Overeating As Addiction

I have spent some lively hours debating with others on the Facething whether compulsive eating is an addiction; which asks for some reflection on the nature of the term "compulsive".


Then I did two BBC Radio stints on overeating, debating with two people who were relying on Overeaters Anonymous to help with their food addiction. It seemed that both participants had become "addicted" to eating as a way of dealing with different forms of loneliness, at different times in their lives.


There are not many eating disorder experts who buy into the notion that compulsive eating is an addiction although they agree the following;


1   You can sort of become addicted to sugar because it affects the same parts of the brain as the other suspects like drugs and alcohol.


2    Eating disorders share some features with addictions.


3 People who overeat speak in the language of addictions. "I can't carry on with my day until I have had my fix... I can't stop at one.... I can't stop when I have had enough".


On our website blog I have made a very short case in favour of not leaping to the conclusion that overeating, even quite horrible variants of it, is addiction. It doesn't help our patients to consider themselves addicts. There are lots of reasons for overeating, even the most compulsive forms. We can free people from their destructive relationships with food without you needing all the paraphernalia of overeating fellowships like group meetings, endless talking about food,  sponsors and a lifetime of thinking of your self  as "In Recovery".  Thousands of us used to overeat and  don't now. We are not "In Recovery."  We can help you to stop.


 Check out   http://eating-disorders.org.uk/emotional-eating-addiction/ 

More About The Personalised Diet

The more I look at this programme the more worried I am becoming. There is some good stuff in it. There are strategies that benefit everyone, like eating slowly and mindfully, teaching people to eat while doing nothing else, finding out that many normal people compensate for exercising by doing less later -hoho!


But I am still absolutely flummoxed by the science behind putting constant cravers on an intermittent fasting programme.  Where is the research behind this? We learn that this group of people are always looking compulsively at food, at people eating it, at shops selling it.  I think we need to know more about it. It is like an obsession. Is it just about lacking leptin sensitivity?   Perhaps the ancestors of the constant cravers were trapped in a famine.


Perhaps the constant craver is behaving like an addict. Perhaps the constant craver has problems in the  opioid centres of the brain. Experts call it Reward Deficiency Syndrome.  Why didn't they think about that? The so called experts have PICKED OUT BITS OF THE PHYSICAL PUZZLE which suit their programme. But have they looked at the whole map?




Either way if you are a constant craver it seems to make sense that you need to eat frequently but a diet very high in protein and complex carbohydrate too. You need to wear an elastic band on your wrist and snap it whenever you NOTICE you are looking at food. You need to keep binge food out of the house.


Intermittent fasting will make the cravings even WORSE. Oh sure you will lose weight while you do the diet, but you will become even more sensitive to the sights and smells of food. I've a lot of research to prove this point.


OK I'm not trying to dismiss the whole programme, but I'm also something of an obesity expert and I'm asking valid questions. You people out there also need to be asking questions and wondering if these world class experts may have sold their souls to the BBC for the money they will be making out of this programme. They are telling a sort of lie, which is that a particular DIET suits different types of people while the work they do in the background suggests that many more psychological interventions are necessary for someone to lose weight and keep it off. And these other strategies are not just "CBT"

Sugar Addiction

Are you a sugar addict?


Can you be addicted to sugar?




There is a robust review on the subject commissioned for the National Institute of Mental Health in the USA which should settle the matter. There is only  weak association of attachment to sugar among people who diet or restrict carbs, while sugar given freely in a balanced diet may have no influence on behaviour such as escalation, tolerance and withdrawal.

Evidence for Sugar Addiction: Behavioural and neurochemical effects of intermittent excessive sugar intake. Neuroscience Bio behavioural Review 2008 32(1) 20-39 published online 2007 Avena, N., Rada, P. and Hoebel, B.

Psychologically speaking, work on the subject of sugar addiction by Terence Wilson published in Binge Eating, Nature and Treatment edited by Fairburn suggests that the so-called addiction to sugar is largely psychological. People only lose control of eating sugar when they BELIEVE they have eaten sugar, demonstrating NO evidence of intrinsic addiction to the substance at all.

The role of sugar in the hedonic systems of the brain are not equivalent in effect or severity, as drugs like cocaine and nicotine, even though there is an effect on endogenous dopamine.

Sugar is present in many foods such as vegetables, potatoes, tomatoes, lentils and other pulses so eliminating sugar from the diet seems impractical. Sugar is not equivalent in its physical effects as fructose including high fructose corn syrup further confounding the evidence.

Sugar-fat combinations are as potent in promoting the surges of endogenous dopamine as sugar alone if not more so. Thus there is danger in focusing solely on the so-called addictive properties of sugar. Based on a macronutrient analysis of binges by Susan Yanovski in 1998, it seems that it is fat which binge eaters really crave when fat is made palatable by sugar.

Thus while clients talk in the language of addiction to sugar,  the evidence-based success of cognitive and cognitive-emotional / behavioural treatments for compulsive eating warn us of the dangers of focusing on sugar as an addictive substance. Addiction approaches to treatment which ask you to remove sugar and white flour from the diet might be unhelpful. It keeps people well only when they continue to restrict their diet. This approach merely fosters the all or nothing thinking that pervades eating disorder work.

 I used to get sugar cravings long ago, but I know now that it was just too much dieting.  I now eat a broad diet which contains all nutrients including a reasonable amount of refined sugar. And I'm fine.


But if you think you are a sugar addict and need help, call us on 0845 838 2040 OR  visit www.eating-disorders.org.uk

The Theft Of Perfect Souls: Facebook?

Today I was reading about how girls as young as 11, 12 and 13 are persecuted on Facebook and Instagram etc to perform sexual acts.

They may be encouraged to self harm on camera, they are threatened if they don't do what they are told and they are slagged off if they dont obey.

They can be called slut,s slags and whores. The perpetrators of such horrible abuse can be the boy next door, or the classmate in school or the chap she thinks has been her friend, perhaps someone she played with when she was younger.

We now know that there is a link between the onset of eating disorders and this dreadful behaviour from which they can't escape.

I've already written more about this on our BRAND NEW WEBSITE (hurray!) Please check out what I have said at www.eating-disorders.org.uk  - the blog links are on our home page.

Dignity and self respect carry a young woman through the tumult of adolescence and protect her from substance abuse and eating distress. How are we going to protect our children from this filth?

The Men Who Make Us Fat

Last night I walked down Marylebone High Street, London. Every two yards there was another place to eat, a Pain Quotidien, a cafe, an epicerie, a Costa Coffee and a cake shop from heaven. People were eating as they walked along the street.


20 years ago I walked down the same street and every 100 yards there was a place to eat and very few people ate as they walked.

40 years ago I walked down Marylebone High Street. There were no places to eat, lots of other shops and no one ate as they walked.

They assume that people who gain weight are weak willed. On the contrary, people who keep their weight stable have to work really hard 24 hours a day 7 days a week to avoid - like bouncing bagatelles- the food they see around them saying "eat me now, you will feel nice, I will give you a lift, you don't need to be hungry -you just need to be wanting a bit of fun and what's the harm in that".

On top of that are the dangers that we can't see; the men who made us fat have inserted them quietly into the food we eat. Corn syrup, tastes so nice but it is food that our body cannot deal with properly. Relax, have a beer, or a bit of ketchup on your chips. It will make you fat while it makes them rich.

Going shopping? Have a packet of crisps, it will reward you for doing all that hard work. They made it big so you would spend more money and feel virtuous because you hadn't bought 2. They knew that you would eat it all up in one go because thats what people do. And while you were scoffing, it made them rich.

Did you know that the food industry has blackmailed, denigrated, rubbished and possibly even murdered the people who wanted to tell you the truth? They have bought or crushed the politicians who could have done something about this. They wanted to make you fat so that you would need what they had to sell you.

And everyone is frightened of taking them on. See that bag of treat sized chocs? See that double caramel flavoured frappucino? JUST SAY NO.

Is Undieting A Good Thing?

This week I have done an obesity training. One of the delegates said I should not be teaching therapists to help people lose weight or restrain their eating. I should be helping people to be healthy at any weight, even very large weights.
There is no doubt that dieting has consequences. Many writers say that dieting leads to compulsive eating and disconnects people from their real appetites. They are right. The first research into the effects of dieting was done by Ancel Keys in the 1950’s. He showed that dieting is linked to food cravings and to abnormal hungers for fattening foods.

A few years later, researchers (Herman and Polivy) have linked dieting to "eating dysregulation and disinhibition". These big words mean that dieters start eating in response to cues like food just being there, or any kind of emotion. People call this kind of eating  "comfort eating". Dieters think about food a lot of the time and another researcher called Kelly Vitousek - in her work with anorexics, concentration camp survivors, and people who restrain their eating for longevity - has shown that this kind of preoccupation is common among food restrainers.

We are all familiar with the kind of thinking that accompanies food restraint. One slip or lapse and the dieter can end up on a slippery slope. She says, I've blown it and carries on eating with a plan to re-start her diet tomorrow or next week. So even thoughts about breaking your dieting rules can lead to a heck of a lot of overeating.
By denying themselves food, dieters make it much more important. Dieters are more likely than non-dieters to turn to food when they are emotionally anxious or depressed. At a recent study carried out in London, female volunteers were divided into three groups, the first went on a strict diet, the second a rigorous exercise programme and the third neither dieted nor exercised. After 5 weeks the subjects took part in an experiment which assessed their food intake while watching a stressful film. Bowls of sweets and nuts were left beside them and they were told to eat as they liked. Women in the dieting group ate far more than the others.

Even thinking about dieting can make you overeat. In anticipation of deprivation to come, dieters’ indulgences “the night before” can reach legendary proportions. The seeming inability of dieters to stop once they have started, stem from the Faustian bargain they make with themselves at the start says my colleague, Sara G.
Undisputed as health risks of dieting are the eating disorders, particularly anorexia, bulimia and binge eating disorder, which can at their most extreme, be life-threatening. It is not surprising that when people with eating disorders do binge, they eat foods deemed forbidden in their dietary systems. Although not all dieters develop eating disorders, serious eating disorders are usually preceded by diets. There are many more people who diet than develop eating disorders, but over-restraint of food has a lot to answer for. So is the solution to give up dieting altogether?

Some writers propose that the solution to compulsive eating is to eat whatever you like including  huge amounts of food previously regarded as forbidden. This is supposed to reduce the attractiveness of forbidden foods, and to stop you from feeling guilty about how hard you find it to control your eating.

The implied promise of undieting is that weight gained as a result of compulsive eating will be lost. It promises that you will regain your innate wisdom of what your body really needs. You will get back in control of foods like chocolate and cookies, and eat them in small amounts again. This is a seductive proposal; after all dieting doesn’t solve the problem of compulsive eating. We are all familiar with the mantra of some of our clients, “Every diet, you name it I’ve done it and I’m fatter than ever”. But might this also be a dangerous thing to do?

I don't think that a knee-jerk return to undieting in overweight people is helpful. For some people, being on a diet is the only way they know of being in control of food. Such people could be described as “diet addicts”. Giving up food restraint altogether may result in rapid weight gain unless appropriate advice is given.

An “un-dieter” eating large amounts of “desired foods” will also risk harms to their health. The eat-all-you-like solution is unethical. If you eat large amounts of your favourite food because someone has told you it is a good idea, you will rapidly develop symptoms that will take you down a long road toward diabetes ......if you don't already have it. That won't help you very much at all.
Undieting won't help change ingrained bad habits such as strategies many people use  in an attempt to offset the calories they are eating. These strategies include drinking diet colas, eating sugar reduced products,  drinking large amounts of tea and coffee or using alcohol to dull the appetite or to deal with low mood states. Is this healthy?  These practices increase bad moods like anxiety and depression -hardly the nirvana that the un-dieting movement suggests.


Dieters can and do lose weight and keep it off. Our solution is to find the strategy that works and a therapy that is holistic. This therapy proudly targets weight loss. And that, as they say, is another story told at my recent training.

Food Addiction Vs. Compulsive Eating: The Meaning Of Overeating:

The statement I often hear that overweight people surely must be “addicted to food” is contentious and offensive.

In 2004 and subsequently in 2006, two separate NICE guidance processes, one on eating disorders and one on obesity attempted to make sense of what psychologists describe as dysregulated and disinhibited eating. Whether this eating results in weight gain depends on the restraint that a person exerts in between episodes of overeating, or the use of compensatory behaviours such as purging which accompany overeating.

Sufferers speak about irresistible drives to eat any food or certain food types such as chocolate - in the context of cravings, low mood states, excitement and a sense that their behaviour is somehow wrong / abnormal. It seems apt to apply the label “addiction” to the behaviour and its motivations because there are many shared features between substance abuse and overeating. These shared features include ways in which “using food or drugs” brings about mood relief, tolerance, withdrawal symptoms, and the activation of similar neural networks, particularly in reward centres in the brain.

Sufferers also describe their experience in the language of addiction such as “I can’t get on with things unless I have my fix”. Or, “It’s like I’m addicted to food, I wish I could just take it or leave it, but it’s never enough.”

The reason why terms such as food addiction, chocolate addiction, binge eating disorder, comfort eating and compulsive eating are used inconsistently in scientific literature are because they are not diagnostic categories. They are simply our attempts to put labels on a rich diversity in human experience and behaviour, which have different meanings to different people (1). They are useful labels because they legitimize the individual’s search for treatment for eating behaviour which they consider at least, uncomfortable and at worse, insane.

For this reason, it is dangerous and incorrect to label the uninhibited eater simply as an “addict”. There is evidence for example, (based on pre load studies with ice cream), that the eating patterns of so-called addicts is motivated more by beliefs about what they have eaten rather than the foods themselves (2). Moreover, the label “addict” is often disempowering, suggesting that you are emotionally sick, with the ever-present danger of relapse. While it is true that there is a poor record of weight loss maintenance in anyone irrespective of where they start from, there are evidence based psychological treatments of “compulsive eating” which have a good and enduring outcome (3). These treatments don’t necessarily lead to losing weight.

Ignoring for the moment the question “what is a binge?”, evidence supports the view that among obese binge eaters there is a greater than average risk of the following; history of trauma, psychiatric illness, mood disorders, history of alcohol abuse, avoidant, dependent and borderline personality disorder (4). But don’t assume that this is true for all obese binge eaters, many of who just got into bad habits, enabled in part by the people who live with them. Or alternatively there are sufferers who have not learned how to manage stress.

So this is why labelling overeaters or even compulsive eaters as “addicts” is nonsense. Careful assessment will pick out factors that may interfere with treatment for weight control. Then, using techniques such as cognitive therapy to deal with the obesity mindset, emotional resilience training, mindfulness work, trauma counselling for some people and nutritional rehabilitation, we can package together a treatment which will help even the most disinhibited of overeaters – often quickly. They will stop bingeing and they will be able to eat their forbidden foods without danger of relapse.

Personally speaking, I have found it helpful to say to my clients “I refuse to call you an addict – you simply have some things to learn which will help you to manage your life differently.”


I would only start thinking about addiction if my overeater also has existing substance abuse problems or a history of them. For sure, there are aspects of 12 step programmes which are useful for anyone with a mental health problem to help with things like self worth and forgiveness, getting help from others and taking an inventory of all ones difficulties. But first and foremost I would turn to cognitive –emotional behaviour therapy for my overeaters(5).

Do we not owe it to our clients to “label” them as potentially normal as the rest of us?


HERE ARE SOME REFERENCES FOR STUDENTS

1 Fitzgibbon and Kirschenbaum (1999). Heterogeneity of clinical presentation among obese individuals seeking treatment. Addictive Behaviours 15, 291-295


2 Wilson T. (1993). Binge Eating And Addictive Disorders, in Binge Eating, Nature Assessment and Treatment. Eds Fairburn, C. and Wilson, T. Guildford Press.

3 Gladis, Wadden et al. (1998). Behavioural treatment of obese binge eaters, do they need different care? Journal of Psychosomatic Research 44 375-384.


4 Yanovski, Nelson, Dubbert & Spitzer (1993). Association of Binge Eating Disorder and psychiatric comorbidity in obese subjects. Am J Psychiatry December (12):1910


5 Smith, Marcus & Kaye (1992). Cognitive behavioural treatment of obese binge eaters. International Journal of Eating Disorders 12, 257-262

Vogue Bans Under Age Catwalk Models - Is The Tide Turning?

Alexandra Schulman is banning models who are under 16 years of age or "who are showing obvious signs of an eating disorder" from her pages. She castigates designers who only provide sample sizes in size 2 which means that she has to seek the very thinnest models from the agencies who sell their girls to the media.

This follows on from a gentle but increasing wave of editorial changes taking place in Israel, in France and Italy. They are finally cottoning on to the notion that they have some resonsibility for the epidemic of poor body image and weight anxiety that is afflicting their readers.

Two anorexic women writing in the Daily Mail, May 5th 2012 described how their anorexia was induced by their obsession at looking the skinny models in fashion magazines. Is this true?  This is not a good argument for banning skinny models. As I have written in an earlier post, skinny models don't cause anorexia; if they did millions of women would have anorexia. Thinspiration and obsessional looking at fashion pics simply reinforce an illness which is already there. Women who are obsessed by looking at fashion magazines need to have an hour with an expert to show how these images are digitally altered. The pictures by and large aren't real.

The big challenge is, how we can teach our girls and our boys how to look at these fabulous icons, these long legs, skinny thighs, plasticated boobs and chiselled stomachs without automatically coming to the conclusion that "I am ugly". Just try this, step out into the street and count how many perfect bodies you will see. Not all that many.

There will always be someone you can find who is thinner than you, or stronger with bigger muscles or nicer hair. Even though I'm an eating disorder therapist who should fully understand, I am sometimes at a loss about addiction to fashion magazines,  images of perfection and people who covet boobs made of industrial plastic.

We have an internal mirror that only needs to be taken out from time to time. If we keep on looking into it and sighing, like Narcissus, we will fade away and die.

On Orthorexia

From someone’s diary before treatment.

“Everyone around me from the employees or the customers who spent hundreds of dollars on nutritional supplements and organic goods believed that eating in this way represented a healthy lifestyle which then would ensure a healthy outlook on life, There was a sense in that environment that the outside world was toxic and contaminated and that by controlling what we put in our mouths and on our bodies we could cleanse ourselves internally and spiritually".

Result: bizarre special diets, food allergies, food sensitivities, raw diets, low fat diets, low carb. diets, weight loss diets, intestinal cleaning and detoxing, vegetarian and vegan diets, food phobias and compulsive food rituals.

Will you really live longer, be healthier, be happier, be an inspiration to others, love, go to heaven? Is this really being in control?

Some Thoughts About Counselling

Writing as a psychologist who reads the BACP Journal to keep in touch with the world of counselling, I was left perturbed by an article named Who Is This Man? March 2012.

The client C.W. in this article ruminates about the wish to know more about her therapist and thinks that after 3 years of therapy it is “not fair” for disclosures to go only from her to her therapist. She manages to extract from him a confession that he has once lost his temper with a mobile phone as did she. Thereafter the client begins to quest for other ways of getting information from him (along the lines of you show me yours and I’ll show you mine) so that she can feel that her therapist is “real”.

Perhaps it is normal for a client to start wondering about the personality/life of a counsellor. It is more sinister to think it isn’t fair for disclosures to go one way (why not?) and to use the counselling space to manipulate information from the therapist – instead of attending to the process of growth and change. Where does it stop? The client seems to be showing all of the signs of narcissism, the effects of which presumably have got her into therapy in the first place. Why is the counsellor not bringing this into the room? And when a therapy extends 3 years, what on earth is going on?

In an earlier version of the BACP Journal, a similar process was taking place where the client wittered on to the point of indigestion (mine) about whether her therapist would think about her while he was on his holiday. I hope that he did not, but why is this stuff published without comment?

Congruence is important, and I may use some of my own emotional reactions judiciously to help the client validate and develop their emotional vocabulary, to build resilience. But the narcissism/dependency of client submissions in the BACP Journal read distastefully. Does anyone else feel this?

If I want my health addressed, I would choose an expert who knows their job; There is no concern to know the details of their private life. Nor do I mind whether the physician thinks about me once I have left the room. Perhaps counsellors should give their clients an introductory booklet in which conditions of the counselling relationship are laid bare. Disclosures DO go one way; the counsellor does not and maybe should not give the client mental space once the session is finished, the notes are written and the supervision is under wraps. Would that be too difficult to bear?

Amy Winehouse: New Poster Girl For Anorexia?

I did wonder if Amy had an eating disorder and while everyone made a fuss about her drug abuse, she really may have succumbed as a result of eating disorders rather than drugs. Yesterday, writing in the Times, Caitlin Moran described how little Amy ate (just Haribos, it seems) and how much exercise she did (treadmill for hours apparently). Moran writes “with an eating disorder like that, you’d have all the tolerance for drink and drugs of a newborn baby”.

Winehouse’s eating disorder was as clear as the nose on your face, it hardly matters whether it was anorexia or bulimia, the damage can be just as bad. Drugs are nirvana for people with eating disorders because you just don’t get hungry. When you go into rehab, you just feel fat when the drugs wear off, or you get very hungry as their effect starts to wane. This makes recovery feel very unsafe, so having eating problems gets in the way of being on the wagon.

Why do I feel cross; Winehouse was the queen of cool for some people, the girl on the edge, who wasn’t supposed to care what people thought. But all the time, behind that bravado, her real pain was the pain of everyone else who has an eating problem, the wish for absolute conformity by being as thin as all the other poster girls like… Cheryl Cole. I wish she had the courage to come clean about it, to help those she has left behind.

The Death of Amy Winehouse

There is a great deal written about Amy Winehouse this week and I like many others have been drawn to listening to her music. We have had the typical musings about the waste and costs of drug addiction and the importance of rehab and other forms of treatment.

But did anyone ever consider that she may have suffered as a consequence of low weight.  I was struck by her early photos and she was clearly a very different size and shape in her teenage years - chubby even.

There is a very strong link between bulimia and addictions, in particular alcohol in both sexes. A lesser link, but one none the less, between anorexia and addiction. The presence of body image problems makes it harder for someone to recover from an addiction. When you stop using, you may gain weight or start feeling fat. This is partly because you start experiencing emotions in your body where emotions must be felt.

If you are bulimic or anorexic, the health risks of addiction are magnified. With poor nutrition, the heart can simply stop beating.

We have yet to discover more about her untimely death. But why haven't I seen any mention of an eating disorder yet? Perhaps?