Over the last thirty plus years we have seen an incredibly steep rise in the number of people struggling with their weight and becoming obese. This has had a significant impact on people’s physical and emotional health, with people grappling with their body image, impacting on their mood and often influencing the choices they make in life.
Reflecting on my work in a Chronic Kidney Service and Community Diabetes Service when I was initially working with people that wanted to change their eating patterns, it was really apparent how much this was getting in the way of the life they wanted to lead.
The number of people who feel they could get back to cherished activities such as swimming because of fears of what people would think of them, or not having the energy to play with their children/grandchildren, or those who would avoid social events with friends or how it would impact on their intimate relationships. I have also worked with many people whose weight has some impact on, or close relation to, their physical health, from diabetes, heart conditions, IBS and chronic pain for example. The impact can be huge, as can the efforts the people have put into making changes. There are people who have been dieting all their lives, have attended many Weight Watchers or Slimming World sessions, those that have had countless personal battles with themselves and expended a huge amount of energy in self–criticism. It is not for the lack of effort that people have found themselves stuck so often and for so many years. When you look at the sheer number of people struggling with this, it reveals what a global issue this is. Below shows a depiction of the rise in levels of obesity in the US since 1985, which is also shown to be a rising issue in the UK and globally (see Parliamentary Research Briefing and World Health Organisation (WHO)).
After working in a number of services with many people struggling with their weight, I have been exploring how so many people could be getting caught in this trap. My understanding is that it is not one simple cause, it is not just “eating less, and doing more” nor is it just simply hereditary. I believe there to be many contributing factors that have become pandemic in our society and have combined to influence the environment we are exposed to and have all led to this significant shift away from how things were only a short period ago. The simple fact is that our genes by themselves or their expression do not shift so drastically by themselves in such a short space of time (30 or so years), and therefore there has to be something within our environment and/or the way we interact with it. The diagram below indicates the many factors that have already been identified to be contributing factors to the rise in weight issues. Each of the 108 variables here are grouped in to the following groups or clusters: Energy Balance (importance, effort, conservation, availability of energy); Physiology (level of satiety, appetite control, metabolic rate, genetic influence, level of fat free mass); Food consumption (food exposure, abundance, convenience, portion size, nutritional value and energy density of food); Food production (food industry is one fuelled by profit margins – pressure to improve sales, therefore influences what foods were exposed to); Individual activity (type and level of activity we do); Activity environment (reliance and availability of labour saving devices – a growing trend, dominance of sedentary employment (sat in front of a computer) and leisure activities (such watching TV)); Societal influences (media influences including advertising, peer pressures, social views on obesity and food, parenting, social media); and Individual Psychology (stress management, self–esteem; food literacy; views on lifestyle choices, impact of many personal motivations and drivers).
This research is already a number of years old, so there will be many more factors, such as the impact of our gut health, our microbiome, that has had a lot of recent attention. The fact that dependent on the difference composition of bacteria in our intestines impacts on obesity (see for example Dr Mark Hyman and Chris Kresser how the body processes our food, is linked to energy expenditure and fat storage (see Auon et al’s 2020 review). This alone debunks the simplistic perspective of the Energy Balance formula, where energy/calories in (what we eat) needs to equal the calories out (how active we are), otherwise people gain weight. Then we can add in the link between our gut health and our brains (the gut-brain axis or HPA axis; see review by Niccolai et al 2019) to see how intricate and complex the bi-directional impact what we eat and how we feel and behave can have on each other.
I would like to focus on one aspect of this and that is food addiction. It seems to me we live in a very different food culture and environment, one where “foods” containing refined sugar and highly processed carbohydrates such as white flour are now commonplace in our supermarkets, workplaces, homes, social gatherings and schools. Research and clinical practice is revealing the highly addictive nature of this foodstuff and that it is often impacting on our personal biology. In fact, sugar and refined carbohydrates seem to have a huge influence over our physiology in much the same as alcohol or even illicit substances. See my brief summary and link to an interview with the paediatric endocrinologist, Dr Robert Lustig.
Emotional Eating & Food Addiction
The word addiction comes from the Latin word addicere, that can be translated to
”being a slave” to.
Along with Dr Lustig and many other practitioners, Bitten Jonsson is someone who has been calling for sugar and processed flour to be recognised as “white poison” both for it’s highly addictive nature, its impact on our physiology or conversely our body’s susceptibility to its addictive calling. She also highlights that sugar/flour addiction is just one of many ”outlets” of addiction, and that there may be an internal process that is activated in some people more than others. Food, particularly sugar and refined carbs, may just be one particularly expression of this addictive process. There are many people that give up smoking for example only to then develop an unhealthy relationship with food, such as emotional eating, and as a consequence become overweight.
Dr. Gabor Maté is a Hungarian–Canadian psychologist, physician and author, and is known for his work exploring the underlying process for addiction and has drawn links with trauma, stress and childhood development. He suggests:
“There is only one universal addiction process. Its manifestations are multiple, from the gentler to the life-threatening, but in all addictions it utilizes the same brain circuits of pain relief, reward and motivation; it imposes the same psychological dynamics of shame and denial, the same behaviours of subterfuge and dishonesty. In all cases, it exacts the price of inner peace, harm to relationships, and diminished self- worth.”
I cannot help reading this and seeing how this captures a lot of the experiences people have described to me and relates to my own personal experiences: the times I have reached in to the “naughty cupboard” following an argument, or surreptitiously tried to hide a chocolate wrapper in the bin to avoid being discovered.
To explore the root causes of this, Dr Maté’s first question for people is not “Why the addiction?” but “Why the pain?”, such that behind every addictive behaviour we often find an attempt to alleviate some form of underlying pain or emotional disharmony, whether it is anger, irritation, upset, sadness, boredom for example. There is something within the relationship we have with these unpleasant emotions that urges us to in some way try to control or get away from them. Sometimes this drive can be so strong that we turn towards unhelpful behavioural patterns such as emotional eating.
There is an insightful interview with Dr Gabor Maté by Dr Chatterjee that explores the impact of past experiences on our current way of interacting with the world. I highly recommend listening to this.
Below I would like to introduce a particularly helpful approach that addresses this unhelpful relationship we can have with food. It offers a powerful way of working through any associated emotional difficulty and therefore break the unhelpful habits.
What is EMDR?
As an applied counselling psychologist there is the before and after training in Eye Movement Desensitization and Reprogramming (EMDR). I have been working in the psychological field for over
15 years and have gained a working knowledge of many therapeutic models. This ranges from the traditional Freudian Psychodynamic and Roger’s Humanistic to the Cognitive and Behavioural Therapy (CBT) approaches including a specialism in Acceptance and Commitment Therapy (ACT), Mindfulness and Self-Compassion. All these models, although different in their approach and theoretical underpinnings, can in some way be collected together under the umbrella of talking therapies.
Following my training in Eye Movement Desensitization and Reprogramming (EMDR), I was introduced to a whole new approach to therapy. We do would not tend categorise EMDR as a typical talking therapy because the catalyst for change is not the words we use and our cognitive thinking but the use of Bilateral Stimulation (BLS) that seems to activate a physiological process we all have within us. BLS involves an alternate activation of the left then right side of the brain which is done through either: eye movement, alternate tapping on the left & right side of the body, or through alternating sounds in our left and right ears. This is done while focusing on a particular difficult and unprocessed past memory. This is a very strange concept to try to describe and for people to make sense, as we as so used to think of talking being the agent of change in counselling and psychology. There are many researchers and scientists intent on understanding how or why this EMDR approach works. Alongside this, there is mounting evidence indicating how effective it can be for a number of difficulties (see 2021 reviews by Valiente–Gómez et al and Scelles et al). On a personal and professional level, EMDR has revolutionised how I work with people and shifted massively how effective I feel I can be in helping people overcome their difficulties.
The theory behind EMDR is that we can experience events that are too difficult – too distressing and/or difficult to make sense of – at the time to process, so the brain stores that memory in a raw, unprocessed form. And it is these unprocessed memories from the past that can greatly contribute to people’s difficulties in the present. With EMDR’s focus being on past memories, it is most widely known for being a trauma focused approach. The meaning of trauma however is not reserved just for the military or if you’ve been in a horrendous car crazy. We experience events that trigger this process a lot more often than we may think. These memories can end up being left to festering in some way and often contribute to some form of disturbance in the mind and body. This could be in the form of being more hyper alert and heightened threat response, increased anxiety, sleep disturbances, greater irritability and/or angry outbursts as well as compensatory conditions such as phobias, obsessive compulsive traits and /or addictive behaviours including overeating.
EMDR was found to be an effective way of identifying underlying original memories associated with the onset of difficulties and then helping the mind and body to process these experiences. The unique aspect of this approach is that through BLS and the associated tapping or eye movements we allow the body to process what has remained unprocessed up to that point. One underlying theory of why this works is that we are activating the same or similar bodily process involved in our Rapid Eye Movement (REM) sleep phase at night. This is where our brains are as active at night as it is in daily activities and what we now understand as the body’s way of processing the day’s experiences. The brain is busily storing the important parts of our experiences, getting rid of the less important, categorising and linking to previous experiences as well as moving these experiences into the long term archive of “past memories”. This process seems to get blocked when we have experienced difficult experiences that hit some form of threshold due to the intensity of distress, the difficult sense making, or when some form of moral injury has occurred. By working through these past experiences with BLS and the EMDR framework, people find that their current day difficulties then tend to resolve and no longer cause them issues. They become free from the burden of associated distress and unhelpful behaviours and are more able to respond to life’s situations in the way they would ideally choose.
Triggers, cravings/urges & “positive reward”
Often people will have certain triggers such as places, times of day, situations such as meal times, moments of difficulty such as conflicts or receiving criticisms from others, as well as internal triggers like thoughts, feelings, bodily sensations or memories. This can then activate our urges or cravings and associated with persuasive thoughts, which can be in the form of urgent, forceful demands that leave little room for negotiation “I’ve got to or you’ll be hungry. Do it now.” or persuasive arguments that have you acting before you know it “well now its open…” ot “there’s no point, it’s only going to go to waste”. There is often a physical, bodily urge, a surge or drive towards action, a force that seems difficult to deny (often associate with the self–criticism that you should be stronger) or has a seductive quality like sirens on the sea rocks calling you to your doom. Or a simple habitual inevitability to it, the times you find you have acted before you have realized, or the absent minded continuing to take one more biscuit, crisp, chocolate, etc until the packet is finished. People often believe it is the lack of willpower that stops them having choice over what they do but I think this often dismisses the sheer strength of the urges, persuasive thoughts and ingrained habits.
There is often also an associated advertised reward or positive feeling attached to the act of eating, usually at its strongest just before or as someone eat. The most common moments of most pleasure are related to feeling secure, specif, being seen, feeling powerful or in control, most alive, a sense of reward. This can often soon follow other unpleasant emotions such as self-defeat, guilt, shame, disgust, frustration, deflation or self–criticism, self–judgement, or self–blame, although not always.
In EMDR we would target both the 1) craving/urges and 2) this positive affect, in the following ways:
1) By checking in with a recent triggering event, we can ask how strongly you feel that urge – measured as Level of Urge (LoU), a number between 0 (no urge at all) to 10 (strongest urge imaginable). You would then ask where people feel this in the body, for example in their chest. You would then do sets of Bilateral Stimulation (the tapping, eye movements, or auditory BLS). At which point we would tend to see the strength of urge and associate physical sensation diminish, often to zero.
2) The same is also done for the positive associate reward-based feeling. You identify a triggering event, measured as Level of Positive Affect (LOPA) with again a score between 0 (no positive feeling) to 10 (highest level imaginable). We identify where that is felt in the body then we do sets of BLS. The LOPA score would tend to drop, often to zero.
You would often repeat this for each triggering event you have identified, until the urges and positive feelings had reduced and were no longer felt in the body. This reduction of urges and associated reward feelings tends to be enduring and people would often feel that the link between trigger and behaviour has been weakened or broken.
Past trauma/s
Linked in with the work on the present triggers, urges and reward–related emotions, it may also be important to explore and work through any associated difficult past experiences. It may be clear to people already that there are underlying traumas in their earlier life, and that they somehow link with emotional eating. Sometimes this link is strong, other times the emotional eating and traumas may seem to link two separate, unconnected experiences. Often people find that as the level of urge or the strength of positive effect diminishes, the connection with or relevance of past events becomes more apparent. People can find themselves more able to acknowledge the negative impact of these experiences and how difficult they were for them at the time. Often we also find that there is an emotional charge when we recall these memories, something that remains alive or a sense of rawness when connecting with them.
This is often where we would use the standard EMDR protocol and work through these past experiences as traumatic, unprocessed memories as described in the section above. If these experiences were longstanding childhood relational traumas (emotional/neglectful, physical or sexual) over a sustained period of time, possibly relating in some way to primary caregivers (parents, siblings, family friends, teachers, coaches etc), then we would consider an adapted approach that is often referred to as Attachment–based EMDR (A–EMDR). This territory of past experiences can also be subtle, sometimes the use of the word trauma feel too much or is believed to only be relevant to war torn experiences or a horrendous car crash. There are however other forms of trauma, not just physical traumas – mainly relational or attachment traumas (we can also use the term relational ruptures) or moral injury (where you may have done or not done something that conflicts with your inner moral compass). Sometimes the connection between these past experiences has been somehow blocked, often due to the body’s ability to protect itself from being overwhelmed, and therefore work is needed to reconnect to them in a safe and measured way.
As these past experiences are revisited and worked through such that the emotional distress is reduced to zero, people would tend to find that the current associate addictive behaviours would subsequently reduce or most often stop. Sometimes we need to work with future imagined scenarios, where we can also use the BLS to shift how future experiences are perceived and reduce any emotional charge associated with them.
Present triggers vs past traumas
Traditionally in EMDR, to create the most effective change, we would locate and work through the most difficult associated (past) memories. This tends to create a radial effect such that it helps to heal other similar unprocessed memories and impact positively on the distress and unhelpful behaviours.
Historically, however it was not advisable to use EMDR in the early work of anyone with any form of addiction. This is because the addiction, such as emotional eating, is often found to be a compensatory behaviour that offers a way to protect someone from the distress surrounding deep emotional pain and past traumas. By working on past traumas there was the danger of triggering this protective process and therefore increasing the unhelpful addictive behaviour (such as overeating).
The adapted approach to EMDR as detailed above allows the focus to start on the current triggers, positive associate affect and urges. This therefore allows processing to start early in the therapy. This is also often a gentler approach where people tend to see positive changes in addictive behaviours sooner.
I have found that there are times when this current focus surrounding strong, often uncontrollable, urge dissipates quickly and the link with addictive behaviour is broken. This can be powerful enough that people do not need to do any further work. There is however the opposite spectrum, where once you have lessened the cravings and reward-based link with the unhelpful over eating for example, that a closer link to a past trauma or traumas is revealed. The past event then becomes the focus of the therapy. This is a discussion that is had between therapist and person coming for therapy where a joint decision and focus is agreed together.
The above approach is described in greater detail through Halvgaard’s (2015) article, Popky’s original DeTUR approach to addiction (as described in this YouTube interview), and Jim Knipe’s EMDR Toolbox.
Whole foods diet to complement therapeutic work
All the above is aimed at addressing the psychological aspects of emotional eating from an addiction perspective to therapy. There are psychological blockers towards healthy food choices and becoming more active. These patterns can derail people’s efforts, regardless of “strength of willpower” they were trying to exhibit. Without the force of the urges, positive association, and unprocessed painful memories, people will tend to feel freer to make different food and lifestyle choices, which tend to be ones that are wholesome and nourishing to themselves and their bodies.
Sometimes however people can feel lost with what is a healthy and most appropriate diet for them. This is especially difficult given the culture we have surrounding diets and the war that is raged between different diet advocates, whether it is paleo vs vegan, low calorie vs low carb vs low fat, intermittent fasting vs continual snacking, Keto, FODMAPS, gluten or dairy free, or raw food diets etc etc.
I have been on my own food journey, following a personal health crash, where I discovered the health area called integrative or functional medicine which explores the health benefits of various lifestyle factors, such as: nutrition, sleep, movement and exercise, stress management/wellbeing, and relationships (see Dr Chatterjee’s Four Pillar Plan for example). After reviewing my previous fairly poor diet and experimenting with changes based on my new knowledge and understanding around food nutrition, I have now settled on a diet that I am comfortable with. It is largely a wholefood, real or nutrient–dense food diet. Much of what I eat comes in its original, unprocessed form. I eat a variety of fruit and vegetables, which make up the majority of my diet (particularly vegetables) along with nuts, seeds, pulses, carbs including potatoes, rice, bread and lesser known ones like quinoa and buckwheat. I eat free–range outdoor reared meat (although less than I used to), eggs and dairy (although I have periods not eating dairy products). I imagine this may well evolve in the future in some ways, as I play further with what works for me and my body.
This is not an advocacy for any particular diet, but maybe a pointer towards you doing your own exploration and deciding what seems the right diet for you and for your body. An important part of this is to find good, reliable, trustworthy professionals you can lean on to take the hard work out of it. I prefer professionals who are thorough in their explanation and take a scientific ability to critique and question the research studies that are available. Here are a few names I have relied on while on my journey:
● Dr Rangan Chatterjee – see drchatterjee.com – he is a UK GP, who is passionate about the use of lifestyle (food, movement, sleep, relationships, and psychological or stress management) as an approach to improving our health and wellbeing. He is an insightful, knowledgeable and inspirational figure how is doing great work to shift our culture around what we and our bodies been to thrive.
● Chris Kresser – see chriskresser.com – His original book The Paleo Code was a real inspiration to me and I have listen hundreds of his podcasts over the past seven or so years. He continues to interview many professionals in varied fields relating to health and wellbeing, given a broad and in-depth picture of how our lifestyle choices can impact on our health. See here for articles and interviews on weight management and what Chris Kresser refers to as diabesity.
● Dr Mark Hyman – an American doctor with many accolades to his name, and a significant
number of best selling health books as well as many interviews and articles. I great source of knowledge and is passionate about helping people improve their health.
EMDR and Emotional Eating article by Dr M Wardley – Final
WARNING: In this article I describe in to detail about the process of EMDR therapy. The purpose of this is to give people an understanding what it entails and to help people decide whether it’s the right approach for them. It is not instructions to conduct self–therapy. Bilateral Stimulation can be very powerful and can open up traumatic or disturbing experiences that may not be easily contained or worked through by yourself. I recommend EMDR to be conducted within the therapeutic guidance of a trained professional.
References
Aoun A, Darwish F, Hamod N. The Influence of the Gut Microbiome on Obesity in Adults and the Role of Probiotics, Prebiotics, and Synbiotics for Weight Loss. Prev Nutr Food Sci. 2020 Jun 30;25(2):113-123. doi: 10.3746/pnf.2020.25.2.113. PMID: 32676461; PMCID: PMC7333005.
Halvgaard, K. (2015). Single Case Study: Does EMDR Psychotherapy Work on Emotional Eating? Journal of EMDR Practice and Research, Vol 9, Issue 4, DOI: 10.1891/1933-3196.9.4.188
Niccolai E, Boem F, Russo E, Amedei A. The Gut⁻Brain Axis in the Neuropsychological Disease Model of Obesity: A Classical Movie Revised by the Emerging Director “Microbiome”. Nutrients. 2019 Jan 12;11(1):156. doi: 10.3390/nu11010156. PMID: 30642052; PMCID: PMC6356219.
Valiente-Gómez A, Moreno-Alcázar A, Treen D, Chjjhgedrón C, Colom F, Pérez V and Amann BL (2017) EMDR beyond PTSD: A Systematic Literature Review. Front. Psychol. 8:1668. doi: 10.3389/fpsyg.2017.01668
Scelles C, Bulnes LC. EMDR as Treatment Option for Conditions Other Than PTSD: A Systematic Review. Front Psychol. 2021 Sep 20;12:644369. doi: 10.3389/fpsyg.2021.644369. PMID: 34616328; PMCID: PMC8488430.
Shift N’s “Clarity in Complexity” Obesity System Map. https://shiftn.com/_uploads_pdf/shiftN-Obesity-Map-A0-kopie.pdf. Developed for the Foresight Tackling Obesities project, this causal loop map was designed to provide systemic insight into the multiplicity of factors contributing to the obesity epidemic.
Wardley M. ACT for Weight Management, London networking event, UCL 9 August 2013. Advert and PowerPoint slides and here’s the YouTube audio recording.
