Breaking Food Addictions:
A Cognitive-Behavioral Treatment Approach
By Karen R. Koenig, LICSW, M.Ed.
While anorexia and bulimia nervosa receive widespread clinical attention, more common problems of compulsive eating and overweight are often grossly neglected during the therapy hour. Yet 46% of the US adult population is overweight and at any given time approximately 30 million Americans are trying to lose weight, mostly by dieting. As social workers, we know that excess weight increases clients’ risk for heart disease, diabetes, and back and joint problems, and that out-of-control eating often leads them to chronic states of shame, guilt, self-hatred, frustration, hopelessness, and isolation.
Why then is the problem of overeating and overweight so often overlooked in treatment? One answer might well be that social workers (and therapists in general), so skilled in treating other addictions, do not know how to effectively address such conditions. We may think that the only options for compulsive eaters are diet doctors and groups such as Weight Watchers, Diet Workshop, Overeaters Anonymous, and Jenny Craig. Unfortunately, these programs often compound the problem. Diets don’t work—90% of those who diet and lose weight, gain it back—because the real problem, the causes of compulsive eating, are not adequately addressed.
There is, however, a cognitive-behavioral treatment approach which has proven effective in overcoming compulsive eating. It focuses on three major areas: unhealthy eating habits, emotional eating, and unconscious beliefs about fat, thin and food. The goal is to transform compulsive eaters into "normal" eaters.
Using this approach, we can move clients toward healthy eating habits by helping them reconnect with their bodies and follow the basic rules of "normal" eating:
- Eat only when you are physically hungry or have a specific craving (say, sweet or salty)
- Make food choices based primarily on what your body feels like eating
- Eat slowly, tasting, savoring, and enjoying your food
- Stop eating when you are full (no longer hungry) or satisfied (no longer craving)
After years of dieting and bingeing, clients may need our help in identifying long forgotten signals of hunger, food craving, fullness and satisfaction, and they certainly need our encouragement, understanding, patience, and support when the application of new, unfamiliar eating skills does not come easily. Clients also benefit from our coaching them to eat without distractions and not on the run, and being kind to themselves when they relapse into destructive, old habits, especially bingeing.
Additionally, we need to teach clients that reaching for food is not an appropriate way to get emotional needs met, that the healthy response to loneliness, sadness, rejection, abandonment, confusion, disappointment, anger, boredom, frustration, and anxiety is not eating. As clients learn that food is food and feelings are feelings, they are breaking their addiction to food and learning effective emotional management skills.
Exploring how compulsive eaters can successfully get their needs met, which generally involves risk-taking, tightening or loosening boundaries, and learning new ways of self-soothing, ensures that substitute addictions do not arise as eating normalizes.
Lastly, there are a host of unconscious, damaging beliefs that compulsive eaters hold that must be transformed before they can end their food addiction for good and lose weight permanently. Unhealthy food beliefs include: the need to eat to please others and clean one’s plate, that food is love, that there are "good" and "bad" foods, and that three, square meals a day are a must. Beliefs about fatness and thinness are among the trickiest to unearth and change, such as equating thin with selfishness, perfection, being cold or problem-free, or fat with not being sexual, needy, successful, or attractive.
Along with these beliefs come hidden messages that are unconsciously delivered through clients’ overweight and overeating, such as: don’t hurt me, I need help, give me space, I have problems too, I need comfort, you can’t ignore me, I’m scared, leave me alone. Clients need to learn to express these feelings directly, not indirectly through layers of fat or having a chronic eating problem.
For social workers who need more information about how to help compulsive eaters become "normal" eaters, there are many excellent, how-to books that take the non-diet approach to permanent weight loss. For clinicians there are continuing education workshops on the subject and for clients adult education classes, support groups, and programs such as Feeding Ourselves, which teaches "normal" eating.
On the long, long list of complicated problems involving trauma and abuse that clients often bring to us, compulsive eating and overweight may seem relatively minor and mundane. (They also may signal that sexual abuse has occurred.) Recovery from a food addiction by learning to eat "normally" is not just about slimming down and looking good. The process and results offer clients not only a saner, more comfortable relationship with food and body, but teach them crucial life skills which will enable them to live healthier, happier lives.
FOCUS Newsletter - June 2001
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