Emotional/Stress Eating: Facts, Challenges, and Interventions Jeremy Clorfene, Ph.D.

1. Emotional/Stress Eating: Facts, Challenges, and Interventions Jeremy Clorfene, Ph.D. Head Psychologist Advocate Weight Management Program (Chicago Area) 565 Lakeview Parkway, Suite 102 Vernon Hills, IL 60061 o 847-990-5770 c 847-877-1331 www.jeremyclorfenephd.com

2. Why do we eat? 1. Hunger/Fuel 2. Every other reason

3. What is Emotional/Stress Eating? • Eating in response to negative emotions • Stress, anxiety, sadness, anger, despair, loneliness, boredom, hopeless, helpless, shame, pressure, fatigue, sleepiness…so you can feel better (temporary).

4. Emotional/Stress Eating is mitigating an unpleasant uncomfortable state by eating to temporarily feel better or distracted… “I just have to have it.” • Usually you will never feel more justified eating when they are feeling these negative emotions(Stinking Thinking)

6. NOTE: • Emotional eating discussed in terms of negative emotions rather than eating when “happy” or “excited” (positive emotions). • Human emotions and experience is complex, and the link between negative emotions and eating is key. Separate Issue: • Eating when happy…usually “reward eating.” • Eating for celebration/social/out …“I’m Italian, we eat”

7. What Triggers Emotional Hunger? • Stimulated by situations, thoughts, feelings, people, cues, time of day, and long-standing habits. Examples: commute, supervisor, paying bills, parenting… • Human beings are emotional: it provides color, depth, quality. • Imagine a life without emotions? Dictates how we live, interact, work, play, meaning and purpose. • Clearly, eating and emotions can have a strong relationship. • How we related to food is emotional, passionate …. “a love affair with food.”

8. Physical vs. Emotional Hunger • Physical hunger occurs when our body needs food for energy. • Anxiety, sadness, or anger does not feel like hunger even though a person may want to eat. • Years of emotional/stress eating forgotten what physical hunger truly feels like – • Over time, when emotional eating is targeted as a treatment goal patients will reconnect with physical hunger cues. Progress is when eating in response to physical hunger rather than emotional hunger.

9. What is the Biochemistry / Physiology? Where do we feel negative emotions? Negative emotions and stress will activate our body in a fashion designed to protect us against that threat. Our body does not know if the threat is real or perceived but it is receiving messages from the brain that something is wrong. Anxiety, fear, anger, betrayal, sad activates the "fight or flight" response.

10. “Fight or Flight Response” • During Stress adrenal glands release two hormones: Adrenaline and Cortisol • Stimulate our organs and muscles to cope with the threat causing our negative emotions. • Our body’s response to a bear chasing us in the woods is very similar to being scolded by a supervisor at work.

11. Cortisol • Cortisol increases appetite and sugar cravings • We love sweets, sweets, sweets • Also, Turning off of “full centers” in the brain • Numbing all other feelings… Sugar is the great anesthetic! • Once obese, got to eat to stay obese Vicious cycle Taubes, G, Why We Get Fat , 2010.

12. The Cycle • Concomitantly, obesity can contribute to a negative self-worth which can significantly impact a patient's overall mood (gender differences as well). • Thus, a cycle of lowered self-worth fuels negative emotions which in turn increases eating and subsequently obesity. In most situations, emotional eating takes place when a patient is rarely physically hungry.

14. BTW…we are the most in debt, obese, addicted, medicated cohort in history …woa!

15. Limbic System - Dopamine • Brain’s “pleasure chemical” • Controls emotions, memories, and smell • We make many decisions based on emotions (dopamine) • With the sight of food, dopamine flushes your brain • Takes approx. 2 seconds to make a decision (uh ya fast) • Once levels decrease, question why you did it? • Buyer’s Remorse Lindstrom M. Buyology of Belief. 2008

16. Similarities b/t Food Addiction and Drug Addiction • PET scans show obese patients have lower dopamine levels • Similar to drug addicted subjects • Thus less sensitive to reward stimuli • Takes more food (stimulus) to gain pleasure • Obese patients more vulnerable to food intake as a source of pleasure Wang GJ. J Addictive Diseases. 2004

17. Conscious Mind • Our personal identity, creative mind runs the show about 5% of the time • Aware of the Past, Present, and Future • Holds our wishes, desires, and aspirations • Holds our “positive thoughts” • Our “Free Will” Lipton BH. Biology of Belief. 2008

18. Subconscious Mind • Stimulus-response cycle…reflex system • Not governed by reason or thinking • Years of stored, learned programs, habits • Runs the show 95% of the time Lipton BH. Biology of Belief. 2008

19. Subconscious Mind (cont.) • 50,000 (est) automatic thoughts per day / called sub vocalizations • Every thought, aware or unaware has a chemical signature • 95% are automatic! • Aware of only 5% = 2500 ... • 80% of those thoughts are Negative / Limiting (approx. 2000) • 4 negative to 1 positive • Why so much negativity? Marshalla, Repeatlessness, 2006

20. Perceptions and Feeling Brain is attracted to negativity: Researchers looked at how we fall into negative mindsets and then it is difficult to undo

21. How to describe the glass? Glass is ½ Full = Gain Frame (positive) Glass is ½ Empty = Loss Frame (negative)

22. New Surgical Procedure Group 2 Group 1 30% Failure 70% Success 30% Failure 70% Success

23. Governor Rating Group 1 Group 2 40% Jobs Saved 60% Jobs Lost 60% Jobs Lost 40% Jobs Saved

24. Mind Frame Conversion (600 lives at stake) Group 1 Group 2 If 100 lives are Saved how many are Lost? If 100 lives are Lost how many are Saved? 600-100 = ? GAINES TO LOSS LOSS TO GAINES

25. How long to figure out the problem? LOSS TO GAINES GAINES TO LOSS 11 seconds to figure it out 7 seconds to figure it out Chaiken, S., & Ledgerwood, A. (2012)

26. What does this mean? • Once the mind experience, thinks, perceive loss…it resists change • Shifting from positive to negative is easy • Shifting from negative to positive is hard… It takes effort and work!! • Why? Negativity is emotionally protective. • Control/predict pain is better than feeling good and then be disappointed!

27. Positive feedback is short-term, transient. • Negative feedback sticks all too well. • Ex. Performance review… “25 things you do awesome, but that one opportunity for growth” • Ask people about “love,” tell you about heart-break • Ask about belonging, tell you about rejection • Ask people about connection, tell you about disconnection

28. Positive Attitude!

29. Also…Anything that is perceived to require “EFFORT” is also considered negative! • Building success is about effort, effort doesn’t feel good, increases risk for emotional eating unless there is a payoff/reward/reinforcer. • Building frustration tolerance, victories off-set the discomfort, confidence and positive results ensue!

30. Let’s Get Real…A typical Day What is the emotional/stress eating pattern? Most people do not emotionally eat in the morning or early afternoon. Patients report emotional/stress eating takes place mid to late afternoon and in the evening. Factors: Sleep/Energy, Hormones, Hunger, Behavior…

31. Sleep/Energy • Sleep and Energy: Greatest level of focus, attention, and energy mid-morning! • Post-prandial dip…nap time would be great/siesta (good luck)…then, “4pm, Tea and Crumpets” • The day progresses fatigue, sleepiness increases, b/c most people totally sleep deprived (caffeine) • Sleep deprivation increases cortisol, and caffeine activates adrenal gland (double whammy).

32. Ghrelin Levels (hunger hormone)

33. Behavior What are we doing between 6am and 6pm? Working, busy, distracted… Then we commute, come home and then …bills, kids, marital issues, single parent, medical issues… THEN WHAT?

34. BACK UP THE EMOTIONAL/ STRESS EATING TRUCK! (4pm – Midnight!)…sugar/carb time!

35. H.A.L.T. (4pm – Midnight) H = Hungry… A = Angry… L = Lonely… T = Tired…

36. Brief Summary Once obese (morbid) there are some real challenges: 1. Cortisol 2. Dopamine 3. Fat cells influence the brain to eat 4. Negative thinking 5. Sleep deprivation 6. Ghrelin 7. Food is the go to numbing agent!

37. Behavioral Therapy “We’re pretty good at engineering and building roads, cell phones, drinkable water, but good luck trying to change peoples behavior” Charles Merbitz, 1996

38. Treating Emotional/Stress Eating But what are we treating? Depression, Fatigue, Hunger, Convenience, Trauma, Irritability, or A really good opportunity to eat what we want? …HABITS and drive-thrus!

40. Levels of Stress/Emotional: Low, Medium, High Low Stress (0-3) tired, hungry, bills, commute, child’s grades, boredom, night time eating, TV eating, eating while cooking… Medium Stress (4-6) water in your basement, car accident, chronic back pain, family… High Stress (7-10) Death/Disability, betrayal, DUI, divorce, job loss…

41. People need their stress to eat! Ex. Lori, Michael

42. Treatment/Intervention • Break the problem down for the patient: Where’s their stress “hotspot”? • Get a commitment…have they bought into working on this issue? • Discuss the downside to taking away their “coping” and/or “buddy” (mild discomfort)

43. STRUCTURE and PRECISION

44. I. STRUCTURE • Regular visits with health care team (1-4x/mo) • Regular monitoring of weight and biometrics. • Higher the connectivity between team and patient better results. • Emotional support, cheerleading with successes and victories, and interventions for lapses • Accountability, cause “naughty” is done in private • Keep ‘em coming…even when not doing well.

45. II. STRUCTURE • Do they have a meal plan? • Meal Replacements – 2 for wt loss and at least1 for sustaining – great tool • Nutrition needs met (and quality) without excess cals • Simplify decisions • Reduce temptation (eat this first, less likely to eat that) • Control costs Ditschunett et al., Obesity Res, 2001

46. I. PRECISION • Elevate awareness: acknowledge and recognize negative emotions • Self-monitoring (food records) • Raising self-awareness is absolutely necessary • Patients underestimate calories by 1/3 • Overestimate physical activity by ½ • Keeping food records is critical • Hold patients accountable, no records no treatment • Food records are diagnostic and intervention • If you count it, you change it Foreyt J. Medscapre Diabetes & Endocrinology. 2004

47. II. PRECISION • PREVENT • Identify and fight biggest risk factors for patient and • Battle Stinking Thinking • Battle the “Emotional/Stress eating habits” • FIX • Get back on meal plan at all costs • Work hard till it is not so hard

48. III. PRECISION PREVENT: • Stimulus Control – that is, risk factors/triggers • Home (kitchen, fridge, pantry, hidden drawer) = get it out of the house, they’ll get over it • Eating out/drive thru = planning • Late night eating = stop • Strengthen the “internal muscle” …fight the urges, develop tolerance for the discomfort

49. IV. PRECISION Dieting cycles produces unhealthy thinking relapse behavioral patterns. “Stinking Thinking” are methods to get off plan and justify eating what you want! Stinking Thinking: The Big Five 1. I already messed up lunch…so…let’s party! (stole a little, might as well steal a lot) 2. “I’ll just have one” or “I’m just getting a Diet Coke from McDonalds” 3. “I’m stressed so I need this” 4. “I can’t do this/I can’t handle this” 5. “I’m not in my routine so I can have…”

50. V. PRECISION FIX • once off their plan…stress ate • GET THEM BACK ON PLAN • This is the key!!!! • This is hard, this is the work, this is the change! • Separates the old pattern and builds the correct new behavioral pattern • This is what is always missing! • But it is NOT what your patient wants to do! • This is where the negativity flourishes! • This is where they Give Up! • Must fight this and help them get back on plan!!