as controlling her. She describes her struggle: “I gained weight as an adolescent. I was very unhappy as a teen. I felt unattractive and unloved and unwanted. The food was a way of making me feel better. I didn’t worry about the eating because I figured I could lose the weight when I wanted and I was very successful at it. As a teen ager I could lose 10lbs in a week but the ease of losing weight gave me permission to eat whatever I wanted. The day came that I couldn’t lose it so quickly. My weight went up and down for a long time and then the general trend was that my weight increased over time. I had phases when I lost weight, but it was a struggle not to put the weight back on. I would re-gain the weight I lost plus add a few pounds. As I experienced the increased weight after a successful round of dieting I became even more restrictive and crazy about my weight loss schemes. I would spend a day or two not eating at all and then decide I would eat only cabbage soup for a few days. This is an example of the wild schemes I would concoct to control my weight. Now I am totally out of control. I am about 86 pounds overweight and I feel completely helpless to do anything about it. The more I try to control the more I want to eat. The more problems I face and the more stressed I feel, the more I eat. Actually most things end up with: ‘the more I eat’ .”
Jessica is typical in that her desire to lose weight is often accompanied by an extreme diet. Sometimes the unusual eating patterns include taking diuretics, laxatives, an assortment of OTC diet pills, but almost always includes an odd concoction of foods or an extreme restriction.
Mark was in the same position as Jessica. He felt out of control with his weight and was seeking to have bariatric surgery to lose weight. He reports that he has multiple health problems that include hypertension, diabetes and knee joint pain. He works as an accountant and his work is highly stressful but is also very sedentary. He describes his eating habits: “I eat at my desk on most days. I have several snack foods that are my favorites, such as chips, cookies and chocolate. I like to munch while I work. As a consequence I never take time out for a meal because I’m not hungry. I seldom sit down to a full meal unless my wife forces one on me. I think I am not eating that much, but I keep gaining weight. I weigh 295. It’s the highest weight that I have been in my life. I want to diet and exercise but I don’t see how I can. I don’t have enough time to have a normal meal. I don’t have time to exercise except some time on the weekends, but, when I try to exercise my knees bother me, so I give up. I feel the only way I can do anything about this problem is if I have surgery. Once I have the surgery then I don’t have a choice, then I have to change my behavior.”
Jessica has behavioral and emotional issues that have played a part in her disrupted eating patterns. She has lost touch with the real purpose of eating which is to nourish her body with the nutrients it needs to function properly. She has become weight obsessed. Mark is overworked and overstressed and has used food as a means of managing his subjective experience of stress. He is unaware how he is actually adding to his stress by relying on the momentary pleasure of snacking. The stress is increasing exponentially as he gains more weight and changes his physiology that makes him even more inclined to store fat.
Kate has a problem that stems from childhood. She experienced her mother as a controlling person. They had struggles over many issues including what to eat and how much to weigh. Kate’s mother was very thin and very preoccupied with her weight, food and body image. Kate was always overweight since early childhood. Her mother would try to control her food intake and Kate craved sweets as many children do. Her mother would force her to sit for long hours to consume her vegetables and if she saw her daughter with sweets she would take them from her. Kate had decided that when she was able, she would access all the sweets she wanted. As a preteen her weight was within 10 lbs of normal but by the time she was 14 she was 50 lbs overweight. Her mother was exasperated with her and tried to get her to lose weight. This became a constant battle between them on a daily basis. The more her mother tried to exercise control over her food intake, the more Kate ate the foods that were “forbidden”.
Kate discusses her issues regarding food in her consultation. “I think my eating problem started in childhood. I had a healthy appetite. My mother may have had one too but she was in a constant state of control over her food choices. She was very particular about what she ate and she tried to exert the same control over me. I use to sneak food whenever I could. I especially like the foods she wouldn’t allow, such as cake, cookies, candy, French fries, potato chips. I would spend my allowance or find money around the house and secret it away until I had a chance to buy the foods I wanted. When I did it felt even more special. The food took on a special significance for me: the food represented my willful disregard for my mother’s control but it also represented my getting something forbidden and special. To this day I still crave these foods even though I know they are harmful to me.”
Food can be used as a reward or a punishment. It can generate guilty pleasure or be used to comfort us. Food is used to connect us socially and is a primary connection to the first person who loves us—our mother. Eating is a complex behavior. It is triggered by a number of biochemical reactions, psychological motivators and behavioral patterns.
Current scientific thinking indicates the complexity of the chemistry of eating by identifying the numerous neuropeptides, neurotransmitters and peripheral neurological system via the gastrointestinal tract and pancreatic hormones that control our desire to eat. Our metabolism and our fat cells also influence our desire to eat. Even the temperature in the room will cause you to eat more. Most restaurants are cool because cooler temperatures are an inducement to an increased appetite. In addition, we have environmental stimuli to compel our eating. We are bombarded with advertisements and social enticements to eat constantly. There is food everywhere, plentiful and food is reasonably inexpensive for most Americans.
Eating behavior can go awry for many reasons. The first cause is genetic. If you are born to obese parents you have an 80% chance of being obese. If one parent is obese or carries the OB gene, then you have a 40% chance. The genetic predisposition, if present, is not direct cause of obesity; you have to have acquired the behavior of overeating along with the environmental influence to indulge. Obese people can and do overcome genetics. If you have a thin parent, it may be that he or she is carrying the OB gene.
If you think you have the OB gene, you have environmental influences to overcome as well. Over time the portion sizes in American have increased as much as 2-4 times. For an example, in the past 10-20 years the average muffin has increased from 210 calories to 400-600 calories. The typical popcorn at the moves went from 5 cups to 8 cups and when you add the butter topping, instead of consuming 270 calories, you are now eating 600-800 calories. The average burger has gone from 330 calories to 800-900 calories. The average soda has been up-sized from a 6 ounce serving to a 16 ounce serving. At a restaurant the average meal with the oversized portions usually represents a full day’s allotment of calories. While caloric intake has increased, our lifestyles have become more sedentary as we have changed from an industrial society to a service oriented one working at our desks by day and sitting at our TVs at night.
As our portions have super-sized so have we. The average rates of overweight and obesity have increased to more than 50% of the population. The astounding increase cannot be explained by genetics alone. Apparently our culture has influenced our thinking and behavior around food intake. Eating behavior can range from mildly disordered (eating too much junk food) to moderate or severe disorders that include binge eating disorders, bulimia and anorexia. Abnormal or unhealthy eating patterns can be present in the very thin, normal weight or overweight individual.
Severe disorders require professional treatment. Binge eating is different than overeating. Binge eating is often done in secret while overeating can be shared with others and include over indulging in sweets and snacks for pleasure or comfort. Binge eating like bulimia and anorexia are often accompanied by lack of control and can be associated with mood disorders, such as depression and anxiety.
Unusual eating behavior is almost always characterized by craving and not by appetite. Many people with eating problems often can’t tell when they are hungry. They eat for a variety of reasons and rarely experience real hunger because cravings are indulged. Obese individuals are considering surgery as a technique to lose weight. Surgery is almost always successful in controlling caloric intake because of mechanical or physiological barriers, but once individuals adapt to the changes, they start to re-gain the weight. Some regain only a few pounds while others regain a substantial amount. The reason is that the eating behavior is motivated by craving and not by hunger. Craving is a psychological experience, while hunger is a physiological one. Creating a physical barrier to prevent eating will not overcome the psychological motivation to eat.
HOW TO DISTINQUISH CRAVINGS V. HUNGER
Psychological v. Physical
Sudden onset v. Gradual onset
Desire for Sweet or Salty foods v. Non specific desire for food
May already have eaten and be full v. Never occurs when full
Guilt follows the indulgence v. Satisfied after eating
Comfort foods that usually accompany a craving include, cake, candy, chocolate, ice cream, pizza, bread, fatty foods, fried foods, potato chip or other salty snacks. Comfort foods have achieved their reputations because they are intensely flavorful and eating the foods is often experienced with a great deal of pleasure. Comfort foods are always made or contain some amount of manmade or processed elements. Comfort foods rarely are whole, natural substances. Few people over indulge in broccoli or lettuce.
Cravings are often followed by thoughts that help to continue the over indulgences in the future:
“I’ll start tomorrow.”
“I am out of control; I can’t help myself.”
“I won’t eat later.”
“This is the last time.”
Most people hope for a magic pill that will control their food intake. The reality is that we don’t overindulge in foods because of physiological deficits. We overindulge because of behavioral and cognitive events. What makes us fat is the change in our physiology that results from years of overindulgence. As the physiology is altered from overweight or obesity, the changes in our bodies make becoming thin and staying thin very difficult. The most effective cure for obesity is never to let your weight go beyond normal limits. The second best cure following weight gain is exercise.
Exercise is the magic pill. When your body’s physiology changes because of obesity, it becomes a fat making factory so to speak. No one pill is going to change all the chemistry in your body to make you not want to eat or to burn fat. Wanting to indulge in comfort foods has little to do with body chemistry, but hunger does have everything to do with body chemistry. Indulging cravings is a behavioral and cognitive problem.
Identify the triggers to your desire to indulge. Make notes on your desire to eat, when, what was happening and what triggered the desire.
Plan alternative behavioral responses other than eating. If stress causes you to snack then choose an alternative response, such as meditation, deep breathing, taking a walk, etc…
Change your thinking. Eliminate the negative thoughts that cause you to feel convinced you can’t do anything about the problem.
Live the life you desire. Real substantive change occurs when you are in touch with your frustration.
Learn to identify your feelings and express yourself. Develop and use your network of social support. Emotional support is always fulfilling; overeating never satisfies.
Decrease you indulgence in intensely flavorful processed foods. By doing so, you will teach your brain not to want comfort foods.
Journal your feelings and use your journal to develop a positive relationship with yourself. Be kind to yourself and learn to take care of your body.
Cravings can be controlled by eating whole, fresh foods. Stay away from processed foods especially those high in fat, sugar and salt.
Spend time with healthy eaters. Use them for support and as role models.
Hire a coach to help you to identify the specific changes you need to make to be successful at overcoming your unhealthy eating patterns. It is difficult to take a critical evaluation of one’s self. For this reason, an experienced health and wellness coach can be very helpful in this regard.
Exercise is the miracle pill.
Exercise will reverse much of the problems associated with overeating. Exercise increases good cholesterol and you will reap additional benefits: increased metabolic rate, decreased appetite, less stress, improved mood, better glucose regulation, higher energy levels, increased confidence and more. In effect the physiological changes that overweight and obesity caused can be reversed with exercise. Exercise for the health benefits and don’t worry about the caloric burn. The caloric burn is just an added benefit.
Jessica describes her journey back to healthy eating and a normal weight. “I learned to identify what I was thinking and feeling. Every time I had a craving I kept a journal in my purse or in my pocket and wrote down what I was doing and what was going through my mind. I reviewed my notes with my coach, who gave me helpful ideas on what to change in my behavior. She coached me through my negative thinking—I had no idea how often I was indulging in negative thinking. I learned that if I felt the least bit out of control or feared I might not be in control, I wanted to eat. I put all of my focus on my relationship with my mother but she wasn’t influencing me anymore. I was living my own life but I was still acting as if I had to have my secret stash of food to make me feel better. I learned to eat out in the open. Once I did that I was really aware of how much I was eating and I wasn’t going to eat a bag of cookies in front of other people. It was interesting in that as I gave up my food habit I realized there were important aspects about myself that had to change. I learned to take control of me and accepted the fact that nothing else is really in our control. I learned to take life a step at a time and to welcome the surprises and challenges. The other odd thing is that as I gave up relying on food as a remedy for all of my emotional ailments, I felt challenged by a lot. Food was like a sedative to me. Once the sedative wore off, I felt really alive and now I realize I can live with the challenges.”
Mark made substantial changes as well. He was able to lose 50lbs and although not exactly back to normal weight, he is on his way. More importantly as he describes his journey he was able to change his life.
“I didn’t realize how miserable I was. I was using chocolate to make my life more bearable. I hated my job and I dragged myself to work every day. Once I stopped over indulging my cravings, I felt miserable. I understood how powerful my cravings were because it was like going cold turkey. I relied on sweets to get myself through the day. When I finally gave up the sweets and worked through my depression and fear of facing change, I got up the nerve to change my career direction. I got a new job that I love and more important than losing weight, I learned that I had to face my disappointments head on and do something about them.”
Dr. Vanessa Gourdine is a psychologist, executive and life coach and Director of Specialized Therapy Associates, LLC and Life Work Strategies, LLC. She can be reached at DrG@LWSCoach.com. She has a behavioral health column in BC Magazine and is a regular contributor to lifestyle publications. She has developed a coaching model based on using strategies to influence growth and change for successful living. She can be reached at 201-224-5200.