It’s Not About The Food

PART 1

Being a nutritionist it seems logical that when someone comes to see me, the first thing I need to do is work on their diet. But the more I work with people, the more I see that it is not all about the food. While food is incredibly important, often it is not the most important thing to start with. To make sense of this, I ask myself ‘is the persons diet the cause of their current situation or is it a symptom?’

When the diet is the cause of someone’s issues, things are generally straightforward. We go through their current health issues, how they are currently eating and make improvements. These people are more likely to stick to the advice, and when they do they are rewarded for it. While they might not get improvements overnight, they see improvements quickly enough that it makes it easier to see it through. There is a clear correlation between the effort they put in the results they see.

But things aren’t always so simple and often someone’s diet is a symptom of a bigger issue, rather than being the direct cause. These are the people who I could set the best diet in the world for but they will never stick to it, or even if they do they won’t get the results.

I often get clients who have ‘previously’ had eating disorders. I put the word previously in inverted commas because as we go through the process it becomes apparent that these feelings are still there. They might not have an out and out eating disorder but they still restrict their eating to 1,200 calories a day and exercise 6 days a week. They no longer look like a skeleton or are having organ shut down but the issue is not really resolved.

The advice that they need to eat more food is one that they can understand on an intellectual level but not on an emotional one. When food intake increases they get those ol’ fashion feelings back again  – how long can I go without eating, how light can I really get, do I really even need food to survive?

In this situation, I can set the best diet in the world but it isn’t going to work. They can start to have symptoms improve – they get their period back, their IBS goes away, their skin improves, etc – but all is not well. Even if they are not putting on weight, they are aware that they are eating more and the weight gain, they tell themselves, is inevitable. So they go back to their old way of eating.

When I work with someone my goal is always to deal with the root cause. Focusing on the diet in this situation is futile because it is not the root but rather a symptom of the bigger issue.

Anorexia is always portrayed to them as something horrible, something that is damaging to them, something they need to stop doing. I prefer to take to opposite position and congratulate them on having a skill that very few people are able to master. I ask how they are able to do it – what do they tell themselves, what do they focus on, what do they do with their body and physiology.

By going through this they explain their pattern of behaviour. While they may not have thought about it before, it helps to show they are in control of this behaviour. In the past they may have tried to deal with it by being stricter, more in control, tougher on themselves. Instead they now realise it is more to do with a set of things they say to themselves, the picture they make in their head and the way they hold their body. All useful information if they ever decide they want to change this behaviour.

We then look at the benefits that they get from doing what they are doing. People keep their problems for a reason, at some level it serves them. When we start talking they will tell me that they get attention from family and friends, which makes them feel safe. Or they really want to change their career and are scared; the anorexia means they don’t have to make the change. It distracts them from making that tough decision.

Finally, we now know what the root cause is. It isn’t about the food but about wanting to know for sure they will be loved and protected. Or that they are making the right choice in their career. We are no longer fighting against anorexia, as this isn’t the problem; we are uncovering the strategy that they use to deal with a different problem.

For this person their issues with food are a crutch. It is the best way they know of to help themselves deal with a problem. Removing the crutch without replacing it with something isn’t going to work. The person will fall down and quickly reach for the crutch that they have always known.

Our needs can be met in positive, neutral or negative ways. The eating disorder may be seen as ‘negative’ but it is still meeting their needs. By understanding what needs it is meeting, we can come up with much better and more positive ways of doing this. You are replacing the crutch with something that is more constructive and fulfilling. It is still meeting the same needs but in a way that is useful rather than destructive.

It is only at this point that we start to work on their diet. I can now make food suggestions without the knee jerk reaction of thinking ‘but this is going to make me fat’. To say that this is liberating for a client is an understatement. Rather than obsessing about food they can get on with thinking about the things that are really important in their life.

PART 2

When I deal with issues around food I think about it from lots of angles. One of the ways of looking at the issue is identifying if it’s being driven by everyday meal habits or if it is a deep-seated issue relating to something else. I looked at how I deal with deep-seated issues in the last article, so this time around I will explain about what I mean by everyday food habits and how they can impact on your relationship with food.

A lot of clients have issues with binge eating. I tend to find that these people are perfectionists and as part of this they often see things in black or white. They refer to ‘good foods’ and ‘bad foods’ and talk about ‘good days’ and ‘bad days’. Food weights heavily on their mind and even though they often skip meals they think about food an inordinate amount of the day. They are incredibly hard on themselves and normally deal with their binge eating by deciding to be stricter and more determined than ever.

In my experience, binge eating most often happens in the evening time. They are ‘good’ during the day, normally eating very small amounts of food, having a salad or getting by on just a soup. There is a tendency to skip meals and often breakfast or lunch is missed (or both). On the rare occasion that I have someone who binge eats in the morning, the pattern is the same but the order of their meals is reversed. They will have a small dinner or none at all, possibly choosing to skip lunch as well.

How this relates to everyday eating habits is structure. Binge eating normally happens after a period of food abstinence. The person who binges in the evening has gone all day with barely eating anything. They have spent all day thinking about food, congratulating themselves on being strong-willed but secretly wishing they could sit down to their favourite forbidden treat.

Without fail I make my worst food choices when I go a long time without eating. When I am hungry, self-control takes a back seat and I want something that is packed with flavour and that I barely have to chew because I am so hungry. For me this would be something like pizza, or burger and chips.

And this is what I often see happening with binge eaters. In all my years I have never come across a binge eater who eat 6 or 7 meals a day, it just doesn’t happen. Hunger needs to build to a certain level before the desire to binge kicks in. They have gone for such a long time with no food (or minimal food) that the urge becomes too much. Rather than breaking the fast with something sensible, they want food that is a taste overload.

In this case, the best place to start is meal structure. I will get them to eat every 3 hours starting as soon as they wake up. Even if they aren’t that hungry I want them to eat at least something. Often they aren’t very good with registering hunger as they are used to waiting such a long time; unless they are feeling faint and about to collapse they don’t think they are hungry. By instilling structure they get back in tune with the feedback their body is giving them.

When people implement this kind of structure the binge eating normally goes away. Often they had been telling themselves they were doing it for some negative reasons (my Mum doesn’t love me, I am weak willed, it runs in the family) when this was just a story they created to explain their behaviour. Really it was just about how they were structuring things.

Altering meal frequency isn’t always the final answer and for some people they still get problems even with regular food (although it does help). What I tend to find in these cases, are a consistent pattern of behaviour that leads to the binge even when it feels random, unconscious or out of their control.

The trigger can vary but it is normally something that stirs up some negative emotions. This could even be a positive event that gets switched in their head to something upsetting. For example they go around to a friends house to see their new baby. They are super happy for them and love seeing their new tot. Unfortunately they start focusing on their own life. Maybe they are single and dwell on this, or they are in a relationship and it is not going so well, or they are in a happy relationship but they haven’t been able to conceive. Whatever it is, it triggers an emotional response.

It is at this point that the consistent behaviour kicks in. They start to say certain things to themselves. They say them in a certain tone of voice. They ask themselves questions and fill them with negative answers. They change their body to bring these feelings on stronger; like lowering their head, altering their breathing, and altering their walking gait. There are certain things that they know will pull them down into the state even more and they focus on them. Before you know it, they’re heading towards their favourite binge food and nothing can stop them.

In situations like this, we need to give some conscious control back to the person and I like to do this with a pattern interrupt. I get the client to describe the process of what happens leading up to the binge eating. Most of the time they start out describing it as out of control and end up realising there’s a logical set of steps they take.

Now it is one thing to see this when sitting in a room chatting with me and another to notice it while it’s going on. It is not as simple as just telling them to stop doing it; they’ve tried that before. Instead I want to pull them out of the experience by interrupting the pattern.

I tell them that I am happy for them to binge but when they feel themselves ‘in the zone’ and heading in that direction, I want them to stop for a second and write a list of 5 things that they are grateful for. Or write a list of 5 things that they will accomplish by having the binge. Really think about the responses, make the best list they can. Once they have written it down, they can get right back on track and have a binge.

Writing the list means the binge doesn’t normally happen. They have had to stop and do something else that is not part of the normal pattern. The couple of minutes they have spent writing the list changes the focus; it pulls them out of state and stops it in its tracks.

Or I get them to change the voice in their head. There is normally a particular tone that they use that really helps bring on the experience. I ask them to make the voice in their head sound different. Do their best impersonation of a Glaswegian or Caribbean accent. Make the voice sound like Daffy Duck or Homer Simpson. If they want to continue saying the usual stuff then go for it, but it has to be in a different voice and they have to totally nail the accent. I want them to really think about how they would pronounce the words.

Once again this helps to pull the person out of the state they are currently in. They start to realise what is going on and change the direction things are heading.

Obviously these are just a couple of examples and depending on the person and the situation I will pick whatever I think is going to be most useful. I am focusing on the structure of how the problem gets started and interrupting it before it goes any further.

This article originally appeared on the Frame blog here and here



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Chris Sandel is the founder of www.seven-health.com. He is a nutritionist, working with clients on a one-on-one basis, as well as creating online trainings and products about health and nutrition. He is the author of The Health Trap: Why "Healthy" Eating Isn't Always Healthy which is available on Amazon UK and Amazon USA.

Chris has three free emails series. One is on how to quit dieting. One is on simple tests you can do at home. And the other is his take on the world's healthiest foods.

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