In Session with Debbie: Hunger

Like many dieters before her, my client Jill was having trouble sticking to her food plan in the evening. She told me that she would usually eat what she had planned but then would wind up taking seconds and eating more. In order to figure out what was going on, I first asked Jill whether or not she thought she was hungry when she took more food. “Is the desire for more food coming from an emptiness in your stomach, or more of a desire to eat stemming from your mouth or head?” Jill thought about it and reported that she wasn’t entirely sure, but thought it was likely that, at least some of the time, it was coming more from her mouth than from her stomach.

I discussed with Jill the difference between physical satisfaction and psychological satisfaction. The fact is that most dieters feel physically satisfied well before they feel psychologically or emotionally satisfied. After they’ve eaten a reasonable amount of food, physically they’ve had enough and their bodies don’t need more. But they often want to keep eating more for a variety of different reasons: because they enjoyed the taste of the food, they didn’t pay enough attention to the food they did eat, they want to continue being social at the table, they’re trying to procrastinate getting on with their next activity, they’re thinking about a stressful situation and want eat to calm themselves, and so on.

Jill and I also discussed that if she finished eating and wanted more food, it could also be because the food she did eat hasn’t yet registered in her stomach. To help with this, we decided that every time Jill finished her planned meal and wanted more, she would set a timer for twenty minutes. During those twenty minutes, Jill would first do the dishes and then leave the kitchen and read a magazine or play a game on her phone until the timer went off. Once it did, she would then ask herself if she still wanted more food, and, if so, where the desire for more was coming from. Was it coming from her stomach or from somewhere else?

Because Jill thought that sometimes the desire for more food really was coming from her stomach, I then discussed with Jill what level of fullness she thought she was shooting for. Was she trying to feel pleasantly full and no longer hungry, or was she actually trying to feel stuffed? Jill thought about it and realized that she often was aiming for a level of fullness that meant that she couldn’t fit in another bite. I discussed with Jill that that was likely overfull, and that what actually might need to change is her concept of what reasonable fullness entails. Jill agreed to closely monitor her level of fullness over the next week and make an effort to stop when her stomach felt full but not stuffed.

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We discussed the fact that, at least initially, it might cause her some discomfort to have to stop eating before she wants to, although she can train herself to get used to feeling only full instead of overly full. I reminded Jill that being overweight is hard too, (it’s hard not fitting into her clothes, feeling heavy in her body, having knee and back pain) so either way she’s going to experience discomfort. Jill knew she’s rather try to put up with the very momentary discomfort of not eating more food as opposed to the completely pervasive discomfort of being overweight.

With these new things – paying attention to the difference between physical and psychological satisfaction, setting a timer for twenty minutes after she finishes eating, shooting for full instead of overly full, and reminding herself that either way there’s discomfort – Jill had a lot of new strategies to help her keep her evening eating under control.

In Session with Debbie: No Exceptions

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My client, Helen, has been struggling recently. When she came in to see me this week she told me that the previous week hadn’t gone very well and she had a number of off-track days.  She said that she was still making food plans the night before, but was increasingly finding it difficult to stick to it.  Some of the time, she would make substitutions that seemed legitimate (subbing one fruit for another, or one snack for a different one of equal caloric value) and some of the time she just threw out the plan completely.

To help Helen reset and refocus, I suggested that for the next three days, she makes a plan and sticks to it with no exceptions and no substitutions. Because of her struggles, Helen’s sense of discipline and self-efficacy had taken a hit over the past week, and so in order to help her build it back up, it was critical that she prove to herself once again that she can make a plan and follow it 100%. Once Helen is back on track with sticking to her plan, then she can resume being somewhat flexible and making reasonable substitutions.  I reminded Helen that it should only take a couple of days to get her back in the “sticking to my plan” mindset, and she agreed that it would be helpful to do so. Helen and I also discussed the fact that there would probably be some element of relief in knowing she was going to stick to her plan because it means, at least for the next three days, she is relieving herself of the burden of making spontaneous food decisions and therefore alleviating the struggle about whether or not to eat something.

I then asked Helen a very important question: What thoughts might get in the way of you sticking to your plan 100% over the next three days? Helen responded that the one thought she might have would be, “I’m not going to stick to my plan because I don’t feel like eating what’s on it.” To help Helen overcome this thought, she made the following Response Cards to read at least once a day, every day, for the next three days, and more frequently if she was tempted to stray from her plan:

I need to eat in response to my bigger goals (losing weight, being healthier, feeling better about myself, feeling comfortable in my body, etc.), not my smaller goals (eat what I most feel like eating at any given moment).

I’ve planned this food because I like it. Even if I don’t especially feel like eating it, it will still taste good because it’s something I enjoy.

It’s okay if I don’t get to eat exactly what I want at all times. If it’s something I really want, I can plan to have it tomorrow. It will taste good then, too.

Once I start eating, I’ll be caught up in the enjoyment of what I am eating and won’t remember the other thing I felt like eating.

It’s critical for me to prove to myself that I can stick to a plan 100%. Once I do, I can start making substitutions again if I feel like it. This is not forever. It’s only for three days. I can do it!

With these helpful Response Cards, Helen felt confident that she could stick to her plan for the next three days. She reminded herself that she did it before and she can do it again – and when she does, she’ll stop struggling and start feeling great again.