Category Archives: Emotional overeating

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.

If We Celebrated Thanksgiving in July, Would We Gain Less Weight?

Weight gain season has started: first Halloween, then Thanksgiving, and finally the Christmas/New Year holidays. The trick-or-treat candy has been barely put away (in our stomachs) when the recipes for Thanksgiving dinner are pulled from the drawers, or torn out of the November magazines. Even those among us who rarely cook begin to fantasize about a perfectly cooked turkey, moist dressing, gooey sweet potato casserole (will last year’s marshmallows still be edible?) and pies…How many pies should we bake? Surely not just one. What will our guests think? And as the days grow colder, wetter, windier, and darker, we fantasize about spending an entire day focused on eating. No need to exercise. The gyms are closed on Thanksgiving anyway (at least most of them), and who wants to go outside for a walk when it is so cold and/or so dark?

So begins the season of real weight gain.

What makes Thanksgiving so fraught with weight-gaining potential is its position on the calendar. Presumably when President Lincoln picked the fourth Thursday in November as a day of national Thanksgiving, he could not have known that the holiday would be altered into a day of national overeating due, to some extent, it being plopped in one of the darkest months of the year. It wasn’t until more than a hundred years later that scientists linked the short days of late fall with a winter depression causing significant overeating. Nor was President Lincoln concerned, skinny as he was, that the feasting on Thanksgiving was a prelude to weeks of overeating associated with December holidays. Indeed, for a country in the middle of a civil war, obesity was not something anyone worried about, nor was anyone in the position to spend much time in festive parties.

But just consider the impact on our food intake and weight if Thanksgiving were moved to the warmer, sunnier months like June, July or August. The benefits are obvious:

1. Menus would not be filled with butter and cream-infused carbohydrate dishes like mashed potatoes and creamed onions;
2. Stuffing soaked in the melted fat of the turkey would be incompatible with the warm temperatures of a late June afternoon;
3. Vegetables might come from the farmer’s market and reflect what was harvested that day, rather than limited to what was harvested weeks earlier, or shipped from a country a continent away;
4. Desserts could include really fresh fruit whose tastes do not have to be enhanced by large amounts of sugar, or baked in piecrust made with copious amounts of butter or lard;
5. Long hours of daylight would allow outdoor activities before and after the meal, such as a lengthy walk after dinner instead of lying on a couch; and
6. Wearing bulky clothes to disguise large figures would not be possible, thus adding a bit of restraint to indulging in more than two servings.

Were Thanksgiving moved to another date not bookended by holidays characterized by overeating, there would be time to diet or exercise off the pounds that might be added by the meal. But coming as it does at the time of the year when we think wistfully of the joys of overeating and then hibernating until spring, it seems easier to ‘go with the flow’ and continue to overeat until January ads for diet programs make us get on a scale.

When the Pilgrims celebrated the first Thanksgiving in October (by the way), they did feast for three days on foods provided mainly by their Native Americans neighbors. They did not have to worry about overindulging a couple of months later at Christmas, as they did not celebrate this holiday. Moreover, they were worried that their food supply would not last through the winter, and so were very careful about how much they were eating. Death from hunger, not obesity, was their constant worry.

It is unlikely that Thanksgiving will be moved to another time of the year, regardless of the benefits that would confer on those of us struggling to maintain our weight. But if we, like Governor Bradford and President Lincoln, focus on the reasons for the holiday rather than the recipes, we might emerge with our weight intact.

 

Bringing Home Pounds as Well as Souvenirs from Your Vacation

Vacations should make it easy to keep from gaining weight, and indeed to even losing some. Designed to remove daily stresses, give time for adequate sleep, eliminate the endless chores, escape preparing meals, and all the other responsibilities that erode whatever free time we have; vacations provide a respite from the triggers that cause us to eat too much. Vacations also are opportunities for the kinds of physical activity unavailable (for most people) at home: hiking, long bike rides, scuba diving, water skiing, and more.

But then again vacations are times to indulge in alcoholic drinks with umbrellas, and seasonal treats like fried clams, lobster dipped in melted butter, and homemade ice cream bursting with butterfat. Vacations are times to lounge on a beach with a cooler filled with beer and bags of chips… or relax on a terrace in the moonlight enjoying a five-course dinner.  Vacations are also times to park yourself on a tour bus, car, or plane for hours, restrict walking because it is too hot to be outside, and sit even more at sporting events, outdoor concerts, and movies.

Unless the vacation is spent in a spa known for its 6 am hikes up nearby mountains and semi-starvation meal regimen, few people expect to lose weight while they are away from home. After all, why try to diet when the point of a vacation is to enjoy one’s self and not obsess over the calories in the hot buttery croissant served at breakfast or whether the crab salad has too much mayonnaise? But (and there is always a but) should the vacationer who may be somewhat or even more than a little overweight at the start of a much-needed break be oblivious to the possibility of gaining weight? Should the combination of a relaxing, sedentary week or two and deliciously fattening foods be noticed for its weight gain potential?  Should vacationers bury their heads in the proverbial sand about their weight?

I suspect the answer is, ‘Who cares?!?’

And one reason for this answer is that obesity is so common, it seems normal to be many pounds overweight. Recently I had to travel to Miami Beach for some work, and as the weather was very hot people were not wearing much. It was not unusual to see tourists on the streets in bikinis or shorts and skimpy T-shirts. Many were obese, perhaps not more than on the streets of any other American city, but more obviously so because of the lack of clothing. It was too hot to go for long walks or bike rides, and beach walks usually crowded in the winter months were almost empty by late morning because of the heat. Poolsides were packed, but the pools were empty, except for the kids. And crowds were heading toward the beach, pulling carts and coolers that were probably NOT filled with carrot sticks.

And so on the one hand, the answer, ‘Who cares?!?’ is appropriate. It is your vacation and time to be self-indulgent. You are already in a bathing suit so obviously it is too late to lose weight before you put it on, and hey, life is short so why not enjoy yourself!

On the other hand, when the vacation is over, and extra pounds are brought home along with your carved coconuts or mermaids in a snow globe, they may stick around longer than the souvenirs. You resume the life that caused you to gain weight, and now there are more pounds to get rid of. The weather will become cooler and the skirts or pants somewhat tight in early June may not fit over a stomach or hips enlarged by many Mojitos, taco chips with guacamole and chocolate lava cakes. And in not too many turns of the pages of the calendar, the days become noticeably shorter, windier, rainier, cloudier and eventually cold. Inevitably, a weight- gaining lethargy settles in.

So why not take a vacation from weight gain? If buffet breakfasts and multi-course dinners are part of the eating plan, then skip lunch or restrict it to a salad or fruit. Early mornings and evenings are usually cool enough for walks or bike rides (many cities provide bikes to rent at minimum cost) and air-conditioned museums and visitor centers allow for more walking during the day. Pack the cooler with containers of blueberries, raw vegetables, water, and low- calorie munchies like rice crackers, rather than fat-laden chips and sugar-filled sodas.

Yes, it is hard to resist impulsive purchases of ‘tourist’ food like fudge, fried dough and arepas (corn patties filled with melted mozzarella) while sightseeing. These small food items pack impressive caloric content, and their consumption is often overlooked when thinking about what may have been eaten during the day. Carrying your own snacks may prevent you from succumbing to the allure of these streets goodies. Sometimes thinking of possible food poisoning from snack foods baking in a warm sun and soaking up air pollutants is sufficient to make them unappealing. (Of course, food poisoning is one way of preventing weight gain… however, it is not recommended).

Coming back from a vacation weighing less than you were when you began it may not be possible. But if your luggage is the only thing that weighs more at the end, consider the holiday a success.

Can Antidepressants Turn You Into a Food Addict?

What is a food addiction? Having heard several people explain their inability to lose weight due to this problem, I searched out the answers on, where else? The Internet. It appears there are addictions, and there are addictions.  Apparently, being addicted to your grandmother’s strudel or your brother-in-law’s barbecue is one type of addiction to be put in the same category as your impulse to drive 40 miles to eat homemade ice cream, or a fresh-from-the-sea lobster roll.  But these are not real addictions because if they were, you would be driving to eat the ice cream daily, even when the temperature was colder than the treat.

Real food addictions, according to many so-called food addict experts, are more grim and relentless. If you are a food addict you are unable to stop eating sweet, sometimes starchy, high-fat carbohydrates. Indeed, simply by consuming these foods, if you are susceptible, you will be thrown into the abyss of food addiction. If you have the misfortune or mindlessness to eat some refined carbohydrates, say some jelly beans or a piece of birthday cake, you will be assaulted by uncontrollable urges to continue to eat. You may find yourself eating the entire birthday cake or leaving the party to search out more carbohydrates.  Eventually, unable to stuff any more food in your stomach, you will stop…but the longing and urge to continue to eat will remain.  Not only will you experience a constant craving for more food, especially sugary snacks, you will, according to some food addiction websites, suffer from  emotional, social and spiritual deterioration. (Curiously, television networks do not seem to realize the profound damage caused by eating sugar as evidenced by programs devoted to making incredibly decorated cakes, or people fighting over who makes the best cupcakes.)

The solution, or sobriety, if this word can be applied to the sugar and refined carbohydrate addict, requires a life-long total abstinence from these addictive foods. Organizations like Food Addicts Anonymous exist to help people recover from their addiction.

Is it possible that for some, eating cookies or a slice of bread causes them to become food addicts? Maybe. But it is also possible that the reasons driving a compulsion to eat are more complex, and have to do as much with psychological and physiological factors as swallowing a piece of bread. Binge eating disorder and bulimia, two eating disorders characterized by compulsive overeating, are associated with complex psychological problems, not a simple food addiction. Someone who weighs 750 pounds or more, and cannot stop compulsive eating needs solutions to lose weight far more complex than eliminating flour and sugar. Self-described chocoholics (people addicted to chocolate) usually manage to eat normal amounts of ordinary non-chocolate foods most of the time.

Are there reasons people may find themselves with a compulsion to eat sugary carbohydrates other than the random digestion of a sugar cube? Below are some situations that cause people to crave carbohydrates:

People treated with antidepressants and related medications report intense cravings for carbohydrates, especially sweet ones. Why the medications cause these cravings is not understood, but the cravings are recognized as a side effect of the medications, not a food addiction. When medications are stopped, the cravings disappear.

Women crave sugary carbohydrates toward the end of their menstrual cycle, right before menstruation begins, and for some it is all they want to eat. Their longing for these foods are so intense that a cartoonist named Boynton pictured a premenstrual woman saying ‘I could kill for chocolate.’

Is this an addiction? Doubtful, since women return to eating normally as soon as menstruation begins.

A decrease in hours of daylight characteristic of late fall and winter is associated with a type of depression known as Seasonal Affective Disorder. A milder form is simply called the, ‘Winter Blues.’ Typically, the mood change is accompanied by an almost insatiable need to eat sweet carbohydrates; indeed, this is one of the ways this depression is diagnosed.  But how can it be an addiction if it mysteriously disappears as soon as daylight increases, and is usually gone by late spring?

High-protein diets that forbid or limit carbohydrate consumption may cause a sugar addiction due to a decrease in brain serotonin levels. Serotonin, a neurotransmitter responsible for affective mood, appetite, and pain perception, is made only when the consumption of carbohydrates allows the brain to receive the tryptophan it needs to make new serotonin. Craving carbohydrates, like thirst when not enough water has been consumed, may be the signal sent to indicate that the brain needs to make serotonin.

Stress and carbohydrate consumption go together like peanut butter and chocolate. Studies in which people were given, covertly, carbohydrate or protein-containing beverages decreased their feelings of depression only after consuming the carbohydrates. This is probably due to an increase in serotonin production. People tend to self-medicate with carbohydrates to decrease the emotional discomfort of stress. If the stress doesn’t go away, neither does the carbohydrate consumption. Therefore a so-called food addiction may last as long as the stress. The best way to stop the overconsumption of carbohydrates, if indeed that is occurring, is to stop the stress.

Is that plausible, really?

Our bodies and minds can certainly exist without the consumption of sugary carbohydrates. But let’s wait until there is evidence from a placebo-controlled, double-blind studies (neither the subject nor researcher know what is being consumed) that eating a graham cracker, a pancake with a drizzle of maple syrup or their equivalent in sugar grams is generating a food addiction. The situations that cause a craving for sweet carbohydrates such as depression or PMS are difficult enough without the additional burden of worrying that a few gumdrops are going to turn these eaters into addicts.

Relieving Pain Without Gaining Weight

Eating to deal with chronic pain is often overlooked as a cause of weight gain, overlooked by everyone, that is, but the over eater. Individuals who experience pain for days, or even years, also often suffer from the collateral damage of obesity or being overweight. The overeating occurs either as a response to pain itself, depression, and/or sleeplessness due to pain. Too much weight may exacerbate pain in bones, joints and muscles,* and make even gentle exercise difficult because it is so much harder to move.

Pain often seems less bearable at night; perhaps because there are fewer distractions. Often pain drives us from bed and we wander around the house hoping the pain will recede so we can go to sleep. Munching on snacks to relieve pain and the anxiety and frustration at not being able to go to sleep is common.  And the overeating carries over to the next day in an attempt to feed wakefulness into a drowsy body and mind.

Lack of sleep and chronic pain, not unexpectedly, are often accompanied by depression. Who wouldn’t be depressed if neither a good night’s sleep nor a life free of pain was attainable?  Anti-depressants are often prescribed, but they may cause intense cravings and overeating.

And, of course, pain itself may provoke excessive food intake.

I still remember the frantic way a co-worker raced into our office asking if anyone had any chocolate. Someone handed her a chocolate bar, and she tore off the paper and gobbled it down in seconds. She normally was extremely controlled and deliberate; the most impulsive thing she might do is kill a mosquito, so we were amazed at her behavior.

“I am getting a migraine,” she explained, after the chocolate had been eaten. “I usually carry something sugary with me to eat when I feel one coming on, but I didn’t have anything with me.  If I manage to eat some sugar, sometimes I can stop the pain from worsening. ”

Overeating as a result of chronic pain is probably even more common than eating during an acute painful episode. A young woman who came to me for weight-loss counseling after a painful recovery from a sinus operation told me, “I just wanted to eat sweets! I don’t know why, but they made it easier to bear the pain, and gaining weight was not as important as having some pain-free moments.”

Is it possible to eat to endure a painful condition and not gain weight?

Yes. If eating is not indiscriminate, but rather focused on foods which will reduce pain and are eaten in the correct portion size.  There is a specific class of foods that will decrease pain: these are sweet and starchy carbohydrates.  Protein has no effect mitigating pain, nor does fat. Eating a bacon cheeseburger or barbecued spare ribs may act as a distraction from pain because of the pleasure of eating these foods, but will not diminish your brain’s perception of painful signals from your nervous system.

Carbohydrates however, (except fruit sugar, fructose) will decrease discomfort by bringing about an increase in brain serotonin. Carbohydrates do this by potentiating the entry into the brain of tryptophan, the amino acid from which the brain makes serotonin.  (Even though tryptophan is found in protein, eating protein prevents serotonin from being made.)

Serotonin, a multi-tasking neurotransmitter involved in mood and eating regulation, is known to  diminish pain. In fact, this is why anti-depressants that increase serotonin activity are sometimes prescribed for the chronic pain of fibromyalgia, and even back pain. However, these drugs do not increase the amount of serotonin in the brain; only eating carbohydrates can do this.

Twenty-five or thirty grams of a fat-free or very low-fat carbohydrate food like pretzels, Cheerios or oatmeal are sufficient to raise brain serotonin levels. Eating two or three 25-gram snacks a day to reduce pain contributes no more than 300-400 calories to the day’s calorie total. This is less than the calorie content of a modern day bagel. It is important that the carbohydrate be consumed on an empty stomach, however, to speed up digestion so pain is decreased more quickly. It is also important to avoid carbohydrates that are processed with fat such as cookies, ice cream, piecrust, fries, chips, and chocolate, because fat slows down digestion and adds unwanted calories. Of course it is more pleasurable to snack on these foods than steamed rice or rice cakes. However, the long-lasting comfort carbohydrates provide comes not from their effect on taste buds, but from their effect on increasing serotonin.

Anyone who has suffered acute or chronic pain yearns for its end. Eating carbohydrates won’t bring this about. But doing so might make the pain bearable at least for a few hours and that small relief is welcome.

After Stress Stops, Overeating May Continue

Many of us are familiar with a tendency to eat in response to a non-catastrophic stress event. (Impending plane crashes, avalanches, or lighting strikes rarely call for snacks.) An income tax audit, burst water pipes, a fender bender, or a long delay in an airline departure may make us first gnash our teeth, and then put something in our mouths. Sooner or later, ways to cope with the stressful situation are generated (i.e., the plane departs), and we no longer feel the need to use food as an emotional pain reliever.

There are some stressful situations so prolonged that even the memory of them can provoke overeating for many weeks, even months, after the stress is over.  I recently visited with S, a friend whom I do not see often because we don’t live in the same city, and we hadn’t seen each other in over a year. I was shocked by how much weight she gained. Never thin during the time I knew her, she was now morbidly obese, and my plans for us to walk a few blocks to a restaurant were dropped because she couldn’t walk more than a few feet. Catching up with each other’s news, I waited to hear about some stressful situation that might explain her weight gain, but there was none. She had recently retired, but was actively developing a non-profit enterprise she had long dreamed of. Friends, financial situation, and family were all fine, according to her account of the past year.

So why the weight gain? She had told me many times that she ate out of stress, but there was no obvious recent stress to explain her adding at least 40 pounds to her frame over the past 12 or so months.

Later on, as we reminisced about her past job, the reason for her overeating became clear. She had taken on a project no one else in her company wanted to try, due to high risk of failure. She succeeded by tirelessly working, getting no more than 3 hours of sleep a night for months on end. Indeed, she had time for nothing else except work, and once told me that she caught herself dozing while standing up and another time, leaving for work, she’d forgotten to put a skirt on over her slip.

This was no recent event, the project was completed successfully at least five years earlier, but the emotion with which she described her work was as intense, as if she had finished it a few days before our lunch. She told me over and over again how hard she worked, how many more hours she clocked than her staff did, how her meals were eaten at the company cafeteria, and at night these meals were supplemented by snacks from the vending machines.

“I had time for nothing else but work. Nothing…” she recounted.

Now it seemed as though leaving work, this company that demanded so much from her, was causing a delayed stress response. Perhaps the overeating and subsequent weight gain was her way of coping with the stress from that time. Certainly she must have experienced not only intense fatigue, but also the fear that her coworkers were right and the project could nor would not succeed.

S is so obese that some type of bariatric surgery may be suggested to her as a way of bringing her weight to a manageable level. Certainly her inability to walk because of shortness of breath was very worrisome. Yet should she opt for such a procedure, or any other weight-loss intervention, it was doubtful that she or her medical/nutrition team would recognize the reason for her substantial weight gain. Nor is it likely that S would reveal the reason for her ballooning into morbid obesity, as she probably is unaware of it. And yet will she be able to keep her weight off unless she recognizes the reasons it was gained?

Overeating in response to a delayed stress reaction may be common, but it’s often unrecognized. Many times a physician will ask about previous stress in trying to understand why a new medical problem has arisen. The stressful event may have occurred months ago, but the aftermath may show itself in rashes or insomnia or mysterious aches and pains. The physician is probably less likely to look at someone who has gained a great deal of weight recently to ask about past stressful events. And to be fair, the patient may not be able to make the connection, either.

Stress may be close to the top of a long list of reasons why people gain/lose/regain weight, or can’t lose it at all. If it is ignored or underestimated in developing an effective weight loss intervention, then the probability of long-term weight loss success is diminished. The dieter might be better served by focusing on the emotions behind the overeating before being treated for the overeating, or at least at the same time. It may take longer to deal with the psychological aspects of weight gain, and required weight loss, as other than the physical, but doing so will guarantee a better long-term outcome.

Stopping After-Diet Weight Gain: Is It Possible?

A sobering report in the New York Times about the weight gained by contestants on “The Biggest Loser” confirms what every failed dieter knows: it is harder to keep weight off than to lose it. Research on post-dieting metabolism and eating behavior among these contestants might convince some wannabe dieters to indefinitely put off even starting a diet. The post-diet contestants were found to have such slow metabolisms that their bodies were using up far fewer calories than predicted, based on their height and weight. People of the same size who had not been on a prolonged diet were found to be using up less than 800 calories. It was no surprise that the contestants were gaining weight.

If that were not bad enough, the contestants experienced an almost constant need to overeat. The urges were strong enough to cause them to binge on foods that never should have been eaten, even in small quantities, if they were to remain thin.

These changes in metabolism and absence of self-control over eating are hardly unknown. Decades ago, scientists measured changes in calorie use before and following substantial weight loss. They put people in a room called a “respiration chamber” for 24-48 hours, and measured how many calories were used when the volunteer was in a relatively inactive state. The results were consistent with those reported for the Biggest Losers: After substantial weight loss the body uses markedly fewer calories than those of people of the same size that have not lost weight. Why this occurs is still not understood years after the first observations. Changes in the activity of certain thyroid hormones might cause a slowdown of metabolism, but other factors may also be involved which have not yet been identified. This is a significant problem since it means that at present there is no way of preventing others who endure a rapid weight loss caused, essentially, by low rations and excess exercise from suffering the same fate.

Other possible explanations for the post-diet side effect of weight gain are related to the reasons weight was added initially. Some of the contestants had been gaining weight since childhood and were unable to stop the weight gain. Why were they unable to halve their weight gain before it transformed them into morbidly obese individuals? Were they gaining weight because their bodies did not have the same control mechanisms to regulate their food intake? Were they always less active than their thinner peers? Did they drink soda instead of water, eat fried fatty food rather than lean protein and vegetables, and consume many large meals each day? Was food used to dampen emotional pain, or as entertainment?

Each of us have our own reasons for overeating, whether it is only a few extra calories, or several thousand. Not knowing why, or just as likely unable to change the “Why?” will make maintaining weight loss very difficult.

Undoing the side effect, weight gain, after successful weight loss requires:

• Decreasing post-diet hunger and lack of satiety;
• Developing strategies to halt overeating in response to emotional and situational triggers;
• Adherence to a food regimen compatible with anticipated post-diet metabolic slowing;
• Investigating whether changes in gut bacteria allow too many calories to enter the body;
• Decreasing sleep disturbances that trigger fatigue associated overeating; as well as
• Preventing overeating triggered by seasonal decrease in sunlight.

The immediate problem that requires intervention is making it possible for the ex-dieter to adhere to a reduced-calorie food plan. Unless the calories consumed correspond to those required by the now sluggish metabolism, weight will be gained again. And yet, the dieter is being asked to stay on a post-diet diet. How frustrating and difficult! After months of being caloric deprived, the dieter is being told to continue the deprivation.

Perhaps it is time to help the dieter by offering temporary treatment with an appetite-suppressing drug.

The FDA has approved several new appetite-suppressant drugs over the past three years. They all have side effects, some of which, such as elevated blood pressure or increased heart rate, might be dangerous for an obese individual who already suffers from cardiovascular problems. But if healthy, normal weight post-dieters used these drugs? Their side effects may be less potentially harmful.

These drugs decrease hunger and cravings and increase satiety. They might help the ex-dieter follow a reduced calorie regimen at least for some of the time it takes for their bodies to become metabolically normal. If they are no longer beset with the urge to overeat and the frustration of seeing their weight increase, they might have the mental and emotional energy to grapple with the triggers that caused them to become obese.

We still must figure out how to prevent the metabolic meltdown that makes it so easy to gain weight after a diet. We still must find out how to prevent post-diet weakening of the satiety signals and exacerbation of urges to binge. We still must develop counseling paradigms during and after the diet to address all the factors that caused weight to be gained. Without these answers, the dieter may not be able to escape the side effect of successful weight loss, i.e., weight regained.

Binge Eating Disorder: Hunger for Food or Something Else?

The advertisement for a drug to treat B.E.D. kept appearing in commercials during our favorite TV series.

“What is B.E.D.? “ I asked but my spouse had no idea. “Bad Energy Day?” he responded. “No,” I answered, “it must have something to do with hunger because the drug is similar to amphetamine.“

Then it hit me. Binge Eating Disorder, that’s what it is. Interesting that a drug to take away hunger has been approved by the FDA. People who binge never eat only from physical hunger. Otherwise they would stop eating when the hunger is gone.“

I treated patients with binge eating disorder but insisted that I would do so only if they were also being seen by a psychotherapist. Even though the major symptom of binge eating disorder is the ingestion of enormous quantities of food in relatively few hours, the disorder is a psychiatric problem. Interventions focus on psychotherapy, along with nutritional advice to undo the weight gained from constant bingeing.

Binge eating disorder may affect as many as 1-5% of Americans, according to the National Eating Disorder Association. In fact it has its own association, BEDA, which offers Internet support and information as well as Internet contact with others who are living with this problem.  It is only relatively recently that the binges have been viewed as more than a derangement of appetite, or an inability to adhere to a rational eating plan. People with this disorder feel helpless to prevent themselves from gorging.  And because they do not compensate for their high calorie intake by starvation, laxative abuse, vomiting or excessive exercise, they may be morbidly obese.  Women are more prone to having this disorder than men and the bingeing is often accompanied with anxiety, depression, guilt and self-loathing.  Bingeing can occur several times a week, and sometimes a few times each day.

But bingeing is not the same as being very hungry and unable to stop eating until feeling stuffed. Teenage boys who can clean off a buffet table faster than a swarm of locusts are not bingeing; they just eat an enormous amount of food.  Diners on a cruise ship may feel an obligation to eat gigantic quantities of food to compensate for the price of their trip, but they are not bingeing either.

Bingers eat in secret and often they consume only tiny amounts of food when they are eating with others. Moreover, binges are often planned for the time when the eater is alone. The binger goes food shopping so there will be food in the house that the binger enjoys eating. Or she might go to several restaurants in a crowded food court. Ordering take-out food from several restaurants is also done because it is embarrassing to order a large amount of food from the same restaurant all the time. I had a patient who shopped on Thursdays for weekend binges. She turned off her phone, pulled down her shades, and spent from Friday evening to Sunday afternoon eating until her stomach could no longer hold food. Then she would sleep and upon awakening, start bingeing again. She was never hungry. How could she be?

Bariatric surgery might seem to be an obvious solution to halting bingeing and restore normal weight. But according to experts, reducing the size of the stomach, or bypassing it altogether, might cause extreme side effects. Physically limiting the amount of food consumed doesn’t reduce the emotional pain causing the overeating.  Without the psychiatric counseling before and following surgery to detect and help the underlying cause of binge eating, the bariatric patient is at risk for consuming much more food than the surgery allows and becoming extremely ill in the process.

In the winter of 2015, the FDA approved Vyvanse for the treatment of B.E.D. The drug is classified as a central nervous system stimulant like amphetamine, and had been already approved in 2007 to treat ADHD.  Vyvanse decreases hunger when used for ADHD, and this may have been the reason it was tested on binge eating disorder patients. Two studies were carried out, each for 12 weeks, among 700 people with binge eating disorder.  Compared with placebo treated subjects, the drug decreased the number of days each week people binged and also decreased the number of binges each day.

According to eating disorder experts, it is unclear how the drug works to reduce bingeing.(It is important to note that bingeing did not stop entirely in the studies.) Moreover, long-term results have not been reported. Questions to consider are… does the effect of the drug wear off or become even more effective over time? It is possible that the amphetamine-like drug removes the compulsion to eat, thus giving binge eaters a respite from their pathological focus on food. Instead of dealing with the constant bingeing with the guilt and shame of the aftermath, they  now have  emotional  time to deal with the reasons for their overeating. In a sense they are like binge drinkers who go into recovery and while they are abstinent, attempt to deal with the causes for their excessive alcohol intake. It is obvious that helping such people would be useless while they are drinking. And so too, it may be that helping the binge eaters, while they are still bingeing constantly, would also be futile.

Vyvanse is not a magic pill, and its ability to decrease binges does not mean it can decrease the emotional antecedents to the binges.  Replacing food as a coping mechanism will require more than a pill that takes away hunger. Eliminating binges is a long, complicated process requiring emotional healing and learning non-eating strategies to deal with future emotional upheavals. Removing hunger is necessary but not sufficient. But at least it is a beginning.