Changing Problem Eating Behaviors

Problem eating behaviors are like dandelions. A few of them may be tolerable, while too many, especially in the wrong places, can be a nuisance. If a person does not attend to them right away, they can multiply and become overwhelming. Both require knowledge and persistence to uproot and discard.

How do you get rid of dandelions? Most people do so in one of three ways.

First, by mowing them down (cutting them off at ground level); this results in a short-term solution.

Second by digging into the soil and removing part of the root; this results in a longer-term solution.

Third, by taking the time to dig deeper and remove the entire root before the weed matures. This results, hopefully, in a more permanent solution.

Please note that when you do Method 2, you have essentially done Method 1; and when you do Method 3, you have also done Method 1 and Method 2. In each of these three methods, you could use a tool to help remove the dandelion. You could use it to:
(a) break the dandelion at ground level,
(b) dig partway into the soil and remove part of the root, or
(c) dig deeper and remove all of the root.

The results are similar, whether or not you use the tool.

Using a tool does not guarantee that you will successfully prevent the dandelion from returning. The tool only makes the process easier. You are still responsible for ‘thinking’, for ‘choosing’ when and how to rid the yard of dandelions, and for doing the ‘work’ of bending over and removing each one.

Similarly, you can approach problem-eating behaviors from different directions, each with its own possibility of success. If you have had bariatric surgery, then you have the added advantage of having a ‘tool’ that can help you with the change process. Even with this tool, you are still responsible for ‘thinking’, for making ‘choices’, and for doing the ‘work’ of replacing the problem eating behaviors with healthier ones.

Please keep in mind that bariatric surgery is only a ‘tool’. Indeed, many people say that it is a miraculous tool that has given them an opportunity for a new life. In order to nurture and maintain that ‘new life’, you will need to work. As one patient told me: “This surgery is responsible for only 10% of my success, 90% of my success is due to my own hard work.”

The Basic Building Blocks

A dandelion consists of three basic parts – leaves, a bright yellow flower (that matures into seeds), and a long root that is underground (and out of sight). A fourth element, the soil, provides support and nutrients for the dandelion to grow. The dandelion is difficult to exterminate for at least two reasons. First, when you simply cut off the top of the dandelion, the root promptly regenerates new leaves and flowers. Second, if the dandelion is cut too late in the season (when in full bloom), the seeds will scatter and sprouts more plants later.

Human behavior also consists of three basic parts – a stimulus or cue (such as hunger, fatigue, a food item, a person, a crowd); a response network that consists of interacting thoughts, feelings, and behaviors; and one or more consequences. The cue triggers the response network, and consequences follow it. Like the soil for the dandelions, the person’s attitudes and values provide support and direction for how that person sees the world. That is, your attitudes and values shape how you think, feel and behave in response to a cue. Behaviors are difficult to change for at least two reasons. First, they are connected to underlying thoughts and feelings. Second, the longer a person has engaged in a behavior (that is, the “older” a behavior is), the more likely it has “scattered: and sprouted connections in the brain with other response networks.

Thoughts and feelings are similar to the dandelion’s root system. Both exist “under ground” and out-of-sight. Thoughts and feelings are internal responses that are not easily seen by others or by the person. For this reason, people who are not in tune with their feelings (or who feel ‘numb inside’) often have difficulty talking about their feelings.

Behaviors are similar to the dandelion’s leaves and flower. Both are “above ground” and are easily seen. Behaviors are external responses that are visible to others, as well as to the person. Some people make the incorrect assumption that just because a behavior is removed, the underlying problem is gone.

Three Approaches to Behavior Change

Let’s look at the three approaches for changing problem eating behaviors that are similar to the three methods used to get rid of dandelions. Approach #1 You can “mow down” the cue, so that it is no longer in sight. By removing the cue that triggers your problem-eating behavior, you give yourself the opportunity to not respond.

Example A: I can remove cookies from the kitchen counter and place them in a cupboard. By not having the cookies on the counter, I do not see (mental image) the cookies that could stimulate sensations of hunger (feeling), do I do not eat the cookies (behavior).

Example B: I can remove myself from a noisy lunchroom and quietly eat my meal elsewhere. By avoiding the noise, I have a quiet mind, and I feel calm and relaxed while eating.

Example C: I can remove my water glass from the table. By not having the glass at the table, I do not see the water (which might make me feel thirsty), so I do not drink with my meal.

If you need a quick, short-term solution to a problem behavior, removing the troublesome cue is a good way to change that behavior.

Approach #2 You can do some “digging” and remove the self-defeating thought that is connected to the problem-eating behavior.

Example A: Let’s say that I put the cookies in the cupboard, so that I am not tempted to eat them. I go into the living room to read the newspaper. In my head, a little voice is saying, “Those WONDERFUL cookies are hiding in the cupboard and calling to me.” If I keep listening to that voice, I will probably convince myself that I need to have one. In fact, due to the nagging self-talk that has been going on for so long, I’ll be LUCKY if I just eat one!

The point: When I put the cookies “out of sight,” I also need to keep them “out of mind,” so that I don’t lure myself into eating them.

Example B: Let’s say that Sally, who has had bariatric surgery, finds herself too tense to eat in her noisy lunchroom. She walks to the park and sits on a bench where she quietly eats her lunch. As she is eating, a little voice in her head keeps saying, “I should be eating lunch with the others; they are going to be upset with me for this.” That thought is likely to get linked to inner tensions and insecurities. Although Sally took herself to a place that is quiet on the “outside”, she is still tense “inside.” This emotional tension becomes connected to physical tension. If Sally tries to eat when she is tense, she is likely to feel physical pain and discomfort in her chest. She may even vomit.

The point: Sally made the deliberate decision to eat outside with the idea of eating in a relaxed and quiet state. In fact, the negative nagging voice in her head became linked to emotional and then physical tension inside of her, so she still had difficulty eating. In order to reduce the inner tension, Sally can choose to change the nagging negative voice that plays in her head. For example, she could tell herself: “I made the decision to have surgery so that I can be healthy. In order to stay healthy after surgery, I need to take care of myself and eat away from the noisy lunchroom and in a setting that is quiet and restful.”

To summarize: The second method for removing an unwanted behavior is to dig underneath and change the nagging, self-sabotaging thought that is connected to it. At times, however, simply correcting or changing one’s thinking may not be enough.

Approach #3: You can dig more deeply and remove the out-of-date attitude or value that is interfering with your newer and healthier response.

Example A: Many people are driven by the attitude: “I live to eat.” After bariatric surgery, a person who hangs onto this attitude is facing a great deal of conflict with food. By contrast, people who hold the attitude, “I eat to live,” have less conflict with food and are likely to be more successful both in losing weight and in maintaining weight loss.

Let us say that Sally holds the attitude, “I eat to live.” If she takes a moment to think about this attitude when thoughts of the cookies come to mind, she is more likely to stop and ask herself, “Am I experiencing physical hunger, or emotional hunger?” That is, “Is it time for me to eat?” If Yes, it is time to eat, Sally thinks about her nutritional needs and chooses to eat a balanced meal or a healthy snack that may include a few bites of the cookie. If No, it is not time to eat, Sally needs to dig deeper. More likely than not, she is experiencing emotional hunger. For example, her hunger may be related to feeling emotionally “empty” inside (as in feeling unfulfilled with her home life or her job); it may be related to feeling lonely or alone; or it may be related to feeling bored. When Sally realizes that she is not physically hungry, she chooses to focus her attention on digging deeper so that she can “get her hands on” her emotional needs. Please note: When Sally feels hungry, she does not automatically assume that she is hungry for food. Because she operates by the attitude that “I eat to live,” she first asks whether it is time to eat. If No, she digs deeper and looks for ways (other than food and eating) to meet her emotional needs.

Example B: Many people with weight problems tend to value caretaking behavior (that is, doing things for another person at one’s own expense). These individuals might say, for example: “I’m always on the bottom of the pole. I can’t say no, I’m a very nurturing person.” “I usually wear myself out putting other people first.” “I should not make anyone upset; I’m responsible for keeping the peace.”

For a person who has had bariatric surgery, this attitude often leads to trouble. Let us say that Sally postpones eating in order to do two errands for her child; this leads to the consequence of becoming overly hungry. When Sally finally sits down to eat, this state of being overly hungry triggers one or more behaviors (such as eating one spoonful too many, or eating too fast, or not chewing adequately). Any one of these behaviors may lead to physical pain and/or vomiting. A more nurturing attitude (that is likely to result in greater happiness and a healthier lifestyle) is: “I need to take care of myself right now, so that I can be in a position to be helpful to others later.” By deciding to take the time to eat a snack and to do just one of the two errands, Sally is able to sit down and eat mindfully, while enjoying dinnertime with the family.

To summarize: Attitudes and values are very powerful. In essence, they are a person’s “rules to live by.” Attitudes and values shape and nurture how a person thinks, feels, and behaves. More importantly, they are in the person’s control. While you cannot change what you did last week, or change what your mother says, or change the weather, you do have control over how you choose to “view your world” and how you respond to each of these cues. Your attitude and the priorities that you set for yourself can greatly influence your happiness and your success in engaging in healthy behaviors for the rest of your life

Post-Script: Three more lessons to learn from the dandelion.

Lesson #1: Only with time, will you know whether you have successfully eliminated the dandelion. If it comes up again, then you will know that the root is still there and that the problem still exists. If the dandelion does not come up, you do not know for sure whether it will come up later in the year, sometime next year, or never again. Similarly, you may not know for several years whether you have successfully changed a problem-eating behavior. This is especially important to keep in mind, since obesity is a chronic disease. For this reason, it is very important that you remain alert and watch for the red flags that signal that you may be slipping off-track and reverting back to old behavior. Long-term success is defined not by whether you stay on-track, but how quickly you regain your balance when you start slipping off.

Lesson #2: Dandelions have an uncanny tendency to flourish right after a heavy rain. Similarly, problem-eating behaviors tend to flourish during and after times of stress. This may happen when you are experiencing happy, positive stress (as in stress associated with preparing for a celebration or a baby’s birth). It may happen when you are experiencing difficult, negative stress (as in stress associated with facing a deadline, or resolving a conflict). Finally, it may happen when you are experiencing little to no stress (as in boredom). You can prepare yourself to handle these situations by having at your side a list of strategies (other than eating) that help you to effectively manage stress (including boredom).

Lesson #3: When you remove the dandelion’s root from the ground, you leave a hole in the ground that you will need to fill in. Similarly, when you remove the problem-eating behavior from your life, you leave a void that needs to be filled. Your journey does not end when you have bariatric surgery, and you begin to lose weight. In fact, your journey is only beginning. As you learn and engage in healthy eating behaviors, you will need to find healthy ways to fill the void in your life.