Category Archives: Emotional overeating

Could Being Obese Make You Lose Your Teeth?

Having one’s teeth cleaned is not as bad as undergoing a root canal procedure, but certainly not as pleasant as getting a manicure. However, it does give one time to think of the implications of not doing so frequently, and the importance of carrying out the in-between cleaning tasks such as brushing, flossing and not eating caramel apples. Many of us may be not as compulsive about doing so as our dentist would like, but if we are also obese there is a greater cost to the health of our teeth and gums if the basic requirements of good dental hygiene are ignored.

No one disputes the adverse effects of consuming simple sugar on tooth decay. Ideally, if we indulge in eating or drinking sugar (as in soda or juice), we should race to the sink and brush our teeth immediately.  Dentists see the unfortunate consequences of not doing so, especially among those whose weight was gained by frequent consumption of sugar-rich snacks and drinks. Very few people will stop in the middle of a chocolate chip cookie or ice cream binge to floss and brush their teeth.

Obesity puts teeth and gums at risk for other reasons as well. Gastroesophageal reflux (aka acid reflux or heartburn) tends to be common, and causes teeth to be in contact with acid from the stomach, thereby contributing to the breakdown of teeth enamel. If the obesity is associated with depression or other mood disorders, the medications used to treat these disorders often leave the mouth extremely dry. The absence of saliva is also associated with dental decay. (Obesity Complicates Dental Health - Be Proactive!” Obesity Action Coalition, Stillwell, D.)

Patients who choose bariatric surgery to reduce the size of their stomach may be even more vulnerable to dental problems. Often vomiting occurs after this stomach surgery if too much food is put in the now tiny digestive organ. As with acid reflux, the teeth are coated with stomach acid, and enamel demineralization may result.  Moreover, according to Stillwell, an increased craving for sweets has been seen after surgery along with a significant tooth sensitivity that may make exposure to water or pressure uncomfortable. Patients who were not diligent about caring for their teeth before surgery are not likely to improve their dental hygiene afterwards, unless the importance of doing so is stressed.

Complicating care of the teeth and gums for someone struggling with obesity is this unpleasantness of attempting to fit an oversized body into a dental chair sized for smaller bodies. For someone with morbid obesity who finds walking difficult, getting to a dentist’s office is often physically painful. Added to this is the psychological pain of attempting to squeeze onto the reclining chair underneath the hanging trays and instruments. Stillwell suggests in his article that obese patients seek out dental offices equipped to handle their needs, but admits that there are very dental few practices that even consider this a problem.

Ironically, dentists were involved in developing and inserting devices in the mouth that would markedly reduce food intake to produce significant weight loss. Wiring of the teeth to prevent chewing was popular several years ago, but interest in using this approach declined rapidly in proportion to the rapid regain of weight when the jaws were freed. A modified version using a retainer-like device custom made to fit the roof of the patient’s mouth has been used with some success. The mouth can open only partially, so the patient has to take very small bites and consequently must eat very slowly. Since it takes about 15-20 minutes for the brain to realize that food has been consumed, the idea behind the retainer is that forced slow eating will produce fullness or satiety before excessive amounts of food can be consumed. Of course, it is also possible that the eater loses patience or becomes bored with the length of time it takes to complete a meal and goes on to do something else.  (“Are dentists involved in the treatment of obesity?” Karma, M.,Aw, G., and Tarakji, B., J Int Soc Prev Community Dent 2016 183-188) Once the retainer is removed, weight can be regained, unless the patient is willing to continue to eat very slowly. .

Although dental devices to reduce food intake may not be the most effective way of producing weight loss, the dentist may be an effective “first responder” in offering help and advice to obese patients. Most of us are unaware of the health of our mouths since it is almost impossible to see the state of our teeth and gums except for what stares back at us in the mirror. The possibility of losing our teeth and/or going through the pain and expense of periodontal surgery for gum disease is enough to motivate or frighten us into practicing what the dentist preaches.  Unlike a physician who makes the obese patient confront his or her weight, a dentist does not deal with the size of the patient’s body. The advice and suggestions about modifying food choices to decrease sugar intake and pointing out the association of gastric reflux with enamel erosion focuses on what is above the neck.  It is hard to ignore advice which, if not followed, may cause loss of one of our basic functions— chewing—as well as negatively affecting our appearance.  The simple suggestion about brushing in association with snacking might be enough to decrease between-meal food intake. The feel of a clean mouth and teeth is sometimes enough to prevent eating from immediately starting again.

And the dentist has an immense advantage over everyone else trying to help an individual improve food intake and lose weight: the patient can’t talk back.

Does Running Holiday Errands Count as Exercise?

“I‘m exhausted!” a friend told me when I bumped into her at the supermarket. “I spent the entire weekend running around doing errands.”

“Sounds like a good way of getting exercise and errands done at the same time,” I replied, knowing what the response would be. “Well, obviously I am not running,” she retorted. “But fighting the traffic in the mall parking lot and standing in line every store is so tiring. I don’t have the energy even to get to the gym.”

Holiday preparations, with its multitude of obligations and looming deadline of December 25th, seem to cause a frenzy of multitasking and soak up scarce free time. Even before Thanksgiving leftovers are consumed, the holiday to-do list is made and the running begins.

There is a high mental and physical cost to transforming ordinary life into one characterized by holiday decorations, buying and wrapping presents, sending cards, cooking, entertaining, hosting company and/or traveling. Since these tasks are added to those normally carried out each day, such as going to work, caring for family and social activities, the result is that time normally spent preparing and eating meals and exercising is drastically decreased. Indeed, going to the gym, a yoga class, or for a run seems like an indulgence done at the cost of cramming even more holiday obligations into remaining hours of the day or week. And for some, like my friend, the fatigue that comes with probably too little sleep, too much stress, too much shopping in malls with recirculated air, and too much waiting in traffic…it all makes sitting on a couch rather than on an exercycle seem like the only option at the end of the day.

Weight gain during the holiday season is so common that right after New Year’s Day, dieting kicks in. Gaining five pounds or more from Thanksgiving to the next year is not unusual, and holiday food and drink are major contributors to increased calorie intake. But even without the eggnog, sugar cookies, mayonnaise, sour cream or melted cheese dips, and fruit cake, weight would probably be gained. Lack of time leads to food court dining, fast food drive-ins, pizza, or nibbling all day on nutritionally weak snacks. Steamed vegetables, grilled fish and large salads are for January, not for December with its endless errands.

Frequent exercise classes or solitary workout routines followed by a shower, hair drying, and make-up applying is not compatible with a mind-set of counting down to Christmas.  And for those who exercise at home rather than at a health club, the convenience of having a piece of exercise equipment nearby is often ignored, because household tasks call more loudly than 30 minutes on the treadmill.

The approach to getting through the next few weeks without compromising sleep, weight, emotional well-being and fitness?

Schedule time to keep the body and mood healthy. You are not running a toy workshop in the North Pole and setting up a sleigh (rather than Amazon) delivery system by Dec 24. Which is to say that if there is a choice between getting enough sleep, or eating a salad, lean protein and high fiber carbohydrate, or taking a brisk walk or an exercise class, or making another dash to the mall, or baking one more batch of cookies? Choose exercise you want to do. Study after study has shown the positive and immediately impact that exercise has on decreasing stress and improving mood and cognition. Over the long term? Exercise can improve general health, decrease risks from heart disease, and perhaps even neurological diseases like Alzheimer’s.  A fatigued, stiff, grumpy body dragged to the gym unwillingly will not be the same after exercising. Paradoxically, the fatigue seems to lift….probably because increased blood flow oxygenates the muscles and brain. Stiffness from sitting in a car or standing in line goes away as the heat from the exercise makes the muscles more limber. Grumpiness disappears as well. People do not scowl at themselves in a health club; they may grunt or groan from the difficulty of their particular exercise, but somehow nasty moods go away (except if there are no towels when you leave the shower).

But the best part of literally (not figuratively) running or doing any other form of physical activity is that you are doing something for yourself. You are the beneficiary. You are the one who feels better, more energetic, less irritable or worried. The time you spend in exercise belongs to you.

Giving yourself the pre-holiday gift of time to take care of yourself is not something that is done easily. Guilt and anxiety over what has to be done, and what might not get done, may interfere with your healthy intentions: “I will make that salad or take a walk after I do (fill in the blank),” you say to yourself.

Putting your need for healthy food, exercise and sleep at the top of the long to-do list is hard. And yet, what better gift can you give to your family and friends than a cheerful, not sleepy, energetic, and unstressed you?

If We Had More Time to Eat, Would We Eat More?

The national eating day, Thanksgiving, is unusual in several respects. People who rarely cook spend hours in the kitchen transforming a rather ungainly raw bird into something beautifully edible and making artistic creations out of mashed sweet potatoes with marshmallows.  Stale bread that otherwise might be fed to the birds is turned into a complex dish that may or may not cook inside the turkey.  The table is formally set, and many courses with numerous dishes are served.  And the meal will take time.

Unless they have another Thanksgiving meal to go to, or feel compelled to Christmas bargain shop, guests are happy to dine leisurely. The meal may take considerably more than an hour, and rushing through is restricted to getting seconds on desserts before they are gone.  In this respect, Thanksgiving and other major holiday dining differs significantly from the way many of us eat the rest of the year.

That we eat more on Thanksgiving than on other days is not disputable.  Serving excessive amounts of food is appropriate, and we are expected to eat until we feel stuffed, and then eat some more. But would we eat so much if there were less time to do so?  Would we eat less if, like so many other days of the year, late afternoon/early evening activities and obligations shorten supper to a grab-and-chew type meal, rather than a sit-down dinner? Would we change the amount of food we eat if we actually sat and ate breakfast and lunch, rather than standing in line for take-out and then quickly consuming it before going back to work? Is eating quickly a prescription for too much, or too little food intake?

A few weeks ago I was having lunch with a relative who works for a large law firm. She kept looking at her watch as we stood in line for our salads at a food court. “They don’t like us to take more than 30 minutes for lunch,” she told me. “I hope I have time to eat.”

She is not alone. For many of us, eating is something we fit into our busy schedules often while we are doing something else, e.g. sending messages on our cell phone, working at our desks, or driving.

Hypothetically, if we have very little time to eat, we should be eating very little. A muffin or bagel for breakfast and two slices of pizza or a tuna wrap for lunch feels like fewer calories than a traditional breakfast of eggs and toast… or a lunch of baked chicken, potato, vegetables, roll and dessert. However, often when we choose foods that can be eaten quickly, we don’t notice that they can be calorically dense. A muffin or bagel with cream cheese may contain 600 calories, and a tuna salad sub with mayonnaise and cheese delivers as many calories as the hot lunch.

When we do not have time to eat, we may do it so quickly that we dump more food than necessary in our stomachs, like someone competing in an “All the hot dogs you can eat!” contest.  Sometimes when we gulp our food we don’t even notice how much we are eating. This is also true if we are multi-tasking while putting food in our mouths.

Sitting for a long time at a meal has its own perils. We may find it impossible to resist eating more than we intended to because we have the time and the food, especially the desserts, are there to tempt us. We are no longer hungry, yet the cookies or nuts or chocolate or pies are still on the table and it is hard, unless we are sitting on our hands, not to reach for them. A friend who often hosts long, leisurely meals told me that guests who resist eating dessert when she first serves it will often reach for the cake or cookies later on if they are all still sitting and chatting. Of course, meals that are interrupted by speeches between courses are a perfect prescription for overeating. The guest is a hostage to someone’s boring talk and eating seems to be the only way to endure it.

On the other hand, if we have the time to have an “appetizer” of carbohydrate, e.g., a roll, rice cakes, or crackers about 20 minutes before we start our meal, we may find ourselves eating less.  The carbohydrate potentiates the production of the brain chemical serotonin, and that in turn will make us feel somewhat full before the meal begins. This helps control how much we eat subsequently (a critical aid for dieters), and causes us to stop eating before we clean our plates.  But when time is limited, eating quickly and without the benefit of the satiating effects of serotonin, we could be eating more than we should.

Either too much or too little time can disrupt moderate and reasonable food intake. But certainly we should take the time to enjoy Thanksgiving for its own sake regardless of how much, or how long it takes to eat.

Does Halloween Begin the Trifecta of Weight Gain?

Soon after Labor Day, almost before the bathing suits of summer have been put away, bags of miniature Halloween candy begIn to appear on supermarket and drugstore shelves. Those tiny candy bars will be devoured to celebrate a holiday that has nothing to do with candy, and the hundreds of calories they contain will initiate the fall season of weight gain. Soon the black and orange wrapped candy will be replaced by chocolate turkeys for the national binge day, Thanksgiving, and then towers of green and red wrapped candies, cookies, and cakes will be displayed for the December holidays.

It is understandable how Thanksgiving and Christmas became holidays characterized, in part, by excessive consumption of special foods that are usually replete with cream, butter, sugar, egg yolks and chocolate. In the old days, these holidays represented the few times a year when expensive, scarce food stuffs like sugar, chocolate, costly cuts of meat, and exotic fruits like oranges, and special alcoholic drinks were served in liberal portions.  Religious and national events like Christmas, the 4th of July, or the yearly fair have always been celebrated with copious amounts of food.  Often guests contributed their own special recipes to a gathering, and it was not unusual to have several main dishes, many sides and a large number of desserts. No one worried about how many calories were eaten because food intake was frugal and, for some, even scarce for the rest of the year.  But now, of course, the caloric excesses that begin with devouring miniature candy bars and end with New Year’s Eve buffets may not be compensated with frugal eating the rest of the time.

But how is that Halloween, a holiday which originated as a religious event, has metamorphosed into the opportunity to eat excessive amount of sugars, fat, artificial flavorings and color while wearing a costume? And how is it that the attempt by some food companies to reduce sugar content in many of their products is being offset by large confectionery companies marketing Halloween candy? And how, as our nation becomes fatter every year, are we going to continue to allow this?

Collecting, counting, and collating the candy gathered during an evening of trick or treating is a relatively new phenomenon. To be sure, hordes of face-painted or masked kids have been roaming the streets on Halloween, ringing doorbells and asking for handouts for many decades. Mid-20th century, the handouts were rarely commercially packaged miniaturized candy bars. Treats like cookies, popcorn balls, Rice Krispy squares, brownies and fudge were often homemade. Candy corn, invented in l880, Hersey’s Kisses in l907 and M+M’s in l941, along with a smattering of regular size candy bars, were available as treats, but competed with homemade chocolate chip cookies. Then we became scared of anything that was not made and sealed in a factory. The appearance of razor blades in apples and the possibility of toxic ingredients in homemade baked goods frightened us into allowing our children and ourselves to accept only commercially produced, sealed snacks like miniature candy bars and tiny bags of candy corn. And the confectionery companies responded. Any candy that could be shrunk, wrapped in Halloween colors, put in a large bag and sold in bulk, was.

Of course, the calories per candy item were also shrunk because the candies were one big bite.  Alas (and the candy makers know this), we think, “They are so small, how could they be fattening?” and pop three or four tiny Snickers or Butterfinger bars into our mouths.  The little candies can be stashed in drawers, brief cases, knapsacks, glove compartments, pocketbooks and pockets and constitute an almost endless supply of sugary, high-fat treats—and calories. And so the season of fattening ourselves up begins.

The over-consumption of sugary treats falls at the time of year when we may be feeling stressed because of after-summer vacation workload for adults and for kids, homework.  Are we craving candy because as darkness increases, our good moods decrease? Would chewing through a mound of candy corn be as appealing in the middle of July as it is at the end of October?  We know that the good mood brain chemical, serotonin, is made when any carbohydrate (sugar, starch) other than fruit is eaten. Is candy more appealing than a bowl of oatmeal that brings about the same feelings of calm and comfort?

It is hard to find any good reason for children or adults to consume mounds of candy. In an ideal world, the plastic bags of miniature candy bars would be replaced by bags of vacuum-packed apple slices, or oranges or baby carrots. Treats might also include pretzels, popcorn, miniature protein or high fiber, high-energy bars or breakfast bars. These have the virtue of being low or fat-free, have some nutritional value, and, after the holiday, can be put in a lunch box for a daily snack.

But how are we going to stop the avalanche of fall candy consumption? It means pushing back against the confectionery companies so that like the large soda manufacturers who have reduced sugar in their drinks, they see a profit in offering healthier Halloween treats. It means working within neighborhoods and schools to convince everyone to resist dumping handfuls of candy bars into plastic pumpkins held by seven year-old trick-or-treaters. Perhaps people can be convinced to donate some of the money that would have been spent on candy to a local food bank and contribute the rest to the local school or neighborhood center for a Halloween party.  Halloween is a holiday made for fun, and surely we can figure out how to have fun without the candy calories hanging on our hips the next day.

Feeding Your Guests to Decrease Their Stress

“I am reluctant to have friends over for dinner,” my neighbor confided in me recently. “By the time we are finished with the main course, everyone at the table is arguing about politics or sports. Once I had two guests get so upset that they stopped talking to each other for almost a year. “

“Maybe it is what you serve,” I responded.

She looked offended.

“No,” I said quickly, “You misunderstood…your food is delicious. I wasn’t criticizing your cooking. But maybe you could alter the menu to decrease their agitation. “

Usually contentious dinners are limited to family occasions, most notably holiday celebrations when relatives who may not like each other are forced to eat at the same table. Avoidance of either the relative, or avoidance of topics offensive to said relative, is the strategy many take when forced to attend such gatherings. But having friends over for dinner used to mean assembling people who enjoyed each other’s company, with the presumed mutual goal of a pleasant evening of food and conversation. Now it seems that the conversation may have to be limited to traffic, weather and vacation travel, unless all the guests have exactly the same political views and love of the same sports teams.

But why resort to such vetting of the guests or the topics?  A better option is to feed the guests in such a way that they become mellow, patient with the opinions of others and, in general, agreeable.

Years ago, in a book I co-authored called Managing Your Mind and Mood with Food, I described the culinary strategy of the CEO of a large French pharmaceutical company. The research department often invited scientific consultants to discuss and evaluate research on new drugs. One of the CEO’s associates told me that the lunch menu was designed to induce a state of benign drowsiness in the scientists so they would be agreeable to anything the company might discuss in the afternoon session. Having been witness to the aftermath of some of these meals, I can attest to the success of the strategy.

This being Paris, the meal contained different wines for each course including brandy with coffee. There was always an appetizer, main course, salad, cheese course and then, unusual for Paris, an elegant cake or elaborate pastry, sometimes with ice cream.  Sauces rich in butter, cream and possibly egg yolks were poured over the entrée and sometimes the vegetables as well. The cheeses were 95% or higher in fat and the desserts sweet enough to make one welcome the mild bitterness of the tiny cups of espresso. (There certainly was not enough caffeine in those tiny cups to counteract the soporific effects of the meal.) Interestingly, the host the CEO drank only water, and nibbled at the food.

An American host would need a sizable kitchen staff to prepare such meals. Fortunately, altering the mood of the guests so they also become tranquil and agreeable can be accomplished with much less effort and food.

To do so requires knowing only two facts about food and mood: carbohydrates consumed with little or no protein will make serotonin, and leave most people feeling relaxed. Fat, which can be consumed with protein, carbohydrate or both, may make the diners mentally fatigued and sometimes even a little befuddled. Befuddled is not a good state for scientists or dinner guests to be in, so it is probably best to use carbohydrates to alter mood rather than bacon, butter, egg yolks, cream and high-fat cheeses. Curiously, our American habit of serving appetizers of cheese and crackers may inadvertently potentiate mellower moods because of the combination of fat (cheese) and carbohydrate (crackers). The wine or other drinks will (usually) add to the relaxation effect.

Perhaps the ideal sequence of foods to produce happy, enjoyable guests is to be found in Italian homes. Carbohydrate, as in pasta and sometimes polenta, is usually served a first course. The amount is small, unlike American-size portions, but certainly contains at least the 30 grams of carbohydrate that must be consumed in order for serotonin to be made.  Because the pasta is eaten first, the eater benefits not only from the mood-soothing effects of serotonin but, in a value added sort of way, the beginnings of satiety as well.  This means that when the small portion of protein is served as a second course, it will not be viewed as too small, because the eater is already feeling a little full. Bread and wine accompanies the meal, and presumably even if arguments occur at the dinner table, there is enough serotonin being made to keep the arguments from becoming contentious.

Alas, our American avoidance of carbohydrates, and this incorrect insistence that eating copious amounts of protein may have the opposite effect on our temperament. Eating protein inhibits serotonin from being made because it prevents the amino acid tryptophan from getting into the brain (tryptophan being this from which serotonin is made.) Is it possible that our moods are deteriorating because we are not eating enough carbohydrates?

Eating carbohydrates to improve the group mood does not have to be restricted to your dinner guests. There are work environments so stressful that, as one employee told me; it feels as if her flight or fight responses are going off and on all day. “I am sure it is not healthy to be working in such a stressful culture where people think it is all right to continually shout, demand, berate, and insult those beneath them, “ she told me.

Would carbohydrates help? Apparently, no one in that volatile office touches them because not being fat is mandatory (unspoken), and everyone is convinced that eating a piece of bread will cause them to gain weight. What they don’t realize is that eating a piece of bread or a cup of breakfast cereal might make them a little less abrasive, and perhaps a little kinder. And that is a good thing.

Getting the Super Obese to Lose Weight: It May Take a Family

Anyone who ever saw any of the television programs focused on the attempts of individuals 600 pounds (or heavier) to lose weight often wonders why their family members are enabling the obesity. The viewer watches the mostly bed-ridden obese individual demanding food, lots of it, and then being served large portions of whatever has been requested. The camera lingers over the individual crunching potato chips, spooning up macaroni dripping with melted cheese, or eating a gallon of ice cream. It is possible that the television crew doesn’t film the subject of the show when he or she is eating kale salad, or fat-free cottage cheese, so we get the wrong impression. But given the stated food demands of the obese individual, the viewer has the impression that if kale salad, or indeed anything resembling low-calorie healthy food were offered, he or she would be in the unique position of saying no to the food. The occasional trips to the supermarket by some of these TV stars who are able to ride in car (and use a motorized shopping cart) also focus on the purchase of junk food. Although it is obvious that some nourishing foods must be bought and eaten to avoid nutritional deficiencies like scurvy or anemia, the healthy menu items are rarely, if ever, shown being consumed.

The viewer wants to shout at the family members bringing food to the massively obese person, “Why are you enabling this?” Indeed, in one particularly poignant episode, a father buys a large pizza for his son who has been told he must lose 60 pounds before weight-loss surgery can be performed. The son has demanded the food and as the father watches the son gobble the entire thing, he asks for a piece for himself. “No,” was the reply, “I am going to eat the entire thing.”

Internet comments predictably share the bewilderment over the enabler function of family members as depicted on the show. As the fattening foods are prepared and served, the enabler expresses concern on air about the likelihood that the obese family member will die in a few years from the massive weight gain. And yet the food is served, and the concerned warning is absent. But to be fair, perhaps saying something is useless. The obese individual expresses concern over the pain caused by living in such a large body, and also worries about dying. So what good could it do if a family member states the obvious? It may even have the opposite effect. But still, we the viewers still wonder why the family members enable the continued weight gain.

What if the family member was a chronic alcoholic and developing liver disease, collapsing from frequent blackouts, and cognitive impairment? Would the same restraint be used, that is, “Don’t criticize, nag, cajole and threaten?” Would family members buy alcohol for the abuser who might be too drunk to get to the store?  Or drive the alcoholic to the nearest liquor store?

People say that one can’t compare alcoholics to excessive overeaters because the latter have to eat to live, so they cannot be abstinent. True, but one can live quite nicely without consuming highly caloric food in mega quantities, and drinking sugar-filled soda and juices.

Nevertheless, it is hard for family members to take corrective action alone. Professional help is needed, yet there is no process by which a concerned parent, for example, can force the adult extreme overeater to see a physician, dietician and/or therapist. Medical privacy laws forbid sharing the information with healthcare providers unless written permission from the family member is given. But waiting for the heart attack, stroke, skin infection, or cancer to occur in order to obtain medical intervention to start the weight- loss process is hardly an option either.

Family members of an alcoholic often turn to Al-Anon, whose meetings offer advice and support. Inpatient rehabilitation facilities often insist that family members be present for some of the therapeutic sessions to support recovery.

O-Anon is a spin-off of Al-Anon and runs with the same rules of privacy and espousal of the twelve-step process. But is this enough? Can a family take upon itself to provide only healthy, portion-controlled meals and beverages without medical and nutritional advice? Can the family handle the emotional fallout when the obese individual no longer has access to foods that for many are the only reason for living? What happens if anger, anxiety, and depression follow the imposition of a new eating regimen? Must someone be home all day to prevent fattening foods from being delivered, or the obese individual from finding these foods hidden in the house?

It is hard not to notice that often family members on the show are also obese, but may be 100 pounds overweight rather than 600. Will these folk be willing to change their eating habits to support the dietary changes they are imposing?

It may be as hard for the family to change its role with the patient as it is for the patient to lose the weight. In an ideal television series or world, such issues would be raised and solutions found. The bariatric surgeon would insist that both patient and family members meet privately, and as a group with a dietician, therapist, and even personal trainer instead of telling the patient to go home and lose sixty pounds.

People don’t gain 500 pounds simply because they like doughnuts or French fries. Their reasons for their morbid weight gain are complex, and their success in losing weight permanently depends on the family with whom they live and eat understanding these reasons. Maybe the producers of these television shows ought to realize this, even if it doesn’t make such interesting viewing.

Eating Your Meals at Restaurants May Decrease Loneliness (But Increase Weight)

One of my neighbors, widowed about three years ago, never eats at home but goes to specific restaurants for breakfast, lunch and dinner. “I don’t want to sit in my kitchen and eat a microwaved dinner while watching the news,” she told me.

“Eating in restaurants makes me feel less invisible.”

Her social objectives to meet people and not eat alone are being met. She has made friends from the neighborhood who eat at the same restaurants, and she is less lonely.  But the cost of eating all her meals away from home has been a marked increase in her weight.  Never slim, she now had gained so much weight that her already compromised knees and back have made walking difficult without a  walker, and she is short of breath.

Her weight gain from eating in restaurants puts her in good company. It is thought that the doubling of the prevalence of obesity in the U.S. over the last 35 years is due in large part to the increase in meals eaten away from home. Fifty years ago, 30 percent of the food budget went toward meals at restaurants. Now it is almost 50 %.

Not all restaurants, of course, generate weight gain. But chain restaurants in particular promote calorically dense foods: fried chicken, chicken nuggets, double or triple cheeseburgers, meatball subs covered with cheese, sandwich fillings that are more mayonnaise than protein, and high fat salad dressings and special ‘sauces.’ Some food items may contain enough calories for the day, not just one meal.

But my friend, who after all had cooked for a husband and children and then grandchildren for decades, knows enough to avoid fried chicken, French fries, and a salad limp under a quarter of a cup of salad dressing. She thought she was making nutritionally wise food choices. The problem, when she asked me how to start losing weight, was that neither she nor I had much of an idea of what the foods she was eating contained.

“I try to avoid foods that I think will have too much salt or sugar but who knows what is in the food?, she told me. I try to pay attention to the calories if they are listed on the menu, but it is confusing. I don’t mind eating a lot of calories if they are from good protein, but what if the calories are from butter or mayonnaise, or some fatty meat like bacon? “

Jane (not her real name) did not want to stop going to restaurants and begin to eat at home in order to lose weight.  The cost of doing so would have been social isolation and even depression. The solution was to find out what she was eating, and to make some informed choices.

The solution: we spent a cold rainy afternoon in front of the computer looking up the nutrients and calories in the foods offered at the restaurants where she was eating. We were surprised at what we found. Oatmeal for example: She liked oatmeal for breakfast, and I couldn’t convince her to eat it at home. “If I don’t get out of the house when I wake up, I feel depressed,” she told me. She had been going to Dunkin Donut for coffee and a cup of oatmeal. The calorie content of the oatmeal was reasonable, 310 calories, but we were shocked to see that it contained more sugar than oatmeal: 40 grams of sugar and about 26 grams of the starchy carbohydrate. Choosing the flatbread veggie-egg white sandwich with diced pepper and cheddar cheese? She would be getting 18 grams of protein (the oatmeal had very little protein), and only 5 grams of sugar.  Had she gone instead to Au Bon Pain, a block away, for her oatmeal she would have eaten about the same number of calories, but only 1 gram of sugar.

On the other hand, when we checked the calorie contents of some calorically innocent sounding Au Bon Pain sandwiches, we were surprised at how many calories they contained.  A chicken sandwich which should have been a relatively low calorie option contained high fat ingredients like avocado and bacon and clocked in at more than 600 calories.  Other chicken or turkey sandwiches were also calorically high, especially for someone as sedentary as Jane.

“What about a roasted vegetarian wrap?” asked Jane, peering at the computer screen, “It sounds healthy.”  But that came through with a whopping 700 calories. Fortunately, half sandwich options were available, and if combined with a low calorie vegetable soup, this seemed like a good lunch option.

Eating dinner at a restaurant forestalled Jane’s returning to an empty apartment too early in the evening, so that meal became even more socially important than the previous two. Unfortunately, her favorite eating place served gigantic portions, which Jane tended to finish because she hated to waste food. She thought a solution might be to share an entree with a friend who also lived alone, and if her friend was not available, asking the waitperson for a half size portion. “They don’t have to put so much food on my plate,” she said. “Look, if you can ask for salad without dressing, or a dish without nuts or bacon or cheese, why can’t you ask for less food on the plate?“

The financial and caloric costs of eating away from home are higher than eating in one’s kitchen. But the social and mental health benefits, as in Jane’ case, are compelling.  If we can make nutritional information about restaurant food easier to obtain, portions smaller and healthier, then the choice does not have to be eating a lonely meal at home, or eating with the company of others away from home.

Can Being on a Committee Make You Overeat?

The neighborhood association meeting started out benignly enough, with a non-contentious minutes read and acceptance, followed by people chitchatting as the chairperson droned on about some street maintenance issue. Someone had placed bowls of snack food on the table, along with diet and non-diet sodas, but all were ignored. About 20 minutes into the meeting an agenda item launched agitated discussions with people talking over each other and, when they couldn’t be heard, muttering to themselves. Just as suddenly hands dipped into the bowls of pretzels, chips, nuts, and crackers and cups of soda poured and gulped. Some people were talking through mouthfuls of chips as they attempted to enter the conversation and others, who were shut out, stuffed more food in their mouths.

The committee meeting was a living poster for stress-induced eating.

What was a little surprising was that the gobbling of snacks occurred in public. We tend to assume that those among us who resort often or even infrequently, to emotional overeating, do so in private. The ice cream, cookies, chicken fingers, pork rinds, or doughnuts are usually eaten alone or in the company of people who are sympathetic and supportive of the problem driving the eating.  But the behavior of this group shows that if the provocation is sufficiently strong, the eating response may be immediate, even if embarrassingly visible to others.

This is not to say that people in groups don’t overeat. Watch people at a meal listening to a speaker as they eat. Their interest in their food increases in proportion to their boredom. If a speaker notices that the members of the lunch or dinner audience are attempting to eat the crumbs of the roll from the tablecloth, it’s very clear signal that he or she ought to wrap up the talk immediately.

But people at the committee meeting were not eating out of boredom; they were eating because of stress. Each member of the committee felt that he or she had to influence the outcome of the discussion, and many were afraid that the outcome would not be to their advantage.

Were they aware of how much they were eating? If they had been asked to fill out a food diary a few hours later, would they have reported eating three handfuls of pretzels or nuts, or drinking 10 ounces of soda? Probably not.

Did the eating influence the intensity of the discussion?  The act of putting food in one’s mouth may have been somewhat calming, just as giving a whining child pieces of breakfast cereal to eat has a distracting and calming effect. And obviously chewing somewhat dry food made it hard to shout out comments without spraying a fellow committee person with bits of pretzels or chips.

The mainly carbohydrate snacks would have had a calming effect—if the meeting had gone on long enough for the food to be digested and serotonin to be made. But that would have taken at least another half an hour, and the meeting broke up before then.

Stress associated with group interaction is usually overlooked among the many triggers inducing overeating. And there are unspoken rules about eating behavior in the corporate culture that probably deem any unrestrained eating at a meeting as unprofessional even when food is available? If someone at a lunch meeting begins to munch on several chocolate chip cookies brought in with the sandwiches, others will notice and wonder at his or her lack of control. There is stress most certainly, but if it generates overeating, it is usually done afterward, in private. I once had a client whose presentation to her team was so criticized that she went to a gourmet chocolate shop in the lobby of her office building, bought five pounds of chocolate and ate it all in her office (with the door closed).

The advice I gave her might, however, be useful to those attending future meetings of committees where emotional discomfort is inevitable: Eat proactively to reduce future stress. She was to eat a small, non-fat carbohydrate, such as half a plain bagel, 30-45 minutes before going into her meetings, so that the serotonin made after she consumed the carbohydrate would be a little calming.

If my fellow neighborhood association members had followed the same advice would there have been a quieter, more restrained discussion? If they had “armed” their brain with more serotonin before the meeting, would they have ignored the snacks on the table?

But of course there is another solution to the problem of committee meeting-induced overeating: stay home.

 

Is Mindless Eating Like a Dog Worrying a Bone?

One of our dinner guests, a thin older man who prided himself on his eating and exercise discipline, sat down next to a bowl of nuts and almost inhaled them. We were having cocktails before dinner, and as hostess I was paying more attention to whether there was a coaster under every glass and napkins next to the finger foods, more than to what our guest was eating. But his rapid almond-to-mouth movements caught my attention.

“Did you see how much Jake (not his real name) was eating?” my husband asked after everyone departed. “He is usually so deliberate and slow in his eating, but this evening he cleaned his plate almost before everyone had picked up his or her fork. “

We mused over his uncharacteristic behavior, and then one of us remembered a story he told later on in the evening about a possibly nasty legal situation he was facing with a neighbor.

“I don’t think he even knew what and how much he was eating,” I commented. “I suspect that if he had been asked what he had eaten for dinner, he would have no idea.“

Not paying attention to what, especially how much, we are eating is one of the unsolved causes of weight gain. Who has not munched on a sandwich or crunched baby carrots while staring at a cell phone? Peering at the screen while eating is so common that eventually restaurants will probably provide cell phone stands so the phone can be propped up while eating, thus relieving the necessity of eating with only one hand. However, the perils of attending to the cell phone screen rather than to your food on the plate is that everything on the plate is consumed (possibly even the toothpick holding the sandwich together) without the eater being aware of doing so. Have you ever eaten a large bag of popcorn in a movie theatre and found that your munching was faster or slower depending on what was on the screen in front of you? Your fingers were able to direct the popcorn to your mouth without much awareness of your part.

Psychologists and nutritionists tell us TO PAY ATTENTION to what we are eating. We are to look first at the food before biting into it and notice its texture, smell, and color, perhaps the same way we might look at a glass of wine. Then we are to chew slowly, savoring the release of flavors and how they change in the mouth. Finally we are allowed to swallow. I was at a workshop watching the facilitator demonstrate this with a strawberry. We all had several on our plates so we could practice along with her. One of the participants was so mesmerized by the slow motion consumption of the strawberry by the leader that she mindlessly munched on all the strawberries on her plate.

Of course, paying attention to what we are eating, and especially noticing when we are full so we don’t continue eating beyond fullness, is helpful in controlling our universal tendency to overeat.  But perhaps more important is noticing why we put our mouths on automatic pilot and eat and eat the way a dog gnaws and gnaws at a bone. The dog is probably not thinking much of anything except where the next bone might be coming from, but the automatic eater is, for sure, thinking of something other than the food.

Mindless eating should really be called “mind elsewhere” eating. Like the dog worrying a bone, or our dinner guest, the “mind elsewhere” eater is gnawing away at an unresolved, troublesome situation.  It is unlikely that the eating and the somewhat obsessive thinking will produce a solution at that moment, but is more likely to result in the consumption of excessive calories. (And, to my mild annoyance, probably no recollection of what the food tasted like.)

A dog owner will take away the bone when it is apparent that the dog should move on to something else.  As owners of our “elsewhere minds” we must take away our own bones. We must put away or move away from the food, set our forks down, determine how much we have already eaten, and halt the repetitive movement of either a utensil or a hand carrying food to the mouth.

Dogs usually sigh and then go to sleep when the bone is gone. We should learn from them. A few minutes of calmness, of allowing ourselves not to be consumed by the problem at hand, will bring our mind and our eating into harmony.  It will also bring the benefit of enjoying the food we are eating.

Are Kids Born, or Made Into, Emotional Overeaters?

Anyone who has eaten when frustrated, angry, bored, worried, exhausted, lonely, or depressed—but not hungry—has engaged in emotional eating
(So that makes most of us.)  And for most, the food eaten is less likely to be steamed broccoli, poached chicken breast, or fat-free yogurt and far more likely to be a member of the so-called carbohydrate junk food family.

We know this from studies carried out at the MIT clinical research center about 25 years ago. Emotional overeaters were offered a choice between protein snacks like miniature meatballs or luncheon meat and carbohydrate snacks like cookies and crackers. The choice was always the carbohydrate foods. The predictable choice of carbohydrates led to research confirming that the carbohydrates were chosen not from taste (the meatballs were delicious but ignored) but because eating crackers or cookies led to an increase in the mood-soothing activity of serotonin. Our conclusion, reinforced by many subsequent psychological studies, was that people used carbohydrates as a form of self-medication.

But how did we learn to do this? And indeed, did we learn to do this, or is medicating with food something we are born with?

Infants don’t eat to make their bad moods go away. They eat to make their hunger go away.   And infants don’t eat when they are not hungry.  Theoretically infants, especially those who are breastfed, do not overeat since it is almost impossible to get infants to swallow more milk when they are done feeding. The mouth closes, the head is turned away, and often sleep takes over.

So how does an infant who self-regulates her food intake turn into an emotional overeater? Some pediatric obesity researchers such as Savage, Birch, Marini, et. al.1 suggest that it is the mother’s fault. Mothers who interpret every sign of their infant’s distress as hunger will feed their infants too often. The baby may not eat but eventually, so the researchers surmise, the baby associates feeling bored, lonely, wet, annoyed or whatever emotions babies feel with being offered food.

This association seems to be strengthened when parents offer treats to the now older child to soothe her. Blisssett, Haycraft and Farrow measured cookie and chocolate consumption among preschool children when they were stressed in a research setting. Children whose mothers often gave them snacks to comfort them ate more sweet snacks than children whose mothers did not offer them snacks when they were upset.

Is this how it begins? The child grows up and, when experiencing the predictable stresses of childhood, adolescence and adulthood, turns to food as a means of coping?

But there is much unanswered about this assumption, i.e. that children will turn into emotional overeating adults because they were given treats as children to help them overcome distress, boredom, or anger.

Do children growing up in cultures where food is scarce become emotional eaters? They may worry as adults about not having enough food and hoard food or overeat because they learned as children that food is not always available. But is this emotional overeating?

Do all children in a family become emotional overeaters in response to being given comfort food while growing up? Often some children in a family overeat sweet or starchy junk food and others reject these items. What makes Sally, but not Sam, reach for cookies when experiencing a negative mood state? Why doesn’t Sam also use food to feel better?

Do children, and indeed adults feel comforted if given any food when upset or only specific foods? The answer is obvious, at least in our culture.  Foods offered and eaten in times of stress tend to be tasty, sweet or starchy and often high in fat (cookies, chocolate, ice cream).  If, theoretically, a toddler was always offered a piece of broccoli or spoonful of cottage cheese after bumping his head or feeling confined in a stroller, would he grow up and reach for the same foods when upset? Probably not, but this is testable. If a child grows up in a community where it is common to eat hot chili peppers or munch on dried seaweed or snack on avocado, then would these be comfort foods?

Are children nurtured from early infancy in a daycare center where meal and snack times are regulated and not dependent on a child’s mood less likely to become emotional overeaters?

Might children who are denied so-called tasty junk food because of their adverse effect on weight and health, feel compelled to eat such foods when they are old enough to get the food themselves? And might they overeat such foods to compensate for the years they were denied such treats?

Clearly much research has to be done before we understand whether an emotional overeater is born or made that way.  Answers may come from studies in which self-defined emotional overeaters are given covertly a food that they tend to eat when stressed, and a food that is never eaten  (crackers versus cottage cheese). Measurements of their emotional state before and following eating are measured. If the emotional overeater shows an improvement in mood to one or the other test food, then the change must have come about because of some change in the brain regulation of mood, and not because of taste or the anticipation that the food will help the mood.

And perhaps, eventually, we can find what in the food gives the child or adult an emotional hug, so we can strip away the calories and leave just the good feeling behind.