To Jay Granat, PhD, weight had never been an issue… until he gained 30 lbs. and his doctor suggested a statin medication to improve his blood work. Having treated more than 3,500 obese patients and co-authored a weight loss manual, Dr. Granat had a better idea.  

 

Knowing from his clinical experience that 85 percent of lost weight comes back within two years without a permanent lifestyle change, Dr. Granat, a psychotherapist and a licensed hypnotist, knew he had to keep his motivation up. “Every morning, I close my eyes, take a few deep breaths, and ponder my reasons to lose weight—being around for my wife and kids and my fear of complicated medical procedures,” he says. After losing 30 lbs. by cutting simple carbohydrates, Dr. Granat is aiming for more.

 

The psychological component tends to be a common missing ingredient in weight-loss programs, according to Joshua D. Brown, PhD, a clinical psychologist who specializes in overweight and obesity, eating disorders and body image. And yet, there is more to weight loss than diet and exercise—or so many people wouldn’t struggle with it, he explains.

 

Losing weight is not easy for many reasons. For one, easy access to extremely palatable high-calorie foods pushes many to overeat. Living with stress—a common source of negative emotions—also makes it impossible for many to resist the temptation.¹ In fact, according to www.webmd.com, up to 75 percent of overeating is driven by emotions.²  

 

For centuries, people have associated excessive food with special, emotionally filled events—and with entertainment. “We celebrate with food, we grieve with food—we receive food when we lose a loved one, and food gives us something to do when we’re bored,” says Dr. Brown, director of clinical services at the Medical University of South Carolina’s Weight Management Center.

 

Even before we learn to connect food with fun, it enters our life as a comforter—literally, with mother’s milk. “Food is the earliest symbol of care and soothing that we receive when we are born,” says Judith Matz, LCSW, director of the Chicago Center for Overcoming Overeating and co-author of Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self-Care.

 

We grow up knowing that food is a quick fix for our needs, says Lubna Somjee, PhD, a clinical health psychologist in private practice in the Hudson Valley area of New York. “You can fool yourself into thinking that food can ease your distress immediately—as opposed to treatment, which can help long-term, but requires commitment.” 

 

Of course, the relief is only temporary—the effect of chocolate, for example, disappears after only 3 minutes.³ Yet, “if food or beverage takes away or reduces a negative emotion, even temporarily, we’re likely to turn to it the next time we experience [the same] emotion,” says Dr. Brown.

 

Not all food works, though. When sad, disappointed, irritable or anxious, we don’t crave carrots or celery. Instead, we turn to ice cream, chips, cookies or chocolate. Research shows the palatability of these foods may affect brain chemistry.⁴ Yet food only numbs the feelings—without resolving underlying causes. By adding inches to our waistlines, we also pile guilt onto the mix.

 

Emotional eating can also accompany low self-esteem, poor impulse control, or poor self-image, says Dr. Granat, founder of www.stayinthezone.com. “Many emotional eaters may also overshop or overdrink—they have little capacity to forego immediate gratification.”  

 

While some people may admit to eating when bored or stressed, others may not be aware of it. If you suspect a patient is an emotional eater, ask him or her: “Do you find yourself eating when you are not really hungry or when you are in a certain mood?” suggests Dr. Brown. (For signs of emotional eating, see sidebar.)

 

After emotional eating is established, it’s important to pin-point the triggers. In addition to emotions, overeating may be caused by thinking patterns, such as “I had a bad day at work; let me treat myself” or “I am overweight already, so what harm will one cookie do?” says Dr. Somjee. Unhealthy behavior patterns, such as stocking the pantry with tempting food, can also contribute to the problem.

 

To establish the triggers, ask patients to journal the foods they eat and the accompanying feelings and thoughts—without judging themselves, advises Karen Siegel Propis, MPH, MS, RD, LD, LAc, a Houston dietitian specializing in eating disorders and disordered eating. 

 

Dr. Brown recommends asking patients to record:

Next, review the journal with the patient, searching for triggers. Dr. Brown notes that eating less frequently than every three hours may also trigger emotional eating: When physically hungry, we are more likely to give in to cravings.  

 

Depending on the triggers, the recovery strategy will differ. For example, patients with more serious psychological issues, such as clinical depression, must get help. Referral is also necessary if the patient is binging and purging, including using laxatives or diuretics, or exercising excessively, says Dr. Brown.

 

Patients trapped in a diet-binge cycle may need to relearn to recognize their physical hunger, says Matz. “Ask yourself, ‘What exactly would feel good in my body now? Is it something hot, cold, sweet, crunchy or mushy?’ Narrow the food down without judging it good or bad. Learn to trust your body.” 

 

Those with unhealthy thinking patterns need help to identify the patterns and “refashion” the thinking, says Dr. Somjee. For example, instead of deciding that an extra cookie won’t matter, one might say, “I am trying to lose weight—so the cookie may make a difference. Why don’t I eat something healthier?” While it may sound forced in the beginning, “over time you will change the way you think,” she explains.

 

Patients using food as a reward, a stress reliever, or a distraction must “brainstorm and develop a list of healthier, non-food-related coping activities,” says Dr. Brown. Such activities, which might include reading, Sudoku, exercise, breathing techniques, meditation or massage, should be practiced regularly. Dr. Brown also recommends keeping a written list of the most effective coping activities handy. “It can be hard for us to think clearly in times [of] intense emotions,” he explains.

 

As with any habit, emotional eating takes motivation, time and practice to break. Support by healthcare providers can prove invaluable. Some doctors can collaborate with health psychologists, who specialize in motivating patients to comply with health recommendations.

 

Remember that what motivates one person may not inspire another. In addition, to be meaningful, common motivators—appearance, health, and well-being—may need to be spelled out into practical terms, such as an outfit the patient is dying to wear, a heart attack she wants to avoid … or his desire to be around to watch his kids grow up, says Dr. Granat. “Ask what motivates them. Give them a chance to verbalize in detail what’s in their heart.”

 

Next, explain how specific tools and techniques will help them—and give them detailed homework, says Dr. Somjee. “Telling them to exercise three times a week is not enough. Break down the process and make it very concrete. Ask, for example, ‘Which three days a week do you think you can work out? Do you want to start with five minutes a day and work up?’” Discussing details—the preparation of clothes, equipment or the IPOD for exercising—will increase the likelihood of compliance, she explains.

 

Don’t judge the patient’s weight, so as not to fuel an eating disorder, says Siegel Propis. “The patients get enough judging already. Be compassionate in asking how long their weight has been an issue and how they’ve tried to help themselves.” She adds that patients struggling with food and weight for years should be treated in collaboration with an eating disorders specialist.  

 

Ultimately, healthcare providers want to focus on patients’ health, not weight, agrees Matz. “Research shows that factors such as fitness are much more important than weight in determining health,” she says, noting that the focus on weight in American culture pushes many to develop unhealthy eating behaviors.

 

By helping patients rethink their relationship with food, giving them healthy eating tools, and motivating them along the way, providers can empower their patients to take “control over their eating versus popping pills or trying to follow vague orders to ‘eat healthy,’” concludes Dr. Somjee.