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.

Sarah

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,

Sarah

Fasting, part 3 - Sustainability

Fasting - From Now Until..?

I've done a fair bit of reading about fasting diets. Both from research literature, popular texts (there are a few in the bookshops at the moment!), and also online. 

Lots of people have things to say about fasting, and it tends to take one of two forms. Fasting is either the best thing since sliced bread - take that Atkins! Or it's yet another example of a terrible fad diet, with claims that it can cause anything from bad breath to disordered eating. 

But there's something that, in general, is missing from all of these commentaries. And that's the focus of this post. 

In my first post on the topic, I hope I gave you a reasoned explanation of what the diet is and how it works. But there is one more thing I'd like you to consider before embarking on this, or indeed any other 'diet'. 

My question is this - how sustainable is intermittent fasting/calorie restriction? Can you honestly say that it's something you can keep up for life? Or, in fact, do you need to?

If you undertake a fasting diet as a means of weight loss, what happens once you've lost the desired amount of weight?

At the moment, there is a distinct lack of evidence on how these diets work in the long-term. Particularly so with regard to human studies. So anything you read about long-term sustainability and maintenance of weight loss is likely to be based on speculation.

And sustainability and maintenance of your new weight are rather important.

As with all diets, there is a fundamental issue that rears its ugly head: here’s the scenario – it may well be familiar.

You follow the plan, you obey the rules and lose the weight. Congratulations! But now what? You can stop following the diet, right? Go back to eating ‘normal’ food, every day?

And watch the weight pile back on.

This problem is common to an awful lot of diets. People in general are quite good at losing weight, but not so accomplished at keeping it off. This isn’t an issue specific to fasting diets, indeed we’ve already recognised a lack of long-term studies. But there’s a fairly logical thought progression that says fasting diets, as with other diet plans, if discontinued, will cease to be effective.

So how can you maintain the lost weight?

At the risk of sounding rather dull - it comes back to the fundamental concept that you need to eat a healthy, balanced diet.

The Eatwell Plate

That’s not to say don’t follow a diet, by all means, try it if you will and if it’s safe for you to do so. But learn from it.

Fasting diets can teach you several things.

Firstly, hunger is a natural sensation – it lets us know when we are actually in need of food. There’s nothing wrong with feeling hungry now and again. Embrace it, and learn to listen to the cues from your body.  

Secondly – and perhaps most importantly – the fasting days might put portion sizes into perspective. Portion sizes, more often than not, are the culprit in weight gain. Eating anything in excess, including fruit and vegetables, can lead to weight gain. By fasting you may come to realise that you don’t need to eat quite as much as you think you do, or are accustomed to.

Thirdly, be mindful when you are eating. It’s very easy to pop things into your mouth without thinking about it, or eat whilst distracted. And mindless eating is a guaranteed way of exceeding your energy requirements, thus leading to weight gain. Fasting days demand attention to your diet if you are to stay within your strict calorie allowance. If you are able to apply that same mindfulness to your eating behaviour in general, you are more likely to remain in control of your diet and with it, your weight.

Fasting, part 2: training and fasting

Fasting and training

It’s a question that’s been raised to me by a few people – can you combine a fasting diet with training for a sport?

Well yes, you can. But it requires some thought.

It is possible to continue training and follow a fasting/calorie restriction diet. You just have to be sensible. Planning a long run in marathon training for a fasting day simply isn't clever, nor is getting into the pool if you know you tend to feel light-headed on a fast day.

So for your reading pleasure, these are some of the things you need to think about/consider.

Train early - if you're used to exercising first thing in the morning, then make the most of the previous day's intake and train early. Your energy stores will be somewhat depleted by the overnight fast (also known as sleeping...), but less so than later on during a day of fasting.

Train late - if you simply can't face the thought of training on an empty stomach, wait until you've had something to eat. This depends on how you disperse your calories during your fasting day - if you spread them throughout the day, then it probably doesn't matter when you train - your exogenous (from food you've eaten) fuel levels will be consistently low. If you still have a 'main' meal during which you eat the majority of your day's calories, perhaps consider training a little while after that meal.

Hydrate - fasting encourages the utilisation of stored energy, and this process often also involves the elimination of stored water. Avoid dehydration by drinking regularly throughout the day - this may also help to stave off hunger pangs, and is essential for enabling quality athletic performance.

Eat well - If you have a poor quality diet in general, then the further restriction on fasting days could simply lead to nutrient deficiencies and poor health - less food = less calories, but it also means less vitamins and minerals. It’s important the you make up for the fasting days by eating nutritious foods on your feeding days. This is particularly important if you are stressing your body with training.

Be clever in scheduling - it simply makes sense to plan your most intense training days to coincide with 'feeding' days. You can exercise on fasting days, but it's likely to be a less than optimal performance. 

It may feel like you're giving it 100% (and you may well be), but 100% on a fasting day is unlikely to resemble 100% on a feeding day. It feels hard because your body is struggling, and you're less likely to experience the gains you would expect from a well-fuelled training session.

Train smart, train well!

Refuelling? It's difficult to refuel properly on fasting days, and it's worth bearing in mind that refuelling isn't just about replacing spent energy, but about feeding your muscles so they can recover from your workout. It's what happens in this recovery phase that determines the benefits you see from your training - becoming faster, stronger, developing stamina - all are affected by recovery. Another reason not to plan intense training days to coincide with fasting days.

Don't fast on race day! Let common sense prevail - if you're racing, give your body the fuel it needs. 

A Fast Way to Lose Weight?

Fasting

First things first, real fasting involves abstaining from all food and drink.

Various plans over the years, including detox diets, have advocated fasting, the more sensible of which allows for fluids.

These newly arisen fasting diets don’t advocate anything as extreme as avoiding all food and drink, but instead involve a significantly reduced calorie intake on ‘fasting’ days – usually a maximum of 600 kcal for men, and 500 kcal for women.

So this diet essentially advocates days of significant calorie restriction rather than actual fasting. But they use the term fasting, so I’ll stick with it for the sake of clarity.

The frequency of the fasting varies depending on what you read, but usually takes the form of either alternate day fasting (fasting every other day) or fasting on a 5:2 ratio - the latter involves fasting for two days per week. Both forms of the diet can be considered as intermittent fasting.

So what does it involve?

The pattern of the diet is variable – the frequency of the fast, as already said, varies depending on what plan you follow. Whichever it is it, the fast days involve restricting your calorie intake quite dramatically.

The general advice around calorie intake per day is 2000 kcal for a woman, and 2500 kcal for a man. Now, these are far too general to be of real use to the individual (but that’s another story), but do give us some indication of the rough energy intake that’s considered the norm/common. And it does give you some indication as to just how much of a calorie restriction you’re expected to follow on an intermittent fasting diet.

Let’s take a 500 kcal fast as an example. What do you get for your calories?

The answer, unsurprisingly, is not a lot. But it very much depends on how careful you are with your calories as to how much you have to eat.

For 500 kcal you could have a couple of slices of toast and peanut butter, and a Mars bar. And that’s it. Or you could have a couple of scrambled eggs for breakfast, a bowl of tomato soup and a salad at lunch, and a bowl of vegetable and lentil stew for dinner. This diet requires thought and preparation, and some knowledge and skill. And a liking for vegetables will certainly help.

  

How does it work?

Essentially, the diet involves days of calorie restriction. And when you restrict calories to a level below that which you use, you create a deficit which leads to weight loss. It’s fairly basic maths.

However – and there’s usually a however with diets – there are drawbacks.

There are various potential problems with fasting:

•  Hunger. As a society we’ve got used to being surrounded by food. For most of us there’s never any need or desire to allow ourselves to feel actual hunger. It’s not a pleasant sensation, but it is a natural one. It lets us know when we need to eat – not a drawback as such, but something to be aware of!
• Fasting can affect your mood – don’t be surprised if you find yourself feeling just a little bit grumpy on your fasting days.
• Low energy consumption can lead to low energy levels – on fast days, you may find you feel tired and struggle with normal activities.
• Following on from the above, if you exercise or are training for a sport you may well find your efforts feel that much more difficult than usual. By fasting you are essentially depriving your body of fuel, and the extra demands of being active may be one step too far for your dwindling energy levels.
• Fasting affects hunger hormones, causing a down-regulation of appetite. So after a few days of fasting you may find that you’re not bothered as much by feelings of hunger. However, on non-fasting days you may find that there is a rebound increase in the hunger hormones, stimulating a greater appetite than you would normally experience. This can lead to bingeing and overeating – and the excess calories eaten on non-fasting days can sabotage weight-loss.
• Fasting has an effect on your metabolic rate – low energy consumption causes a down-regulation in how much energy our bodies use, so whilst you may be eating less, your body is also using less. This down-regulation can linger even when you return to your normal diet, so it’s quite possible that you will gain weight on returning to a normal eating pattern.

However – yes, there’s another however – these diets are not well studied.

The known effects of fasting/very low calorie diets are usually applied to periods of extended fasting/calorie restriction. How these transfer to intermittent calorie restriction is not fully understood – and whilst that’s not necessarily something to deter you from following the diet, it is something to be wary of. The long-term consequences of this diet are simply not known.

Non-fasting days

There are different ideas about what and how you should eat on non-fasting days.

Should you eat ‘normally’, that is, stick to whatever dietary pattern you usually follow? Or can you splurge – reward your virtuosity for sticking to your calorie restriction, and devour anything and everything you desire?

Research into these diets advocates that you should maintain a healthy balanced diet on your non-fasting days. You need to get in the nutrients you’ve missed out on during the fast, and an excessively high calorie intake on your ‘feed’ days can sabotage any efforts on your ‘fast’ days. So whilst you may want to eat nothing but cream cakes and pies, try and stick to balanced meals and snacks. And remember there’s nothing wrong with cake and chocolate, in moderation.

Benefits?

In addition to the potential for weight loss, the fasting diets also seem to confer other benefits to general health.

In the few studies that have been published on these forms of dieting, improvements in various health markers were noted, including cholesterol and blood glucose.

Calorie restriction has been studied for years, with the focus being on its effect on longevity – and the findings suggest that there are benefits to be had. In addition to a reduction in levels of IGF-1 (insulin-like growth factor, a compound responsible for the ageing process), cholesterol and blood glucose are reduced, and with these so are your risks of cardiovascular disease and type 2 diabetes.

Anything else?

There’s always a last word to be had – is this eating pattern to be recommended? It’s hard to say. As a dietitian I like to work from evidence – high quality, rigorous evidence. And in the case of Alternate Day Fasting, 5:2 fasting, or any other configuration of calorie restrictive diets, the evidence just isn’t there yet.

The studies that have been published are promising, but there are some questions yet to be answered – what pattern of restriction works most effectively? How should you eat on non-fasting days? What level of calorie restriction is most effective?

Perhaps most importantly you need to consider how sustainable this eating pattern is. Do you just adhere to the plan for a finite period of time for the purposes of weight loss? What happens when you reach your goal? Do you revert back to your previous diet, which was probably responsible for your weight/cholesterol/etc. in the first place? Sustainability in diet and lifestyle is key to life-long health, and is intermittent fasting/severe calorie restriction sustainable?

It’s something to think about.

A word of warning – if you are diabetic, pregnant or breast-feeding, DO NOT follow this diet plan. It’s also strongly contraindicated if you have a history of eating disorders.

If you have any other health conditions, be safe and check with an expert before embarking on this (or indeed any other) diet.