Lately I’ve ground through several books for ongoing light research related to eating disorders: Less Medicine More Health, The Fear Cure, Essentialism and Making Habits, Breaking Habits. It doesn’t seem as if there is a book out there these days that doesn’t have some reference to losing weight and dealing with obesity epidemics as throw away lines representing positive behavior. The books I list represent two medical doctors, one psychologist and an MBA business consultant among the authors. Yet clearly not one has done the research and crunched the numbers to confirm that weight loss has an absolute best outcome of regaining 77% of the initial weight lost by year four and a 0.003% chance of maintaining that lackluster result by year five. 1
I realize that for most people with no history of an eating disorder the misconceptions regarding purposeful weight loss, dieting and the so-called ills of obesity are just noise. We’re all told to stick to the speed limit, not gossip in the office and eat intuitively and exercise. And next to no one dependably sticks to any one of those maxims. Why? Because cheating and lying a little bit, but not to the point where it harms your self-concept as a person of integrity, gets you what you really want. 2 And when it comes to maintaining an energy-balanced body it’s a good thing that most people lie about sticking to diet and exercise programs because the onset and prevalence of obesity have nothing to do with food intake and activity (see here and here) and obesity is neither a disease nor causes disease either (see here).
For average people it’s not at all harmful (for themselves) to believe in all the fluff about intuitive eating, healthy choices, and the dangers of ultra-processed foods, emotional eating and disease onset. They are more than happy to grab the tub of ice cream when they lose their job and they don’t experience any crisis in their self-concept of integrity. And thank goodness for that, because the premise of emotional eating as something to be squelched is utter nonsense.
“As it turns out, we need our emotions to make decisions. They don’t hinder our decision making ability, but create it.
Often we think of keen decision-makers as unemotional and utilitarian – purely intellectual, in other words. Suppression or elimination of emotion from decision-making is key – or so we think! In extreme cases the inability to produce emotional signals and the inability to process them lead to a complete inability to make even the most simple of decisions, such as what to eat; in all cases, decision-making becomes very difficult.” 3
Yes, non-eating disordered folk actually do eat intuitively. But within the healthy living movement “intuitive eating” actually refers to conscious suppression of intuition. Intuition has the following important markers: non-conscious information, holistic associations, affect (emotion), and speed. 4 True intuitive eating therefore involves absolutely no conscious assessment of the desire to eat. Here’s an example of eating with intuition as a guide:
Cassey had a fight with her boyfriend. She’s in tears. It’s coming up to Christmas and she doesn’t have enough money to go home for a visit this year. She heads to the kitchen and makes two grilled cheese sandwiches. Her mother used to make those regularly for the kids when they were sick. She eats her sandwiches. She feels a bit better.
In that example Cassey has made sweeping holistic associations with grilled cheese sandwiches and love, healing, connection to her family, rejection from her boyfriend and her decision to whip up those sandwiches is automatic and unanalyzed in any way. This may come as a profound shock to many, but your thoughts and emotions are functions of the brain. For the brain to function well it demands a disproportionately huge amount of the energy you take in as food. Cassey’s brain needs the energy of those grilled cheese sandwiches and had she second-guessed that need, she wouldn’t be using intuition to support her body’s needs. Instead, she’d be using conscious suppression of her intuition, otherwise confusingly known as “intuitive eating” in today’s healthy living world.
I’ve been swimming around in this eating disorder world for a few years now, but was shocked to discover just a mere month ago or so that those with eating disorders tend to think that hunger is expressed as a physical sensation (or sensations) within the body.
Those of us in the non-eating disordered world identify hunger when the thought of food pops into our minds. That’s it. If we feel light-headed, or our stomachs are growling, or we’re getting a bit irritated or moody, then we know that we have gone far too long without food.
For most with active eating disorders they will laugh at this concept and respond with “But I never stop thinking about food! It’s all I do.” Exactly. Those with eating disorders are thinking about food non-stop because they are that hungry. The energy deficit in their bodies is enormous. However the threat response system is so fired up when someone with an eating disorder tries to eat, that the idea that hunger is just the thought of food and that the goal is to respond to that thought by eating, is very hard to practice.
One of the techniques I suggest to connect to hunger as the mere thought of food, is to carry around a notebook throughout the day and just use check marks jotted down every single time food crosses your mind. You then circle the check mark if you respond to that thought by eating within 20 minutes of the thought of food popping up.
At the end of the day, if you find that you have not circled all the check marks, then you know that you are still struggling to respond to your hunger. A person without an eating disorder responds to any thought of food by single-mindedly finding a way to eat at the absolute earliest opportunity.
For someone with an eating disorder, a thought of food can immediately create all sorts of anxieties and blocks: wanting to delay intake because it's not a specific time assigned to eating, a level of agitation or frustration that it's not convenient to stop for food, an irritation that trying to figure out what to eat is cumbersome and time-consuming, that the food choices available don’t adhere to orthorexic limits, etc.
The goal is to have all the check marks circled at the end of each day: it shows you were able to respond to the thought of food as the hunger signal that it really is and that you ate in response to that signal. Does this mean when you are in recovery you will be eating all day long (and often through the night too)? For a while, yes it will. You cannot reverse the energy deficit in your body by just eating what energy-balanced people eat every day (see here, here and here). Eventually, when you return to an energy balanced state, you will think about food less than a handful of times in the day—just as is the case for someone who doesn’t have an eating disorder.
1. Anderson, James W., Elizabeth C. Konz, Robert C. Frederich, and Constance L. Wood. "Long-term weight-loss maintenance: a meta-analysis of US studies." The American Journal of Clinical Nutrition 74, no. 5 (2001): 579-584.
3. Leith, Scott. “What Neuroscience Tells Us About Successful Decision Making”, Plasticity Labs Science and Research (blog), March 18, 2014, http://www.plasticitylabs.com/what-neuroscience-tells-us-about-successful-decision-making/.