Fat Versus Eating Disorder

Americans are getting fatter and fatter. Anorexia Nervosa and Bulimia are also on the rise as is Binge Eating Disorder. The Wall Street Journal reported (Sept. 11, 2013) on research conducted at the University of California, San Diego School of Medicine. The study focused on impulsive eating and food cravings of children. The purpose of the study was to help curb childhood obesity. Forty children were taught over a four-month period how to distinguish between “head” versus “stomach” hungers. The researchers introduced a process called "cue exposure" whereby the children rated their craving level after waiting, smelling, taking small bites and then staring at the food for five minutes. The study found that the subjects were able to resist food cravings and curtail the quantity of their snacking for an average of six months over a one-year follow-up period. The university's finding are consistent with the understanding among eating disorder professionals—helping patients distinguish between “stomach” and “mouth” or “stomach” hunger in an effort to reduce or ameliorate the symptoms associated with all eating disorders, especially Binge Eating Disorder, is an essential goal in recovery.

The researchers assert, according to the Wall Street Journal article, that "many impulses to eat come from triggers in our environment, such as getting an urge to snack while watching TV, interrupting such automatic responses can help children cut down on mindless eating. "

What then distinguishes a person who is obese because of triggers in the environment from a person who has Binge Eating Disorder and binges because of triggers in their environment? So, are there different types of triggers if some people are becoming obese from “simply” over eating versus those whose triggers are related to an eating disorder? Like people, maybe triggers are not as simple as they appear.

“What then motivates a trigger?” And, what does “triggers in the environment,” mean. Sounds nebulous to me. TV may be a trigger, I suppose, but the notion that the individual is motivated to eat by solely the act of sitting down to watch TV is simplistic, at best. Perhaps for those who grew up watching their caretakers chow down in front of the TV conditions other family members, particularly children, over time so that-the learned response is to eat when the TV is on. Difficult to distinguish if a trigger is devoid of anything that motivated the trigger. Does a trigger then just pop out of nowhere or have merely a simplistic explanation for its existence - habit of sitting down to watch TV? My analytic head says that motivations behind our behavior are more complicated than an explanation of habit. Another example to consider—When a person passes by a bakery and decides to stop in to get a cupcake what is the motivation to do so? Realization that they are physically hungry? Smells were so good that it signaled mouth hunger? Sadness about a relationship break-up and emotionally craving soothing and comfort only baked goods can provide? Or, “simply” just the act of passing by a bakery acts as a signal to go inside and buy something?

What motivates someone to be triggered matters to many of us who treat Eating Disorders – the psychological, relational, emotional, biological and social issues can and generally all play a role and affect how, when, where, and why someone is triggered to engage in symptoms. Understanding what motivates triggers is as vital as working to stop them or find alternative ways to deal with them.

I am struck by the limitations of those who generally don't see the need to pursue what motivates triggers to eat, binge, or not eat in much the same way as I am struck by how some view the personality trait of "perfectionism.” Is someone born destined toward perfectionism rather than examining from where or how the need to be a perfectionist emerged? Perhaps for some their biological nature led them to be more exacting in life (some solid research conducted on genetic loading for the trait of perfectionism) or they learned the trait from a parent, but there is the segment of those patients with eating disorders for whom perfectionism emerged as a solution to feeling bad or shameful or guilty, i.e., if I were perfect I can rid myself of feeling bad.

Triggers to eating disorder symptoms are often emotionally driven and based on psychological factors that make food a compelling substitute and vehicle of expression and suppression for lots of feelings, needs and wants. The act of turning on the TV may not trigger overeating, but watching a TV show that triggers a person to feel negatively about their body or triggers other emotional issues (anger, sadness, loneliness, traumatic memories) can. Overeating can ultimately conceal what motivated the impulse to eat; it is a lot more comfortable to blame one’s body than focus on feelings and internal states.

Of course there is the segment of the population that genetically is predisposed to being large. This blog entry is not about them. Often the issues for some people who are genetically destined to be large focus on their frustration or worse feelings that they do not fit the cultural body image ideal. Whether or not an eating disorder will develop as a result is a complicated issue; usually other factors in combination contribute as well.

The researchers at UC San Diego are on the right track in terms of solution. Helping people stop, smell, wait, taste and turn away are vital cognitive behavioral techniques that work with eating and perhaps non-eating disordered individuals. So, in this way, understanding the root of the trigger may not matter if treatment techniques alone work to solve the problem. The researchers acknowledged, however, that the effects lasted on average only six months post treatment. My vote, maybe understanding motivation behind the triggers can add to longer-term successful outcomes. This takes time.

Best,

Judy Scheel, Ph.D., LCSW