Most therapists have been taught that if we can help clients understand the emotional triggers of their overeating, they’ll be able to control their behavior and lose weight. Some of us, when working with clients on the continuum from occasional overeating to binge-eating disorder, build strategies around nutrition, portion control, and exercise habits. But more often than not, weight loss---should it occur---is fleeting. In fact, the pursuit of weight loss typically triggers and sustains overeating.
My focus with clients who have overeating and weight concerns is to help them learn how to have a healthy relationship with food. Typically, these clients have internalized the cultural message that their bodies are “wrong,” and that shame is reinforced when the dieting solution they’ve pursued, which usually works initially, almost always fails. We therapists need to recognize that when we reinforce the notion of weight loss as a marker of success, we set our clients up to leave therapy with even more shame about one more failure.
When Joelle called me to set up an appointment, I could hear the cycle of shame in her voice. “I’ve got to get my eating under control,” she told me. “I’m a middle-school librarian, and in the summers, when I’m not working, I’m really good at sticking to my diet. But as soon as I go back to school in September, everything falls apart.”
“Tell me a bit about your eating patterns,” I started.
Looking uncomfortable, she crossed her legs, uncrossed them, and then said, “It’s hard to talk about because it’s so embarrassing. Yesterday, for example, I stopped for an Egg McMuffin at McDonalds on my way to work. You’d think that’d be enough, but then I drove through two more fast-food places for more breakfast sandwiches, and I was stuffed by the time I got to work.” “I know these things are bad for me,” she added. “They’re just too tempting.”
I felt the heaviness in my heart that often arises when I hear the pain of someone caught in this struggle. “You think it’s your fault, but it’s part of the pattern for almost everyone,” I said. “If you’re like most of my clients, when the weight comes back, the people who gave you the compliments are silent, and you end up feeling shame. Then the negative body thoughts come back, leading to the next cycle of food restrictions.”
Joelle nodded her head, tears welling up in the corners of her eyes.Attuned Eating
At the core of eating problems is a disconnect from the internal, physical cues of hunger and satiation. We’re born knowing how to eat, but all kind of factors, including dieting, can interfere with our natural ability to honor these signals. Joelle’s overeating certainly had an emotional component, but I knew she had to learn the nuts and bolts of attuned
Clearly, Joelle could no longer tell the difference between her physical and emotional hunger. I suggested that over the next week she could check in with her body every 20 to 30 minutes and ask, “Am I hungry?” in the attuned way we’d just done during our session.
The following week, we explored why Joelle was so frightened of hunger, and then worked on solving that problem. When I asked her to tell me more, she revealed that after school, as an only child, she’d often come home to an empty house, where she’d be by herself for hours, even past dinnertime. “Sometimes there was no food in the refrigerator, and I was so uncomfortable,” Joelle described through her tears. “But other times there was plenty, and eating was a way to pass the time until someone came home.”
Given this revelation, I asked if Joelle could keep food with her in the library so that if she became hungry at work, she could eat enough to take the edge off until she could have a meal. She agreed to try it. Then I proposed she wait for hunger on weekend mornings when she could be sure food would be available.Health at Every Size
Over time, I felt confident that Joelle wouldn’t return to previous diet behaviors, but she started to complain that while she’d stopped gaining weight, she wasn’t losing any either. At that point, we spent some time examining how social pressures to be thin are often unrealistic and damaging to her body image. Rather than using the number on the scale as the criterion for success, it’s positive self-care behaviors that should be the benchmark.
To help Joelle understand this, I introduced her to the evidence-based Health At Every Size (HAES) framework, which has gained momentum in recent years.
Given that there’s no research to date showing that any weight-loss program leads to long-term success, the HAES paradigm offers a positive way to address health concerns without pursuing weight loss. The HAES paradigm promotes sustainable behaviors, such as attuned eating, exercise, good sleep patterns, and mindfulness practices, but it also addresses themes of respect for people of all sizes, the intersection of weight and other oppressions, and the effect of weight stigma on health and mental health.
As Joelle left my office for the last time, I reflected on how far she’d come in building a healthy relationship with food and what a good job she’d done of taking care of her body. I knew that, like all of us, she’d be up against cultural forces that might make her doubt herself if her weight ultimately settled somewhere higher than the thin ideal. But I believed that her willingness to move toward letting go of her internalized body shame would make her less susceptible to cultural messages that can retrigger the diet–binge cycle and a focus on thinness as a measure of personal value.This blog is excerpted from "It's Not about the Diet." Want to read more articles like this? Subscribe to Psychotherapy Networker Today!