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Emotional/Stress Eating: Facts, Challenges, and Interventions

Jeremy Clorfene, Ph.D.Head Psychologist Advocate Weight Management Program (Chicago Area)565 Lakeview Parkway, Suite 102Vernon Hills, IL 60061o 847-990-5770c 847-877-1331www.jeremyclorfenephd.com

Why do we eat?1. Hunger/Fuel

2. Every other reasonWhat is Emotional/Stress Eating?

Eating in response to negative emotionsStress, anxiety, sadness, anger, despair, loneliness, boredom, hopeless, helpless, shame, pressure, fatigue, sleepinessso you can feel better (temporary).

Emotional/Stress Eating is mitigating an unpleasant uncomfortable state by eating to temporarily feel better or distracted I just have to have it.

Usually you will never feel more justified eating when they are feeling these negative emotions (Stinking Thinking)

NOTE:Emotional eating discussed in terms of negative emotions rather than eating when happy or excited (positive emotions). Human emotions and experience is complex, and the link between negative emotions and eating is key. Separate Issue:Eating when happyusually reward eating.Eating for celebration/social/outIm Italian, we eat

What Triggers Emotional Hunger?Stimulated by situations, thoughts, feelings, people, cues, time of day, and long-standing habits. Examples: commute, supervisor, paying bills, parenting

Human beings are emotional: it provides color, depth, quality.

Imagine a life without emotions? Dictates how we live, interact, work, play, meaning and purpose.

Clearly, eating and emotions can have a strong relationship.

How we related to food is emotional, passionate. a love affair with food.

Physical vs. Emotional HungerPhysical hunger occurs when our body needs food for energy.

Anxiety, sadness, or anger does not feel like hunger even though a person may want to eat.

Years of emotional/stress eating forgotten what physical hunger truly feels like

Over time, when emotional eating is targeted as a treatment goal patients will reconnect with physical hunger cues. Progress is when eating in response to physical hunger rather than emotional hunger.

What is the Biochemistry / Physiology?

Where do we feel negative emotions?

Negative emotions and stress will activate our body in a fashion designed to protect us against that threat.

Our body does not know if the threat is real or perceived but it is receiving messages from the brain that something is wrong.

Anxiety, fear, anger, betrayal, sad activates the "fight or flight" response.

Fight or Flight ResponseDuring Stress adrenal glands release two hormones: Adrenaline and Cortisol

Stimulate our organs and muscles to cope with the threat causing our negative emotions. Our bodys response to a bear chasing us in the woods is very similar to being scolded by a supervisor at work. CortisolCortisol increases appetite and sugar cravingsWe love sweets, sweets, sweets Also, Turning off of full centers in the brain Numbing all other feelingsSugar is the great anesthetic! Once obese, got to eat to stay obeseVicious cycleTaubes, G, Why We Get Fat , 2010.

The CycleConcomitantly, obesity can contribute to a negative self-worth which can significantly impact a patient's overall mood (gender differences as well).

Thus, a cycle of lowered self-worth fuels negative emotions which in turn increases eating and subsequently obesity. In most situations, emotional eating takes place when a patient is rarely physically hungry.

BTWwe are the most in debt, obese, addicted, medicated cohort in historywoa!

Limbic System - DopamineBrains pleasure chemicalControls emotions, memories, and smellWe make many decisions based on emotions (dopamine)With the sight of food, dopamine flushes your brainTakes approx. 2 seconds to make a decision (uh ya fast)Once levels decrease, question why you did it? Buyers Remorse

Lindstrom M. Buyology of Belief. 2008Similarities b/t Food Addiction and Drug AddictionPET scans show obese patients have lower dopamine levelsSimilar to drug addicted subjectsThus less sensitive to reward stimuliTakes more food (stimulus) to gain pleasureObese patients more vulnerable to food intake as a source of pleasure

Wang GJ. J Addictive Diseases. 2004

Conscious MindOur personal identity, creative mind runs the show about 5% of the timeAware of the Past, Present, and FutureHolds our wishes, desires, and aspirationsHolds our positive thoughtsOur Free Will

Lipton BH. Biology of Belief. 2008Subconscious MindStimulus-response cyclereflex systemNot governed by reason or thinkingYears of stored, learned programs, habitsRuns the show 95% of the time

Lipton BH. Biology of Belief. 2008

Subconscious Mind (cont.)50,000 (est) automatic thoughts per day / called sub vocalizationsEvery thought, aware or unaware has a chemical signature95% are automatic! Aware of only 5% = 2500 ... 80% of those thoughts are Negative / Limiting (approx. 2000)4 negative to 1 positiveWhy so much negativity? Marshalla, Repeatlessness, 2006Perceptions and FeelingBrain is attracted to negativity:

Researchers looked at how we fall into negative mindsets and then it is difficult to undo

How to describe the glass? Glass is Full = Gain Frame (positive)Glass is Empty = Loss Frame (negative)

New Surgical Procedure70% Success30% Failure30% Failure

70% Success

Group 1Group 2Governor Rating40% Jobs Saved40% Jobs Saved60% Jobs Lost60% Jobs Lost

Group 2Group 123Mind Frame Conversion (600 lives at stake)Group 1Group 2If 100 lives are Saved how many are Lost? If 100 lives are Lost how many are Saved? 600-100 = ?GAINES TO LOSSLOSS TO GAINESHow long to figure out the problem?GAINES TO LOSSLOSS TO GAINES7 seconds to figure it out11 seconds to figure it outChaiken, S., & Ledgerwood, A. (2012)What does this mean?Once the mind experience, thinks, perceive lossit resists changeShifting from positive to negative is easyShifting from negative to positive is hardIt takes effort and work!!Why? Negativity is emotionally protective.Control/predict pain is better than feeling good and then be disappointed!

Positive feedback is short-term, transient.Negative feedback sticks all too well. Ex. Performance review25 things you do awesome, but that one opportunity for growthAsk people about love, tell you about heart-breakAsk about belonging, tell you about rejectionAsk people about connection, tell you about disconnectionPositive Attitude!

AlsoAnything that is perceived to require EFFORT is also considered negative!Building success is about effort, effort doesnt feel good, increases risk for emotional eating unless there is a payoff/reward/reinforcer.

Building frustration tolerance, victories off-set the discomfort, confidence and positive results ensue!

Lets Get RealA typical DayWhat is the emotional/stress eating pattern?

Most people do not emotionally eat in the morning or early afternoon. Patients report emotional/stress eating takes place mid to late afternoon and in the evening.

Factors: Sleep/Energy, Hormones, Hunger, Behavior

30Sleep/EnergySleep and Energy: Greatest level of focus, attention, and energy mid-morning!

Post-prandial dipnap time would be great/siesta (good luck)then, 4pm, Tea and Crumpets

The day progresses fatigue, sleepiness increases, b/c most people totally sleep deprived (caffeine)

Sleep deprivation increases cortisol, and caffeine activates adrenal gland (double whammy).

Ghrelin Levels (hunger hormone)

BehaviorWhat are we doing between 6am and 6pm?

Working, busy, distractedThen we commute, come home and thenbills, kids, marital issues, single parent, medical issues

THEN WHAT? BACK UP THE EMOTIONAL/ STRESS EATING TRUCK! (4pm Midnight!)sugar/carb time!

H.A.L.T. (4pm Midnight)

H = HungryA = AngryL = LonelyT = TiredBrief SummaryOnce obese (morbid) there are some real challenges:1. Cortisol2. Dopamine3. Fat cells influence the brain to eat4. Negative thinking5. Sleep deprivation6. Ghrelin7. Food is the go to numbing agent!

Behavioral TherapyWere pretty good at engineering and building roads, cell phones, drinkable water, but good luck trying to change peoples behavior

Charles Merbitz, 1996 Treating Emotional/Stress Eating But what are we treating? Depression, Fatigue, Hunger, Convenience, Trauma, Irritability, or A really good opportunity to eat what we want? HABITS and drive-thrus!

Levels of Stress/Emotional: Low, Medium, High Low Stress (0-3)tired, hungry, bills, commute, childs grades, boredom, night time eating, TV eating, eating while cooking

Medium Stress (4-6)water in your basement, car accident, chronic back pain, family

High Stress (7-10)Death/Disability, betrayal, DUI, divorce, job lossPeople need their stress to eat!

Ex. Lori, MichaelTreatment/InterventionBreak the problem down for the patient: Wheres their stress hotspot?

Get a commitmenthave they bought into working on this issue?

Discuss the downside to taking away their coping and/or buddy (mild discomfort)STRUCTURE and PRECISIONI. STRUCTURERegular visits with health care team (1-4x/mo)Regular monitoring of weight and biometrics.Higher the connectivity between team and patient better results.Emotional support, cheerleading with successes and victories, and interventions for lapsesAccountability, cause naughty is done in privateKeep em comingeven when not doing well.

II. STRUCTUREDo they have a meal plan?Meal Replacements 2 for wt loss and at least1 for sustaining great toolNutrition needs met (and quality) without excess calsSimplify decisionsReduce temptation (eat this first, less likely to eat that)Control costsDitschunett et al., Obesity Res, 2001

I. PRECISIONElevate awareness: acknowledge and recognize negative emotions

Self-monitoring (food records)Raising self-awareness is absolutely necessaryPatients underestimate calories by 1/3Overestimate physical activity by Keeping food records is critical

Hold patients accountable, no records no treatmentFood records are diagnostic and interventionIf you count it, you change it

Foreyt J. Medscapre Diabetes & Endocrinology. 2004

II. PRECISIONPREVENTIdentify and fight biggest risk factors for patient and Battle Stinking ThinkingBattle the Emotional/Stress eating habits

FIXGet back on meal plan at all costsWork hard till it is not so hard

III. PRECISIONPREVENT:Stimulus Control that is, risk factors/triggersHome (kitchen, fridge, pantry, hidden drawer) = get it out of the house, theyll get over itEating out/drive thru = planningLate night eating = stopStrengthen the internal muscle fight the urges, develop tolerance for the discomfort

IV. PRECISIONDieting cycles produces unhealthy thinking relapse behavioral patterns. Stinking Thinking are methods to get off plan and justify eating what you want!

Stinking Thinking: The Big Five1. I already messed up lunchsolets party!(stole a little, might as well steal a lot)2. Ill just have one or Im just getting a Diet Coke from McDonalds3. Im stressed so I need this 4. I cant do this/I cant handle this5. Im not in my routine so I can have

V. PRECISIONFIX once off their planstress ateGET THEM BACK ON PLANThis is the key!!!!This is hard, this is the work, this is the change!Separates the old pattern and builds the correct new behavioral patternThis is what is always missing!But it is NOT what your patient wants to do!This is where the negativity flourishes!This is where they Give Up!Must fight this and help them get back on plan!!

SummaryNegative emotions / physiology do increase cravingsbutEmotional/Stress eating is more about habitsGet commitment, self-monitorPin-point key pattern and target that behaviorBuild eating plan to help routine Grind it out a bitfight the discomfortIf got off plan, fight to get back on plan asap! And maybe a whole-lotta-psychotherapy.

Questions?