The Life You Want Read online

  BARRIER: EMOTIONAL PAIN

  If you’re alive, there’s no escaping the experience of pain and loss. Some people have more of it, some have less, but emotional discomfort is an inevitable by-product of interacting with the world. You must learn to accept that pain, discomfort, and insecurities are inevitable. During difficult times, say to yourself, “I don’t like discomfort, but I can stand it, I can get through it. It won’t last forever.” Accepting the inevitability of anguish is a critical coping skill. And as contrary as this may seem, you should allow emotional pain and the feelings it triggers to be your teachers. Listen to what they are trying to tell you about your life. You’ll probably find that what’s been eating at you is the reason you’ve been eating.

  DEALING WITH DEPRESSION

  Everyone feels sad once in a while; it’s impossible to be happy all the time. We all experience ups and downs, and it’s important to accept periods of unhappiness as part of life. But if your low mood lingers day after day, it could signal clinical depression.

  Depression is a complicated condition characterized by feelings of sadness, hopelessness, helplessness, stress, lethargy, decreased interest in social activities, and restlessness. It affects twenty million Americans and can occur alongside a variety of medical conditions (such as cardiovascular disease) and psychological disorders (like anxiety disorders), exacerbating these disorders and negatively affecting treatment outcomes. There are varying degrees of the condition, from major depression, the most severe form, to a less debilitating but still serious version called dysthymia. You can also experience depressive symptoms without being diagnosed with clinical depression.

  Studies estimate that about 50 percent of Americans with depression don’t seek treatment; and of the half that does receive treatment, only 21 percent get the proper therapies. This a huge problem because untreated depression can affect your relationships, your work, your health, and your weight loss or maintenance efforts. When you’re depressed, you tend to eat more, move less, and experience less pleasure in your life.

  Although some people lose their appetites when they’re depressed, many more overeat in response to feelings of sadness, loneliness, and social isolation. (Depressive eating is a form of emotional eating.) Food temporarily numbs and alleviates negative feelings, and it can even give you a short mood or energy burst. (This is also why some people suffering from depression turn to drugs or alcohol.) But eating because you’re depressed will lead only to weight gain and, often, a worsening of depressive symptoms.

  Emotional eating isn’t the only problem for people with depression. They may also lack the motivation to exercise. The feelings of hopelessness and helplessness can sap your desire to lose weight or get in shape. You may also feel that you just don’t have the energy; the lethargy associated with depression can make simply getting out of bed a chore. The sluggishness and fatigue you feel can be a direct side effect of depression, but it may also result from the inability to get a good night’s rest, another symptom of depression. And we don’t have to tell you just how much exhaustion can affect your eating: When you’re feeling tired and drained, you’re often not able to make healthy food decisions, even though you logically know what they are. As you can see, untreated depression can be a vicious cycle that causes you to pack on extra pounds.

  Not surprisingly, a growing body of research suggests that there is an association between obesity and depression. Researchers from the Group Health Cooperative in Seattle found that mood and anxiety disorders, including depression, were about 25 percent more common in obese participants than in their nonobese counterparts. In another study, researchers in the Netherlands found that depressed, overweight individuals had more body image and eating concerns, lower self-esteem, and a higher body mass index (BMI) than nondepressed obese participants. (BMI is a measure of body fat based on height and weight; for more on BMI, turn to appendix 2.) Studies suggest that binge eaters tend to experience depression more frequently than eaters who don’t binge. Binge eaters also report that negative moods tend to precede binge episodes, and that their mood is briefly elevated during a binge episode. Depressed people may be at a higher risk of overeating and becoming overweight, especially if food is their main source of pleasure.

  Some experts believe that being overweight can increase the risk of depression. It’s not easy being overweight in a culture obsessed with thinness, or to live with weight-related stigma and discrimination. Indeed, in a study conducted by Yale University researchers, 35 percent of the respondents said that they would be willing to give up a year of their lives rather than be fat; 30 percent said they would rather be divorced than obese; 25 percent said they would prefer not being able to have children; and 15 percent said they would prefer to be severely depressed. Many obese individuals internalize the prejudice and negative stereotypes, contributing to humiliation, negative body image, low self-esteem, and depression.

  A DOCTOR BATTLES DEPRESSION

  Michael Foster, a forty-five-year-old physician, sought help to overcome overeating after gaining forty-two pounds in two years. As a physician, he “knew what to do” to lose weight; however, he continued to overeat and reported being too tired to exercise. His mind and best intentions were in conflict with his behaviors.

  As the youngest of three boys, Michael grew up in a family dominated by his physician father who worked long hours but spent all of his free time with his wife and kids. Michael’s mother struggled with depression and died of breast cancer when he was nine years old. He was close to his father and his brothers, who also became doctors.

  After medical school, Michael joined the family-owned medical practice. He lived in the suburbs and enjoyed playing golf and tennis. Nonetheless, he felt trapped in an unhappy marriage and an unfulfilling career. He did not enjoy treating patients full-time, so he decided to pursue his passion for teaching and research. In search of contentment, he divorced his wife, moved to the city, and took a job teaching and conducting research at a medical school. He enjoyed his new work, developed a good rapport with his colleagues, and became well known in his field.

  However, in pursuit of tenure, Michael took on more and more professional commitments. He spent ten to twelve hours a day at work, including some weekends. Eventually he felt good only when he was being productive at work. He bought into the Puritan work ethic and became more of a “human doing” than a “human being.” He became increasingly isolated on weekends, preferring to stay home, binge on gourmet foods, and drink scotch. Food and alcohol became a distraction, a relief, and a reward.

  During his initial assessment, it became clear that Michael was suffering from depression as well as binge eating disorder. Driven to succeed over the past few years, he had become sad and anxious most of the time. Depression had led him to abandon activities like golf and tennis, so that his only pleasures in life were sleeping, eating, and drinking. In retrospect, he realized that as he became increasingly depressed, his appetite and the incidence of overeating had increased.

  Michael came to me with a classic case of depression: early loss of a loved one, prolonged periods of sadness and anxiety, loss of interest in usual activities, feelings of hopelessness, difficulty getting up in the morning, and an increased appetite. As I helped him overcome overeating, I also used interpersonal therapy techniques, which address stressful social and interpersonal relationships associated with the onset of depressive symptoms; cognitive behavioral strategies, designed to stop the distorted negative thinking that’s linked with depression; and happiness exercises developed by positive psychologists to decrease symptoms of depression.

  As Michael’s energy increased, he joined a fitness club and resumed playing tennis three times a week. He trained for a bike race sponsored by his hospital. As his depression lifted, he was better able to follow the dietitian’s food plans. He became more social, purposefully spending more free time at the health club and seeking out other single adults.

  Although there is a clear association betw
een being overweight and depression, it’s not yet known which is the cause and which is the effect. Researchers don’t know whether weight-related stigma and weight gain due to chronic overeating and physical inactivity lead to depression, or if depression leads to increased appetite, inactivity, weight gain, and negative body image. It’s likely that the relationship is symbiotic, if not reciprocal.

  Regardless, if depression plays a role in your inability to eat healthfully and exercise regularly, it’s important to seek help from a mental health professional in your community who specializes in the treatment of depression. Contact your primary care physician, local mental health center, or your insurance carrier, and ask for names of professionals who specialize in depression. If you’ve resisted the idea of seeking help because you’re worried about the potential for weight gain, a side effect of some antidepressant medications, talk to your doctor. She may be able to start you at a lower dosage or use a different medication. And effective nondrug treatments, such as talk therapy and/or stress-relieving strategies, may allow you to use less medication or wean off of it completely.

  WHAT CAUSES DEPRESSION?

  Many risk factors contribute to depression, including genetics, your biology, and life circumstances. Multiple genes interacting with one another can contribute to depression, and this is passed down from parent to child. So if a family member suffers from depression, your risk is increased. Your biology also can be a factor: Women are much more likely to suffer from depression than men, probably as a result of hormones that affect brain chemistry. Finally, a stressful life event such as a chronic illness, financial stress, or conflicts in a relationship can trigger depression. Past events, too—the early death of a parent or physical, sexual, or emotional abuse—can contribute to depression later in life. Even positive events, like a wedding, a new job, or moving, can be stressful, leaving you feeling exhausted and overwhelmed. Finally, some prescription drugs, such as those used to treat arthritis, heart problems, high cholesterol, high blood pressure, and cancer, can trigger depression. Usually two or more factors are responsible for causing depression.

  How can you tell if you’re suffering from depression? And could depression be playing a role in your struggle to consistently eat healthfully or robbing you of energy to exercise and engage in other body-positive behaviors? Finding out if you’re suffering from depression is the first step to feeling better. If you think you might be depressed, flip to page 236, appendix 3, to take a short survey, called the Goldberg Depression Scale, which will help you identify whether you are, in fact, experiencing symptoms of clinical depression. If your answers reveal that you are suffering from depressive symptoms, the next step is to seek help. Fortunately, there are a number of effective treatments for depression, ranging from talk therapy, to antidepressants, to alternative therapies such as acupuncture and vitamin and mineral supplements. More than 80 percent of people who receive treatment for depression report that it helps them feel better. Seeking treatment will not only improve your mood and outlook on life, but it can also give you the energy and focus to make the changes necessary to lose weight and keep it off.

  IDENTIFYING SOURCES OF PAIN

  As I’ve already mentioned in this chapter, you have to pinpoint the cause of your emotional pain before you can get to work on fixing it. For example, if you’re angry, ask yourself why are you feeling it now? Do you always try to please others at your own expense because you can’t tolerate conflict, and then resent them for taking advantage of your easygoing nature? Whatever your reason, remind yourself that food is not an effective way to deal with stress and pain in your life. Remember, the doughnuts you’re eating may taste good now and may make you forget about your alcoholic spouse, but after you finish them, your alcoholic spouse will still be there. And the cycle, unfortunately, will continue: You’ll keep turning to food as your spouse keeps turning to the bottle. So now, not only are you dealing with your spouse’s drinking problem, you’re also dealing with your disordered eating. While emotional eating may serve as a temporary distraction, this self-destructive tactic will persist in creating more problems in your life.

  You may have to dig pretty deeply to figure out what’s going on, as some of the issues surrounding emotional pain may stem from problems you experienced as a child. For instance, if your needs for love, dependence, or acceptance were not met early in your life, you may have never learned the skills to be in healthy relationships in the present. As a result, you may be at risk of turning to unhealthy alternatives, such as food, drugs, alcohol, overworking, excessive shopping, an Internet addiction, and so forth, to fulfill those needs. You may be overeating because you are unable to engage others in gratifying relationships. Spending the night with your favorite companion, Ben and Jerry’s, feels safer. Christine Walker, a forty-three-year-old mother of three girls, observes insightfully, “I can turn to food twenty-four hours a day. It never says no. I can depend on it to taste good. It’s not going to say, ‘You’re too needy.’”

  WHEN FOOD REPLACES LOVE

  Everyone important to Mary Findlay had failed her. Throughout Mary’s childhood, her mother became angry whenever Mary needed anything from her because she was exhausted from caring for both Mary’s sister, who had cerebral palsy, and her alcoholic husband. The only time her mother would give without resentment was when it related to food and gifts. They ate ice cream sundaes together, and they enjoyed baking cookies together and giving them as presents during the holidays. Mary would go to the candy store to buy pounds of sweets using spare change her father would give her at the end of the week; she’d bring the goodies home to share with her mother and her family. Tragically, at times throughout her childhood, her father came into her room at night when he was drunk and sexually abused her.

  Mary learned early in life that people couldn’t be counted on and were not safe. But she could always count on food. She overate as a child and continued to overeat as an adult, even though she married a wonderful man who offered her unconditional love and support.

  In therapy, Mary realized that for her food was a way to gain nurturance without risking vulnerability. Her obsession with food distracted her from dealing with the disappointment of not feeling loved as a child. Food soothed her when adult friendships didn’t last. It kept her filled up and safe. In order to change lifelong eating habits, Mary had to take risks and allow herself to be vulnerable with “safe” people like her husband. She also needed to learn the skills necessary to develop healthy relationships, negotiation strategies, and assertiveness techniques. With much courage, she allowed herself to get closer to others and use her newfound relationship enhancement skills. Her need to overeat decreased, and the focus switched from food to people.

  However, as Mary lost weight, she became scared and felt vulnerable. She said, “I thought I would love losing weight and look forward to buying beautiful new clothes. But I don’t; I feel scared. When I go to the mall, men smile at me, and I’m afraid they will follow me out to my car. In the past, because I felt fat and big, when my tall husband hugged me, I never felt vulnerable. Now I feel small and insecure in his embrace, as if I will be taken advantage of or hurt.”

  It took time for Mary to realize that she was no longer the young girl who couldn’t escape abusive experiences at the hands of her parents. She learned to feel and act like a confident adult, trusting that her husband was not going to take advantage of her because she was “smaller.” She grew to know that if men approached her, she would be able to protect herself through assertive words and actions.

  Until Mary (see box above) went into therapy, she didn’t fully realize that she was using food to soothe traumatic childhood wounds. Sometimes it’s not obvious why you’re in emotional pain. If you’re struggling to find the cause, the exercise below is a good place to start. Write down the specific issues that apply to you under each problem area. If you are an emotional eater, these are some of the core areas in which emotional conflicts can be buried by overeating.

&n
bsp; MAJOR PROBLEM AREAS

  1. Family conflicts (current or past)

  2. Work and school conflicts

  3. Toxic relationships

  4. Money worries

  5. Health issues (including an unhealthy lifestyle)

  6. Unresolved loss/grief

  DIFFERENTIATING HEALTHY RELATIONSHIPS

  FROM TOXIC ONES

  Many—sometimes all—of the major problem areas listed on the previous page stem from relationships. In some cases, it’s obvious that a relationship is the issue: For instance, a family conflict or a toxic relationship very clearly involves our interactions with others. But work conflicts and other job-related issues may also be caused by relationship problems, such as not getting along with your boss or a coworker. Your money worries, too, could have a relationship issue at their core. Perhaps your spouse spends too much money, or shopping fills the same role for you as food, helping you cope with relationship issues. An unhealthy lifestyle could also reflect the way that you deal with people: Maybe you pour all your energies into others and don’t take enough time for yourself. It’s even possible that the relationship issue you struggle with may not involve anyone else at all—it could be a result of your relationship with yourself. Then again, some of these problems may not be connected to anyone else, but because relationships can be such a major source of unhappiness, you should give yourself some time to thoroughly explore them.

  As you do so, I’d like you to pay special attention to the relationship you have with your parents, because this can give you a lot of insight into your emotional eating. We often learn to love and take care of ourselves from the way we were loved and taken care of as children by our parents. In most cultures, females are primarily responsible for the nurturing role. Mothers are usually the ones who feed us; clothe us; and provide attention, affection, support, and guidance, so your relationship with your mother can be very telling. (As women have become an even greater part of the workforce, fathers are increasingly becoming more involved in the act of parenting their children, so you may have to also explore your relationship with your father to learn more about your issues with others and food.)