The Missing Piece in Response to the Obesity Epidemic: Diagnosing and Treating Food Addiction

1st Annual Food Addiction Conference
Downloadable / Viewable Reference Documents

UMASS Department of Psychiatry
UMASS Department of Psychiatry

Food Addiction Treatment for the Impaired Professional

Phil Werdell Presents “Food Addiction Treatment for the Impaired Professional” at the University of Florida

The University of Florida (UF) Gainesville invited Phil Werdell to speak Wednesday, March 20 during their Continuing Medical Education Grand Rounds lecture series at the Florida Recovery Center. Phil’s lecture, “Food Addiction Treatment for the Impaired Professional” was webcast live and we have the opportunity to share the lecture with you.We are sure you will enjoy the presentation and feel free to forward this to those you think may benefit from viewing.

Fat is Not a Feeling

“I’m feeling fat.” How often have I said that to myself? Usually I follow that statement with a litany of everything that’s wrong with the way I eat. What I do with food, how “bad” I was when I ate (fill in the blank), that I must change how I eat so I can lose weight and then everything will be great. Then I pump myself up with promises (“here’s what I’m going to do to FIX this”).

I end up eating again because I continue to act the same way, despite the promises, or give in to the despair and stuff myself to feel better about feeling fat. (Only a food addict will tell themselves that bingeing will make them feel better about feeling fat!) That’s my best thinking, and it doesn’t change the way I act.

“Feeling fat” is a lie I’m telling myself. I’m really not feeling fat. I’m feeling a lot of self-hatred and despair because I can’t control myself.

When I feel despair about what I do with food, that’s because I believe that I can control my food and fix myself, so I’m just totally screwing up and will have to try again (or just give up). If you’re feeling desperate, appalled and depressed about how you live with food, then you believe that somehow you can fix your actions with your thinking.

Notice two words in that last sentence: “believing” and “thinking.” We food addicts tell ourselves lies all the time about what we think and how we act with food. It’s addictive thinking that has nothing to do with reality, it just enables us to keep eating. For example:

I can have just one

In that moment, I believe I can have just one. I believe it with every thought. In that moment, there’s no room for any other thought or belief. I tell myself a lie (because I can’t eat just one) that I totally believe. Then I act upon that thinking: I eat one (and another, then another and then the horror begins). The moment I believe I can have just one is the moment I am powerless.

How can I stop myself from believing I can have “just one” at that moment when I’m about to eat something that will make me go insane for days, weeks, months or years? In the AA Big Book, they call this a “strange mental blank spot.” They also call it “just plain insanity.” We believe something that has NO basis in fact.

It’s a delusion, and food addicts have it. We have it when we’re happy, sad, angry, scared, any time at all. I’m as likely to have that belief at a celebration as at a funeral. And the results are always the same.

When I can accept that my thinking is fatally flawed (after all, this disease will kill me), then, paradoxically, I’m on the way to recovery. Because there is a solution, and it starts with changing my mind. It is, as the Big Book says, a psychic change.

Almost everything we believe about ourselves and our food when we come into recovery is wrong. We need a lot of help to recognize our addictive thinking and start dismantling the lies we tell ourselves. It’s a long-term process and it starts, of course with getting abstinent. During ACORN’s Primary Intensive©, we focus on helping food addicts to do just this, because this is at the core of Step One: abstinence and acceptance.

Accepting that we are powerless over food is the most powerful thing we can do.

Believe it or not, this is GREAT. Because when you can see that being powerless is the truth, you won’t end up in the food. You don’t have to take on the horrible responsibility of trying to fix yourself by yourself because you know, fundamentally, that it’s not possible. You don’t have to keep trying and failing, over and over again. You can let that whole “feeling fat” litany just go.

It’s a totally different way of thinking, isn’t it? Acceptance is very different from despair. In the recovery rooms, there’s a saying: “Awareness, acceptance, action.” They all go together, in order, for real healing to happen.

Of course, acceptance is not enough. I have to take action, otherwise nothing changes. If all the changes I’ve made by myself to fix myself haven’t worked, what could I possibly do differently?

I believe I’ve tried everything. (There’s that word again: “believe”). That’s the lie I tell myself, because I’ve really tried only what I wanted to try. Everything else, of course, “wouldn’t, or didn’t work.”

Time to let go. Let go of thinking that you know everything about how to be “normal” with your food. You may believe that, but the fact is nothing you know has helped you. So, consider: you may be (gasp!) wrong.

The action we need (we may not want to, that’s for sure!) to take is accepting help from other people. It’s not help on my terms: it’s following directions from someone who understands food addiction and has experience in being abstinent. After awareness, acceptance and action comes: willingness.

Now you are truly moving through Step One: I am aware that my thinking about food is fatally flawed, I accept that I am a food addict and this is how my thinking works, and finally, I am taking the action of getting help and being willing to follow directions.

Congratulations! You won’t have to “feel fat” any more.

Principles of Recovery

Below is a list of Principles of Recovery by ACORN Food Dependency and Recovery Services.

  • If you already have a food plan that works, i.e. one on which you have been abstinent 30 continuous days without cravings, don’t change it.
  • If you need a food plan, find a person with strong abstinence and ask them to be your sponsor. Begin with the food plan your sponsor uses, or try the ACORN Healthy Eating Plan.
  • Identify and eliminate all binge foods and any food that triggers bingeing, purging or restricting. You may need help from other food addicts to do this.
  • If you binge on almost any food, or if you tend to overeat or under-eat food, or if you have trouble estimating portions, then weigh and measure your food. (If you are primarily anorexic and your condition is advanced, surrender to having someone else make your meals and/or decide each meal what and how much you should eat.)
  • Make sure your food plan provides overall nutritional balance by consulting with a doctor, dietitian or eating disorders specialist about nutritional balance.
  • Put down unhealthy eating behaviors, e.g., diet pills, skipping meals, fasting, vomiting, eating while driving, grazing between meals, eating in front of the TV, using laxatives, and eating too fast or too slow.
  • Don’t make a decision about what a normal weight will be for you alone; surrender to consulting a health professional and/or someone with strong recovery; let them decide.
  • Do not make decisions about food alone. Check your food plan and any changes you want to make in it with an abstinent food addict whose recovery you trust (ideally, your sponsor), and/or a health professional with success helping food addicts.
  • As with other chemical dependencies, the first principle of food addiction recovery is “abstinence first, absolutely.”

©Philip R. Werdell, 1995
Revised 2009, with A.E. Heald.

Levels of Denial

Food addicts experience denial at different levels: inability to distinguish between hunger and the false starving impulse of physical craving, confusion between sane thinking and the false rationalizations associated with compulsions regarding eating, and distortion of will and sense of self in relationship to food and life as a whole. Before we look at each of these inter-related levels of denial in depth, it’s useful to see that there are three quite different definitions or types of denial: common denial, psychological denial, and addictive denial.

Common Denial

Common denial occurs when someone tells a conscious lie. For example, I ate the rest of the ice cream in the freezer, and then I told someone in my family that I was not the person who ate it.

Normal eaters may have done something like this once or twice in their lives. Food addicts do it all the time. I have done it much less in recovery, but I still find myself considering lying about food quite often. Occasionally, I still lie about food. I haven’t binged on ice cream for a long time, so my food lies are now likely to be about whether or not I am rigorously abstinent. When I do notice that I have lied, I acknowledge my lie and correct it quickly. (Thank you, God). While normal eaters may lie about other things, they seldom experience such pervasive lying or common denial about their food.

Psychological Denial

Psychological denial occurs when the mind represses a prior experience because of some form of overload. For example, before I got into recovery, I used to tell people that I was never physically abused as a child. I thought this was true. Then one day as a part of my deep work (i.e. being with emotions and letting move through and out of me), I was feeling afraid, and, as I stayed with the experience, the memory returned of my father striking me in the face.

When I asked my father if this could ever have happened, he admitted that it was a frequent occurrence when I was young until our doctor told him that this was an inappropriate way to “discipline” a child. When I talked about these “spankings” with my mother, she said that once she had been fearful that my father would kill me. In short, I was physically abused as a child.

Unresolved psychological traumas from childhood are often underlying problems in serious eating disorders. There is usually some form of physical, emotional, sexual or spiritual abuse, though it is not always repressed. When the feelings are acknowledged and felt, the eating problem often goes away; the problem eater slowly returns to being a normal eater.

In my case, I did work through the feelings and the psychological denial faded, but I continued to have a very serious problem with my food. I was confounded by this experience until I learned that I was a food addict.

Addictive Denial

Addictive denial is not normal, and it is not caused by psychological repression. Rather, it is a biochemical phenomenon that is an integral part of the addictive process.

For example, before I got into recovery, I lived with frequent, strong urges to eat large volumes of food, especially foods that I had binged on previously. As this problem progressed, I developed what seemed to me to be uncontrollable urges to eat before and after I had finished a large meal, even when I was so stuffed that knew it would be very uncomfortable to eat any more. At the time, I thought that this was hunger, but now I know was not normal hunger.

Further, when I considered putting down my binge foods, I really believed that I could not live without them. When at the suggestion of other food addicts I did put all my binge foods down (and went through a period of physical detoxification), my food cravings diminished almost completely and the thought that, “I will die if I don’t eat,” also went away. I continued to have difficult feelings come up from time to time, but I now see my food addiction as separate from and primary to these trauma-based feelings.

Similarly, I see my addictive denial as interrelated with common denial and psychological denial but also distinct and primary.

False Starving

It is my belief that food addictive denial, like the denial associated with chemical dependency on other addictive substances such as alcohol or drugs, has three layers: the false starving experience, false thinking which rationalizes overeating, and a false sense of self. What is common to all these levels of denial is that the food addict is at times powerless to see that these thoughts are not true. Unlike in common denial, the problem is that the lies or false thoughts are unconscious. Unlike psychological denial, though, the problem cannot be worked through in traditional therapy. Food addicts in their disease believe that what they are experiencing and thinking is the real truth, and it is a problem of the body as well as the mind.

The false starving experience of the food addict is a distortion in the brain much like dyslexia or color blindness. Food addicts believe they are starving, i.e., that they have to eat or something horrible will happen, when by all objective measures this is not true.

Normal eaters do not ever have this experience, but almost every food addict reports it. Though the words describing it may vary, the experience is incredibly close to how starving people react. They find themselves thinking about food more and more – eventually thinking of little else. There is a strong sense of urgency about eating. It becomes more important than anything else. Finally, starving people will break personal and social norms to get food, norms that they would never consider violating when not in the grips of this physical craving. Often without thinking, food addicts will lie, cheat, steal and at least say to themselves that they are “dying “ to eat.

What distinguishes food addicts in this state from people who really are starving, of course, is that there is absolutely no chance that they will die. As recovering food addicts are fond of saying, “No one has ever starved to death between lunch and dinner.” At the same time, food addicts need to constantly be reminded of this fact because, if their physical craving is reactivated, they will again have the thought that eating something they really don’t need is vital to their well-being, and the thought will be believable. That is what it means to have an experience of false starving.

Just as the dyslexic person cannot change the way their brain inverts letters in certain words and just as color blind people will never see colors as normally sighted people see them, food addicts cannot simply decide to change the false starving thoughts in their minds. What they can do is to stop eating the foods, e.g. sugar, that most reactivate their condition.

It is the same initial first action that alcoholics and drug addicts must take, that is, to totally abstain from the substances to which they are addicted. However, this does not change what will eventually happen in their mind if they pick their drug of choice again. The situation is identical for food addicts.

False Thinking

The problem of the food-addicted mind is complicated by the development of further false thinking that rationalizes overeating. This is talked about by recovering food addicts this way: “If the problem was just one of abstaining from foods which activate a false starting response, it would be easy, but the food addicted mind begins to keep the food addict from remembering and acting on this important information.”

We don’t know exactly how this works, but it is as if the distorted hunger instinct is working unconsciously all the time in the instinctive part of the brain. It is trying to find a way through the conscious part of our thinking that would oppose the idea of taking that first bite if we could fully remember the negative consequences of binging. The results would be clear to an undistorted mind: unwanted fat, depression, lowered self-esteem, and much more. These are always the eventual result of taking the first bite, but the physical craving of a food addict becomes stronger than the unaided rational mind.

At one point the food addict is without defense and cannot say “No.” It is as if the biochemical stimulus of the craving is just as strong as a general anesthetic is for a patient on the operating table. Before the operation, the patient could simply say, “No, I do not want to be put under.” However, at one point on the operating table after a certain amount of the chemical has taken effect, the patient it powerless to stop the process.

The food addict does remain conscious when bingeing, at least partially. However, another part of the mind is creating rationalization for the eating “I’ve had a hard day, so I deserve it.” “This is a celebration. I can have a little.” “I’m experiencing too much pain. I need to eat.” “I’ll just have one.” “I’ll diet tomorrow.” In each case, the rationalizations are not true, at least not sufficient to offset the consequences of eating. The food addict develops a long history demonstrating that the proposition is not true, but still, over and over again, the food addict believes each rationalization. It is this reoccurring pattern of believing a thought is true despite substantial experience to the contrary that makes recovery from any addiction so difficult. Recovering food addicts often refer to this experience of believing false thought as “stinking thinking” to distinguish it from a reasonable mistake or an ordinary error in judgment.

Sometimes, as in alcoholism and drug addiction, there is no rationalization at all; just what recovering addicts refer to as a “strange mental blank spot.” The food addict will just have the thought that a food they had previously eliminated “might taste good.” There is no thought at all of previous commitments not to eat this food or of the severe physical, emotional and spiritual consequences in the past when it was eaten. While few food addicts have complete blacks outs as some alcoholics do, food addicts in whom the disease is more advanced do report times when they will have completely forgotten having eaten something that very day, even at their last meal. They will look down at their plate expecting a certain food to be there, and it will be gone. Much more common for the food addict is the experience trying to keep the food under control, being successful for a while, then suddenly being back in the food, as it is often said “binging my brains out,” and simply not having the slightest idea of how it happened.

Another form of false thinking common to food addicts is body image and food quantity distortion. It is very common for obese people to not think that they are as heavy as they really are, just the opposite problem of anorexics who are dangerously thin but think they are fat. Similarly, research shows that about 20% of overweight people who are rigorously trying to diet think they eat less food than they actually eat. Just as many underweight people really believe that they are eating more calories than they actually are consuming. This mental distortion is often so deep that those who have it will sometimes vehemently argue that their own thinking is not false, even against evidence everyone else sees as contradicting their belief. It is much like alcoholics who have had several DUIs, but still believe that they can control their drinking.

The most common form of false thinking denial for food addicts is euphoric recall.

Simply put, the positive aspects of a prior eating experience will be remembered in vivid, mouth-watering detail, but even drastic negative consequences will be forgotten or will be so faded as to have little or no effect on the decision-making process. Examples here are many: remembering how good a particular kind of donut tasted but not what it felt like the last time after eating a whole box of them; remembering a time when you were able to keep your eating under control but not that it was followed by a 25-pound weight gain; being sure that over-eating just this once will numb the pain but forgetting that this only lasts for a couple of minutes and then you have to do it again; having a sense of being in control and making a choice to eat this time and not even expecting to slide into the chasm of despair that so regularly follows addictive overeating. There are few food addicts who don’t have a whole bunch of these stories, yet this alone will seldom keep them from experiencing and acting out of euphoric recall in the future.

The False Self

For food addicts who have not yet found a path of recovery, it gets worse: the most advanced food addicts have developed and live most of their lives in a false consciousness or false self. As food becomes one of the most important, if not the most important, thing in their lives, the false starving of physical craving increases and the irrational, false thoughts of rationalizations become so pervasive that these false ideas begin to be confused as the food addict’s self.

When experiencing a false sense of self, food addicts perceive themselves as being the disease rather than as just having a disease. It seems to them not only that they are just hungry when they are actually in a state of craving but also that the decision to eat was freely chosen by their inner most and true self. Thus, even when asked to consider that they might be powerless over food, this does not seem to be true to them. They see themselves as simply not wanting to quit when in fact they are acting out of distortion of will.

In this false self consciousness, the food addict retreats into isolation. Typical behaviors of the food addict at this stage include eating alone more often, not answering the telephone when eating, eating while reading or watching television, even skipping social functions or work responsibilities to binge.

Because there are more and more negative consequences to isolated binging and because the food addict sees these as free will choices, this leads to all sorts of critical judgments about self: “”I’m stupid,” “I’m bad,” “I’m defective, “ “I’m sinful,,” “I’m incompetent,” and so forth.

Eventually, a sense of shame develops which is so deed that this feeling itself becomes a reason to eat: “If there is something wrong with me, I might as well eat; ” “If I’m incompetent, there is nothing I can do about it;” “If I’m immoral, I deserve the negative consequences.” The negative concepts of self become a part of the disease thinking which in turn lead to more eating and more negative results.

For the food addict who is in this downward spiral, begins to see this aspect of addictive experience as almost all that is real. In fact, in the later stages of food addiction, life becomes mostly a cycle of eating to satisfy a craving, an ever short period of satisfaction and numbing of the pain, then further demoralization. Just occasionally, at what addicts often call a “bottom,” the physical, emotional and spiritual pain is so severe that the food addict is able to see the truth, that they are power-less over food, their food addictive thinking and the disease process.

What can food addicts do at this stage? On the one hand, few are able to do anything by themselves. On the other hand, with another recovered food addict or someone to help them find a spiritual path, it is relatively simple to find a way out.

Those who are stably abstinent from their own binge foods and who have worked seriously on their own emotional and spiritual recovery can help even the most progressed food addicts to see when they are “in their disease.” or false self. Those in recovery quickly discern the irrational thinking and denial of a food addict new to recovery. The experience of rigorous physical abstinence makes it possible to notice one’s own experience of false staving, and this basic insight allows a gradual discernment of one’s own false thinking about food. It also gives the recovered food addict a healed intuition about the thinking and behavior of other food addicts.

So, the simple truth is that when a food addict’s disease has progressed to the point that they are at least sometimes confused as to what is true about their experience in relationship to food, they need help beyond themselves. One of the most obvious ways to get this support is to find other food addicts who have had just the same problem and ask them to help.

There is more, though, that we can say that is helpful in knowing whether one is caught inside one’s own food addicted mind. There are simple guidelines for food addicts in relapse to know whether or not they are in denial:

  1. First, are you free from guilt and shame about your eating and out-of-control behavior with food?
  2. Second, do you yourself see your powerlessness over food, and are you able to describe it being very specific about the food and about your addictive thinking about food?
  3. Third, do you see that you need a Power beyond yourself in order to be food abstinent, and are you willing to surrender to this reality?

If you answer each of these questions “Yes,” then you have taken the first step in seeing your own deepest food addictive denial. If not, then you may have serious spiritual work to do.

© Phil Werdell, M.A.