Monday 24 September 2018

Nearly half of us are overweight, and the obesity crisis is growing. Is our problem all in the mind?

Nearly half of us are overweight, and the obesity crisis is growing. Why do so many of us eat when we're simply not hungry? Julia Molony asks if our problem is all in the mind

Karina Melvin, author of Artful Eating
Karina Melvin, author of Artful Eating

Our relationship to the food we eat is the most intimate, involved and enduring any of us will ever have. And as with all important relationships, it's complicated.

Food nurtures, fuels and excites us. It is our very life force. But it can harm us too. Or rather, we can use it to self-harm. It is tied up with the full spectrum of human emotions; pleasure, satisfaction, longing, sadness, guilt and shame.

All of us overeat at some time or another - and for all manner of reasons. Sometimes it's social, or even celebratory, like stuffing yourself at Christmas. Sometimes it's consolation we are looking for, such as when you gorge on ice cream after a bad day at work. The habit of using food to fill a need that goes beyond the body's basic need for sustenance is pretty much universal.

But in Ireland, our propensity to eat too much is harming our health. Four out of 10 Irish people are overweight, according to the latest figures, and an alarming 23pc are obese. The health implications of this issue are clear. A significant proportion of us risk overeating our way to an early death. But why?

Karina Melvin is a psychologist and psychoanalyst. She specialises in weight loss and is the author of the book Artful Eating. She argues there is no one-size-fits-all answer to this question because despite the clear epidemiological trend, the reasons behind overeating are extremely individual.

Overeating, says Melvin "is a spectrum". It ranges from the occasional bout of "emotional eating to the more extreme end where there is compulsive binging, secret eating, eating to the point of feeling sick or in some cases getting sick, which is bulimia. When we talk about our relationship to food and when it becomes problematic, then it's a symptom as opposed to being a bad habit or an unhealthy behaviour," she says.

Karina's therapeutic approach to overeating is all about finding its psychological root. That means uncovering each persons individual "narrative" or "story" which forms their beliefs about food. "For every person, that is different," she says. "You might have grown up in a house where your mother or your father dieted all the time, or your older sisters were really skinny and you weren't.

"There is a story or a narrative there around your relationship with food that starts off either quite positive or quite negative, or somewhere in between. This story "shapes how you relate with food. And the whatever is going on in your life, whether it's stresses, anxiety, fear, frustration, boredom, - personal professional sexual or physical" can for some people "speak through food and a problematic relationship with food."

Melvin is sceptical about the current trend, in the face of rocketing obesity rates, to "over-medicalise" our changing relationship with food.

"Currently there is a lot of interest in medicalising behaviours such as the idea that sugar is addictive," she says. She argues that this is a bit of a red herring, because it leads us to believe that "'the problem isn't me, the problem is the food and I need to quit sugar.' When in actual fact the issue is "how are you feeling in yourself? Are you happy or are you sad? Are you struggling with something? Are you trying to swallow something down? Are you trying to escape something or is there an empty feeling that you are trying to fill up?"

"When we eat to satiate something that is not physical we are trying to self-regulate our relationship to pleasure," she says. "Most people flit in and out of being in a position of desiring, of wanting. Physically that is frustrating at times. It is exciting at times. In order to be living and breathing and getting on with life, there has to be a gap to desire and to want something. But for some people, tolerating desire is difficult. Because when we are desiring we don't have the thing we want. There's a feeling of lack. For people who overeat, it's a way of trying to control or manage or quench that lack that we are feeling."

Her remedy then is to address the broader issue not of diet per se, but of quality of life. "It's not about focussing on what you eat, it's focussing on your life, enjoying life and trying as best one can to consciously regulate their enjoyment. Recognising that everything that you eat is an opportunity to enjoy.

"Look forward to it, anticipate it. Eat things that you are going enjoy. And that nestles in to a wider sense of well-being in your life. Enjoying your life, taking care of your home, what you wear, your relationships. The more we feel at ease in ourselves, the less we are going to focus on food as a solution for some sort of problem that we have."

Experts in human behaviour are now increasingly convinced that diet culture may actually be part of the problem or overeating. Overwhelming evidence suggest that not only do diets not work, over the long term, those who embark on calorie restriction are more likely to gain weight in the long run than lose it.

"The way people diet now and look at food will promote tendencies to binge," says dietitian Aoife Deane, who specialises in weight loss from her practices in Cork City and London's Harley Street. We start the week making "grim" efforts to eschew pleasure and stick to weight loss goals but "that tapers off by around Wednesday, and then by Thursday evening, Friday evening it's full blown, 'oh I need to enjoy myself, I deserve it'."

"It stems from our background - whether our own generation or those before us, especially in Ireland, where there would have been food scarcity or money scarcity," she says.

"You can train mice to become binge eaters. It's really quite simple, you just give them small windows of opportunities where the food is available, and then train them that it won't be available. It's not within your conscious control because your survival mechanism will tell you that if food is going to go away next week, I should overcompensate in advance."

This, says Aoife, is the effect we are creating when we start the diet on Monday and break it by Friday.

As the neuroscientist and food writer Darya Rose explains in her book Foodist, this binge-starve cycle is known as "counter-regulatory eating" or the "what-the-hell effect, where "falling short of self-imposed goals results in a binge".

"The reason dieters are prone to this behaviour is that restricted eating teaches you to ignore your internal satiety cues," she writes. "The biological signals that tell us if we are hungry or full. For example, if you are hungry but the diet you are following says you can't eat for another two hours, you force yourself to ignore the pangs and power through. Not only does this deplete your willpower and make it more likely you'll break your diet later in the day; it also teaches your brain not to listen to your body."

In order to really change our relationship with food then, the first step is to relinquish control. "The more we try to control what we eat, the more we problematise it... there is naturally a wonderful wisdom within our bodies that knows what we need to eat and how much we need to eat," says Karina Melvin.

"Awareness is a big key - starting to recognise without trying to modify or change anything," she says. "Give yourself permission to eat whatever you like, but just observe what happens. See how you feel, how hungry you are, what you enjoy. Just by asking yourself those questions, it automatically changes your behaviour, as opposed to being told what to do, what to eat, focussing on controlling your relationships with food."

Dietitian Aoife Deane advocates a simple change in thinking to encourage a shift from "the abundance mindset rather than the scarcity mindset". Doughnuts and chocolate are not going away. We need to "stop telling ourselves we can't have something, or this is our last chance. It will always make you want it more."

The types of food we choose to eat can also play a role in controlling overeating, says Deane. Some foods make us feel fuller quicker than others. "Really it is the stuff that grows in the ground, walks on the land, lives in the sea. The stuff that is perishable. The stuff that rather than having ingredients, is an ingredient. The water content of a food makes a big difference in triggering satiety," she explains, using cinema popcorn as an example. "I think a lot of use could consume 1,200 calories at the cinema and then go out for meal after a movie. That would be the calorie equivalent of 13 eggs. I dare anyone to eat 13 eggs during a movie and then go out for dinner. Or in carrots, it would be kilos."

Natural food, she says, is "better at signalling to your brain, you are full. You've eaten. It's mainly down to water, protein, fat and fibre, and combination thereof. That's the thing that synthetic foods can never copy."

'It's a pattern that's hard to get out of'

How one woman changed her relationship with food

Over the past two years, Ann Marie O'Donovan has lost an astonishing 9 stone, 3lbs. The Cork woman has always been overweight and admitted to overeating for many years until she finally found the support to reduce her food intake.

"I have always been heavy and most of my family struggled with weight issues," says the 29-year-old. "When I was about eight or nine years old, I started to put weight on and it got more and more problematic the closer I got to puberty.

"The issue was of course that I ate too much - my mother had the 'Irish Mammy' thing of making sure we all ate everything off our plates and while it was drummed into me in the beginning, after a while, if it was put in front of me, I would eat it, regardless of whether I was hungry or not. I was also 'spoilt' by my granny who always had cookies and sweets for me when I went to see her - so it was a case of my eyes being bigger than my belly - until that got bigger too."

Ann Marie, who runs a beauty salon in Bandon, Co Cork, says her early childhood habits carried on throughout her teens as she continued to eat far more food than was necessary.

"I think once you start overeating as a child, it becomes a pattern that is really hard to get out of," she says. "Your mind and body get used to having lots of food and it becomes a comfort. And when I was a teenager, it seemed like there was a hole inside me that I just couldn't fill. I started each day with a big breakfast and then would have something like crisps and a chocolate bar at my small break in school, followed by a big lunch and then a huge dinner.

"I studied home economics, so would often cook at home, following a recipe for six or eight people - there were only four of us in the house but we would always eat the lot as there was never any thought of wasting it or even putting it in the freezer."

Although she knew she was overeating, Ann Marie found it very difficult to stop.

"I knew I had a problem but tried to ignore it," she admits. "Whenever I went to the doctor for anything, I would be told I needed to lose weight so I stopped going there unless I really had to.

"I had so much weight to lose that the thought of doing it was so hard to imagine, so I kept putting it off. Every January I would start trying to cut down, but after a couple of weeks, I would be back where I started.

"Then one day two years ago, I had a lightbulb moment and said 'enough is enough' and registered with my local Weight Watchers. The team leader, who had lost loads of weight herself, was brilliant and told me just to try losing half a pound at a time and keep chipping away at it until I was happy.

"Over time, with her support, I learned to curb my eating and have lost over nine stone - I feel amazing. I always joke that while my body has got smaller, my head has definitely got bigger."

Arlene Harris

Health & Living

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