Stress and Emotional Eating: Using Cognitive Behavior Therapy to Break the Habit

Most of the dieters whom I treat overeat when they’re feeling stressed or experiencing a negative emotion such as anxiety, sadness, anger, shame, and so on. They often have one or both of the following unhelpful ideas:

 “There’s nothing I can do to calm down when I’m upset.”

“I deserve to eat when I’m upset.”

As long as they hold beliefs like these, they will remain vulnerable to regaining the weight they have lost. They need to change their thinking. They need to learn how to accept and tolerate negative feelings and how to cope with stress in more healthy ways.

Katie, a dieter whom I saw last year, had been doing so well initially. Early on, she was highly motivated and was able to stay on track even when she was upset. When she became upset, she would tell herself, “NO CHOICE. It’s not time to eat. I CAN’T eat now.” She would turn her attention to something else, her negative feelings would slowly subside, and she’d feel proud that she had stuck to her plan.

But then Katie went through a particularly stressful period. Her father was hospitalized. Her youngest child started having problems in school. She got a new supervisor at work who was making unreasonable demands on her. Katie continued to follow her eating plan throughout each day. But come 9 pm, when her children were in bed, the permission granting beliefs above led to Katie’s consuming “all the carbs I can get my hands on,” until she went to sleep. She quickly started regaining the 22 pounds she had lost. She was frustrated and angry at herself but couldn’t seem to stop.

First Katie and I did some problem-solving. As soon as she got her kids in bed, she would decompress by doing deep breathing and then she’d have a cup of herbal tea. Next we did some cognitive work. Following our discussion, Katie composed messages on index cards which she was to read each day after work, just before she walked in the house. She was to read them again as she was sipping her tea. This is what Katie’s cards said:

“If I want to lose weight permanently, I have to stop eating when I’m upset—every time. People without weight problems don’t eat when they’re upset. They either tolerate their negative emotions or try to solve the problem or call a friend or take a walk or go online or read a magazine or watch television. But they don’t eat.”

“Negative emotions are uncomfortable but not dangerous. I don’t have to “fix” them. I’ve had lots of times when I’ve felt very upset but I haven’t eaten. I’ve never exploded or lost control. The worst thing that will happen if I don’t eat is that my distress will peak and then the intensity of my emotions will go down. “

“If I eat, I’ll be temporarily distracted from my distress but whatever problem led to my distress in the first place will still be there and then I’ll also have the problem of feeling badly that I ate and I’ll really feel badly when I see that the scale has gone up.”

Katie also started back on Day 1 of the cognitive behavioral program for weight loss and maintenance so she could sharpen her skills of re-motivating herself, gaining confidence by giving herself credit, tolerating cravings, and getting back on track immediately when she made a mistake. The incidence of her eating for emotional reasons declined sharply. She slipped a few times but the challenge became easier and easier as time went on. The chance that Katie will be able to maintain her weight loss into the future has increased exponentially.

Jennifer’s Struggle

Jennifer recently shared with me her struggle over whether to eat certain foods, particularly during evenings. Jennifer would finish dinner, and then, it was as if treats and desserts would start calling out to her from her refrigerator.  She would engage in the classic struggle:  

“Should I have that piece of cake? But it’s not on my plan. Oh, but it looks so good. But then I’ll be strengthening my giving-in muscle. But it’s just a little bit. It’s not about the calories it’s about the habit. But I’ve been good all day…” and so on, and so on.

I asked Jennifer if she ever engaged in this struggle when it came to healthier foods she should eat, food that was on her plan and was part of her diet. Jennifer answered, “no.” She only ever had this problem when it involved unplanned foods. Jennifer realized that although she was experiencing the “should I have this/shouldn’t I have this struggle” – the answer was clearly, every single time – NO, I shouldn’t have this!  I then helped Jennifer reframe the question in her mind. Instead of asking herself if she should or shouldn’t have that food, she should ask herself the real question, which is “should I cheat on my diet OR shouldn’t I cheat on my diet?”  And the answer to that question is obviously, “No, I shouldn’t cheat on my diet.” With this new mindset, Jennifer was able to stop the struggle in the evenings, because she knew that, absolutely, she did not want to cheat on her diet.

Inflexible Eating

When I introduced the notion of following a food plan inflexibly to Robert, he initially experienced both anxiety and skepticism. Robert asked me why he couldn’t just make substitutions when he felt like it as long as the calorie count remained the same. Here’s what I told Robert:

It’s essential for you, and all dieters, to learn the skill of inflexible eating before you move on to flexible eating. By inflexible, I mean making a plan ahead of time (either the night before or that morning) for the coming day, and learning how to stick to it exactly, with no substitutions. Once you can do this, you’re ready to start flexible eating—making a plan and then sticking to it but making substitutions if/when you want to. And to start to calm your [very normal and expected!!] fears, I can tell you that really learning inflexible eating is one of your best insurance policies against regaining weight down the line.  Once you become really get good at this (and of course it will take practice, but the more you practice the better and better you’ll become), you won’t have to worry about regaining weight. If five, ten, or fifteen years from now you begin to see the scale creep up, all you’ll have to do is return to making your food plans ahead of time and sticking to them, and your weight should begin to drop. It’s SO important to learn this skill now—so that you can use it in the future and for the rest of your life.

Hearing this, Robert understood why it is important for him to learn the skill of inflexible eating. He was still nervous about trying and failing, but I told him that every one makes mistakes when learning new skills; it’s what makes us human!  I expect Robert to make mistakes, but as long as he learns from his mistakes and keeps trying, he will eventually become good at this.

Amy’s Business Trip

Amy came in this week feeling quite defeated. Although she had previously been doing quite well with making food plans and sticking to them, she had been on a business trip earlier this week and hadn’t been able to write down her food. She viewed the trip as a complete “failure,” which left her feeling demoralized and unmotivated. As soon as I heard this, I realized very quickly that Amy was probably catastrophizing the trip, and viewing it as much worse than it actually was. I asked Amy what she had done right on the trip, and initially she couldn’t think of anything.  I then asked her if she had practiced any of her other skills during the trip. After thinking about it, Amy admitted that she was still very conscious of eating everything slowly, sitting down, and while enjoying every bite. Even though she ate at restaurants for every meal, Amy said that she always worked hard to make smart food decisions and never finished the whole portion she was served.  She also consistently resisted the cookies and muffins that were served throughout the day as snacks, and she always chose fresh fruit for dessert instead.  And because of all these things she was doing right, Amy didn’t gain a single pound on her trip.

It can be hard to believe that in light of all these things, Amy could have viewed this trip as a complete failure, but this happens often to dieters. They tend to focus only on the things they are doing wrong, or not as well, and completely discount all of the many, many things they are doing right. I asked Amy to take another, more objective look at her trip. When squarely faced with a list of all the things she deserved credit for, Amy was able to realize that the trip wasn’t a failure even a little bit – in fact, for the most part it was actually a huge success. Once she stopped catastrophizing and put the trip in perspective, Amy immediately felt better and even more confident about her ability to handle trips in the future.

Cindy’s Anxiety

Cindy has been having some anxiety about the future. She successfully lost 43 pounds and has been maintaining that loss for over 8 months, but she still has negative thoughts and images that pop into her head from time to time. The most common one is that she sees her future self standing in front of the mirror, trying to zipper her jeans, and realizing that they have become too tight. She experiences a sickening realization that none of her clothes fit anymore. Her heart sinks as she steps on the scale and sees how much weight she has regained.

I discussed with Cindy the fact that this visual in her head of trying to zip her jeans is making things so much harder for her! I helped Cindy replace that visual with a much more realistic one. In this picture, her future self steps on the scale and notices that it has gained 3 or 4 pounds. But instead of experiencing that sickening feeling in her stomach, she immediately becomes problem-solving oriented. Cindy breaks out her diet notebook and her Beck Diet Solution book, reads her advantages of losing weight list, reads back to the times when she was doing inflexible eating, and sets up an eating plan for that very day. Because she has already firmly mastered the skill of following a plan inflexibly, it is not difficult for Cindy to put herself back in that mindset, especially because reading her advantages list has concretely reminded her why it’s worth it to do this. Within a week or two, Cindy already sees the scale going back down. This is completely realistic, and helped put Cindy’s mind at ease.

When Did Special Treats become the Everyday Norm?

When did it happen? When did we Americans go from an occasional piece of pizza to having multiple slices throughout the week? When did we go from the occasional soda to drinking sugary soft drinks throughout the day? When did we go from a weekly overindulgence, such as a big dinner on Saturday night, to excess food every evening?

Now, I’m not against special treats. In fact, I advise people to have a moderate portion of a favorite food every day. But not more than ONE. And they have to make sure the rest of their food intake is healthy and moderate, too.

I asked Marc, a dieter who consulted with me, what a typical day of eating was like for him. Here’s what he described: He would have some kind of sweet pastry for breakfast; packaged cheese crackers and/or chips for a mid-morning snack; a large hamburger, fries, coleslaw and soda for lunch; cookies and/or a doughnut with another soda for a mid-afternoon snack; a large entree such as lasagna, bread, salad and two beers for dinner; and candy and ice cream for a snack. He knew that he was eating too much unhealthy food. But at some level, it felt “right” to him, even though he was borderline obese and suffering from health problems. He felt entitled to eat that way. After all, it wasn’t very different from how his brother and best friend ate—though he saw that they had gained a significant amount of weight in the previous five years, too.  

Over time, I helped Marc change his attitude toward food. He began to see that his way of eating was “right” if he wanted the negative health consequences of carrying around excess weight to continue—and to likely grow worse. He began to see that his way of eating was “wrong” if he wanted to be fitter and healthier. Even as he was losing a significant amount of weight, Marc still occasionally mourned not being able to eat as he had in the past. At these times, he needed to review his list of all the reasons it was worth it to stick to a healthier way of eating. And he needed to read a response card that reminded him that the excess and unhealthy food he had been accustomed to consuming was “right”, only if he wanted to be obese. The concept of “only one favorite food a day” eventually became Marc’s new norm; he stopped grieving and was able to fully celebrate how much better he felt.

Planning to Eat More and Gain Weight

Julie was feeling disgruntled. She was tired of following her eating plan. “You know, I’m still pleased when I get on the scale every day. But now I’ve been maintaining my weight for the past year and a half. It’s not a thrill like it used to be.”

I asked Julie what was the hardest part of sticking to her maintenance diet.  “I’m just tired of what I’m eating. I want to eat more. I want to eat different things for lunch and dinner. I want to have a glass of wine when I go out with friends and dessert every night. I want to have an afternoon snack, like pretzels or crackers or chips. But I know if I do,” she said glumly, “I’ll gain weight.”

Julie and I reviewed her food intake on a typical day. It looked as if she were eating about 1600 calories per day. “What would you think,” I asked her, “about making just one change for this week, instead of all the changes you want all at once. You could plan to eat 200 extra calories each day. Today, for example, you could have a higher calorie lunch. Tomorrow you might want an afternoon snack. The day after that, you might want dessert. Or maybe you want to have dessert every night and keep everything else the same.  You could try this for a week or two, and see how it goes. If it’s going well, you can keep on doing it. If you’re still unhappy, you could add another hundred or two hundred calories.

“But I’ll gain weight, won’t I?” she asked. “Yes,” I replied. You will. But it will probably only be a few pounds. And you might decide it’s absolutely worth it. I know you were proud when you lost 47 pounds. But what’s the big deal if you gain back three or four pounds and maintain there? There’s nothing magic about the number 47. And if you can feel more satisfied at a slightly higher weight, why not go for it?”

Julie decided to go for it. Over the next few months, she gradually added more calories to her daily diet. But she didn’t slip into it. She made conscious decisions to eat more and she planned in advance how she would use the extra calories. Her weight went up by 4-5 pounds and there were a few outfits that became too tight. But she recognized that it was worth the trade-off. She was happier being able to have more variety in her diet.

Calorie Counts on Menus

Earlier this year, Philadelphia joined New York in requiring that chain restaurants print calorie counts on their menus. Even I was astounded, when I ate out a few days ago. I was fascinated by how high the calorie counts were for almost every item.

The calorie counts didn’t change what I had planned to order. They just reinforced my choices. Even before I got to the restaurant (my first time at this chain), I knew I’d most likely skip the appetizers, caloric drinks, and dessert, and have some kind of protein (with minimal sauce), a vegetable, a starch, and a piece of bread. I knew I’d have to ask for my food without added butter or oil. And I also knew that I would probably eat about 2/3 of the protein, all the vegetable, and part of the starch. That’s what I did.

I knew I could have ordered anything on the menu but I would have had to eat much smaller portions and possibly tolerate hunger and cravings later on. I WISH I could have chosen different food and eaten larger portions, but I know that this is what I have to do to maintain my weight. And it’s worth it.

If I ate out at restaurants more often, I would have to eat even smaller portions. Restaurant food is simply significantly more caloric than the food I eat at home.

Or, if I ate at restaurants more often, or consumed more when I dined out, I’d have to accept the fact that my weight would be higher. I think the latter option is fine for dieters and maintainers to choose (as long as they can maintain a healthy weight).

What is not fine is for dieters to stick their heads in the sand and pretend that restaurant meals are lower calorie than they really are. I’m continually amazed by dieters who consume a couple of very caloric dinners per week and are then surprised when they don’t lose weight. I hope that more restaurants will include calorie counts so dieters can make informed (and better) decisions.

You Can Have [Some] Cake and Eat It, Too

Lisa was confused. For a very long time, before she started the program in The Beck Diet Solution, she had tried, as much as possible, to avoid certain foods completely, for example, candy, ice cream, and cookies. She was frankly a little astonished when I suggested that she should allow herself to have one favorite food a day.

Dr. Beck: You know, you’ve gotten really good at following your plan. Can we talk about adding in some of your favorite foods? I think you said you rarely let yourself have candy and ice cream.

Lisa: I thought I should never eat those foods.

Dr. Beck: What’s been your experience in eating them in the past?

Lisa: Well, I never allow myself to have them, but I guess I always slip and end up eating them sometimes, even when I don’t intend to.

Dr. Beck: When you eat them—do you have moderate portions?

Lisa: No, I tend to go hog wild. I never have, say, 5 pieces of licorice. I either have none or half the bag.

Dr. Beck: You know, I don’t think it’s realistic—or necessary—for you to ban these foods altogether.

Lisa: But I’m afraid I’ll go way overboard.

Dr. Beck: What would you think about doing an experiment this week? I think you’re ready. Let’s pick a couple of foods, have you bring a single serving into your house each day, and see what happens.

Lisa: [slowly] Okay….

Dr. Beck: Would you like to try licorice? You can either buy a bag, portion out a single serving, and throw the rest away—even outside the supermarket. Or you could put portions in bags at home and make all but one really inaccessible, for example, at the back of the highest shelf in your apartment.

Lisa: I could try that. I think I’d be okay if I put the bags behind my suitcases high up in the utility closet.

Dr. Beck: Then each day, you take down just one bag. It’s probably best to save the licorice for before bedtime. Then you can look forward to it all day.

Lisa: Okay.

Dr. Beck: So some time in the evening, read your reasons to lose weight and your response cards. Then really enjoy the licorice, eat it slowly, and when you finish, brush your teeth and get in bed, so you’ll be tucked away if you have a craving for more.

Lisa was nervous about doing the experiment but excited that she could actually plan to eat some foods she had forbidden herself. The experiment actually worked quite well. That week, she had licorice three times, a candy bar three times, and ice cream once. She didn’t lose control. She found about half the time  she did want more but was easily able to stop and was proud of herself for stopping. In the future, we’ll work on getting Lisa to having larger quantities of some favorite foods in her kitchen and limiting her self-serving to one moderate portion a day.

Fear of Food

Marie avoided eating potato chips, French fries, onion rings, and crackers. Although she loved these foods, they would trigger cravings and once she started eating them, she found it quite difficult to stop. Marie actually developed a fear of these foods. She was sure she would lose control if she ate them.

I told Marie that I wanted her to start planning to eat one these foods a day (perhaps a couple of times a week), so she could learn how to stop. I explained that I didn’t think it was reasonable for her to avoid them for life, especially if she really liked them.

We made a plan. Marie would read her reasons for losing weight just before dinner and her other response cards. She would alert her husband about the plan. At the restaurant, she would order French fries (and a small plate) along with her healthy dinner. When the fries arrived, she would immediately put the extra fries on the small plate and ask the waiter to take them away.

Marie was a little hesitant. What would the waiter think? We agreed he probably would think, “This customer is on a diet.” Then he would turn his attention to his next task.

Marie tried it. It was much easier than she thought. She didn’t lose control. She did want more when she was finished but she told herself she would have more again within the next couple of days. She’s still a little fearful about eating some of her other trigger foods, but we’ll work on them together.