A major reason for the failure of current
medical treatment for “overweight” is that “weight” problems often are
actually eating problems. Higher weight may be due to genetic loading,
metabolic or hormonal conditions, neurotransmitter imbalances, chronic
dieting and weight cycling, or other causes, but it often occurs because
people are eating in ways that are out of sync with appetite cues for
hunger, pleasure and satiation. To resolve this problem, eating
disorders’ therapists have been successfully using psychology of eating
approaches for more than three decades and it’s time for other health
care professionals to follow their lead.
comes in several varieties, including emotional eating, mindless eating,
and binge-eating. Usually patients have more than one form of eating
dysfunction and often engage in all three types. Underlying them all is
anticipated or actual distress (generally felt as anxiety or bodily
tension) lessened by the act of eating, which prevents or reduces it.
Discomfort might come from obsessing all evening about the leftover
lasagna in the refrigerator and keeping busy to refrain from eating it,
then finally scarfing it down in one fell swoop before falling exhausted
into bed. Or, distress might arise in a flash, driving someone to
mindlessly polish off three cookies in a four-pack, in spite of having
reached satiation after having consumed only one. In broader clinical
terms, this dysregulated dynamic could be called obsession (intrusive
thoughts about eating or distress about refraining from eating) followed
by compulsion (the act of eating), which reduces the anxiety caused by
the intense food craving. Thus, is habit formed, for who wants to
experience ongoing internal angst when it could be made to disappear in a
delicious twinkling. This dysfunctional dynamic overrides “normal”
eating appetite cues: to eat when hungry, choose foods that are
enjoyable, eat with awareness and an eye toward pleasure, and stop
eating when full (quantity) or satisfied (quality).
Here is how dysregulated eating plays out in emotional, mindless or binge-eating:
Emotional eating is done to avoid, prevent or reduce emotional distress
which may be caused by internal or external stress, memories, or simply
experiencing mildly unpleasant or uncomfortable feelings. Emotional
eating is meant to cheer you up or calm you down. Eating a pint of Ben
and Jerry’s ice cream might act as a pick-me-up and be the highlight of a
boring Saturday night alone or, alternately, help soothe rattled nerves
after your boss chews you out in front of your entire department or you
finally mail in your taxes minutes before the federal tax deadline.
Such eating has a distinct, specific purpose: to re-regulate emotional
dysregulation by tuning it up or toning it down. It also can serve as a
prophylactic to unwanted feelings such loneliness, anger or
disappointment. Why feel bad when you can, instead, eat something that
2. Mindless eating is just that—snacking or
grazing through what’s in your food cabinets or refrigerator on
auto-pilot. Or it could play out as overeating because you’re not paying
attention to fullness or satisfaction cues. Mindless eating is done as
if you’re in a trance and is usually not driven by any one specific
discomfiting emotion, unless it’s boredom or the desire to avoid tasks.
It’s done because there is food somewhere to be had. You think of it or
see it and you eat it. It’s that simple, no thinking required.
Unconscious eating is also born of habit: before you flop down on the
sofa to watch TV, you automatically gran a bag of chips or you keep
eating simply because the food is in front of you. Overeating is another
form of mindless eating. When it’s all gone, you’re done, and not
3. Binge-eating is classified as a Feeding and Eating
Disorder in the Diagnostic and Statistical Manual of Mental Disorders.
It involves eating an excessively large amount of food in a short period
of time—often rapidly, with little awareness, to well beyond full—“on
average, at least once a week for 3 months” without the ability to
control intake, followed by feelings of guilt, shame, or disgust (1).
Bingeing is a self-driven activity that takes on a life of its own, an
act accompanied by feelings of frenzy, madness and desperation. In its
aftermath, the stomach feels distended and aches and you are wracked
with guilt, shame and remorse.
To understand patients’ specific
eating problems, health care professionals need to ask questions about
their state of mind before, during and after eating. Moreover, patients
need to hear that they are not bad, permanently defective or societal
outcasts because of their dysfunctional eating patterns, and that they
can resolve them by obtaining emotional and psychological support via
therapy and intuitive-eating or health coaching, as well as through
groups, workshops, books, blogs, podcasts and videos tailored to healing
(1) American Psychiatric Association, ed. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric Association, 2013), 350.
Please note that this article is intended for informational and
educational purposes only. It is not intended as a substitute for the
medical or psychological assessment, advice and individualized care from
your personal health care provider or mental health professional.
Please consult with your personal health care professional regarding
your individual situation and concerns. For health care providers, the
information contained herein may not be applicable or appropriate for
every patient. Paige O’Mahoney, M.D. and Deliberate Life Wellness LLC
specifically disclaim any and all liability arising directly or
indirectly from the use of any information or products contained in
these materials. Mention of products, techniques, methods, resources,
approaches, or other entities in our materials is for informational
purposes only and does not indicate endorsement.