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Obesity, Weight Management

What is "emotional eating"?

Most overweight people admit that they rarely eat because they are hungry. They eat in response to emotions - both negative and positive. Eating becomes a way of coping with stress. When it appears there is little means of changing or influencing an upsetting situation, eating is a way of escaping the problem, a least for a while. Sometimes emotional eating takes the form of a binge - the loss of control over eating and eating more than most people would eat under the similar circumstances. Eating can be a solution to loneliness, fatigue, anger, and hopelessness. Food is like a best friend. It gives you a "pick up" when you are tired. It helps you release tension, and temporarily helps you forget. But overeating can also occur in response to positive emotions. Feeling good, excited, or happy can bring about overeating. Social situations in particular can lead to "happy" eating. Emotional eating works to cope with painful emotions. Unfortunately, it also leads to weight gain and loss of self-esteem.

How can I overcome emotional eating?

To overcome disordered eating, you need to become a better problem-solver and develop coping skills that will replace eating as your primary means of coping. To become better at problem solving, you need first to learn how to accurately define the problem or problems you are facing. Too many overeaters prefer to avoid facing their problems by eating. They may feel so overwhelmed that eating provides a temporary escape. Once the problems are defined, you need to consider various possible solutions and try out one or more of these to try to fix the problems. Sometimes, despite your best efforts, you cannot significantly influence one or more of the problems. Then you must learn how to cope with the negative emotions that arise. One possibility is to learn to seeing the problem in a different light. Another is to learn how to tolerate distress and respond differently to stress.

How can you help me with my weight problem?

The only way to achieving and maintaining a healthy weight is to change your lifestyle habits. That means making exercise a regular part of your life, and eating a healthy diet that is moderate in calories. By exercise, I mean walking, riding a bicycle, or doing some form of activity that uses a good amount of calories. (Yoga and tai Chi don't qualify.) The goal is to get in 150 minutes of such exercise each week. Of course, if you are someone who has never exercised, you will start gradually and work up to 150 minutes a week. Once your exercise is in place, we focus on your eating. You will decide the changes you want to make, and you will implement these changes gradually to ensure success. You will not "go on a diet", nor should you weigh yourself. This idea is to focus on your lifestyle and weight will follow.

What about products and medications for losing weight?

There are no quick and easy answers for losing weight, and any product that promises this is a scam. Potions and over-the-counter medications for weight loss are not worth spending the money. In some cases, prescription medications can facilitate your efforts to lose weight. Medication options should be discussed with your primary care physician. Even if you are prescribed medication for weight loss, you must still make permanent changes in your lifestyle - exercise regularly and eat a healthy diet moderate in calories.

What are the pros and cons of bariatic surgery?

Bariatric surgery is any time of surgery on the gastrointestinal system intended to produce weight loss. The Roux-en-Y is the procedure most commonly used. There are pros and cons to such surgery. First of all, it should be considered the treatment of last resort. Clinically severe obesity-being at least 100 pounds over normal body weight-is a serious disease with serious physical and mental health consequences. Some of the consequences include health problems, increased risk of cardiovascular disease and cancer, higher risk of premature death, difficulty moving around, low self-esteem, social rejection, and even lack of respect even from health professionals. Significantly reducing the risk of such problems would seem to be a strong incentive to undertake bariatric surgery.

Consider, however, that the surgery will force you to make permanent lifestyle changes. You must be careful not to eat foods that are fibrous and hard to digest. Foods or beverages high in sugar must be carefully avoided because they can cause cramps, nausea, diarrhea, weakness, and lightheadedness. You may have trouble tolerating milk, and bread products can be a problem. Snacking between meals must be minimized. You cannot overeat or drink too much fluid at one time or you may vomit. If you do overeat consistently, you can stretch the stomach capacity and regain weight. In fact, some weight regain over time is normal, although you are not likely to regain all of the weight you lose. Similarly, you may not lose as much weight as you expect from the surgery; there is no way to predict how much any patient will lose. Adding daily exercise to your lifestyle can help weight loss and maintenance.

You should carefully weigh the benefits and potential risks before going ahead with surgery, and you should be prepared for the dramatic changes that will take place for you-not only physically and psychologically, but socially as well. It is a good idea to seek counseling both before and after surgery and to participate in a support group. Do not be blinded by the wish for a slimmer and more socially acceptable body without considering the costs to be borne.

Some people say that I should just accept my body as it is and that being overweight isn't unhealthy. What should I believe??

Despite the desire of some people to deny the reality that serious health problems are related to obesity, research demonstrates otherwise. A number of studies have shown that excess weight is related to adverse health outcomes. The most important of these is the Nurses Health Study. In this study, more than 115,000 women from eleven states who were 30 to 55 years of age and free of known cardiovascular disease and cancer in 1976 were periodically assessed over a sixteen-year period. This important study confirmed the link between obesity and coronary heart disease and mortality. Initial data indicated that even mildly to moderately overweight women showed an 80% increased risk of coronary heart disease over an 8-year period relative to leaner women. The researchers concluded that even moderate levels of overweight carry significant health risks. Additional data from this study published in 1995 confirmed the link between obesity and premature death from all causes, including coronary heart disease, cardiovascular disease, and cancer. Furthermore, health risk is exacerbated if body fat is distributed on the upper half of the torso - the so-called "apple" shape, rather than in the hips and buttocks-the "pear" shape. Other research has found that maintaining a healthy body weight also reduces the risk of many cancers. While it is not necessary to aim for becoming socially slim, losing as little as 10 pounds and produce important health benefits.

Some of the anti-dieting folks have made claims such as "three-quarters of studies show no correlation between obesity and health problems." Not only is this a misstatement of the facts, even if this were true, the issue is not the number of studies but the quality of studies. Many badly done studies simply do not outweigh one well-done study.

Those who are dealing with serious obesity - more than 100 pounds over normal weight - are confronted with a difficult problem. Obesity is not a unitary disorder, but may involve alterations in one or more of the body's regulatory systems and may potentially have a genetic basis. These regulatory systems include the brain and its neurotransmitters, the gut and its peptides, the liver and its metabolic processes, the adipose tissue and its secreted proteins, and endocrine hormones. Current research shows that a good number of genes seem to have the capacity to cause obesity or to increase the likelihood of a person's becoming obese when any of these genes are altered or dysfunctional. At this time we do not know what the genetic causes of severe obesity. However, genes generally account for no more than 50% of the variance in body weight. The rest is environment and lifestyle.

The lifestyle component is the only one over which you have any control. The best you can do is focus on eating a healthy diet that involves moderate caloric intake with good portion control and make regular daily exercise a part of your lifestyle. It can be helpful to join a support group or a behavioral weight control program to help you make necessary changes. Many people who are overweight actually eat more than they think they do. It helps to keep a food record to check on yourself. Working with a registered dietitian is also a good idea. Avoid the self-criticism and self-blame that produces much guilt and unhappiness about weight and body shape. Focus on changing that which you can change - your lifestyle - and accepting the results, which may be a larger-than-preferred body weight.

Dr. Joyce Nash, PhD    (650) 329-1000