What’s Your Food Size?

August 24, 2012

Imagine that you need a new pair of shoes. You go to the shoe store, look around at the styles on display, and you find one that fits you perfectly. It’s comfortable, looks good on you, and the leather really feels great to the touch. In fact, you like the way it looks and feels so much that you decide to buy the largest size that they have in stock, so you get more shoe for the same price. Great deal, right?

No, it’s insane.

Now think about a similar scenario, but instead of shoes imagine you’re ordering a meal in a casual dining restaurant. You see that the special for the day is a dish that you really loved the last time you had it. That time it was served in a moderately sized, but very satisfying portion. Today, though, the server tells you that they are offering the special in the “value sized” meal.

For the same price you can get twice as much of your favorite meal! You’ve never been one to take home a doggy bag or leave anything on your plate, but you’re really hungry and you love this dish so you’re confident you’ll be able to handle it. Would you consider the offer? Even if you reject it, it doesn’t sound quite as ridiculous as buying big shoes, does it? But it is.

In both cases you assign value to some useless material that will soon make you feel uncomfortable and sorry that you chose it. But one scenario seems crazy and the other one doesn’t. This is a perfect example of how habitual but irrational ways that we think about food affects our behavior, weight, and, ultimately, our health.

Here’s another common mental habit that is closely related to taking large portions: the idea that leaving food on your plate is a moral transgression of some sort and the act of scraping off any edible food into the garbage is sinful.

Think about it like this: you had a good meal. You’re no longer hungry; you may even be stuffed. You have no real desire for the last pieces of whatever is left on your plate, but you feel a compulsion to eat it. By now, your body is processing all of the nutrition it needs from what you’ve already ingested. What do you think it will do with the rest? It goes to waste just as surely as if you put it in the garbage can. The only difference is that it goes through you first.

What happens to that extra food? Whatever calories your body doesn’t need gets converted by your liver into triglycerides which are then stored as fat cells in different areas of your body. That fat storage is s a great adaptation that all mammals have so that they can hibernate during the winter and survive droughts in the summer. Chances are you’re not in danger of starving through those events, so instead of getting you through the crisis, the fat will just stay there until you start taking in fewer calories. Then your body will begin to siphon off some of the energy stored in those strategic reserves and you’ll lose weight.

I’ll describe just one more common example of distorted thinking that, like the other two, is related to portion control. It’s about how we behave at a buffet.

I’m sure you’re familiar with the scene at a catered event where the food is spread out on a self-service buffet table. People sharpen their elbows and crowd around the table as if they haven’t had a decent meal in weeks. Then they pile up their plates, apparently according to how much food is on the table. It’s almost as if each individual estimates the appropriate percentage of food that’s allotted per person and that’s what they take.

Do you see a pattern here? In all of these situations, the amount of food you eat is based on external factors rather than individual requirements. Whether it’s the amount of food available or what’s left over on the plate, the cue to eat does not come from what you need or want, but from what is available.

How do you change that kind of behavior? It starts, as does all behavior change, with how you perceive the situation. Before eating, try to apply what you really do when you go to buy shoes. Before you even step into the shoe store you know your size. You’ve bought shoes often enough as an adult to know what will fit and what won’t. Well, you’ve also eaten enough in your life that it should never surprise you to discover that you’ve eaten too much. You should know your size when it comes to food portions at least as well as you know the size of your shoes or clothes.

Before you put anything on your plate look at it and visualize what volume of protein, starch and vegetables fits your real need to feel satisfied without overeating. Then you take the appropriate amount of each, with a ratio of about twice as much of the vegetables as each of the other two groups. Try to leave enough space between the different foods to be able to see some of the plate to keep from piling it on. That’s your size.

If after you finish that you feel that you can still comfortably eat more, wait about five minutes before putting any more on your plate to give your brain a chance to catch up with your stomach. It takes a while to register that you feel satisfied. When you’ve had enough, enjoy a few bites of dessert and call it a meal. You’ll be quite content.

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Whether you record what you eat every day or not, it’s useful to do an eating self-assessment before deciding what needs to change in your current eating routine. The first step in this process is to apply the five W’s of journalism: What, When, Why, Where and Who. That will help you get a more thorough understanding of your eating patterns so you’ll know where to focus your change goals.

What: When you try to recall your usual eating patterns, it may be easiest to go through your daily routine, and write down (with brutal honesty, if necessary) the types of meals and snacks that you tend to prefer and are most likely to eat throughout the day. What do you have for breakfast, if at anything at all? What choices do you make and what portion sizes do you take? Do you prefer to prepare your own meals, like cooked or raw salads, or do you go for convenience? If it’s the latter, is it usually frozen meals, diet plan trays, or take-out? Another important ‘What’ question is, what are you doing while you eat? Are you reading, watching TV, working at the computer? Or are you simply focused on the experience of eating whether alone or with others?

When: Once you think about what you usually eat and how much, you can think about your daily pattern of when you get the cues to eat and respond to them. Do you eat at scheduled mealtimes, or do you graze throughout the day? When do you usually eat the first meal of the day? At what point do you stop eating at individual meals? When in the day do you stop eating? Are you a late night snacker? Think about whether your total calorie intake is spread throughout the day, or is it more packed into the one part of the day or another. Is your pattern to eat a lot but infrequently or less and more frequently?

Why: Next, take note of what typically prompts you to eat at each of those opportunities. Of course, I have been talking about emotional eating throughout this book and how feeling controlled tends to trigger an episode of emotional eating. So identifying what the experience is that made you respond by eating is one example of how to answer the Why question. When it’s not a response to an emotional trigger, you can track the timing of your eating. Is it mainly the time of day that makes you think about having a meal, or do you respond mostly to hunger cues? Or do you eat simply because food is in your line of vision and available? (My father, a master of lame dad humor, used to call that his see-food diet.) If your eating has no discernible pattern, then that’s your pattern. Make note of the cues that prompt you to eat when you do.

Where: Now think about where you are at each of those occasions. Are you standing or sitting? Are you at a kitchen or dining room table or at a coffee table or TV tray? Do you eat in the company cafeteria, at your office desk, or in a restaurant – fast-food or other? Do you eat in the car? (Here’s a hint: don’t!)

Who: Do you usually eat with others or by yourself? When you eat around other people do you tend to make better choices and limit how much you eat or are you influenced in one way or another by the choices of others?

This self-assessment is the first step in behavior change. Understanding your eating patterns can help you identify obvious problems. In the next few posts, I’ll go over some of the less obvious patterns that research has shown to increase calorie consumption and where making some changes can be especially helpful. But first I’ll start with some of the more irrational mental habits that may not be obvious but really should be. As you’ll see, you don’t need a researcher to tell you that they add calories, just a little common sense.

I’m very ambivalent about the issue of keeping a food diary. I know that when people do it, the impact it has on their eating can be very impressive. So what’s the down side of recommending it? For one thing, when someone who is just trying to be helpful, tells you that you “really should” keep a daily food diary, that’s one more rock dropped into the pan that hangs on the external control side of the scale.  It’s just as likely to have a negative effect as a positive one.

People differ in how they feel about keeping journals, diaries, or scrapbooks. Personally, if I was told to record everything I ate, I would either give up after about a day, or if I did stick with it, the information wouldn’t be worth the electronic pixels that it’s recorded on. And I know from my patients’ responses to this recommendation that there are many people who have the same attitude toward recording everything they eat as I do.

Even dedicated diarists who are knowledgeable about nutrition can be way off in their estimates of portions and calories that they consume. A study published in 2002 showed that although dietitians who were asked to record their food intake over a seven-day period were more accurate than non-dietitians, they still underestimated the calories they consumed by more than 10 percent. The non-dietitians in the study were off by more than 20 percent!

I believe, however, that the accuracy of the details recorded is not the key factor in explaining the effectiveness of keeping a food journal. The real value of the diary comes back to mindful awareness. Just the process of thinking about what you have eaten forces you to stop and reflect on your eating behavior. That alone can be a very sobering experience for many people who eat so automatically they’re not even aware of having other more appropriate options. If you’re not aware that you have options then literally, you don’t have a choice. From a practical point of view, it’s no better than being forced to eat. More than that, the fact that what you’re about to put in your mouth will be recorded, makes a big difference in whether you eat it or not. Or, put another way, it allows you to make choices.

There’s an old joke about a couple on vacation in the Catskill Mountains in one of those old resorts. They were looking at their menus and pointed out to the waitress that under side dishes it just says “choice of vegetables.” “So?” asked the waitress. The man asked, “Well, what’s the choice?” The jaded server rolled her eyes and said, “The choice is, do you want it or don’t ‘cha?” When you consider any global behavior change on the microscopic, nano-level, it all comes down to individual decisions: Should I have this one or that one? Should I take another portion or not? Do you want this or don’t ‘cha?

How frequently are we confronted with choices about what we eat? A study done by Brian Wansink at Cornell looked at how many food-related decisions we think we make every day and compared it to how many we actually make. The results were pretty astounding. The researchers found that we’re aware of making about 15 daily decisions concerning food. The reality? We make over 200 food-related decisions every day! That difference is where most of your excess calories come from.

So the real low-hanging fruit, where a minor effort can have a major impact, lies in being more aware of even a small percentage of those 185 or so unconscious decisions you make every day. The accuracy and details of your food diary are not the critical factor in its effectiveness. Instead, the value of writing it down is that it encourages you to open your eyes to the many opportunities you have every day to make better decisions.

What does that mean for those of you who, like me, don’t care for keeping track of everything you eat? It means two things: one, you don’t have to obsess over the details. Just making a quick note – even a mental note – in the evening of whatever you can recall eating during the day can make a difference. Second, you don’t have to do it for the rest of your life. You can quit when you start thinking automatically about what you’re eating rather than just eating automatically.

Have you ever found that it’s easier to diet when you’re doing it for yourself rather than to please someone else? If you have, research backs that up; people who make the effort to lose weight for their own reasons are more successful at it than those who are doing it for external reasons.

At least that’s what people in a six-month weight loss program said when they were asked about their reasons for dieting. The participants who reported more internal motivation to lose weight attended the program more regularly, lost more weight during the program, and maintained the weight loss better than those whose motivation was more external.

Mark Muraven was not involved in that study, but he is one of the researchers who helped develop the depletion model of self-control. In fact, as a graduate student working on his master’s thesis, he designed and carried out the original study that demonstrated how self-restraint has a negative impact on later attempts to control behavior, and concluded that it’s an indication that self-control or willpower  is a limited resource that gets depleted with use. Muraven is now an associate professor at the University of Albany and wanted to examine the effects of internal versus external motivation on self-control.  About five years ago he published an interesting paper that describes a study he carried out to explore this question.

He told participants (82 undergraduates) that the purpose of the study was to see the effect that sugar had on strength. It actually had nothing to do with that, but he needed the subjects to be blind to the real purpose of the study. (He straightened them out afterwards in a standard debriefing.) First, they were asked to squeeze a spring-loaded hand grip, which is a common task used to measure self-control. The more self-control they had, the longer they would squeeze the device before giving up. This was their baseline measure of how long they can hold it.

He then presented them with plates of assorted cookies and told them that he’ll be stepping out for a few minutes. Before he left, he explained that they can choose to eat the cookies or not. However, the researchers for the (mock) “sugar strength” test especially need participants who could be in the group of those who did not eat any cookies.  “The choice,” he emphasized, “is entirely yours. But we would really appreciate it if you would not eat the cookies.” When the investigator returned to the room, he administered the grip test again.

Only three of the 82 participants ate any cookies (their results were excluded), so the group was pretty compliant, but they had different motivations for not eating them. As they revealed on a questionnaire they were given afterward, some people endorsed internal reasons not to eat the cookies, like, “it’s fun to challenge myself,” which would be an internal motivation. Others didn’t eat them “because I want the experimenter to like me,” an external motive. The questionnaire was designed to measure autonomous self-control on a continuum from very internally motivated to very externally motivated.

They also measured the difference between the baseline and follow-up grip-strength endurance times for each person and compared the degree of drop-off in endurance with the degree of autonomy the subjects felt. The results? As the previous observations indicated, it confirmed that internal motivation for self-control was less “depleting” (in depletion model terms) than external motivation. The problem is, the resource-depletion theory has no explanation for why that should happen. As Muraven concluded, “this study indicates that the [depletion] model needs a significant revision, as autonomous self-control appears to deplete far less self-control strength than compelled self-control.”

I’m pretty sure I’m not the only one who has had this experience: You’re rushing to get out of the house on a winter morning to drive the older kids in carpool, and as you struggle to get the youngest into his snowsuit he’s screaming, “No! I want to do it myself!!”  Or you might be old enough to remember the tagline from the Anacin commercial, “Mother, please! I’d rather do it myself!” Young or old, people have a need to feel that they are the source of their own actions. Why is the need to do it by and for yourself so important?

The need for autonomous control, or the self-driven motivation to act, has been explained by two psychologists at the University of Rochester, Richard Ryan and Edward Deci. According to this idea,  called Self-Determination Theory, a feeling of autonomy is, along with competence and relatedness, one of the three main elements of intrinsic motivation. For a good non-technical explanation of these ideas, read Edward Deci’s Why We Do What We Do. In it, he relates an old Jewish fable told to him by a friend.

It seems that bigots were eager to rid their town of a Jewish man who had opened a tailor shop on Main Street, so they sent a group of rowdies to harass the tailor. Each day, the ruffians would show up to jeer. The situation was grim, but the tailor was ingenious. One day when the hoodlums arrived, he gave each of them a dime for their efforts. Delighted, they shouted their insults and moved on. The next day they returned to shout, expecting their dime. But the tailor said he could afford only a nickel and proceeded to hand a nickel to each of them. Well, they were a bit disappointed, but a nickel is after all a nickel, so they took it, did their jeering, and left. The next day, they returned once again, and the tailor said he had only a penny for them and held out his hand. Indignant, the young toughs sneered and proclaimed that they would certainly not spend their time jeering at him for a measly penny. So they didn’t. And all was well for the tailor.

As long as their motivation was their own sheer pleasure at giving this poor tailor a hard time, they would do it for free. But once they got used to doing it for a reward, their internal motivation was replaced by the external reward. When the incentive ended, the behavior stopped. (Think about the implications for corporate wellness programs that rely on incentives to get employees to lose weight and exercise!) Similarly, the surest way to doom whatever you might accomplish on a diet is to lose the weight for someone else rather than for yourself. At some point, the pay-off ends while the deprivation continues and is no longer worth it.

But what does all this say about whether self-control is the result of willpower, as the depletion-resource-strength model theorists contend? If you recall from my previous post about why people would repeat something that they know will cause them to feel worse afterward, my conclusion was that the reinforcement for that behavior was actually very powerful; it was all about freedom, autonomy, and control, as self-determination theory has been saying all along.

When Muraven says that the results of his study on autonomy and self-control indicate the need to revise the depletion model, I would agree.  It seems that when there is a sense of imbalance between having control over your own choices versus feeling forced or pressured to behave according to expectations – even self-imposed expectations – that balance must be restored. Sometimes, that may even be at the expense of having to deal with unpleasant consequences later .

When the depletion theorists describe certain behaviors, such as emotional eating, as a “breakdown” of restraint, it is not due to a passive depletion of the strength to resist; rather, it’s an active strategy to restore an imbalance in autonomy. In the next post I’ll describe in more detail this idea of balance, imbalance and restoration, and how it can be applied to improve the self-regulation of behavior.

When I was a clinical intern in the last year of my doctoral program, I worked in a hospital outpatient clinic that specialized in the treatment of eating disorders. Among the patients I had treated in that program were many young women who suffered from bulimia. Each had unique issues and different histories leading up to the problem, but when they described how they experienced their episodes of compulsive bingeing and purging, they did so in almost identical terms. I wasn’t surprised to hear them describe purging as a very negative experience, but if I was asked to guess how they would describe the food binges that preceded them, I would have expected them to say that they were in some way positive or enjoyable. But that was rarely if ever the case.

Instead, they depicted their emotional state during a binge as, at best, emotional numbness. They would turn off the thinking and feeling parts of the experience, and almost mechanically, would proceed to stuff themselves with a large amount of food. They described a sense of disconnection from the behavior, not enjoying it and barely even tasting it. It was as if the outcome was so inevitable they might as well just turn on the autopilot and quickly get it over with. If they were aware of any feelings at all they were negative: self-loathing, guilt, disgust. When I heard this same theme repeated by many of these young women, I recalled something I had learned in one of my undergraduate psychology classes that should have contradicted their accounts, and I couldn’t make sense of it.

In 1905, one of the earliest American psychologists, Edward Thorndike, discovered a principle of behavior that he called the law of effect. We now consider the idea so basic and intuitive that it seems surprising anyone even had to “discover” it. In simple terms, the law of effect states that if a behavior produces a satisfying effect in a particular situation it is more likely to occur again under similar circumstances, and if it produces a negative or uncomfortable effect it is less likely to be repeated.

The problem that bothered me may by now be obvious to you. According to Thorndike, even a puppy can be trained to be housebroken if  some negative experience follows the behavior. So why did my patients with bulimia continue to engage in a behavior that left them feeling physically ill, depressed, guilty, and out of control? Not only were they willing to repeat the behavior in spite of the known consequences, but they felt compelled to do it! This was troubling to me, and I was given a variety of unsatisfying explanations by people more experienced than I. But as a trainee I figured I must be missing something that was obvious to everyone else so I put the question aside.

A few years later, I began a clinical practice treating patients with a wide range of psychological problems. After about ten years in practice, I became interested in the area of health psychology, and narrowed the focus of my practice to work with people who wished to improve their health behaviors and lower their risk of chronic illness. Since obesity is the primary preventable cause of heart disease and diabetes, I began to specialize in helping people who had difficulty managing their weight and eating behavior. Most of these patients struggled with emotional eating.

As I have always done when I meet and evaluate patients with a behavioral problem, I would ask them to describe their thoughts and feelings while they engaged in the unwanted behavior. Almost all of them conveyed their experience in negative terms, or like the bulimic patients I had treated as an intern, as emotional numbness. It wasn’t long before I recalled the puzzle I had set aside years before: Why would anyone repeat a behavior that makes them feel worse? This time, however, I was not going to let go of it. If there was one thing I had learned by then, it was that many experienced people tend to take things for granted and fail to ask the most obvious questions. And often, it is the obvious questions that are most important. The answer to my question took a while longer to find, but I finally solved it with the unintentional help one of my patients.

Lauren was a very successful and driven sales manager. She was able to lose more than 15 pounds over a six month period. Around the time that she lost the weight, she was in the process of changing jobs in a very high pressure industry because she was feeling under utilized. She had started a new job, but with less time flexibility and increased responsibility, she became quite busy and was soon no longer able to continue coming in for therapy. Although she had not yet reached her desired weight, she was happy with her progress and felt she had a good sense of what she needed to do to continue on her own.

After about eight months without hearing from Lauren, I received a call from her asking to set up an appointment. She explained that she had gained back all of the weight she had lost, plus six more pounds. Although she loved her new job, she was very stressed, traveling four days a week. With a husband and two young children, along with many social and volunteer responsibilities, Lauren was pulled in so many directions that she felt she was not fully meeting any of her obligations, especially in her personal and family relationships.

She knew that her overeating was not about enjoying the food itself. As with virtually all of the other patients I was seeing for binge eating, she did not enjoy any part of the eating itself. This behavior was also not directly a result of her frequent travel and lunch meetings in restaurants. In fact, she was always very careful about what she ate when she was with other people because she was self-conscious about what they would think.

She explained that several times a week she would binge when she was alone in her hotel room and needed to take a break from her tightly-packed schedule and responsibilities and just let go. As she described it, “Eating without thinking about it is like taking a mini-vacation or going to a spa whenever I need it. I’m not enjoying what I eat; I just need to let go every once in a while.”

As I listened to her describe her experience, I realized that I had the answer to my question about what triggered her behavior and what maintained it. The reinforcement was powerful; it was just not as obvious a reward as enjoying a snack or giving a treat to a puppy. Call it defiance, rebellion, or self-determination; people have a need to abandon restraint when they feel controlled. Even though the experience was always brief and had a bad outcome, it allowed her to satisfy a much stronger need: to feel free. Thorndike’s law of effect had not, after all, been repealed.

My approach to treating emotional eating had shifted from that point forward. I realized that it was not about food, eating, or even loss of control; it was about gaining autonomy. Instead of viewing it as a passive breakdown of resistance, I see it as an active need to let go by abandoning control and relieving the pressure of restraint.

Why do we have such a strong need to be free of control? Coming up.

From the original forbidden fruit in the Garden of Eden to the simplistic advice to “just say no” to drugs, it has been accepted wisdom that self-control is best exercised by an exertion of willpower. However, despite the time-honored history and intuitive appeal of this concept no one has been able to define exactly what willpower is or how it works. What allows one person to pass up dessert while another person can’t resist the temptation? In fact, why can the same person resist temptation one moment but give in to it the next? Various suggestions have been offered to answer this question.

One idea is that the ability to restrain behavior is a cognitive process in which certain information is necessary to help you decide the best choice to make. Think of it as Mr. Spock’s approach to self-control: you choose whatever you decide will work best and is therefore the most logical. Another explanation is that self-control is a skill that improves with practice, which might explain why adults are (usually) less impulsive than children. A third possibility is that self-control is a resource like muscle strength. Some people just have more of it than others, and it can even vary at different times in the same individual. According to this view, it requires a strong “willpower muscle” to overcome temptation.

About twenty years ago, a group of social psychologists, led by Roy Baumeister, tested these ideas. They did some experiments to determine which of these theories is correct by examining the behavior of volunteers in a series of laboratory studies using a dual task paradigm. This simply means that the research volunteers (college students getting class credit, so I use the term “volunteers” loosely) were asked to perform two different tasks, one after the other, both requiring the research subject to use self-restraint.

According to the idea that it is a logical process, the thoughts that are necessary to make a good decision and exercise restraint can be primed or prepared by the first task to improve performance on another self-control task that follows. The idea is that the first task gets them in the state of mind to use self-control, so their performance on the second task should improve. A different prediction would be made if it was a skill that improves with practice. Since one or two practice trials would not be enough to have a measurable effect, performance on the second task should not change. If, on the other hand, self-control is a resource or strength, then restraint should worsen as each attempt to use that “muscle” would weaken it.

Each of the three theories predicts a different outcome, so only one of the three competing explanations could remain standing. The studies showed that when the subjects had to restrain themselves on the first task, their performance was worse on the second one. These findings support the idea that self-control is a limited resource that gets depleted with use. This effect, often referred to as “ego depletion,” was seen whether or not the second task was related to the one that preceded it, as long as they both required self-control.

This basic research design has been repeated frequently in different ways and has consistently shown that self-control gets worse after it has been used. The conclusion that the researchers came to was that there is a supply of willpower that we have at any given time, and it gets weaker the more it’s used. Presumably, just like muscle strength, this supply is restored with rest, so you should be good to go the next day. A second question, though, has the real practical pay-off because it’s the one most non-scientists really want to know: how can self-control be strengthened? The researchers’ answer to that question also follows the logic of the muscle metaphor. If willpower works like a muscle, it should be strengthened with exercise.

Well, as scientists like to say, that’s an empirical question. So to test this hypothesis, the researchers used the same protocol from the original study, consecutive self-control tasks, but this time the same two tasks were repeated two weeks later. In-between these sessions the subjects were given exercises to do, as a kind of home workout to build willpower strength. This study found some improvement in how long it took to deplete self-control for the second task, but, as the authors acknowledge, it did not improve the ability to actually exert self-control. “Following the muscle analogy, our results did not show that the muscle (i.e., self-control) had any greater power after two weeks of exercise, although the results did indicate that it had greater stamina and was less prone to suffer from rapid fatigue after the exercise.”

The results of other studies that examined this question were, at best, mixed. A detailed critique of this research is beyond the scope of this summary, but it is clear that the results do not offer convincing support for the idea that a “willpower workout” can improve self-control. At best, it improves a very limited aspect of control. Unfortunately, this is of little comfort to those who want some practical advice on how to gain some control over their unwanted behavior.

Before I learned about this research about six years ago, I had been treating many patients who had difficulty with self-control. Most of the people that I saw were struggling with their weight due to emotional eating, but there were also many among them who had other behavior control problems as well, such as compulsive shopping, binge drinking, and gambling. My clinical experience was consistent with the laboratory findings that behavioral control does get worse when people had to restrain themselves in other ways. The behaviors often occurred in the context of increased work stress, marital stress, and very commonly, the stress of feeling obligated to take care of other peoples’ needs without complaint. I know that last one sounds very specific, but it was surprisingly common among the emotional eaters.

I did eventually figure out a connection between these stressful experiences and the behaviors that accompanied them, but I had come to a very different conclusion than Baumeister and his colleagues as to why this happens. Most importantly, my understanding of this effect has very concrete and practical implications that led me to a conclusion about how to treat these patients that is the opposite of the one he came to. Rather than improving self-control by practicing more of it, I tell my patients to figure out where they’re experiencing a lot of self-restraint and do less of it. I have been using this approach with very good outcomes over the past six years.

When I eventually discovered this body of research, I read it carefully to understand why our explanations of why this happens were so different if we’re seeing the same thing, and I think I figured it out: the difference is in how we view the concept of self-control. My way of understanding it also helped me solve a mystery that had first bothered me more than twenty years ago. I’ll describe that in more detail, as well as the implications for change, in future posts.

What do we mean when we refer to emotional eating, and how does it differ, if at all, from compulsive overeating, binge eating disorder, and bulimia?

It may surprise you but there is still, as of this writing, no official diagnosis for binge eating disorder, much less emotional eating. This is in spite of the fact that it is the most common of all eating disorders. It affects almost half of all adult women who have any type of eating disorder, and one-third of all people who diet. For the time being, it’s officially categorized in the diagnostic manual as Eating Disorder Not Otherwise Specified. It may not be necessary to stick a label on every problem, but it is useful to have a widely agreed upon and accepted way to define a common syndrome so we’ll know if a treatment that has been found effective for some people can be expected to help many others with the same symptoms.

There is a behaviorally-based definition for binge eating disorder that has been proposed for inclusion in a future edition of the Diagnostic and Statistical Manual. The central features of this diagnosis include eating an excessive quantity of food “that is definitely larger than most people would eat…under similar circumstances” and consumed within a “discrete time period,” accompanied by feeling a loss of control and followed by marked distress. There are a few other associated behaviors like eating quickly and feeling uncomfortably full that are added, but the basic definition is virtually identical to that of bulimia but without compensatory behavior, such as purging.

This similarity to bulimia, plus the vagueness of the supposedly objective criteria in the definition may be an indication of why there is not yet an official diagnosis for such a common syndrome. That’s because this behavior is not only a mental disorder, but it’s also a very common though maladaptive coping mechanism that virtually everyone has experienced at one point or another. In other words, it includes a very broad gray area that gets darker and darker until everyone would agree that it is no longer grey. The problem that the DSM people seem to be struggling with is agreeing on how to define the point that it turns black.

This reflects a larger problem with defining many disorders that are dimensional or based on frequency and severity. When does daydreaming or restlessness become attention deficit disorder or hyperactivity? At what point does apprehension become anxiety? Where do we draw the line between a burst of creative exuberance and hypomania? These are easy to identify as pathological at the extreme end of symptom frequency and severity, but defining that boundary can be very subjective. It’s different than a diagnosis that’s defined by categorical symptoms, such as many that accompany psychosis, which are either present or they’re not.

Emotional eating is an example of a dimensional behavior. Rather than viewing bulimia, binge eating disorder, and compulsive overeating as unique disorders, they can be seen as a subset of emotional eating. The difference between them is that the behavior may differ in frequency and quantity, and people vary in how they deal with the anxiety caused by it – some try to compensate by trying to undo it while others don’t – but the emotional eating may really be just one very common coping mechanism to ease stress. If that’s the case, how does this coping mechanism help?

To explain that will require a separate post (or several). But it’s helpful to first understand the current thinking about self-control and what causes it to break down. In a nutshell, this theory proposes that self-control, or willpower, is a limited resource like muscle strength that gets weaker each time we use it. That means that the more you have to restrain your behavior, the worse your self-control will be. The theory is well summarized in David McRaney’s blog post and it offers a very compelling explanation that’s based on a slew of studies. Keep an open mind while reading it though, because there are a lot of problems that this theory does not address and there are other ways of interpreting the research.

Meanwhile, ponder this: why would anyone try to cope with distress by doing something that will make them feel worse? Rather than solving the problem it just adds to it! Even if it happens once or twice, don’t we learn from doing something that turns out badly and try to avoid repeating it? Stay tuned.