Friday 15 December 2017

Do you gorge on treats in the evening? Here's how you can break the comfort eating cycle

Are you a comfort eater? Do you gorge on sweet treats as soon as your day ends? Dr Claire Hayes is here to help you break the cycle

Binge eating as an eating disorder. It is recognised as being a potentially serious and even life-threatening condition
Binge eating as an eating disorder. It is recognised as being a potentially serious and even life-threatening condition
Problems arise when comfort eating becomes a habit; a predominant way of coping,

What do you do when you feel upset? Are you one of the many people who instinctively turns to sugar to get an instant hit?

I was and sometimes can still be. I remember clearly many years ago, answering my phone and hearing very bad news. As soon as the call ended, I ran into the kitchen, opened a press, took a packet of biscuits and proceeded to eat one biscuit after the other while tears rolled down my face. I did not stop to question why I was eating compulsively when I was not hungry, did not even taste the food, did not need it and was not enjoying it. Maybe it was a distraction. Maybe I was deliberately seeking out sugar to give me some sort of comfort. Maybe my extreme distress was overriding my normal awareness of when ‘enough’ was ‘enough’.

I don’t know when I began to associate sugar with providing me comfort, but it was probably when I was a child. It is not just psychological, as we know that sugar gives our bodies a hit of chemicals such as dopamine and endorphins that we generally associate with feeling good.

I know I am not unique in associating food with comfort. Celebrations such as birthday parties, weddings and anniversaries often centre on food. Food also plays an important role in supporting people in difficult times, such as after funerals. Like almost everything, comfort eating in moderation is fine so long as we are able to regain control quickly and we do not dive into self-loathing. Problems arise, and can arise very quickly, when comfort eating becomes a habit, when it becomes a predominant way of coping, when it becomes an addiction, when it is done in secret and when it leads to compulsive or binge eating.

The latest revision of the Diagnostic Statistical Manual and the International Classification of Diseases both describe binge eating as an eating disorder. It is recognised as being a potentially serious and even life-threatening condition. Like other eating disorders such as anorexia nervosa and bulimia nervosa, it can result in a crucifying cycle of shame, upset and guilt, resulting in serious health and social difficulties. So in an age in which we are bombarded with messages designed to make us want more and more, how do we know when our comfort eating is in danger of becoming a binge eating disorder (BED)?

Professor Christopher Fairburn, an international expert in the field of eating disorders, describes BED as one of the two newest eating disorders (the other being avoidant restrictive food intake disorder). BED has been found to affect people at every age with the majority being diagnosed and treated in middle age. Approximately one third of these are male. Statistics for the rate of eating disorders in general vary as not everyone who has the condition is diagnosed and treated. BodyWhys, the Eating Disorder Association of Ireland, gives details of research carried out by Professor James Hudson and his colleagues in 2007 which indicate that the lifetime prevalence estimates of anorexia nervosa, bulimia nervosa, and binge eating disorder are 0.9pc, 1.5pc, and 3.5pc respectively among women, and 0.3pc, 0.5pc, and 2.0pc respectively among men. It also refers to a 2007 study of Irish children and adolescents carried out by Professor Fiona McNicholas which found that 1.2pc of Irish girls may be at risk of developing anorexia nervosa, with 2pc at risk of developing bulimia. Some aspects of bulimia nervosa are similar to those of anorexia nervosa, ie, severely restricting certain foods. Other aspects are similar to those of BED since people with bulimia nervosa can swing from starving themselves to binging on large amounts of foods.

Changing habits can be difficult
Changing habits can be difficult

 

The key diagnostic features of BED are recurrent and persistent episodes of eating an abnormally large amount of food with loss of control. These are associated with at least three of the following:

 

● Eating much more rapidly than normal

Do you gorge on sweet treats as soon as your day ends?
Do you gorge on sweet treats as soon as your day ends?

● Eating until feeling uncomfortably full

● Eating large amounts of food when not feeling physically hungry

● Eating alone because of being embarrassed by how much one is eating

● Feeling disgusted with oneself, depressed, or  guilty after overeating.

 

People who have been diagnosed with BED generally have marked distress about their behaviour and tend not to engage in purging or vomiting. While not everyone who is obese has BED, many people who do have the disorder tend to be obese. A range of conditions can develop as a result, such as diabetes and coronary heart disease. BED can also lead to isolation, depression and anxiety. It is distinct from Prader-Willi syndrome, which is a genetic disorder causing initial feeding difficulties and failure to thrive with overeating becoming a major difficulty as the child grows older.

So how can we work to prevent an increase in the number of people developing BED and what support is available for people who already have it? Let’s look at prevention first. This starts with an increased understanding of the factors that contribute to overeating so that we can consciously change our patterns to take control of what we eat, how much we eat, when we eat and how we eat. When we look at when patterns of overeating start, we may point to the diets of many adolescents. Actually, eating habits can be established in children as young as five. We can easily underestimate the power that advertising, positioning of sweets and chocolate in supermarkets and use of ‘free toys’ have in enticing children into wanting to eat certain foods.

It is almost 30 years since I first came across cognitive behavioural therapy (CBT) as the recommended psychological treatment for a range of difficulties including eating disorders. I remember wondering why its key principles were not taught as a means of prevention, years before people experienced difficulties.

Answering this question and teaching the basic principles of CBT has become the focus of my work in the years since. I have developed a clear, three-step model called ‘The Coping Triangle’ to explain how our thoughts, beliefs and actions can impact on our feelings. In my book Finding Hope in the Age of Anxiety (Gill, 2017), I describe a story I devised called Betty’s Biscuits. I use this to explain how thoughts such as ‘I’d love a biscuit’ can conflict with ‘No, you already had a big dinner, you are not to have one’. These thoughts can trigger a range of emotions such as upset, shame and/or guilt. To feel better, we may give into our cravings and decide to eat two biscuits and no more. You probably can guess how this story ends! If we have a tendency to see food as a way of making us feel better, two biscuits are often not enough. Two can lead to three to four and even the whole packet. My work with people focuses on helping them acknowledge their feelings as making sense, identify thoughts as ‘helpful’ or ‘unhelpful’, become aware of and challenge underlying core beliefs they may have such as ‘I am useless’, ‘I have no will power’, ‘No one will ever understand’ or ‘I need sugar to feel better’. We work together in helping to develop understanding and self-compassion, in becoming aware of their behaviour and in deliberately changing patterns, eg no longer automatically using food to feel better when upset.

Problems arise when comfort eating becomes a habit; a predominant way of coping,
Problems arise when comfort eating becomes a habit; a predominant way of coping,

Changing habits can be difficult. When we are used to sugary food, reducing or even removing our sugar intake can be torture! However, it does not need to take massive will power to successfully change our eating habits. Once we become aware of how simply using a smaller size plate can automatically reduce our portion sizes, how deliberately eating slower can make us feel full more quickly and how eating sugary foods can actually make us feel ill, we are more inclined to have better eating habits. It is essential that we are kind to ourselves in the process. We will have slips and while we might feel ashamed of them, we do not have to use them as proof of how ‘useless’ we are. Instead, it is essential that we develop self-compassion. 

By now, you will know whether your eating is something that you are concerned about. If it is, please go to your GP who will coordinate referral to an appropriate service for assessment and/or follow-up treatment if required. I highly recommend you read Professor Fairburn’s excellent book, Overcoming Binge Eating, second edition: The Proven Program to Learn Why You Binge and How You Can Stop (Guilford Press, 2013). In it, he clearly explains what BED is and how it is treated. He describes three main treatment approaches. The first is cognitive behavioural therapy for eating disorders. The second is interpersonal psychotherapy, which focuses on strengthening and developing relationships. The third is an approach he has developed and adapted from CBT, which he calls guided self-help. The more informed you are and the more support you get, the better. I also encourage you to contact BodyWhy’s (bodywhys.ie); to avail of courses in mindfulness such as those run by the Sanctuary (sanctuary.ie); to do the life skills courses run by Aware (aware.ie) and to learn about Dr Paul Gilbert’s approach to self-compassion (compassionatemind.co.uk).

I would like to stress that no packets of biscuits were consumed while writing this article! Most of the time, I now recognise that when I crave a particular chocolate bar, I am under too much stress. Instead of automatically giving into my craving, I deliberately do something else such as going for a walk, mowing the lawn or telling someone I trust what is exactly going on for me. On those occasions when I give in and have the bar, I do my best to be kind to myself. Finally, regardless of how out of control you think your eating behaviours are, there is always help. Please take it!

 

Overeating has been related to a wide range of factors including:

● Poor self-esteem

● Difficulties in childhood

● Difficulties in adolescence

● Frequent exposure to advertising

● Boredom

● Eating while watching television

● Eating while playing with computer games

● Too large portion sizes

● Parents’ attitude to food

● Eating too quickly

● Associating food with giving comfort

● Associating food with rewards

● Stress, depression and/or anxiety

● Availability of high-calorie, high-sugar food

● Low consumption of healthy food

● Insufficient physical activity

● Poor sleeping habits

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