Understanding Food Addiction and Binge Eating

Okay. Well, hello everybody. Today we're going to go ahead and get started with our presentation. We're going to be talking about food addiction. Now we've talked about a variety of different addictions over the past, you know, few weeks, but food addiction is one that, it's kind of interesting. If you're not in the eating disorder circles, you don't hear a lot about it, which I find to be very frustrating because the co occurrence of eating disorders or the correlation between eating disorders or food related issues and addiction are really, really high, like 80%. So if we are not addressing food issues and self soothing through the use of food, then we are really leaving our clients open to a back door for relapse. If you. Over the next hour, we're going to examine the difference between overeating and food addiction because we all overeat at times. But food addiction and food related issues or eating disorders not otherwise specified are different. And those are things that we really want to think about when we are talking with our clients. We don't want to pathologize something that doesn't need to be pathologized. But we also want to help people understand the relationship between their eating behaviors and their moods and everything else. We'll evaluate some myths about food addiction, explore the behavioral and biological mechanisms underlying food addiction. We're not going to go into this in a whole bunch of depth right now because we only have an hour. But it is really important to recognize the fact that when someone is starting to get hungry, when their blood sugar is getting low, the body's natural mechanism is to make them think about food. So the more somebody is restricting and restraining and you know, avoiding certain foods or eating at all, the more the body is going to go, I'm really, really hungry. So those obsessions about food are going to get stronger. We'll talk about that more as we get there. And we're also going to identify ways to address food addiction triggers. There's just like alcohol, there's everything from triggers in the environment to just having things in the house. When people are in early recovery from food addiction or eating issues, I really recommend that they identify those foods that they tend to binge on the most or that are unsafe for them right now and get them out of the house. I don't want to say to eliminate them because once you eliminate a food, it sets you up to really focus on, well, gee, I'd really like to have those M&Ms, but we want to have them so it's not easily accessible. You can't just get up off the couch and walk into the, into the kitchen and get a two pound bag of M&Ms. And you know, be on your way. So there are ways to address the food addiction triggers, to put some time between the thought, the craving and the acquisition. A lot of times it's not worth the effort. But also removing some of the cues that may be in the house. So why do we care? And I said that a little bit about that earlier. Excessive food consumption is socially acceptable and food addiction rarely causes imminent legal problems. So it can go unchecked for a really long time. Unfortunately, food addiction issues and food and eating issues can cause a lot of health problems. Everything from erosion of dental enamel to problems in your esophagus, problems in your stomach, digestive issues. Actually people will start losing some bone density and calcium as they become more malnourished. So there are a lot of physical problems. And as you know from prior presentations, if our body doesn't have the building blocks it needs to make the neurotransmitters and to keep us healthy, then we are going to set ourselves up for depression, anxiety and relapse. When someone is engaging in some sort of a eating related problem, they're likely not getting all the nutritional building blocks that they need. So for some people, addictive behaviors started with a food addiction. You know, way back when. There are a lot of young women, young children who report starting their first diet when they're like 7, 6, 7, starting their first diet, starting to restrict, starting to form these negative attitudes about good foods and bad foods instead of looking at why am I eating? Good reasons to eat and good reasons to do something else. So we want to start looking at when did your issues with food start? And you know, like the alcohol, like anything else, it doesn't really matter. But we can understand that if addictive behaviors, you know, somebody has alcoholism right now or meets the criteria and we look back and we see that they had a history of binge eating disorder or bulimia when they were in high school and college. The alcoholism, once we take away the alcohol, what is their drop back in punt? Their secondary coping skill may be that eating disorder. And a lot of times we see that happening for others when their substance of choice was removed, food was available for self soothing. I worked in residential substance abuse treatment for over a decade and people would come in and they would be either slight, well, their weight would be whatever it was. Some were under, some were over, some were average, it didn't matter. But Almost everybody gained 15 to 30 pounds in 30 days. Some of it is water weight, some of it is eating because their body wants those nutritional building blocks. And our cooks were really good. They cook southern, but it was really, really good. So they would eat nutritional foods, which was great. But then they would also in the day room and I had issues with this. You'll learn throughout this presentation. We had all kinds of cookies and breads. Yeah, we had fruit. But there were very few limitations or restrictions on eating high sugar foods, high fat foods throughout the day. So when things would get tough or when they'd get bored, or when they get antsy, they would go to the day room and eat. So we were teaching them or reinforcing a behavior of self soothing through eating and regularly using food to self soothe is at the very least a relapse warning sign, if not a full blown relapse. Because when people are using food to self soothe, it's that distress tolerance. It's getting you through the adrenaline rush, it's getting through the initial craving, but it's not dealing with whatever triggered it. We need to deal with those triggers. We can't just focus on the here and now when we're talking about recovery. We need to identify the underlying factors. What was it that caused you to be stressed, anxious, angry, resentful? You know, the whole list of dysphoric emotions? What was it that happened that triggered that desire to use. Food can become an addiction when it's used to escape from negative feeling states and continues to be used despite negative consequences. The person experienced psychological withdrawals and cravings when he or she cannot access food to cope. Remember, not eating emotionally is not unheard of. It's probably not the best, but we all do things that are not the best. Sometimes. If you have a really bad week and you come home and you want to get into a bath with a pint of Haagen Dazs. More power to you. If that's what happens once in a while, it's when it happens as your primary coping mechanism continues to be used despite negative consequences. That is the mantra for addiction when you put this behavior above all else, including your own. Well, being. Overeating is often a bad habit, but can be stopped with education, planning and mindfulness. Food addiction, on the other hand, often takes a little bit more. We still have to do education, planning and mindfulness, but there's also coping skills training and a lot of other stuff. People who overeat tend to overeat because they like food. It's not that they are coping. It's not that they are escaping, it's not anything like that. They just like food. So helping them identify ways to kind of curb that. And we'll talk about those. Experiments have shown that for some people, the same reward and pleasure centers of the brain that are triggered by other addictions are also activated by food, especially highly palatable foods. So what's highly palatable? You know, I like food, I like all kinds of food. But sugar, fat and salt tend to really trigger those areas in our reward system in our brain to where the person may use those in order to try to feel okay. Just like the person who engages in gambling or Internet porn or, you know, any variety of behavioral addictions, the rush is not as intense as that from like methamphetamine, but for some people, it's enough to kind of numb the pain and get them through. So remembering that sugar, fat and salt, anything that's highly processed is going to tend to be something that people are more likely to binge on and more likely to find neurochemically rewarding. So signs and symptoms. If you frequently crave certain foods, I want to put a caveat with that. Craving certain foods may mean your body is saying, hello, I'm not getting the nutrients I need. When I start craving iceberg lettuce, I know I'm dehydrated. Because iceberg lettuce is like 90% water. There is very little nutritional value in it. So we need to not just take this and go, oh well, you have cravings, you must have an eating issue. No, if you have cravings, listen to your body. If you're craving salt, it may be telling you something. If you're craving sugar, it may be telling you something. And I know I sound like a broken record when I say this. If you have cravings for certain salty foods or sugary foods especially, you may need to talk about it with your doctor if this is an ongoing thing, because it may indicate an underlying hormonal, thyroid or diabetic issue. So frequently craving certain foods, especially those highly palatable ones, if you're craving chocolate, if you're craving peanut butter, if you're craving pizza, I'm getting hungry. Now those are the things that a lot of people self soothe with if you eat even when you're not hungry. Now, you know, thankfully this isn't a room full of people where everybody can see. And so a question comes in. Do you feel that artificial sweeteners are better or worse than sugar in terms of prompting cravings, etc. Interesting question. I just read an article on that artificial sweeteners confuse your brain. Your brain knows how to deal with sugar, but artificial sweeteners say there's this really fast acting sugar coming into the system and you need to release stuff from the liver and the pancreas in order to digest it. But with an artificial sweetener, it gets that message and it sends out all the, all the, you know, stuff that it would need to deal with sugar, but then nothing's there. So they found that artificial sweeteners can actually confuse your body, make you feel hungry more often because your body was expecting to digest some food, so now it's going to, dude, where's the food? So it can prompt cravings, part of it. And you know, when you're working with somebody with an eating disorder, if I told somebody with an eating disorder you need to lay off all the diet soda and you can only drink regular soda, they'd never come back to me. That is just a terrifying concept for somebody with an eating disorder. So what we want to say is let's look at how it affects you. But also part of these cravings may be psychological. You want something really, really sweet because you're stressed. So when we start understanding our relationship with food and start understanding why we are eating, the function of that food, whether it's to self soothe or whether it's to meet a blood sugar issue, then we can deal with it differently. If people are eating artificial sweeteners, you know, drinking diet soda, whatever, some studies have found that if they also eat something with it that is, you know, celery, apple crackers, something, not a whole bunch, but enough to give their body something to focus in on, then that confusion is a little bit lower. If you've worked with clients with eating disorders, you know that anything you say that goes toward telling them the way they're eating right now needs to change, is going to get a lot of resistance. That's terrifying. So let's look at how we can make it work for this person. Can they cut down on the sweeteners? Some of the companies have come out. I think it's like Pepsi 10 or something where it's a blend of sugar and regular sweetener. That might be something that they're willing to consider doing ultimately, you know, if they're not purging and doing things that are seriously harmful to themselves, I'm happy. When we're talking about people who binge eat the sugar, if they're binge eating emotionally and the sweetness is used to self soothe, it may not prompt additional binge eating, but it may satisfy that sweet tooth, if you will. But the research has indicated basically that it does confuse your body. So figuring out how we can help our clients deal with that is going to be what we need to do. If you eat even when you're not hungry, how many of us eat when we're bored or just eat out of habit? I come home and I put my stuff down in the front foyer, and I go into the kitchen and I start making supper and I start eating. It's just a habit. Well, sometimes I'm hungry, but sometimes it's just a habit. Sometimes it's a habit to snack when you do certain things. Sometimes you eat when you're bored. My daughter is kind of going through that tween phase right now, trying to figure out how she feels. And she's tired sometimes because she's doing a lot of growing and she's eating a lot more. And I remind her to check with herself. Are you eating because you're hungry, or are you eating because you're bored or you don't want to do your schoolwork? Those are not necessarily eating disorders. That's mindless eating. But it can lead to an eating disorder if the person ends up going down that road. If you feel guilty after eating particular foods. Now, this guilt is more characteristic of an eating disorder than just overeating. People who eat food because they love it, they'll eat it. And they may be like, well, I shouldn't have had that sixth piece of pizza. But, you know, oh, well, people with eating issues may be like, I shouldn't have had that second piece of pizza. I need to go run three miles. There's a difference. You can see that one's much more extreme. Guilt surrounding control of what goes in to the body is one of those signs that there may be an eating disorder developing. Sometimes making excuses in their head about why they should eat something that they're craving. I need to eat this because I deserve it. If I eat this now, then I won't binge on it as much later. There's a lot of rationalizing, minimizing, denying, and blaming that goes on in eating disorders as well as other addictions. So if you find your clients are trying to rationalize why they ate something or make excuses for it, you know, I wonder why. Why do you need to rationalize that to me or to yourself? You eat, you ate. If somebody's repeatedly tried to quit eating or setting rules, including cheat meals and days about certain foods, but been unsuccessful. All right, now here's My soapbox on cheat meals. I work out. I tend to be something of a gym rat. I enjoy the gym. I love being there. But it drives me crazy to no end when I hear people at the gym. And a lot of times it's bodybuilders talking about cheat meals or days. And I mean, they obsessively count their protein, they obsessively count their carbs, they obsessively count their fats six days out of the week. And then one day a week, they can just eat like they haven't eaten in a month. Now, aside from not being good on your metabolism, that's really setting them up for developing an eating disorder. So these cheat meals or days start to tell people or communicate that there are certain foods that are bad that you shouldn't eat, foods that you like. So I don't like that word. I don't like cheat meals. I like treats. That's a little bit different. Now, a treat is, you know, ordering an ice cream sundae after dinner. Not three gallons of ice cream, a whole container of Oreo cookies, you know, six plates of spaghetti and something else, which is what I see the bodybuilders doing. And I'm just like, oh, my gosh. Because then they start talking about how bloated they feel and how guilty they feel. And, you know, the therapist in me is just going, oh, I wish you could see what you were doing to yourself. So look out for words like guilt and cheat meals. If people are hiding their consumption of unhealthy foods, you know, we don't usually hide our consumption of bananas, apples. If you're going to find something squirreled away in your kid's room, it's going to be chocolate or Oreos or, you know, something else that they like. If they're hiding these foods from you or, and or from themselves, why are they afraid? Why don't they want to eat them in front of other people? What does that food and eating that food mean to them? You feel unable to control your consumption of unhealthy foods despite knowing that they're causing you physical harm, including weight gain. So unable to control your consumption of unhealthy foods. And here's another one I want to put a caveat on, because it can be for healthy foods either as well. Bread. Bread is technically, you know, it's in the food pyramid. It's one of the little pictures on the bottom of the food pyramid. Technically, it's a healthy food. You know, okay, we'll say whole wheat bread, but if you're Eating three loaves of whole wheat bread, that's way different than three slices. So if you feel you're unable to control your consumption of food to the extent that it's causing you physical harm, it may be time to check in and go, mmm, there's something going on. Some ways to control consumption, and we've talked about this in other classes, use a salad plate instead of a dinner plate. Always put food on a plate. If you take the bag of Oreo cookies and sit down on the couch, you're going to eat a whole lot more than if you get, get out three or four Oreo cookies and put them on a plate and then put the bag away. Other ways that people can stop their mindless eating and control the amount of consumption is always put food away. If it's out there on the counter, people are going to be more likely to grab a handful or grab an apple or grab something every time they walk by and stay hydrated. People eat certain foods so often or in such large amounts that they start eating food instead of working, spending time with family or doing recreational activities. Now this, we're talking binges here. And a binge is not two bags of M&MS. Now, two bags of M&MS. May give you enough of a sugar rush that you feel nauseous, but that's not technically a binge. When we're talking about binges, we're talking about something that takes an hour, two hours, and we're talking 4, 6, 8,000 calories. The person avoids social situations where certain foods are available because of fear of overeating. A lot of people with food related issues are very, very uncomfortable going to restaurants. They're very, very uncomfortable going to like holidays where there's going to be potlucks and things like that. They don't want to see people eat because just like the alcoholic, one drink is never enough. For the person with a food issue, one bite is never enough. So they're afraid of A, losing control, B, not being able to engage in compensatory mechanisms, I.e. binging and purging and, or being evaluated by others for how much they eat. When the person cuts down on certain foods, they have symptoms such as anxiety or agitation. Except for caffeinated beverages, which is, you know, there is a detox from that. But if you cut out chocolate and then you just start getting really agitated because you can't have chocolate may indicate sort of an unhealthy relationship between you and chocolate. So let's look at what chocolate does for you. Eating food Any food causes problems such as depression, anxiety, self loathing or guilt. People with eating and food related issues, they'll eat. And if they eat a salad that's, you know, a good sized salad versus, you know, the same amount of a steak and baked potato, they will feel equally as bad and they'll be going into the, into the bathroom and looking at themselves in the mirror sideways, hating themselves, feeling like they look like they're pregnant, or they feel bloated like the some of the bodybuilders talking about, which causes depression, hopelessness, helplessness, anxiety, self loathing and guilt. People with food and eating issues rate their worthwhileness, their worthiness, based on what they look like, their shape, their weight, and their ability to control their food. If they can't do that, then they're useless. Their minds, these are eating disordered thinking rules. People who find themselves eating more and more often due to stress. You know, obviously you're using food to escape. So let's, let's take a look at that. And before we move on to myths, I do want to emphasize the fact that there's a variety, a spectrum if you will, because we seem to like that word in the literature. Now, eating disorders. There are eating disorders that have disordered thinking, self loathing, excessive control on food, bulimia and anorexia being two of the biggest. But there are also people who just use food dysfunctionally. They use it to cope with stress, they use it to avoid doing things, and they may continue to use it despite being clinically obese. So is that a problem? Yeah, that kind of falls into the food disorders not otherwise specified. We want to look at how much and how often, which takes us to myths. Food addiction is just an excuse for overeating. No, it's not people who overeat. There are some people who make this conscious decision and they go, you know what? I'm going over to my grandma's house and my grandma cooks like nobody else. I am going to eat and I am going to eat until I have to loosen my belt. That is a conscious choice. Food addiction is someone who's stressed and they're just frantically searching for something to numb the pain or they're malnourished or their blood sugar is out of whack because they're not getting enough calories and they're preoccupied with food. So once they start eating, they continue eating. It takes your brain about 20 minutes to register that first bite of food. So it's not just you eat it and your brain knows, oh, hey, we're Getting food now there's a delay. So we need to be able to help people understand that, you know, if they're eating because of anxiety, if they're eating because of stress, they may ravenously eat. Then 20 minutes later feel completely bloated and overfull because they were so desperate to feel calm. Someone with food addiction is using food to cope and activate reward pathways. Get that dopamine going sometimes just to help them feel normal because they have a neurochemical imbalance myth. Any emotional eating is wrong. No, you know, people are going to do it occasionally. Eating to self soothe is a normal reaction to an abnormal situation. If you do it every day, that's something different. And even if you do it once a week, how much does it bother you? Is it causing you physical harm? Is it causing negative consequences in any other area of your life? You know, some people like to go out on Friday or Saturday evening and go out to eat and have a high calorie meal and you know, it's just what it is. And they're okay with that. That's their way of winding down or rewarding themselves after a long hard work week. Is that an eating disorder? No, it's not causing them problems and they don't have an issue with it. Unfortunately, our society teaches us self soothing through food. Think about, you know, when you were little and you fell down and scraped your knee. You got a cookie when you went to the doctor and got a shot, you got a lollipop at your birthday, you get cake at holidays, we eat. At funerals, we eat. Our society is really central or centered around eating. A lot of times abstinence is key. I like this one. Yeah, let's just tell people they can't ever eat again and that'll solve the problem. We can't do that. We can't tell them to quit eating. And like I said earlier, if we tell people to quit eating any certain food, it's just going to set them up to obsess about it. Now in early recovery, some clients will choose to eliminate certain foods from their diet. And while that's not a best practice, you know, we're gonna have to make some concessions and work with them at what they feel okay about. Since one addiction will likely be be replaced with another. Understanding and, and an awareness of why the person is eating is more important than eliminating the food. So have them create a food diary. And there are lots of resources in the class that you can look at in the additional resources section, including the 18 week eating disorder protocol. But food Diaries need to identify what they ate, how much they ate, what time it was, and what they were feeling. Were you hungry, yes or no? And how were you feeling? Angry, happy, numb. A lot of people with eating disorders are alexthymic, so they're gonna have a really hard time filling out that feeling section. Binge eating is caused by certain foods. Not so much. Certain foods can make us want to eat more. But binge eating, in the true definition of 4, 6, 10,000 calories, is caused by a need to numb, escape, or feel some kind of pleasure. Yeah, we tend to eat more than we should of foods that are really good. And that's true especially of highly processed foods, which are more likely to activate reward pathways. But we also have the ability to make conscious choices about when to stop eating. The food doesn't control us. Food addiction is the same as loving food. I missed an s. Anyway, people who love food can stop eating when needed. Food is not serving a protective function. If, you know, they decide that, hey, I've put on an extra £50, I need to cut back a little bit, yeah, they're not going to be happy. They can't go back for seconds. But it's not going to cause a whole bunch of intrapsychic angst, if you will. So immediate interventions. You know, when somebody comes into your office and they say, I've got these issues with food, that's fine, let's talk. Certain foods are more rewarding and certain foods are more rewarding for certain people. Some people don't like chocolate, Some people don't like peanut butter. I just can't fathom it. But some people don't. So what we want to do is provide a temporal separation, making it more difficult for people to access these foods that they are more likely to binge on. I personally am less likely to binge on, you know, celery, apples. You know, even if you binge on apples, you eat four, and that's, you know, 400 calories or something at most. But the temporal separation is going to make it more difficult. You have to get out and go to the store. You have to get out and go to the restaurant. Some people can do, like, we have cookie mix at the house right now. Some people are fine with that because that means they would have to make the cookies. Not so much for me, I like cookie dough. So cooking is absolutely optional. So that's not providing a whole lot of time separation between when the craving hits and when I can access the food of choice, have the person get the high risk foods out of the house for now. It's not that they can't have them, they just need to get them while they're at work. Instead of buying a 1 pound bag of M and Ms. And keeping them at the house, allow yourself to have a snack bag of M and Ms. While you're at work or something like that. So the person is still getting the reward or whatever they consider it, but it is in a very controlled sort of situation. Make sure there are lower calorie, rewarding alternatives. Again, sugar. Fruit has sugar. Right now, my strawberries are just. I can't even keep up. I've canned almost 7 gallons of jam and there's still fresh strawberries coming out constantly. If fruits are available and lower calorie alternatives are available, it'll ease the transition. Because even emotionally, eating a rice cake isn't going to make you gain 5 pounds. Only eat at the table and without television. This puts the mindfulness into the eating. If you're eating while you're standing up, if you're eating while you're walking around, if you're eating and it's not on a plate, that's mindless eating. If you have the television on, if it's the news, if it's anything, you're concentrating on that and not on eating. So that can also help people to set certain times when they eat or certain places. The person who gets hungry, you know, and the protocol says we should help our clients figure out how they can eat a little bit of something every three hours to keep blood sugar stable. So I'm not saying three meals and you can never eat again. I'm saying if you're going to eat, you're going to sit down at the table with a plate. Try to close the kitchen at a certain time. My grandmother, when I go over to her house, used to go over, she would make dinner and we would have dinner, we would have dessert. She'd do all the dishes. Everything would be pristine clean in the kitchen and you just wouldn't even want to go in and put a dirty dish in the sink. Or maybe that was me. But having the kitchen clean and closing the kitchen helps people sort of resist the urge to go in and eat some more. Also, brushing your teeth helps a lot. They've done studies that have found that once you get that minty taste in your mouth, the messages going to your brain change and there's more of a satiation. Identify other tools. Get four sheets of paper, one for boredom, one for anxiety, one for anger, and one for depression on each Sheet identify three or more things you can do to alleviate that feeling. Some examples would be, you know, call or message somebody and know who that somebody is. Go on a walk or a run, listen to music, clean the house, surf the Internet, journal, play with the cat, play with the dog. Have people brainstorm. These are the distraction techniques that we talk about in dialectical behavior therapy. But, you know, it's just common sense. If you're feeling bored, what can you do? When I'm bored, it's amazing how little I can think of to do when I'm bored. But then when I am busy as anything, I can think of 16 things I would rather be doing. Same thing with anxiety, anger, and depression. When you're in the moment, you're not going to be thinking of exactly what you want to do. So write it down ahead of time. Brainstorm. The other awesome thing about brainstorming and having it written down is it empowers the client because they're like, hey, yeah, I have this whole toolbox of tools I can use. Instead of going, well, next time I get bored, you know, I'm sure I can think of something to do. Get a baseline for a week. Keep a food journal of what you eat, how much, whether or not you were hungry, and what your emotional state was. The other thing you can put in there for some people is what were you craving? Salty, sweet, sour, or water. This will give you an idea about how often you eat when you're not hungry and what your food choices are. Then for the next week, we want to add alternative activities. Keep a food journal of what you ate, how much, whether or not you were hungry, what your emotional state was, and what alternate activity you considered doing. Sometimes you're just going to be like, yeah, I could go on a walk, but no. One thing I suggest to people for those alternate activities, because the craving may be pretty powerful. Do 15. If you're not hungry, drink a glass of fluid. And I said fluid, not water. You know, some people would rather drink tea or coffee or something. And yes, I know those are diuretics, but the idea is to give you some time before you launch into high calorie foods and then do something else for 15 minutes. A lot of times the craving will pass if you go out and start playing with the dog. You know, after 15 minutes, you may have forgotten that you were craving whatever it was. If after 15 minutes you're still craving it, then you need to take some other actions and figure out what to do. Identify triggers and ways to deal with them. Habit eating Time of day, do you get up and eat breakfast just because it's breakfast time? Now, don't get me wrong. Breakfast is the most important meal of the day. We do need to eat, but I want people to eat and be cognizant that they're eating and why they're eating. Not just, well, I need to eat something before I run out to the office. Just like sleeping, the body actually will start cueing you in to eat. My guess is, you know, everybody here, when it gets to be about whatever your lunchtime is, your stomach starts going, lunchtime, I'm hungry. Habit eating can also involve certain activities, like going to the movies, watching tv, you know, fill in the blank. Whatever activities you do, that you like to do, that you may just kind of eat out of habit. Driving in the car when I was growing up was huge for me because whenever we would be in the car, we would eat. And, you know, between the store and the house, my mother and I, the two of us together could demolish an entire bag of potato chips. And, you know, the calories are just mind boggling. But so eliminating habit eating in the car. I try to avoid having the kids eat in the car unless, you know it's urgent for some reason. Visual triggers, restaurants, other people eating, and the television seeing restaurants, you may drive past and go, ooh, I remember having such and such from there. I want to go back and have that again. There are a lot of visual triggers, other people eating, especially if you can smell it. And the television, the television does a really good job of making food look appealing. And it's not even just commercials. Sometimes it's on the TV show you're watching people eat or you're watching people drink. And smell triggers. I make scented wax tarts because I'm big on smell. But certain triggers, certain smell triggers can make people feel more hungry. Blueberry muffins, caramel. There's one that's a caramel coffee that I just absolutely adore, but every time I smell it, it makes me want coffee. Another visual trigger that we haven't really talked about on this PowerPoint is color. Did you ever wonder why Subway, Pizza Hut and oh, Little Caesars use red, yellow and brown? Because those are three colors that actually trigger us to be more hungry. And when you think about it, it makes sense because a lot of the foods that we like to eat are red, yellow and brown. Amazing how green didn't make it in there. Eliminate vulnerabilities. I am not going to belabor this, but make sure you get adequate sleep so you are not eating to stay awake. When my kid's dad was on midnight shift, his body didn't know whether he was supposed to be eating, sleeping, consciousness, unconscious, and so he ate to stay awake. Inadequate sleep will throw your circadian rhythms off and also throw your cravings off. He would also crave carbohydrates, dehydration. If you're dehydrated, you can start craving foods because your body's going, I need to convince you to drink something. You actually may crave salty foods if you're dehydrated. Some people crave water, juice, iceberg lettuce. Know your body, eliminate boredom and have good time management. If you have bad time management, you either have too much time and you can get bored or you have too little time. So you're always eating on the run. And we're back to that mindless eating again. Address mood issues. If you're self soothing with food, we need to figure out what's causing these issues. Address those. So in the past week or two weeks, think about the clients that you've seen or even think about your own life and how food may have been played a part in how you coped or how you felt about things. Eating. You know, maybe you were craving, I don't know, coming up short, maybe you're craving a deep dish pizza and you decided not to get it. What went into your thought process? How effective was it? You know, if you were craving it because you've had a really bad week and you were really stressed out, what did you do to cope instead? It is so important in my mind, of course, for us to have our clients, regardless of their clinical diagnoses, to understand their relationship with food. Some people are terrified of it. Some people love it more than life itself. Some people have love, hate, you know, sort of a borderline issue with it. What is your relationship and why? And then making peace with it. Food is there to sustain us. Food is a reward at times. That doesn't make it bad. It doesn't make it bad to have it as a reward. It's important to be mindful of why you are eating though. That way you know you don't have a whole lot of other problems in dealing with it. Food, especially highly processed foods, activate the brain's pleasure circuits. Oh, interesting article I read. Golly, it's been about three months now. You can probably Google cheese is an addiction. Obviously that headline caught my eye. But cheese is super, super highly processed and they found that it activates those pleasure circuits just like a lot of other addictive or highly processed foods. You may have a food addiction if you're spending more time than intended, preparing to eat, eating or recovering from eating, thinking about what you're going to eat, figuring out where you're going to get it from. And this doesn't necessarily mean high calorie foods. People with eating disorders may be very obsessive about eating things that are 100% organic. Planning out the calorie, the protein, carbohydrate, fat ratio and amino acid profile. And they can spend an entire day charting out a single meal. If that's happening, we need to kind of take a look at what's going on with that. Common thought in eating disorder treatment is if you're spending that much time manipulating and planning food, chances are you're trying to avoid dealing with something else or you're afraid of eating. So you're trying to delay the eating, but you still are just obsessing about it. If you're eating for reasons other than hunger, might want to take a look at it. If you're foregoing other interests in order to eat, you know, that's, you know, that's kind of a warning sign there. I won't eat in front of other people, so I'm not going to eat in social situations, but I want to have my pizza, so I'm going to stay home by myself this weekend. Might indicate a problem, might indicate you just had a really bad week and don't have the energy for everybody else's drama. But you know, patterns is what we're looking for. And experiencing guilt or shame about eating can be a clue that there may be a food issue. And again, I keep saying food issues because it may not rise to the level of clinical addiction. But if it's causing the person problems, if nothing else, we need to address it for that reason. But it could also be a relapse warning sign for other problems, including addiction, but also depression and anxiety. If they're struggling with food more, it may be that they're also struggling with their mood disorders more. And we need to take a look at that. The first step is to figure out what you're eating and why, and then identify triggers and interventions for non hungry eating. When they're hungry, we want them to eat, but if they have a lot of times when they're eating because they're not hungry, how can they prevent that? How can they arrange that? Explore other ways you can deal with stress, anxiety, anger, depression and boredom. Eliminate vulnerabilities and address underlying mental health issues. This is all easier said than done. A few little tidbits or caveats that I'll throw in there. Working with someone with an eating disorder, if they are really stressed about their eating, their food related issues and their compensatory behaviors over exercise purging, telling them not to worry about it because as they deal with their mood disorders that stuff will, you know, sort of remit is not going to make them feel better if they present to you identifying these as they're presenting issues. We need to deal with that. Too often I've heard therapists and doctors minimize the eating behaviors or the dysfunctional eating behaviors, saying yeah, you know, well, you've got all this other stuff going on, so let's focus on this because we basically it turned communicates to the person. I don't know how to deal with that. So we'll deal with this and hopefully that'll just go away. It may, but that doesn't give the person any relief at that point if they are. And the average person with bulimia is purging multiple times a day, like four, five, six times. We're not talking just once a day or once every couple of weeks. In my college that I went to, they actually had to redo the pipes in one of the sorority houses because all of the hydrochloric acid or whatever the stomach acid is from all of the women throwing up actually ate away and corroded the pipes because it was a group activity and we didn't even get into peer pressure and sanctioning and things like that. But purging is a sanctioned group activity in some circles, just like binge drinking is. So it's important for us to understand the motivations behind the behavior and the motivations behind wanting to get better. Okay, any questions? That was a really loaded topic for an hour.