Beyond a Shadow of a Diet

The Comprehensive Guide to Treating Binge Eating Disorder, Compulsive Eating, and Emotional Overeating

Judith Matz, Ellen Frankel

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781136183560
• Edition: 2
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Beyond a Shadow of a Diet is the most comprehensive book available for professionals working with clients who struggle with Binge Eating Disorder, Compulsive Eating or Emotional Overeating. The authors present research revealing that food restrictions in the pursuit of weight loss actually trigger and sustain overeating. Next, they offer step-by-step guidelines to help clients end the diet mentality and learn an internally-based approach known as attuned eating. Divided into three sections–The Problem, The Treatment and The Solution–this engaging book contains chapters filled with compelling case examples, visualizations and other exercises so that therapists can deepen their knowledge and skills as they help clients gain freedom from preoccupation with food and weight.

In addition to addressing the symptoms, dynamics and treatment of eating problems, Beyond a Shadow of a Diet presents a holistic framework that goes well beyond the clinical setting. This invaluable resource includes topics such as the clinician's own attitudes toward dieting and weight; cultural, ethical and social justice issues; the neuroscience of mindfulness; weight stigma; and promoting wellness for children of all sizes. Drawing from the Health At Every Size paradigm–and the wealth of research examining the relationship between dieting, weight and health– Beyond a Shadow of a Diet offers both therapists and their clients a positive, evidence-based model to making peace with food, their bodies and themselves.

Part One

The Problem

CHAPTER 1

I WANT TO LOSE WEIGHT

Identifying the Problem

A new client arrives at your office. “What brings you here?” you ask. “I need help losing weight,” she replies. “If only I could control my eating and be thin, I know my life would be better. This isn’t the body I was meant to have. I want to have more energy and I know my marriage would improve if I looked more attractive. I’ve tried every diet and lost a lot of weight, but I’ve always gained it back. I’ve never been this heavy before. It’s been a really stressful time. I know I turn to food when I’m unhappy. Can you help me?”

You’ve worked with a client for the past 10 months. During this time, he has achieved many goals, including managing his depression and choosing a career path. He is a large man but has never referred to his body size. You know that he would like to begin dating. Do you bring up his weight as a therapeutic issue?

After many months of therapy, a client tells you that she feels great shame about her body. This comes as a surprise to you because she appears to be average weight and physically fit. She explains that she works very hard to keep herself this size. She follows a strict food plan and doesn’t allow herself any “junk” food. “It works pretty well for me,” she tells you. “I couldn’t stand myself if I gained any weight. But, whenever I go to a party or out with a friend, I get really worried. What if there’s nothing for me to eat? Sometimes I want what they’re having so badly, and I do eat it. I feel so guilty afterwards. Sometimes I’m really good while I’m out, but on my way home, I stop at the store and buy some candy or cookies. They’re usually gone before I walk in my house. That is the worst feeling in the world.”

Another client tells you she feels in control with food during the day. “At work, I’m really ‘good’ about staying on my diet and eating healthy. But after dinner, even though I promise myself I won’t, I find myself in front of the television and I can’t stop eating the rest of the night. I end up feeling so mad at myself and so ashamed.”

These scenarios are typical of the different ways in which clients bring food and weight issues into treatment. Binge or compulsive eating problems may be the presenting problem, or they may arise as a client moves deeper into the treatment relationship. Conversely, they may never be mentioned during the course of therapy.

ASSESSING YOUR REACTIONS

Take a moment to reflect on your reactions to each of these scenarios. How might you respond in the session? Your assessment of these vignettes depends upon your own experiences with food and weight. Messages about the desirability of thinness and controlled eating habits are strong in our culture, and they influence everyone, including therapists.

Think about yourself for a moment:

• Are you now or have you ever been on a diet?

• Do you worry about your body size?

• Do you engage in diet conversations with friends or family members?

• Do you think dieting is a healthy behavior?

• Do you feel good when someone says that you look like you’ve lost weight?

• Have you ever commented on someone else’s weight?

Each of these behaviors may seem innocuous at first, but they have profound ramifications in terms of what you will bring to the treatment setting. Turning back to our case scenarios, there are, of course, many possible reactions. Here are some common responses of therapists:

“I know exactly what she means.” In this situation, the therapist identifies with the client. She has also struggled with overeating and understands immediately the pain and suffering of her client. She may feel a sense of helplessness in this area or may try to get her client to succeed with diets where she herself has failed.

“It’s a matter of self-esteem. If she felt better about herself she would do something.” This belief often comes from the therapist who has not encountered significant problems with food and weight. The therapist wonders why her client doesn’t just “do something” if it bothers her so much.

“She s not fat. I don’t understand what she is complaining about.” In this scenario, the therapist may be uncomfortable with her own body size. She worries about her appearance and can experience counter transference in her work with thinner clients. She may also be unaware of how clients with body image problems present their experience.

“My client hasn’t told me that she has food and weight issues. It’s not relevant to our therapy.” The therapist feels uncomfortable exploring the possibility that these issues have meaning in the client’s life. Or, she may assume that food and weight concerns pose no problem for the client and may, in fact, be correct. However, the therapist may not know how to ask about these topics or know what to do if, in fact, they require intervention.

“The solution is for my client to understand the emotional triggers of her eating through our work together. Then her overeating will diminish and she’ll lose weight.” This response stems from the therapist’s training in helping cure clients of symptoms by exploring the underlying causes of a problem. Although ultimately the client does need to understand the emotional components of overeating, if there is in fact a connection in her life, the therapist may be less versed in the need to intervene directly with binge and compulsive eating patterns.

“I conquered my weight problems. If my client develops more willpower and stops sabotaging herself she can do it too.” The therapist has had success with a particular method of weight control. She expects her client to be able to follow the same plan.

Most therapists identify with one or more of these responses. As your reactions occur, either consciously or unconsciously, you must decide how to proceed in treatment. Some therapists will encourage diet, weight management, or lifestyle programs designed to help the client lose weight. This recommendation can take the shape of a formal program, a diet philosophy based on a book, or a self-imposed restricted food plan and exercise regime. The therapist also may take the route of trying to help the client understand why she overeats. In this case, the underlying belief is that once the client understands and resolves the emotional issues triggering binge, compulsive, or emotional overeating, she will no longer need to turn to food. While both of these strategies may seem logical, they usually fail. A successful treatment for solving eating problems lies in an approach that combines direct interventions regarding food, body image, and psychological insight.

Defining the Terms

The terms binge eating, compulsive eating, and emotional overeating all describe a relationship with food that has little to do with physical hunger. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) now contains specific criteria to evaluate the presence of binge eating disorder (BED). At the same time, clients will choose different terms to describe their own overeating, perhaps describing themselves as an “emotional overeater,” or referring to a “binge” that does not actually fit the diagnostic criteria. As you consider these terms, it is important to know that BED indicates a psychiatric diagnosis, compulsive eating describes a subclinical eating problem, and emotional overeating refers to the reliance on food as a major way of regulating affect, which is frequently present with both BED and compulsive eating.

Unlike a “normal” eater, a person with an overeating problem repeatedly reaches for food when she’s not physically hungry. Everyone eats occasionally for reasons other than hunger. A person may take a bite of food because it looks good or may overeat at a holiday meal. The natural eater usually notices that she ate too much, feels uncomfortable, and then waits for the next indication of physical hunger to eat again. The binge or compulsive eater, on the other hand, experiences the overeating as evidence of being out of control. She begins to yell at herself internally for her transgression and thinks of ways to counteract the overeating such as tightening food restraints. For the client who has many overeating experiences throughout the day, this type of thinking consumes a large portion of her mental energy and contributes to feelings of low self-esteem, guilt, and depression.

Overeaters come in all shapes and sizes. There are large people who do not binge or eat compulsively, and there are thin and average size people who struggle with these issues. The amount of food eaten can vary from small amounts of “too much” food throughout the day to binges characterized by large amounts of food consumed in a short period of time. Janine frequently reaches for a few handfuls of chips or a few candy bars when she feels lonely or bored, which bothers her, but she never eats the whole bag of chips or bag of candy. Henry, on the other hand, stops at the convenience store on his way home from work, and before he arrives home has finished the box of cookies. The key factor is that eating has little to do with physical hunger. In fact, the person may no longer know what it feels like to be hungry.

THE DIETING FACTOR

Dieting is commonly viewed as the solution to the loss of control that characterizes binge and compulsive eating. However, dieting necessitates tuning into external cues with regard to food intake and disconnecting from internal cues of hunger and satiety. A meal plan for weight loss typically specifies the timing of meals and a predetermined amount of permissible foods. Invariably, the food restrictions placed on the dieter eventually result in breaking the diet with consumption of the once forbidden foods of the diet plan, often in the form of a binge.

A classic study by researchers Janet Polivy and Peter Herman at the University of Toronto illustrates the way in which dieters, or restrained eaters, have lost touch with the internal hunger and fullness cues that are necessary for normal eating. In the experiment, a group of dieters and non-dieters were given the task of comparing ice cream flavors. Participants were divided into three groups. Those in the first group were given two milkshakes to drink before eating the ice cream. The second group was asked to drink one milkshake before eating the ice cream, while the third group was not given any milkshakes prior to the ice cream. Next, the researchers offered the groups three flavors of ice cream and asked participants to rate the flavors, eating as much ice cream as they desired.

The results revealed that the non-dieters ate more ice cream when they had not had any milkshakes, less ice cream when they had one milksh...