As holistic practitioners, we know that treating the root causes of disease is the most effective way to elicit positive long-term change. In the treatment of obesity, no other physicians have better training to put the physiological pieces of the puzzle together. We understand inflammation, hormones, neurotransmitters and other factors that play a role in weight. However, when it comes to counseling our patients about food and emotions, some of us feel lost. This article will explore some of the emotional and behavioral issues around food, so we can be effective in helping patients not only to lose weight and keep it off, but also to experience peace in their relationships with food and freedom from the ineffective cycle of dieting.
Emotional Ties to Food
There is no doubt the relationship with food is complex. We live in a culture where food is closely related to feelings. Advertisers know this, and we are exposed to thousands of marketing images and sounds each day. “Nothin’ says lovin’ like somethin’ from the oven” has been engrained in our brains from a young age. We nurture others with food and equate food with love. In addition, as humans, whether or not we eat is the first decision we get to make in life; it is our first experience of autonomy. Is there any wonder why we have such control issues around food? We are definitely fighting an uphill battle, so asking patients the right questions is crucial to helping them during the process of weight loss. In addition, as patients lose weight, each “layer” that is uncovered will have a different texture and flavor, like peeling an onion. Because of this, the case of each patient will need constant reassessment. So, what do we ask? What do we listen for? How can we help?
One of the most fundamental things we need to know is each patient’s relationship with food and weight. Is the patient a compulsive eater who indulges in response to certain emotional triggers, such as boredom, sadness, anxiety or even happiness? Does the patient have a specific eating pattern, such as secret eating when no one else is around? Or does the patient eat primarily in response to social pressure at home, work or at parties? These questions not only allow us to understand our patients’ experience with food and weight, but also help us to work with them to adapt new behaviors. For example, if a patient comes home from work so hungry every day that he or she makes poor food choices, counsel the patient to eat a healthy snack before leaving work. Or, maybe the patient needs to take a different route home that doesn’t go past fast food restaurants. I once got a call from a patient who pulled into the parking lot of a fast food restaurant during his evening commute. He wanted me to convince him not to eat a bucket of fried chicken. From that day on, he took side streets home to avoid the strong smell of the fast food restaurants.
Another important aspect of the patient’s story is their dieting history. How many times has a person lost and regained weight? The conventional cycle of dieting starts with the reduction of caloric intake, leading to weight loss. This loss of weight is a combination of both fat and muscle loss. Since muscle tissue is highly metabolically active, the loss of muscle decreases metabolic rate. With each pass around the cycle of dieting, it is more difficult to lose weight and easier to regain. In addition, each pass feels like another failure to dieters. If the patient is a chronic dieter, this person is not only metabolically challenged, but may also be emotionally worn out. Ask patients about their goals. Do they have a realistic idea of what a healthy weight is? Are they attached to a certain number on the scale? Do they want to be the same weight they were in high school, though now they are 50 years old? If patients do not have a healthy or realistic goal, it is best to discuss this early on in the process. How do they define success?
When assessing a patient’s dieting history, it is important to know if the patient has a “sticking point” in the weight loss process. Is there a number on the scale that he or she historically cannot move beyond? If there is, this magic weight might have more than frustration attached to it. Sometimes a certain number on the scale or dress size will trigger a flood of emotions. Maybe there was abuse or a trauma at that weight. As this weight approaches, does the patient find him or herself sabotaging the plan or experiencing uncomfortable emotions? For many people, excess weight can serve as protective or insulating. Patients might feel more comfortable with the perception that they are less attractive to others. Ironically, when people are obese, they might angrily tell you that they feel “invisible,” yet the deeper truth might be that they unconsciously want to feel invisible.
Fear of Failure, of Success
Fear is a natural part of change for many people, even if change is positive. Fear of both success and failure often accompany the process of weight loss. While some say being fat is a failure, being overweight is a way of avoiding failure, because it is an excuse for never trying, competing, engaging, etc. Excess weight serves as an excuse for why people don’t have the job or relationship they want. When life is not what it should be, the weight can take the blame. However, with weight loss, the scapegoat disappears and people can only blame themselves. A patient once asked me, “What if I lose weight and my life still stinks?”
Fear of success can also intensify when patients feel others will place higher expectations on them if they are thin. In addition, identity issues may arise as someone loses weight. A patient of mine, a young man, told me he was known to all of his buddies as “big guy.” If he is not “big guy” anymore, who is he? He struggled with this throughout his treatment and overate whenever he spent time with his childhood friends.
Perfectionism is an issue for many patients, especially women. We have all heard the common adage, “I’ve messed up, so I’ll start again on Monday.” For these types of patients, messing up a little can lead to an all-out eating extravaganza. Once they have “blown it,” they figure they might as well keep “blowing it.” They tend to be embarrassed by their perceived failure, and disappear! Call them if they miss an appointment. Discourage “all or nothing” thinking and encourage positive self-talk and affirmations. Ask them a few questions: Have you experienced what you perceive to be a failure? What feelings did this bring up for you? When confronted with this situation again, what will you do differently next time?
Relationships with Other People
Relationships can have a profound effect on the eating behavior of some people. What is the patient’s support network like? Does the patient live alone or with others? What relationship dynamics are in play? Is this person losing weight for someone else? Do they live with someone who is the “food police”? For example, a married couple came into my office. The husband said, “I want my wife to lose weight, help her.” I asked the wife if she wanted to lose weight, and she half-heartedly answered, “Yeah, I want to lose weight.” Over the next six weeks, she gained 15 pounds, as if to say, “Nobody tells me what to eat.”
I have seen this over and over. Control issues and power struggles can develop between a husband and wife, mother and daughter, etc. As eating is the first thing we can control as humans, food connects us to very deep feelings of survival, autonomy and control. This can be a particularly difficult issue for patients with a critical parent and/or spouse. Secret eating is a sign of a passive-aggressive need for control. If control is not the issue, guilt may be. Do they have a “fat” family? Loyalty, pressure or simply wanting to “fit in” may cause them to feel guilty or uncomfortable losing weight.
In summary, we need to ask patients a host of questions. Then, it is time to ask the most important question, the question that takes all of these aspects into account: What are the benefits of not losing weight? At first, most patients will tell you there are no benefits to being overweight. But, with a little contemplation, most will be able to list some ways in which being overweight has served a purpose. When patients are fully ready to confront those issues and let go of the benefits of carrying extra weight, they will experience true, long-term success.
Amy Bader, ND completed her bachelor of science at the University of California at Berkeley and earned her naturopathic doctorate with honors from NCNM. Currently, Dr. Bader is an adjunct faculty member of NCNM, overseeing naturopathic medical students at NCNM’s clinic. In addition, she is leading the development of NCNM’s naturopathic weight loss program. Dr. Bader sees patients in her private practice in Portland and travels to her hometown of Lodi, Calif., a few days a month to see patients. She has trained extensively in the areas of clinical nutrition, classical homeopathy, botanical medicine, counseling and physical medicine, as well as conventional medical treatments. She has completed extra coursework in the areas of women’s health, immunology, nutrition, homeopathy and counseling. Dr. Bader has also trained extensively in biotherapeutic drainage. Contact: 800-738-7303, firstname.lastname@example.org, www.benourished.org.