Any given month in America, between 6 and 15 million people binge out of control, according to the National Institute of Mental Health. Yet millions never get help or seek treatment. If they did, they would find our community, along with doctors, scientists, researchers, and therapists who confront overeating, divided on what to do. What causes this epidemic? Is the problem biological or psychological? Are there answers in a matter of will power or hardwiring in the brain and addiction?
Meanwhile, as we sort through the questions, food manufacturers keep introducing new foods designed to be irresistible in taste and texture, with synthetic flavor enhancers that stoke and instill cravings. [The New York Times did an extensive report on this just a year ago, “The Extraordinary Science of Addictive Junk Food” by Michael Moss, February 20, 2013.] And people keep overeating, and gaining weight, and obsessing about food till it runs and ruins too many lives.
Today, one in three adults (nearly 40 million people) is considered clinically obese, along with one in five kids; more than half of American adults are considered overweight, and 24 million Americans are afflicted by type 2 diabetes, often caused by poor diet, with another 79 million people having pre-diabetes.
It doesn’t make sense, does it? Food is something every person needs to live, like air and sleep. How can you be addicted to something essential for life?
But the facts are undeniable: Too many people spend their days and nights obsessing about food and consuming it in voluminous amounts. Too many others don’t necessarily obsess, but find themselves in situations that spiral out of control. They start snacking on chips and end up downing the whole bag. A small bowl of ice cream turns into emptying the container. They go into debt or spend their last dollars on desserts or bread and high-fat food for a fix one day, and a new diet plan or program and exercise equipment the next.
Life is being eaten away. Food is costing us health, money, relationships, vocation, hobbies, and peace.
How did we get to this place of such dysfunction with food, and the resulting weight? And how can we as the professionals help?
Understanding the Issues
A starting place is in recognizing that the brain can be hardwired to crave certain foods just as an alcoholic craves a drink and a drug addict joneses for a fix.
It’s tempting, even in our field, to think the problem is emotional and a person who overeats just needs to use more self-control and will power and workout and exercise, or go on a diet and substitute carrot sticks and celery for cookies and ice cream, or eat less and in moderation. Every day, another diet book or program or fitness guru tries to convince us of these things, as well as how much better life will be when we’re skinny.
Such advice couldn’t be more disastrous.
For the person whose brain is hardwired to be triggered by certain foods, this over-the-counter advice lasts but a moment and the problem remains unsolved. For the person who falls prey to foods designed to be addictive, these mantras don’t even register—a taste can trigger an episode of overeating and the shame of it makes this person turn to food for comfort, and the food triggers more episodes, and on the cycle goes.
The Science on Addiction
The reasons people pig out, overeat, and find themselves addicted to foods or snacks consumed in an outrageous amount in a single sitting aren’t because they’re fat, stupid, lazy, indulgent, greedy, or have no willpower or pride. In fact, it takes a lot of work, creativity, and intelligence to hide overeating and binges, food abuse and addiction, from a world that frowns on overweight bodies and links overeating to obesity.
The bigger picture is this:
Professor Bart Hoebel and his colleagues at Princeton University’s Neuroscience Institute discovered this in a series of studies on food addiction, reported in the abstract “Evidence for Sugar Addiction” in Neoroscience & Behavioral Reviews, Vol. 32, No. 1 (January 2008). They found in studies with rats that trigger foods, sugar in particular, do have long-lasting effects in the brain of a sugar-addict just as alcohol has in the brain of an alcoholic and drugs in the brain of a drug-addict.
Your clients aren’t rats, but they can be hardwired like them to be hooked on sugar just like cocaine. So just as rats showed signs of withdrawal when researchers took away their sugar, people trying to quit bingeing on desserts and snacks fight the same battle as those trying to kick an alcohol or drug habit. Take away their trigger foods and feel-good chemicals in their brains go way down. Fear and anxiousness increase. Withdrawal symptoms appear: sluggishness, headaches, irritability, rapidly changing mood swings, anxiety, sadness, anger, cravings, sleep disturbance.
To deal with it all, just like drug and alcohol addicts taking another hit or drink to keep the symptoms at bay, the food addict goes for another bite, another carton or container, another binge.
Hoebel’s rats showed an anxiousness and desperation to consume more sugary foods on which they’ve become hooked. After bingeing on foods rich in sugar and fat for a two-month period, the addiction became so strong that when presented with healthier foods, the choice is to go hungry before eating anything without the sugar and fat craved. The rats would starve themselves rather than free themselves from the high they got on sugar and fat.
Food addicts do the same. Comfort food becomes just that in their minds: a source of relief and release . . . at least until the next fix on food is needed, and that’s quite soon because not only is there a physical craving but an emotional shame and spiritual emptiness that the addict seeks comfort to soothe.
Think how much junk food, made up mostly of sugar and fat or both, debilitates us. Sugar and fat can actually desensitize the reward pathway in our brains so that we need more and more in order to experience the same happy feeling as before. Nothing else, including healthy foods, satisfies, not for the rats, nor for the food and sugar addict. Yesterday, it may have only taken one candy bar to boost their mood. Today, it takes two candy bars to bring back the happy.
It is indeed a rat race, this experience of a true chemically-driven craving.
This is Why Diets Don’t Work
So the problem is when a brain is hard-wired for addiction, the addict can never eat enough of their trigger foods to get that happy feeling they want. Each binge sets in motion an uncontrollable chemical process that has a feedback loop. Like a hamster on a wheel, the food addict wants to eat even more sugar or carbohydrates or high-fat foods. It’s a vicious circle: eating the trigger foods stimulates the pancreas to release insulin, which decreases the concentration of amino acids, which manufacture serotonin in the bloodstream, which cause a drop in blood sugar level, which results in feelings of weakness, hunger, headaches, and trembling. Every drop in blood sugar for the food addict triggers eating more to offset the symptoms—and round and round the cycle goes.
While many people who overeat can try the latest diet on the market and find some success with temporary weight loss, it doesn’t last for the food addict. The person with a brain hard-wired to be addicted to certain foods (sugar and white flour are often the culprits) can start out deciding to live completely without the carbs, sweets, or fat. Then, because that’s hard, they stray a bit. They take back a little bit of bread, maybe add some butter to the vegetables, a drop of cream to the coffee. That’s all it takes to be off to the races again, running with whatever tastes good.
You see, the diet was never the real issue to start. There is an addiction, and that means there are trigger foods to be avoided, just like wine or liquor for the alcoholic—and there is mind and spirit work to do too.
Treatment We Can Agree Upon
That’s why it’s essential for an addictions model of treatment, addressing not just the body but the emotions and spirit too. Here’s where we, as counselors and therapists, can best serve clients with eating issues, whether those issues are just being triggered to binge once in a while or in full-blown addiction where the obsession with food and weight is consuming and ruining life.
However, there needs to be a greater understanding of food addiction by our clients and ourselves. We live in a culture where loss of control with food is fairly common, where people make light of it, where the skits on Saturday Night Live and in movies show someone downing their troubles in pints of ice cream and piles of candy bars, or the overweight actor goes crazy, going for laughs, in a binge scene—and we laugh along.
This is no longer a laughing matter, no longer a matter where we give in to the temptation to being treatment with a diet and fixing solely upon the food.
We’re not nutritionists, and the diet, remember, is not the issue.
There needs to be a change of thinking and a change of heart for the change in eating and weight to occur.
To Treat the Body
Of course the temptation is to focus first on the food. While a client doesn’t need a diet, they do need a food plan that’s structured and measured, something a nutritionist who understands addiction can help develop. The plan isn’t a diet because it’s not about restricting, though it does involve some abstaining from foods that trigger just as a plan for the alcoholic calls for keeping away from the liquor. The difference with food is you have to have food to live and a key on a healthy food plan is being sure clients get what’s needed and isn’t left feeling so deprived and hungry that they reach for a trigger food or turn again to binges.
Most food addiction treatment programs start out with a sugar- and refined carbohydrate free plan (the most common triggers), where you weigh and measure foods at three meals with one or two snacks a day. This is so important because a client probably has a fairly distorted view of what’s a normal portion. While some people can eat cleanly without weighing and measuring, your client may need to stick with the scales and cups at the start. Look for the plan to . . .
There’s not one way to eat trigger-free. A nutritionist well versed in food addiction treatment is preferable for making a plan. If a client gets a plan from a nutritionist who is not an addiction specialist, you can advise getting it adjusted by someone well-versed in overeating issues, maybe someone overcoming bingeing in recovery. This is important because a nutritionist may see nothing wrong with a plan including sugar-free foods. But even a taste of sweet, though it isn’t sugar per se can trigger a food addict to binge, and someone understanding addictions can advise better substitutions.
Good advice to offer here is: Learn the language of food, the names for sugar and ingredients that trigger binges. Read labels. Know appropriate portion sizes, including how to easily eyeball right portions.
As a food plan is developed, it’s important step to help a client see that if they fail to plan, they plan to fail. Thinking through situations, and thinking ahead is a huge step toward change: how to manage eating out when they can’t control the food offered and at what time, ways to get through social events centering on food.
This is part of not just making, but keeping a food plan, preparing one’s self, strapping on that seatbelt, driving defensively through the choices and changes along the way, strengthening the mind and spirit to help when the body and emotions will feel out of control. This isn’t an issue of willpower, not a matter of looking for determination to stick to a diet. This is positioning the self to make good choices, planning the changes to make, relating in a new way to food and eating, mapping out the steps needed to avoid the triggers and the behavior to take away from whatever will drag down or set the client back.
To Treat the Mind
And here is where real work begins: to start recognizing what drives clients to eat. What’s their first memory of a binge or overeating? Ask them to write down the place, circumstance, what was eaten and where, how they felt afterwards, what they did. And then have the client write down the next memory, and a next. Is there a pattern? Are there emotional triggers: boredom, frustration, anger, feeling abandoned or unloved and unattractive? You can begin to deal with each of these emotional keys.
Important then is to help a client recognize and separate the hungers of mood and food. Emotional hunger doesn’t notice signs of fullness, isn’t satisfied by eating, leave one feeling ashamed and guilty, must be fed what is craved, and can come on suddenly. Physical hunger, on the other hand, can be satiated without guilt by most any food and grows gradually.
As a client begins to recognize what’s driven them to dysfunctionally seek comfort in food in the first place, a range of troubling issues and anxieties can surface. Now you’re getting to the heart of things: where walls have been put up or bridges burned, where clients have been stopped or tripped or become stuck, what’s kept them isolated or from connecting with others, when they’ve felt their best or worst or in control or not, and what’s made them feel rejected or accepted.
A big help here for the overeaters’ low self-worth and self-care is helping them arrest what physician, psychiatrist, and author Daniel G. Amen (Feel Better Fast) calls the ANTS or Automatic Negative Thoughts: the cynical, gloomy, complaining thoughts that come on, one after another, and keep a client from moving forward. These are thoughts that run like a freight train through the mind, looping over again with negativity that can become self-fulfilled prophecies: They won’t like me. I’ll never beat this. I always fail. I’ll never be more than a mess. I can’t do anything right or well.
The ANTS aren’t just bad for a client’s mind, but spirit. (See how mind, body, and spirit treatment must be connected?) Angry, unkind, sad, and grumpy thoughts can activate the deep limbic system and make the body feel bad. Muscles tense, the heart beats faster, hands sweat, and a dizzy and off-balance feeling can take over, triggering irritation, frustration, depression, anger, sadness and despair—any manner of negative thoughts. By the same token, happy, good, hopeful, kind thoughts trigger the brain to release chemicals that cool your limbic system, creating calm, relaxation, slower and more steady heartbeats and breathing. Dealing with the ANTS will give a client the difference between finding self-acceptance, worth, and peace.
Treating the Spirit
That’s what the person overcome by food issues is looking for really—peace of mind, in body, with food, and in relationships. So many clients with food issues have harbored their secrets for so long, in such shame, that there are lifetimes of deeper issues to deal with—and such hopelessness and absence of faith and belief that life can be better. The self-blame and loathing is so strong it as though clients are walking around in a movable prison, always bound, never free.
To truly recover, the soul, not just the stomach, needs to get and live clean.
Here’s where the addiction model of treatment offers the best course for change and progress. The prayers and meditations for surrendering to what a person can do and what they can let go of truly lead to freedom. These prayers not only calm the soul but build an inner strength, especially the Serenity Prayer (God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference) and the Prayer of Saint Francis of Assisi (Lord, make me an instrument of your peace; where there is hatred, let me sow love; where there is injury, pardon: where there is doubt, faith; where there is despair, hope where there is darkness, light; where there is sadness, joy . . . that I may not so much seek to be consoled as to console; to be understood, as to understand; to be loved, as to love; for it is in giving that we receive, it is in pardoning that we are pardoned, and it is in dying that we are born).
Even science acknowledges there is a biology of belief, meaning faith and the practices of it help the body heal, strengthen, and achieve more vitality. Neuroscientists Andrew Newberg and Mark Robert Waldman chronicle the effects from a multitude of respected studies in their book How God Changes the Brain (Ballantine, 2010): Spiritual practice reduces stress, contemplating a loving God curtails anxiety, prayer deepens the capacity for gratitude and increases feelings of security, compassion, and love; meditation has lasting effects on the positive functioning of the brain, belief in God helps one handle a diagnosis of illness and fare better afterward.
Faith, hope, and love for the self are what help a client finally burst free and forward from food issues. Belief in what’s good and true empowers the client to love themselves enough to do the work on their emotional past, their confused present, and stick to a food plan. When this happens, clients can finally focus on their goals and relationships more than food, build a winning support system to get through the hard events, and live free of the mad cycle round and round the binges. What’s been eating them alive is no longer what they chew upon—and we can serve them this freedom by first agreeing on this model of helping the whole person, not just a part, not just the body.
