Tuesday, 2 December 2014

I'm unhappy because I eat, I eat because I'm unhappy.

What do you think of when you hear the words ‘emotional eating’?

An imagine of a Bridget Jones type character, dishevelled, and sobbing into a tub of Haagen Dazs?

These are certainly the type of images of emotional eating that are portrayed in the media.

Emotional eating is probably much more common than you would think. In fact, I’d wager that anyone reading this has done it at some point. And quite possibly does so on a regular basis.

You get home from work, tired and frustrated, and reach for the wine. You’re celebrating someone’s birthday so out comes the birthday cake. The kids are fighting and the cat has been sick in the laundry – you need some chocolate. Little Eric, despite being scared, was a good boy at the dentist, so you take him to McDonalds.

Eating or drinking in these circumstances typically has nothing to do with satisfying physical hunger. These acts of eating are linked to how we are feeling – and this is emotional eating.

I asked a question on my Facebook page recently – what’s your favourite comfort food? The replies varied, but tended to focus around carbs – toast, mashed potato, macaroni cheese, chocolate, pasta, crisps, ice cream…

People were very forthcoming with their answers – quick to reply and very specific. No one challenged the idea of ‘comfort’ food. It wasn’t a trick question – comfort food is a concept that we, as humans, are familiar with. When we’re feeling down, food – specific foods – cheer us up, make us feel better, sooth us.

This is often something we learn from a very young age. Going back to the example of little Eric – a (potentially) unhappy experience such as going to the dentist, having jabs at the doctors, sitting an exam, falling over… these are followed with food as a salve. And more often than not, the foods used are high fat and high sugar – ice cream, chocolate, biscuits, crisps, alcohol, etc.

And so our relationship with food becomes confused. Rather than eating through hunger – real, empty stomach, physical hunger – we eat for a whole host of reasons that have nothing to do with a physical need for food.

If these instances are infrequent they aren’t necessarily something to be concerned about – there’s nothing wrong with having a slice of cake to celebrate a birthday.

But for some these are daily occurrences. Food becomes the go-to solution for coping with emotional distress. You find yourself upset, stressed, anxious, frustrated, bored, lonely – and you know food makes you feel better, so that’s where you turn.

And this is where the real problem lies. Eating does nothing to address the underlying cause of the negative emotion. Any relief is temporary, and typically the bout of eating is followed by guilt, thus leading to a vicious cycle of eating and shame.

Emotional eating can be linked to deep psychological issues, or it can be a seemingly innocuous coping mechanism for daily stresses. Either way, it is an insidious behaviour and one that, particularly in its milder forms, we often aren’t consciously aware of, but certainly has its impact on our weight. 

So how do you know if you’re an emotional eater?

Firstly, you need to be able to identify the difference between emotional and physical hunger.

Physical hunger typically comes from the stomach. It can be described as an empty or hollow feeling in the stomach, and there may be associated noises – growling, rumbling, etc. But it’s important to acknowledge that the stomach also makes noises for other reasons, for example, when digesting food or if you have wind.

Emotional hunger originates from the head. There may well be a feeling of emptiness, but this is not from empty, growling stomach. If the emptiness is from low mood, boredom, etc. no amount of food will resolve it.

Physical hunger usually comes on gradually, and unless you have gone many, many hours without food, physical hunger does not typically ‘demand’ immediate attention. It can be ignored or ‘forgotten’ when we are busy. Physical hunger can wait.

Emotional hunger tends to come on quickly. You feel a sudden need for food – usually quite a specific food – and that desire can be overwhelming.

Physical hunger can typically be satisfied by a variety of foods, and this would include healthy options such as vegetables, salads, meat, fish, etc.

Emotional hunger tends to demand a specific food. Nothing else will satisfy the desire, because it isn’t originating from a physical need for food.  

Physical hunger tends to be responded to in a (at least partially) mindful way. You decide what you want to eat, you buy it/prepare it/cook it, and eat it. Your food choice may not always be ideal, your portions may not be quite right, but you are aware of your choices.

Emotional hunger is often responded to mindlessly – your decisions are made almost on auto-pilot. The food choice is your predetermined ‘comfort’ food, the portion size is irrelevant and the eating is often mechanical.

And here’s something essential to recognise - physical hunger is satisfied by eating. 
Emotional hunger isn’t
If you are eating through reasons of emotion, then no amount of food can possibly satisfy the need.

When physically hungry, the stomach and brain are sated by eating. If bored, tired, low, etc. then what does eating do to meaningfully address these feelings? And if your intake is not based on physical hunger, then how can you know when to stop?

For these reasons, emotional eating is usually a harmful behaviour.

-       Eating through emotion tends to lead to poor food choice.
-       Eating that is not driven by physical hunger cannot be satisfied by food, so overeating is a common feature.
-       It doesn’t address the underlying feeling, so there is no meaningful resolution from eating.
-       Emotional eating is commonly followed by guilt and/or shame, which drives its cyclical nature.
-       Emotional eaters often struggle with their weight.

So if you are an emotional eater (perhaps wanting to lose weight), what can you do about it?

Emotional eaters – if aware of their habits – often feel powerless to change their behaviour. But eating to pacify our feelings is a learnt association, and it can be unlearnt.

It is not an easy thing to do, but with consistent effort it can change. Depending on the extent of the problem, professional support may be needed – don’t be afraid of asking for help.

Some things you can try are:

Keep a food and mood diary: knowing exactly what is happening is crucial. If you don’t quite have a grasp on the problem, how can you know how to solve it?
  • Write down everything – everything – that you eat.
  • Try and think about how you are feeling before/during/after you have eaten – both physically (is the hunger coming from your stomach?) and emotionally.
  • Write down who you were with, and what was happening in your environment.
  • Look back through your diary – more likely than not you’ll see a pattern emerging that links how you feel, who you are with, or what’s happened in your day, and what/when you have eaten. This will allow you to identify your triggers.
  • One you have worked out what initiates your eating behaviours you can begin to plan strategies to cope that don’t involve food. 
- When you know what your triggers are, you can begin to pre-empt them. And the earlier you can intervene in the developing situation, the more likely you are to be able to ward off/protect yourself against the precise trigger. 

Address the trigger – emotions can be difficult to handle, particularly the negative ones. But regularly ignoring how you are feeling is no good for your mood or mental health in the long term. This doesn’t mean you have to be obsessed with every feeling or thought, but instead find the middle ground in which you can acknowledge that you are unhappy/sad/anxious/worried/etc. Most emotions are transient – trying to suppress them with food will lead you to the emotional eating cycle. Recognise how you are feeling – it may be uncomfortable, but it isn’t as scary or overwhelming as you might fear.

·         If you do find yourself wanting to eat, and you are aware that the reason is not physical hunger, at the very least give yourself a few minutes before eating to work out what’s happening. That brief pause can help to break the cycle of automatically reaching for food. Even if you do give in, each time you take a moment you are putting yourself in a better position to be able to resist.

Resisting the urge to eat is difficult. Make it easier for yourself by planning some non-food related coping strategies. If you can put your mind to something else, the distraction provided can help you to overcome the desire to eat. Eating through emotion is itself a distraction from something else – replacing the eating with another behaviour/activity doesn’t address the underlying trigger (but nor does eating), but is less harmful to your waistline and health.

Distraction techniques might include:.

  • Be creative: do some knitting/crochet, draw a picture, make greeting cards, do some sewing (all of those missing buttons and hems will be a thing of the past!), paint a picture (or the walls…), play an instrument, write a poem
  • Be productive: wash the car, bath the cat (good luck with that one!), mow the lawn, plant some herbs
  • Treat yourself: have a bath, read a book, paint your nails, listen to some music, phone a friend, browse the internet, meditate. Treats should not involve eating or drinking!
  • Be active: go for a walk, put an exercise DVD on (Youtube is also good for this), take the dog out, dance around to your favourite album, play with the kids, go for a swim
  • Engage your brain: do a crossword, do a puzzle, help the kids with their homework, learn a language.

Ideally the activity will be something you enjoy. And something engaging – passive activities (now there’s a contradiction in terms!) such as watching tv don’t tend to work as distraction techniques as you are not engaged in the same way as if you are actually doing something. You can be as wild and creative as you like in what you choose – the key is to find a behaviour or activity to replace emotional eating. This will help to carry you through the desire to eat, and for long-term sustainable weight loss this is an essential issue to address.

Identifying the difference between emotional and physical hunger is an essential first step to being in charge of what and when you eat, and for weight loss this is crucial.

Traditional diets do not work well within the context of emotional eating. They work on the basis of restriction of ‘bad’ foods or whole food groups; they demand portion control; they suggest high fibre/protein to increase satiety, and so on. If your eating is driven by emotion, is not underpinned by hunger, or rationalised with logic, how can the principles of the ‘diet’ work?

The truth is they can’t. Not in the long-term. And short-term change lead to temporary results. But the dieting cycle is for another day…

So if emotional eating is something you struggle with, or something you think might be contributing to unwanted weight gain, then trying some of the techniques above can begin to help. If you need further support, then a referral to a specialist weight management or mental health team is precisely there to help with this kind of thing.

Any thoughts or comments, I’m always happy to hear from you.


Tuesday, 28 October 2014

New challenges, new opportunities

I’ve been a little quiet of late.

I’ve had to step away from The Food Whisperer a little bit as other aspects of life have taken over. My blog has suffered, but I’m pleased to say that we’re continuing to grow through social media. There’s a nice community building up on Facebook in the Food Whisperer Nutrition Hub, with lots of lovely people sharing recipes, talking nutrition and health, and asking questions – I’m always around to take part in the discussions!  

Whilst I’ve not been able to devote as much time to the Food Whisperer as I’d have liked, it has been for a good reason! First up, I changed jobs. This then necessitated a house move which, I’m glad to say, is now complete! In the sense that my husband and I are in the new house – we’re still surrounded by boxes J

The change in the day job has been a fantastic experience. I now specialise in weight management, an area of dietetics I am extremely passionate about.

I work with people whose BMI (body mass index) ranges from 35kg/m2 up to and exceeding 100kg/m2. Some of my patients will go on to have bariatric (weight loss) surgery. All of my patients – whether going forwards with surgery or not – will work hard at making positive lifestyle and dietary changes.

Patients come in despondent, hopeless, talking about themselves with disgust and despair. “Useless, rubbish, a failure…” I wonder how anyone can hope to muster the strength and determination to make sustainable, meaningful changes to an integral part of life when they have such low self-esteem and no self-belief.

Weight loss is hard-work. It takes years for the weight to come on, and it's hard to be realistic that it will take time - sometimes a lot of time - to lose it. And if it were as simple as eating less and moving more, then two-thirds of UK adults wouldn’t be overweight/obese. No one chooses to have a BMI of 60kg/m2. No one aspires to needing weight loss surgery. It’s a situation that most people sleep-walk into, and then struggle know how to change.

Much of the work I do is to help people to understand what has brought them to where they are now, and to identify the emotional and habitual aspects of their eating which – typically – are at the core of their weight gain. Eating is a behaviour, and not always one that we are consciously in control of. There is much, much more to weight than simply choosing the ‘wrong’ foods and being lazy. And this widely held, superficial ‘understanding’ is often part of the problem – if it sounds so simple, and yet is so hard to achieve, then how can a person value themselves and belief they are worth the effort to change?

I am in awe of the determination and hard-work that goes in to achieving the total life transformations that I have had the privilege of seeing and supporting, and over the next few weeks and months I’m hoping to write a series of posts about weight loss, bariatric surgery and explore the thoughts and behaviours that influence our food choices and eating behaviours.

If you have anything you’d like to me write about, please leave a comment below and/or come by the group or page on Facebook.

All the best,

Thursday, 16 January 2014

Exercise and Weight

Exercise and Weight

It’s the start of a new year and as always, the start of New Year’s resolutions. The evidence of this can be found quite easily in my gym, which has gone from being pleasantly busy when I arrive after work, to resembling a mosh pit of sweaty, lycra-clad exercisers, jostling for position in the queue for the treadmills.

Despite my exasperation at having to fight for my turn on the cross-trainer, fair play to the New Year’s Resolution crew – regular exercise is one of the most beneficial things you can do for your health and wellbeing.

The benefits of being active are far-reaching, extending to cardiovascular, respiratory, joint and mental health, as well as any other physiological system you care to mention. The simple fact is that the body is designed to be active, and sedentary lifestyles can be linked with all manner of ailments. If we don’t use our bodies, they begin to lose their capacity to be used. The joints cease up, bone density decreases, the muscles weaken (including the heart), resting heart rate and blood pressure increase, lung function is reduced, the immune system is less robust… All possible consequences of an inactive lifestyle.

Unfortunately, the New Year inspired enthusiasm that’s currently clogging up my gym (not that I own it…) will not last. Many of these people will have reverted to a more sedentary way of life before January is out.

One reason for this may be the lack of results that people see. Weight loss is high on the list of reasons why people take up exercise in the first place, and one of the easiest ways of ‘seeing’ results from exercising. But alas, many of the goals people set themselves are not realistic, leading people to give up, disheartened with the lack of results.   

So why is it that exercise doesn’t produce the weight loss we think (or hope!) it should? There are several reasons

1.      Our appetite increases

Appetite is a tricky thing. It’s a very complex mechanism influenced by hormones, genes, the nervous system, fat cells, psychology, the environment... Some people find that their appetite is suppressed by high intensity exercise, others find it increases. Others still find it varies depending on what exercise they’ve been doing (running, swimming, cycling, etc.) and on the conditions (temperature, humidity, etc.) they’ve been exercising in. So as you can see, there’s nothing simple about appetite and exercise!

For those who do find that exercise increases their appetite, it can be difficult resisting the urge to eat more after a session, be it at gym, running in the great outdoors or friendly game of football with your friends. If you know this is going to be an issue, plan your day so that you have a snack or meal timed to coincide with the peak in appetite. This way you can avoid extras but still satisfy the desire for food.

2.   We're not exercising consistently

Consistency is essential if you want to get the most out of exercise. A Sunday morning 10 mile run is all well and good, but if that's followed by a week of nothing more strenuous than climbing the stairs to bed, then a bit of common sense tells you that's probably not going to make much of a difference to your weight in either the short or the long term. Exercise needs to be consistent. It needs to be built in to your daily routine, and it needs to be something you enjoy, or be honest - you're simply not going to want to keep doing it. 

3.    We feel as though we’ve ‘earned’ more food

Exercise should not be about earning food. If one of your reasons for exercising is to lose weight, then you need to make the most of the energy deficit that exercise can contribute to and DON’T eat back the calories you’ve used exercising. Thirty minutes running, or 20 lengths in the pool does not automatically entitle you to a cappuccino and a muffin, unless you want to undo all of that hard work. The exercise will still have its health benefits but as far as calories are concerned, think twice before reaching for the biscuit ‘because you’ve earned it’.

 4.      We overestimate ‘the calorie burn’

All movement requires energy. The higher the intensity and the longer duration, the higher these requirements are. Measuring these calories outside of a research facility is rather difficult, and a variety of formulae are used to estimate the energy demand of an activity. Gym machines like to display calories used, as do various pieces of kit such as heart rate monitors, GPS watches and so on. The accuracy of these is always slightly questionable, and it’s important to see these figures for what they are – an estimate. The more information you are able to program in (age, sex, weight, fitness level, etc.) the more truthful this estimate will be, but it’s not likely to be correct down to the very last calorie. And more importantly than that, the calorie estimate is usually looking at gross calories rather than net.

Gross calories are the total number of calories used during an activity. This includes the calories needed to perform the activity, AND the calories that your body would be using anyway – the energy that is used to keep your heart beating, your blood circulating and your brain functioning: the energy needed to keep you alive, also known as the basal metabolic rate (BMR).

Net calories are those that you use to perform an activity, excluding the calories used for the BMR.

Why does this matter? Because we get fixated on calories, and the difference between gross and net does impact on the rate of weight loss.  

Let’s use an example.

A 30 year old, 5’4”, 70kg woman wants to lose weight. She maintains her diet to a level that would usually keep her weight stable, but starts running on a treadmill for 60 minutes every day. The display on the machine tells her that each session uses 500kcal. She does this every day, accumulating a 3500kcal burn over the week. This should, using the old equation of 3500kcal per pound of fat, result in 1lb of weight loss per week.

However – the 500kcal estimate is gross calorie burn. This includes the calories her body would be using regardless of exercise. Her net calorie burn is 500 – BMR.

The BMR varies from person to person, as it is relative to age, height, weight and sex. For our 70kg lady her BMR is ~1500kcal. Therefore, her energy requirements for BMR are 62.5kcal per hour, regardless of exercise. So her NET calorie burn is 500kcal (from one hour of running) minus 62.5kcal, leaving 437.5kcal. After a week, she will have used just over 3000kcal through exercising – not quite enough to see a one pound weight loss.

Now it is important to remember that our lady should lose weight following a regime like this. But not as rapidly as she might think. And this can lead some to becoming disheartened. Her weight loss is also dependent on her dietary intake – losing weight through exercise alone relies heavily on a carefully controlled diet. And this leads onto our next point.

5. You can’t out-train a bad diet

There’s a certain sense of entitlement that people can feel when they exercise regularly, which links back to point #2 – earning food. This can become more of a persistent problem whereby all dietary restraint is lost and people assume that they can eat freely, as the exercise will take care of any excess calories.

Now let’s think about this.

It’s very, very easy to overeat. Not just the volume of food, but more so the calories. An extra few calories here and there (half a slice of bread, a slightly thicker spreading of butter, an extra splash of gravy, another piece of fruit, etc.) will start to make an appreciable dent into any calorie deficit you might achieve through exercise.

If you start adding in snacks, the dent gets bigger. One digestive biscuit contains 70kcal, and do you really have just the one? A standard packet of crisps is around 180kcal, with the ‘light’ option being around 100kcal. If you’re anything like me, you’ve still got chocolates lingering from Christmas. One Quality Street chocolate is around 40kcal, and again – would you have just one? And as for takeaways - just one per week can rack up a 1000kcal easily, obviously dependant on what you have. That one meal - tasty though it may be - can single-handedly destroy any energy deficit you might have generated. Small snacks, picking at extras, once-in-a-while treats, and slightly larger portions will very quickly sabotage an otherwise healthy diet.

And let’s not forget drinks – a large latte made with whole milk contains a whopping 340 kcals, a can of Coke contains 140kcal, and a 200ml glass of orange juice contains 90kcal. So if you were to have a glass of OJ with breakfast, a mid-morning latte and a can of Coke with lunch you’d have consumed 570kcal – without chewing on a single piece of food. Top tip – don’t drink your calories! If you are thirsty you need to hydrate, not fuel. Keep your energy consumption to meals, not drinks.

If you are like most people, you simply don’t have the time (or perhaps the inclination) to spend hours per day exercising. And if you have a sedentary job, drive to and from work, and enjoy relaxing on the sofa once you’re home, then it’s quite likely that you spend most of your waking hours being inactive. An hour of vigorous exercise simply isn’t enough to make up for 23 hours sitting and a bad (poor quality, energy dense) diet. A more active commute to/from work will help, but still won’t guarantee an energy deficit from exercise.

The simple fact is it is much easier and quicker to consume calories than it is to expend them through exercise. Our 70kg lady would have to cycle at 12mph for 30 minutes to expend 280kcal, the same calories as in a Bounty or a small (50g) bag of dry roasted peanuts – which take far less than 30 minutes to eat.

Unless you spend multiple hours per day training, it is nigh on impossible to out-train a bad diet.

And putting weight to one side, a healthy, balanced diet is essential to good health, longevity and wellbeing. The risks of cardiovascular disease, type 2 diabetes, hypertension, stroke, cancer, etc. are closely linked to dietary intake, and a menu of refined carbohydrates, low quality meats, hydrogenated and trans fats (common in pastries, biscuits, etc.) and sugar is going to take its toll on your health, irrespective of time spent exercising.

Putting all of these factors together you can hopefully see why exercising for the purposes of weight loss isn’t necessarily as easy as it seemingly should be. We overestimate how many calories we’ve used, we eat them back (and then some!), we lose focus from what we’re eating and over-rely on the exercise to compensate for a less than ideal diet.   

As I’ve already said, exercise is one of THE BEST ways of improving your health and wellbeing. There is nothing in the world of medicine and science that can offer the same benefits as regular exercise. 

You can reduce your risk of a whole host of diseases that are associated with sedentary lifestyles, BUT you still need to pay attention to what you are eating. Exercise can improve practically any aspect of your wellbeing – it strengthens your bones, muscles, cardiovascular system, immune function, and respiratory system, it can improve mood, self-esteem, and confidence. Exercise can help with depression, arthritis, diabetes control, and lower blood pressure and cholesterol. And whilst it may not be a magic bullet where weight loss is concerned, it certainly plays a part. Just be realistic in your expectations, and don’t forget all of the other benefits besides what the scales say – after all, your health and wellbeing is about more than your weight.