BODY AS GARDEN FEATURED IN TIMES PICAYUNE THURSDAY, JUNE 9
Relationship with food can be very complicated
As a child, Ann sought out food when she couldn't get the hug and kiss she needed.
"In my family, we were not allowed to express any type of emotion," she said. "We could be happy and that was about it. I learned to eat to cope with the other emotions."
As she grew older, Ann continued to have a troubled relationship with food.
"It's like a switch that goes on or off, and when that switch goes on I become obsessed with food," she said. "I wish I could know why it does that."
The notion of food as a form of comfort has become an accepted part of the American mentality. On the TV show "Friends," Monica and Rachel stocked up on low-fat frozen yogurt to eat for consolation every time they got dumped, saving the real stuff -- ice cream -- for dire emergencies.
But for many overweight patients, this is no laughing matter. Nutritionists and doctors say these patients have a severe psychological dependence on food. And while a clinical term has not yet been assigned to this, most experts agree that it deserves a label: emotional overeating.
According to Molly Kimball, a sports and lifestyle nutritionist at Elmwood Fitness Center, emotional overeaters are distinguished by their tendency "to continue to eat when there are no physical reasons to be hungry." Essentially, instead of addressing their problems, emotional overeaters swallow them.
The majority of Kimball's clients who struggle with emotional overeating are women. They tend to binge at night, and often overindulge in carbohydrates and sweets, which trigger a release of the chemical serotonin in the brain, producing a calming effect. But, they all eat in response to specific psychological triggers, Kimball said, and identifying these situations is essential to controlling their eating habits.
"I had one (client) who was bingeing at 9 o'clock in the morning because that was when her husband left for work," Kimball said. "As soon as he left, she'd run to the convenience store for chocolate."
Another of Kimball's clients, who struggled with nighttime overeating, was amazed when she returned from a solo vacation and reported that she hadn't binged once during her weeklong trip. After reflecting upon it, she realized that the trip had provided her with a respite from her husband, and that she felt the need to overeat only around him.
Unhappy marriages aren't the only underlying problem for women who experience emotional overeating; almost any psychological stress -- dealing with an overbearing parent, facing an intense work environment, coping with the death of a loved one -- can cause people to seek solace in food, Kimball said. But she has noticed that a high percentage of her clients who have been victims of emotional or physical abuse are also emotional overeaters.
"Sexual abuse is a very common cause," she said. "They're unhappy with their current state of life and are using food to fill a void."
Dr. Nancy Brehm, a psychologist and the founder of Body as Garden, focuses almost exclusively on treating emotional overeaters. Her practice, she said, "was born helping abuse victims. All of a sudden it hit me that all of my trauma patients were overweight. They were abusing their bodies. In some ways it can be seen as a control issue."
Brehm's theory makes sense to Melissa, who, like Ann, has struggled with emotional overeating her entire life.
"I think it's all about control," Melissa said. "You may not have control over your job or traffic, but you can control every little morsel you put in your mouth. You can use that to your advantage or to your gross disadvantage."
In Melissa's case, she became a full-scale bulimic, or binge-and-purge eater.
"I thought it was an easy form of weight loss," she said. "I equated food with comfort, and I was not willing to give up that comfort to be thin."
According to Brehm, there is a clear link between emotional overeating and bulimia. Bulimia is marked by a cycle of binges and purges, and since emotional overeaters are already bingeing, for many of them purging is the next logical step.
"A lot of people who overeat eat more and more until they feel the need to purge," Brehm said. "It's a general sliding down the hill."
Both Melissa and Ann believe that Americans' love/hate relationship with food contributes to the problems emotional overeaters face.
"In this country, we have made food our enemy," Melissa said. "You can't go to a party without hearing someone around the buffet table say, 'Oh, I'm going to have to pay for this later,' or 'Oh, I'm going to have to spend an extra 20 minutes on the treadmill today.' "
And yet, even though people recognize -- and sometimes exaggerate -- the pitfalls associated with eating certain foods, many fail to push for access to a more healthful diet.
"How easy is it to get a healthy meal in a restaurant?" Ann asked. "I've had to almost get into an argument trying to get a meal without a rich sauce."
Although Ann and Melissa first attempted to deal with their eating problems on their own, both eventually sought professional help. The critical first step, as with any classic 12-step program, requires patients to admit they have a problem.
Many emotional overeaters, especially those who suffer from deeply rooted psychological trauma, are reluctant to lose weight, Brehm said.
"Think of fat as a heavy coat," she said. "You wouldn't go out in the winter without your coat -- you might freeze to death. That's their fear, that something will happen to them."
Whether an emotional overeater seeks help from a nutritionist, a psychologist or both, the treatment typically follows a set pattern. Initially, the patient works with a doctor or nutritionist to identify situations that cause the overeating and find alternative ways to relieve the stress.
"I've noticed that a lot of (my clients) binge in private," Kimball said. "So I get them to go get a small scoop of ice cream with a friend instead of eating the whole pint at home. It takes the secrecy out of it."
Many experts who treat emotional overeaters are moving beyond simply modifying their patients' eating habits; they're working to change their attitude toward food in general.
"Dieting is a huge problem with (emotional overeaters)," said Susan McQuillan, a dietitian and the author of "Breaking the Bonds of Food Addiction." "They diet as opposed to engaging in healthy, mindful eating."
Both McQuillan and Brehm emphasize the latter.
"I teach (patients) to love food again," Brehm said. Having owned a French cooking school, she advocates the "French way of eating," popularized by Mireille Guiliano's "French Women Don't Get Fat": eating small portions, eating in courses, and, most important, eating slowly. Nonetheless, she cautions against putting too much stock in Guiliano's book.
"Her way of eating is very healthy," Brehm said. "But she doesn't address any of the emotional problems that can lead to overeating."
Above all else, experts say, emotional overeaters must address the psychological stresses that cause them to overeat in the first place.
"Emotional overeaters need to get to the core of their problem. Diet is secondary," McQuillan said. "But in general there's a real reluctance to get help with their emotions. It's hard for people to understand how sitting in a psychiatrist's office is going to help them lose weight."
There is no quick cure for emotional overeating. For many people, it's a lifelong battle that involves numerous setbacks.
"There's a strong element of self-sabotage with (emotional overeaters)," Kimball said. "Some people set themselves up for failure. When they reach their goal weight, what will they have to work on then?"
Even Ann, who has lost 90 pounds over the past four years, finds herself constantly struggling with the condition.
"I still resort to food, mainly sweets, to take care of myself," she said. "I have periods when I eat healthy and exercise regularly. Then something happens -- I get sick or work becomes very time-consuming -- and I feel overwhelmed and go back to food. If this lasts for a while, it becomes like climbing out of a pit to get back on track -- it takes a tremendous amount of effort."