End Emotional Eating: Using Dialectical Behavior Therapy Skills to Cope with Difficult Emotions and Develop a Healthy Relationship to Food by Jennifer Taitz
My rating: 2 of 5 stars

This book was given to me by one of my coaching clients. She struggles with emotional eating and she thought it might be helpful if we read this together.

Jennifer Taitz is "a clinical psychologist and director of the dialectical behavior therapy program at the American Institute for Cognitive Therapy in New York, N.Y. She is a certified diplomate of the Academy of Cognitive Therapy and is a founding board member of the New York City Association for Contextual Behavior Science."

Taitz spends the majority of the book talking about emotions. How to face them, accept them, and embrace them for what they are. Interestingly, much of what she writes applies to just about everyone as the narrative deals with emotions, both negative and positive, and the way we that deal with them. In a nutshell, she suggests it's not the emotion, but what we do with it and allow it to do to us that ultimately matters. Negative emotions are a part of life. Pain and sorrow are a part of life. Acceptance of the emotion is key. It's when we try to numb ourselves so as to not feel the discomfort of certain emotions that we get into trouble. For example, many people use food as a means to "escape" from an uncomfortable emotion.

Unfortunately, her discussion of emotional eating never quite goes much behind the observation that emotional eating is an unhealthy way of dealing with emotions, which is sort of strange given that the book is titled "End Emotional Eating." In fact many times while reading I completely forgot that this was a book that promises to help you develop a healthier relationship with food.

Of course, emotional eaters do benefit from learning more appropriate strategies for dealing with emotions, but still. It felt as if something was missing. The information was fairly generic in that respect, and not necessarily focused on emotional eating as much as emotion avoidance. I also felt her attempt to discuss mindfulness as it relates to eating was a little over the top. For example, she recommends an exercise that involves eating a strawberry by first smelling it, feeling it, noticing its texture and taste, savoring it, etc. I mean, come on. Really? I'm a foodie. I love food. I love to cook and experiment. I love to eat. But this? This is not helpful. This is also not mindful eating. Mindful eating is about taking inventory of the eating experience. Paying attention to cues for hunger and satiety. Being aware of motivation and emotions as they relate to your eating. Mindful eating is not taking 20 minutes to eat a strawberry.

I think "The Binge Code," a book I recently read and reviewed, did a much better job of not only exploring the emotional context of emotional eating, but also in providing real life strategies for dealing with eating disorders like binge eating.

I get it. Emotional eating is driven by emotions. We eat to avoid dealing with some uncomfortable emotions. Clearly, an emotional eater must learn how to work through their emotions in a more positive way. But in a book that targets emotional eaters specifically, I would expect a more in depth discussion of food's role in avoiding emotions. Seriously. This book could just have easily been called "End Emotional Drinking" or "End Emotional Drug Use" or "End Emotional Fill-in-the-Blank (destructive behavior)."

Conclusion

The good:

Taitz addresses the importance of dealing with our emotions in a positive way. This often means learning to simply experience the emotion and allow it to pass, because it will.

The bad:

Taitz never really connects the dots between emotions and eating, nor does she discuss how dealing with emotions through food (abuse) might be different than dealing with emotions through sex abuse or alcohol abuse, etc.

The Binge Code: 7 Unconventional Keys to End Binge Eating and Lose Excess Weight by Ali Kerr
My rating: 4 of 5 stars

Kerr is a self-admitted recovering binger who now uses her personal experience with emotional eating to coach others who are also struggling with the same disorder.

Binging, just one form of emotional eating, is the term used to describe the compulsive consumption of large quantities of food in response to some emotional cue, and while not all "emotional" eating would be considered disordered eating, the repeated and out-of-control nature of binging certainly qualifies as unhealthy and beyond the norm. It is also probably more common than we realize.

Kerr's advice is pretty spot on and mostly centers around "mindful" eating. The goal is to get people to recognize and understand the emotional and sometimes physiological triggers behind a binge. Techniques as simple as waiting several minutes before giving into a craving can create space between an emotion, an impulse, and an action and time to distinguish between true hunger and an emotionally driven impulse.

I read this book because some of my clients suffer from disordered eating, binge eating being an extreme. They often report eating in response to emotional cues and claim that they don't know what it feels like to be hungry. For some reason food has become their drug of choice, a way to self-medicate and numb emotional pain, even if only for a minute.

Unfortunately, as Kerr points out, abuse of food can be just as harmful (and maybe just as hard to kick) as abuse of drugs or alcohol.

Clearly, those who suffer from destructive emotional eating patterns like repeated binging have a problem with food that goes beyond food, hunger, and weight and thus can not be adequately addressed by dieting. In fact, the cycle of chronic/yo-yo dieting can actually make things worse. Interestingly, the weakest part of the book is when Kerr makes dietary recommendations. She advises that binge eaters should focus on eating six meals a day, 3 meals and 3 snacks. The main issue I have with this is the whole point of mindful eating is to start to pay attention to your body and signals of hunger and satiation while also identifying eating that is emotionally driven. I'm sure this way of eating worked for her, but I'm not sure it will work for everyone. And that's kind of the point.

For what this is, it's a decent read. Much of what Kerr says squares with what I have seen and experienced over the years. I think Kerr hits the nail on the head with not only describing the forces behind emotional eating, but also in the strategies she offers to free oneself from the destructive cycle of binge eating.

The End of Dieting: How to Live for Life by Joel Fuhrman
My rating: 4 of 5 stars

Joel Fuhrman is a physician who is perhaps best know for his book "Eat to Live." I have not read that book, but imagine that this book is an extension of his original book.

There were many things I liked about this book such as Fuhrman's emphasis on eating more nutrient-dense foods such as fruits, veggies, nuts, beans, legumes etc. I also like that even though he promises weight loss if you are able to follow his "nutrarian" lifestyle, his emphasis is on eating for health. And he's right. Good nutrition is likely the best defense we have against chronic disease.

That said, I'm not sure how successful the average person would be with implementing his advice. He repeatedly reminds the reader that he isn't advocating a diet, but rather a way of eating...only his "way of eating" will feel like a diet to a lot of people.

When working with clients, I help them rate their diet as a whole on a scale from 0-10, 0 being the worst and 10 being the best. The majority of clients fall in the 2-4 range. The emphasis is on getting them to improve that score to a 6 or 7. For most people this means making healthier choices like eating a variety a fruits and veggies, quality meats and carbs, and by limiting processed/nutrient-void foods. Fuhrman's diet is more like a 9 or 10, something to aspire to but probably unrealistic for the average person...and maybe even unnecessary. For example, we know that for a sedentary individual, adding just 30 minutes of moderate intensity exercise 5 days a week is a enough to provide significant health benefits. 60 minutes 5 times per week offers even more benefits but at a decreasing rate of return. And at some point, increasing exercise time and intensity beyond a certain point either offers very little additional benefits or may even be associated with poorer health.

I'm not sure we've established the same sort of relationship for diet, yet based on my years in the field, it seems that the difference between eating a 7 and 9 is relatively minimal with respect to health outcomes. But the difference between adhering to a 7 and 9 may be huge from a practicality standpoint. Furthermore, Fuhrman admits that people who follow his advice may need to supplement to ensure they are getting all the nutrients they need. This is in part because he recommends significantly limiting animal products. And while he doesn't go to the extreme of veganism, it does seem strange that "the healthiest diet" in the world requires supplementation.

At times, Fuhrman uses words like detox and toxic and his tone is somewhat alarmist. I also think his promises of "quick" weight-loss are a little over the top, though I suppose that's what readers really care about.

Finally, a good chunk of the book is recipes.

All in all, I think that Fuhrman offers some good advice, namely focus on eating the most nutrient-dense foods you can. I think he's right. The food we eat can either help prevent disease or contribute to it. Furthermore, a healthy diet will result in a healthy body. And while his suggested way of eating may be unrealistic for everyone, it can certainly serve as a goal or something to aspire to even if it is never achieved.

Body of Truth: Change Your Life by Changing the Way You Think about Weight and Health by Harriet Brown
My rating: 2 of 5 stars

I read this on the heels of "The Obesity Myth," another book that challenges the assertion that overweight and obese are unhealthy.

According to Harriet Brown, we've been misled by the medical community. Not only is overweight and obesity (calculated using BMI) not necessarily unhealthy, in some circumstances it may actually lead to decreased mortality.

Unfortunately, much of her argument regarding the "health benefits" of being overweight and obese depends on cherry picking through what she describes as "the research" and "the evidence." In particular she cites at least one study that looked at mortality and BMI. What researchers supposedly found was that those who were overweight had a slightly better life expectancy than those who were underweight. They also found that the only "overweight" group with a decreased life expectancy (by a nominal amount) were those who were at the outer ranges of obesity.

Similar to Paul Campos in "The Obesity Myth," Brown seems to narrowly define healthy as being alive and unhealthy as being dead. Neither author adequately addresses the health risks associated with overweight and obesity. Both also fail to address the spectrum of overweight and obesity. There is a huge difference between someone who is 20lbs overweight, 40lbs overweight, and 100lbs overweight. Despite Brown's criticisms of BMI, she fails to grasp that public health recommendations aren't meant to be specific to individuals or used in isolation, but instead used as a quick and easy tool that allows health professionals to quantify a patient's risk. Contrary to what Brown suggests, most health practitioners understand that in order to truly assess health you have to look at many markers, weight/BMI being just one of them.

They both also suggest that anyone who isn't overweight is either genetically "blessed" or has a eating disorder. Furthermore, they scoff at the idea that being healthy should take work. They seem to be saying that if adhering to a certain lifestyle is challenging, why bother. Interestingly, I have a client now with whom I have a recurring dialogue. She continues to complain that getting healthy (not losing weight) is so much damn work. Ah, yeah. Just about anything we do in life from exceling at a sport to raising kids to pursing careers takes work. That's the point. And like it or not, in a world where low quality, cheap food is super-sized and super-accessible, eating healthy can sometimes feel like work. Yes, sometimes we just need to say "No." "No. I'm not going to eat that because it doesn't jive with my goals." And sometimes saying "no" is hard.

Like Campos, Brown also talks a lot about body image, social norms, and cultural standards of beauty. She makes some good points. For example, we are constantly bombarded with unrealistic images of an ideal body that only exists in photoshop land. And she is right when she asserts that skinny doesn't equal healthy and that fat doesn't necessarily equal unhealthy. She's also right when she suggests that trying to achieve unrealistic body standards is a set-up for failure.

Brown and Campos claim we need to stop focusing on weight, and instead focus on healthy behaviors, though neither book ever quite clearly defines what those "healthy" behaviors are.

Perhaps most importantly, she points out that by demonizing fat and "fat" people, we are actually making it harder for people to get fit as our obsession with weight and weight loss is, according to her, a battle we aren't winning.

Believe me. I get it. The "war on obesity" by its very nature demonizes fat and those people we decide have too much of it. It is perhaps the one socially acceptable "ism" of our times. This surely leads to a sense of inadequacy and self-loathing, and people don't generally make change from a place of inadequacy and self-loathing. And both authors are right. Diets don't work. Most people who lose weight via "dieting," do gain it back. It is also very possible that weight cycling (repeated bouts of weight loss followed by weight gain) is more destructive to our health than simply staying overweight. I also understand that "eating healthy" and exercising in today's world can be a challenge. Believe me. I do get it.

But I also get that public health officials are in a precarious position. They need to put forth public health recommendations that reflect the research, and whether Brown admits it or not, the research has established a correlation (even if not a causation) between overweight and obesity and many health problems like diabetes, high blood pressure, and heart disease. And they need to do it while somehow not demonizing, minimizing, or stigmatizing people who are "overweight."

I appreciate the necessary role of the body positivity movement. Self-love and self-acceptance is the foundation for positive change, ie making the healthiest choices we can. Both Campos and Brown try to validate the latter by invalidating the former, and I'm not sure how helpful that is to individuals or to society.

When I work with clients, we talk a lot about their goals. They always tell me they want to be healthier or at least healthy, but they also want to lose weight, and to be honest, weight loss is often the overriding motivation. In their minds these two things are essentially indistinguishable because like Campos and Brown say, right or wrong, most people associate thinness (or the behaviors that will lead to thinness) with health.

That said, I focus primarily on health. I remind my clients that healthy bodies are the result of healthy behaviors. Therefore if one focuses on making healthy choices over the long term, their body will gravitate toward a healthy weight which may or may not be their idealized weight. And it's amazing how some people get it on an intellectual level, but still insist on weighing themselves to monitor progress. It's a challenge. Because weight loss shouldn't be a goal. It should be a natural side-effect of the goal. I remind them that anyone can lose weight by going on the keto diet. That's a no brainer. The question is how many people who lose weight on the keto diet will keep it off for any substantial period of time. I have clients who can't even maintain their weight and yet they are worried about losing weight.

"Dieting" as we think about dieting generally results in weight loss. However, research has shown that most people will gain the weight back. This yo-yo dieting is unhealthy both physically and mentally. And despite the faults of Brown's book, it is a valid point she tries to make. Instead of a focus on weight loss (and most of my clients not only want weight loss but they want it as of yesterday) we need to focus on making healthy choices (eat less calorie-dense foods like fast food and processed crap and instead eat more nutrient-dense foods like fruits and veggies) and exercise almost every day in some way.

From day one, I encourage my clients to make nourishing food choices that serve their health and wellness goals. There is no striving for perfection, as if there were such a thing. Together I help the client focus on making better choices. We do this primarily by looking at behaviors that aren't serving them. Often times people do things out of habit that are not only counterproductive but actually destructive. For example, we eat at a certain time because "it's time to eat," not because we are hungry. Or we limit ourselves to certain foods because those are the foods we are used to eating. Maybe we go to McDonalds because that is what we have historically eaten when stressed or short on time. And sometimes the root of those behaviors has nothing to do with food or hunger.

I will say that from my experience, it's clear that too many people have an unhealthy relationship with food. It's kind of sad. It's not an eating disorder in the sense that bulimia or anorexia is an eating disorder but it is disordered eating all the same. Brown addresses this in her book.

Though there was a lot I hated about this book (mainly Brown's somewhat distorted interpretation of the "facts" and her impressive mental gymnastics) there were some worthwhile tidbits. I think her discussion centered around beauty standards had a lot to offer at least in regards to that particular topic. Unfortunately, she erroneously blames public health recommendations for our body dissatisfaction. Medical professionals aren't pushing thin because our actresses are thin. They are pushing thin because there is research that correlates overweight with increased incidence of disease. Furthermore, BMI classifications are not the root cause of our "weight" problems, perceived or real.

Personally, I am intrigued by our reaction to fat as a whole. Many people are repulsed by fat. Fat people, fat dogs, fat mice, whatever. Is this attitude the result of cultural standards or are our cultural standards the result of our attitude? Could it be that we see fat as unhealthy because it is actually unhealthy? Or is it because being fat represents a perceived lack of discipline and self-control. I don't know. This is an interesting question, and I'm not sure Brown has the answer. Brown pointed out that in certain cultures overweight women are considered attractive because them emulate vitality. But if this is true, maybe in our culture, overweight signifies a lack of vitality for whatever reason and is thus seen as less attractive.

Alas, just two stars as there was more I disliked about this book than I liked.

The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health by Paul Campos
My rating: 3 of 5 stars

Paul Campos is a lawyer and a writer who by his own admission(at least until recently) has had an ongoing struggle with his weight and maintaining a positive body image. In The Obesity Myth Campos tries to convince his readers that the "obesity epidemic" is a farce, part conspiracy theory and part ingenious marketing campaign championed by companies and special interest groups that have nothing to lose and everything to gain from our obsession with weight loss.

With the eloquence of a skilled orator and talented writer, Campos puts forth an argument that seems at first to be indisputable if not immediately obvious. The war on obesity is unfair, unfounded, and ultimately making us fatter.

His case goes something like this:

1. Despite popular belief, the health risks associated with carrying excess weight are actually quite low. According to Campos, weight is not an independent risk factor with respect to morbidity or mortality.

2. There is no good long-term evidence that shows that weight loss even if sustained is beneficial to health. However, there is evidence to suggest that the all-too-common cycle of weight loss and weight gain is harmful.

3. Finally, despite decades worth of dieting mantras, diet manuals, and fitness gurus selling us the latest weight-loss package, the research shows that even when dieters lose weight, they can't seem to keep it off.

Campos makes some good points, though at times he goes too far by reaching conclusions that aren't supported by the evidence he provides.

Campos repeatedly claims that weight is not an independent risk factor for morbidity or mortality. To support his assertion, he cites several studies that supposedly found that when other risk factors like smoking or sex were taken into account, being overweight and even obese (with the exception of morbid obesity) did not lead to a decrease in life expectancy. What he doesn't seem to get is that most health experts understand that a cause-and-effect relationship has not been established for overweight and obesity, though it does correlate to an increased incidence of disease. That simply means that while we can't prove that being overweight causes a disease like diabetes, we do know that being obese correlates to an increased incidence of diabetes. Most health experts concede that it may not be the extra weight itself that leads to the increased incidence of disease. Rather the behaviors that lead to weight gain may also lead to a particular disease. Campos seems to be missing the point, or rather misrepresenting it. The studies he cites to make his case relate to mortality and say nothing about morbidity. It's as if he believes there are only two basic states of health, being alive (good health) or being dead (bad health), and because excess weight is not linked to death it isn't harmful to our health. But that's ridiculous. Trust me. I am a clinician. There is a whole spectrum of health that exists between life and death.

Another major theme in Campos' case revolves around BMI or body mass index. Health professionals often use BMI to establish ideal ranges of weight for various heights. He quickly and repeatedly points out that BMI is not always a good indicator of body composition. After all, just about every professional football player is obese based on BMI alone. This is because a very athletic or muscular man and/or woman can have a large amount of muscle mass which distorts their BMI. He seems to think this is news to the medical profession. It's not. Clinicians know the limitations of BMI and only the most clueless doctor would tell an athlete like Marshall Faulk (at his prime) that he's obese. It doesn't work like that. BMI is simply a quick and dirty way to get a feel for body composition. Those who use it are well aware of its flaws and limitations. They understand it needs to be viewed in context.

Campos rests this particular case by claiming that exercise not weight loss is the key to improved health (longevity) and cites studies that have shown that a "mildly overweight" active person tends to live longer than a sedentary "thin" person. There is certainly lots of research to suggest that being active at any weight does indeed have health benefits. Campos however conveniently neglects to address how weight impacts an individual's activity level. I work with many large patients whose mobility and/or joints are impacted by their weight and size.

His assertion that yo-yo dieting is actually worse than being fat so why bother is also ludicrous and akin to why make my bed if I'm only going to sleep in it again.

Perhaps of the all the points he makes, this is the most convincing. The cycle of yo-yo dieting is unhealthy, both physically and mentally. This particular point also ties into his last point which is that despite health experts telling us to lose weight, no one seems to have figured out quite how to take the weight off and keep it off for good. And again, in one sense, he's right. There is decades of research that suggests dieting (dieting as we know it) doesn't work. People lose weight, but then gain it back. They then must lose it again, and thus the cycle starts. But I would argue that yo-yo dieting isn't inevitable, that there are dietary approaches that can and do work. It's just most people don't want to take the slow and steady road. For whatever reason, usually quick weight loss, people are attracted to less than ideal weight-loss methods.

I often tell clients that if they want to lose ten pounds in 3 months, I can't help them. However, if they want to adopt healthier habits that over time will help their bodies find a healthy weight (whatever that weight may be), then I am their "man."

But to simply say that because the diets that most people get sucked into don't work doesn't mean that people can't lose weight and keep it off. It just means the approach that we're using is wrong. That's part of what I do when I coach clients. I try to help them abandon the "diet/weight-loss" mentality and instead focus on healthy behaviors. If they lose weight, great. If not, great, because chances are if they are eating healthy and exercising and not losing any weight then they wouldn't be able to keep any additional weight off anyway.

Throughout the narrative Campos also discusses body image and the culturally induced unrealistic ideals that lead to self-loathing and feelings of inadequacy. I think most of us (women at least) have felt less than desirable (aka fat) standing in line at the grocery store and perusing through Sport's Illustrated Swim Suit Issue. And he's right. Every culture has standards of beauty that are unfair and unrealistic. Furthermore, thanks to living in a time and age when those of us with the funds and inclination can do so much to change our outer appearance, the pressure to conform to some crazy and, in many cases, unattainable standard has never been stronger. I get it. But that's not a valid argument against the health implications of overweight and obesity.

He does make some interesting observations about fat and obesity and our attitudes about fat and obesity. He claims we see being overweight as a moral failing and a weakness of character. We think of fat people as lazy, disgusting, and slothful. Even worse, the experts are now claiming they have a disease. We assume people are fat by choice or at least by lack of effort on their part. And I agree. Fatism is arguably the last acceptable "ism," but I don't think it's fair to equate fatism with sexism or racism or to assume that the public health message that encourages people to maintain a "healthy weight" is somehow just fatism in disguise.

I also agree with his assertion that our "war" against fat is actually making us fatter. Though, I don't believe there is some underlying conspiracy, namely the health and wellness industry has too much to gain from our attempts to lose weight.

Finally, Campos talks a lot about eating disorders. And while I don't agree with his use of anorexia to describe our mentality about food, I do believe that many people have a unhealthy relationship with food. I see it all the time when working with clients. So many people have so many confused ideas about food. And while misinformation and conflicting advice is partly to blame, it goes deeper than that. Some people use food much the same way that an addict might use heroin or an alcoholic might use alcohol. And it's kind of sad. Campos blames our "thin" culture. I blame the abnormal food environment in which we currently live. It's probably both and more.

At the very end of the book, Campos admits that despite his confident and self-assured narrative, he is actually just like everyone else. Ironically, in the course of writing the book, he lost 50 pounds by eating healthier and exercising more. Of course, he didn't diet (just made better food choices and denied himself on occasion.) Yeah, he dieted. He understands this makes him a hypocrite of sorts, but then why should he be any better than the rest of us.

All in all, this is an interesting read. Campos makes several worthwhile points that forced me to stop and question my own beliefs about "fat." Obesity myth? Not quite, though I understand what he's getting at. We do live in a society obsessed with weight. Our obsession with weight does not seem to be making us thinner. To the contrary, we appear to be getting fatter thanks to an almost universal and unhealthy relationship with food that is worsening thanks to the never ending stream of quick-fix dieting trends. There is a correlation between excess weight and several diseases such as diabetes and high blood pressure, but it is impossible to establish a cause-and-effect relationship. Weight is also not always an accurate reflection of body composition and/or health. It is also not clear if losing weight alone is enough to improve health, particularly if people can't keep the weight off for any significant period of time. Finally, there is ample evidence to suggest that making healthier food choices and getting regular exercise will have a positive impact on our health independent of weight loss and thus a more positive public health message might center more around promoting healthy behaviors and less around stigmatizing weight and fat. We also need a more accurate method of quantifying health that isn't based around things like BMI. With BMI, you essentially get what you pay for. It's quick, easy, and cheap. Unfortunately, it doesn't really say anything about health other than maybe establishing those at the most extreme ranges of underweight and overweight (both with their own health implications.)

I'll add that when I work with clients, it is often a struggle to get them to abandon their scales. For whatever reason, many are fixated on those three little numbers. I spend a lot of time focusing on getting clients to accept and love their bodies "as is" and to show that love by taking care of it through a balanced diet and daily exercise. I also spend a lot of time helping people to learn to love, savor, and enjoy food, real food, not the crap that comes in a box or depends on processed oils, sugar, and salt to make it taste "good." When they ask me about weight loss I tell them that if they eat healthy and exercise their bodies will generally gravitate toward a healthy weight, though that weight may not always reflect their "ideal."