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.
“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.
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.
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.”
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.
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:
First, are you free from guilt and shame about your eating and out-of-control behavior with food?
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?
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.
In the long term, diets do not work for compulsive eaters and food addicts, but we still need a way to give structure and support to our physical recovery. Since we have become powerless over food, a food plan must be used in a spiritual context. Thus, a food plan is a spiritual tool; it is an instrument for implementing “surrendered” food abstinence.
Everyone’s nutritional requirements are subtly different, but there are general principles and patterns which work for most people. When the food addict is looking for an effective food plan, the situation is similar. Every food addict must look to his or her own food history and be rigorously honest about what has worked and what has not worked. Each of us must check out for ourselves whether a particular food plan works for us in practice. Yet there are principles and patterns which have developed in our collective experience and these provide a helpful guide to compulsive eaters wanting to choose the best food plan for their recovery program.
Issues of Nutrition and General Health vs. Issues of Compulsion and Addiction
It is helpful first to see that we can separate the important issues about nutrition and general health from the issue of compulsive eating and food addiction. While these two types of issues can often over lap, it is practical to consider them separately. Nutrition is an evolving science, and there is still much controversy about basic questions like – What is a healthy weight? What food groups are essential and in what balance? What are the most effective strategies for weight loss (or gain) and long term maintenance? How is diet best supplemented by exercise?
The compulsive overeater needs to answer these questions just as much as the normal eater does. We recommend consulting a doctor, dietitian or other trained health professional regarding these matters. However, as compulsive eaters and food addicts we have an additional question: What do we do when we have a healthy diet to follow and cannot do it? Or when we cannot maintain a healthy eating process and weight over time?
If we are powerless to eat in a basically healthy way – much less in a manner conducive to optimal health, we obviously need help beyond ourselves, and it is in this area that a fellowship – and most importantly the Twelve Step Program – provide real practical experience, strength and hope. As is often mentioned, though, the problem of “putting down” food is different, and more complicated, than putting down alcohol or another addictive drug. The decision regarding exactly how we should abstain and/or from what specific foods we should abstain must be considered in the context of what food we do need and want to eat. This is where a food plan becomes most helpful.
Detoxification
If you are chemically dependent on specific foods or food in general, you are likely to have to go through a period of detoxification. There is no choice here either. Some compulsive eaters will experience immediate relief when they find an abstinent food plan that works for them. This sometimes last several months or even years, though at one point almost all compulsive eaters need to learn to be abstinent when the going is really rough. For many food addicts, however, it gets worse before it gets better. The symptoms of physical detoxification can be very subtle but they can also be quite severe.
Withdrawal symptoms may vary from subtle anxieties to strong physical cravings. Other symptoms of detoxification can include headaches, irritability, fatigue or insomnia. Withdrawal varies for different foods and from one food addict to another Most of all it is possible to have the thought that you have to eat or that certain feelings will be unbearable without food. It is always good to remember that no one has yet starved to death between meals and that feelings any particular feeling is not dangerous in itself… If we don’t eat, any feeling will eventually pass.
This is simple to say but often quiet difficult to do. Food addicts often need increased structure and support for their recovery in the first week to as long as a month because of going through detoxification. Some need extra structured support for much longer.
Similarly, most of us were eating over our feelings, using food essentially to medicate or numb our feelings. We needed to find and use other ways of dealing with even the most difficult feelings if we wanted to stay abstinent and recover. The most common way for food addicts to begin dealing with new and difficult feelings is to surrender to more structure and support: talk more with other food addicts, go to meetings, and use the tools. For long term recovery, this means a thorough working of the Twelve Steps.
It is in this context that we can look at the basic principles of choosing a food plan. Some compulsive eaters need to follow only one or two of these principles in order to discover a food plan that works. Others have to use almost all of these principles. Here again, it is important to base our choice on our best understanding and acceptance of what may be necessary to recovery from this disease. Many of us find it useful, even necessary, to make our choice of food plan with the help of other compulsive eaters or food addicts who are abstinent and who have a food plan that works for them.
Why Use the Term “Food Plan”?
Since most of us have been unable to eat or diet like normal eaters, we choose not to use the word “diet”. To us, diets mean something we can follow by reason and will power alone. We have come to accept that we cannot manage our food by self-control alone. Willpower failed us utterly, so we surrender to our powerlessness over food. The purpose of the food plan is to make this surrender more specific.
Few compulsive eaters chose a food plan because this is always the way they want to eat the rest of their life. Rather, we chose to surrender to a specific food plan because we have surrendered to the fact that we are powerless over food. There is real choice in deciding to use a food plan and what specific plan to use, but the first and most important decision is choosing to use a food plan – and practice surrendering to it – that works for the specific ways we are addicted to food.
There are some choices which are not available to each of us.
Most abstinent food addicts have an abundance of choice regarding what they eat. There are over two hundred different foods in most grocery stores, and only a handful are foods most of us find addictive. However, there is no choice about which food plans or principle will work and which will not. If you are addicted to a specific food, for example, it is not likely you will be able to include this food in your plan and have an abstinence that works.
Most compulsive eaters would like to be able to eat everything they want, exactly the way that they want, and suffer no consequences. Most of us would like to eat like normal eaters, but this choice is simply not available to us if we also want recovery. There is no such thing as surrendered food abstinence without giving up foods and ways of eating that your disease has long been wanting dearly.
Principle #1: A Food Plan as a Principle of Surrender
The simplest food plan is a “one day at a time” commitment to no compulsive eating.
Another version of this principle is “Eat when hungry. Stop when full.” Some food addicts who see this as a spiritual problem are able, with the help of the fellowship, to use this simple principle as an effective spiritual practice.
The problem, of course, is that most food addicts would not have sought help if they were able to do this. Many are mystified by the very idea of developing a spiritual practice in relationship to food. However, for some people, when they try to commit to this principle in a spiritual context – praying , doing the tools and Steps of the program, and opening to the support of the fellowship and other spiritual support – what was previously impossible becomes possible.
It is worth noting here that almost all food addicts have needed much more specific guidelines.
Principle #2: A Food Plan With Specific “Bottom Lines”
The first food plan often mentioned is now called “301.” It is a good example of the use of bottom lines. The 301 Food Plan contains three bottom lines: three meals a day, nothing in between, one day at a time. The bottom lines are specific commitments of surrender. The idea of abstaining from eating between committed meals was a conscious adaptation of the AA principle of not drinking at all. Focusing on one day at a time is also a practical AA practice which keeps us focused on the present and the possible.
Many who use a “301” food abstinence find they need further specific bottom lines about what they do eat. For example, a common variation of the 301 plan adds another specific bottom line, for example, “moderate meals” and/or “no seconds.” Others commit to a “balance of food categories”. Still others break their food plan up into more small meals or having a planned snack at a time in the day when hunger is chronic. Each of these is a general bottom line based on an assessment of past food history.
Those needing even further definition will use a specific “exchange diet” or “point system” as their food plan. Normal eaters often use doctor prescribe diabetic diet, a calorie counting system of a commercial weight loss program or an individually designed exchange diet from a dietitian. If a compulsive eater uses such a diet a food plan, the difference is an acceptance that s/he cannot do this by self-control, i.e. not by willpower or alone. So it is done in a prayerful context and/or by committing the food daily to another food addict. Food addicts learn to do the spiritual part of this work by sharing with each other and by consciously working the Twelve Steps.
Since many compulsive eaters also have eating disorders, it is not uncommon to include eating behaviors as bottom lines. Among the most common are “no purging,” “no restricting,” “no use of laxatives or diuretics.” Those who are compulsive over exercisers will often make a maximum time limit for exercise as a bottom line… On the other side of the exercise issue, many compulsive over-eaters find they have an aversion to exercise. This suggests that they have a minimum amount of exercise as a bottom line and a part of their abstinence commitment.
Sometimes these positive or pro-health parts of the food plan are called “top lines”. An exercise commitment is one of the most common top lines, for example, walking briskly at least a half an hour a minimum of five days a week. Other examples of top line include “sitting down while eating”, “eating slowly”, or “preparing meals I like to eat”
There is one type of bottom line, eliminating a specific food or a category of foods that is worth addressing separately.
Principle #3: A Food Plan Eliminates Binge Foods
For those who are chemically dependent on food, the basic concept is to eliminate the food(s) on which you binge and which trigger a binge. A way to begin is to make a list of all your specific binge foods. Then – best with another food addict who is abstinent – look over the list. Are there foods that are common to all your binges? The most likely suspects include: sugar, flour, wheat, caffeine, excess fat and salt. For food addicts, these foods often act in their bodies like drugs. Sometimes you have to look very carefully. Someone saying that they binge on salad may eat their greens with a dressing that contains any or all of the most common drug foods. Someone who thinks of themselves as bingeing on meat might always use steak sauce, always have rolls or bread with their protein, or just chose especially fat portions. If the food comes already prepared, it is always necessary to identify the ingredients with which it is cooked.
A practical application is to have a “bottom line” for certain highly addictive foods, e.g., no sugar. Many compulsive overeaters have even more specific ways of committing to not using a specific food. Regarding sugar addiction, for example, the more sensitive the compulsive eater is to sugar, the more thoroughly and completely sugar needs to be restricted. Some examples of common sugar bottom lines in order of progressive rigor:
– no added sugar
– no refined sugar or obvious sugars, e.g. corn syrup
– no hidden sugars up to the fifth ingredient
– no sugars, hidden sugars or artificial sweeteners
Each of these “levels” of abstinence is common.
How do you tell what level is appropriate? The answer is usually very pragmatic. What level of abstinence eliminates physical cravings – or minimizes them to the point you can commit what you eat and eat what you commit? What level works over time, i.e. 30 days, 90 days, a year? Some food addicts find a level that works and never needs to be changed over a long, stable period of abstinence. Some find that after a period of strict abstinence, they are able to reintroduce some foods in moderate portions. Others find that the road gets narrower and their bottom line has to become more restrictive over the years.
Principle #4: A Food Plan based on weighing and measuring.
What about compulsive eaters who have binged on almost every food? This is not uncommon, and there is a common answer: weigh and measure. For those who are addicted to volume, the use of a cup, scale and measuring spoons is not a form of dieting but rather a physical aid to portion control. The cup and scales are for these food addicts what glass are for the near sighted, a cane or crutches for the injured, or a wheel chair of the disabled.
Many compulsive overeaters experience mental distortion regarding food volume similar to the distorted body images of all those with eating disorders. The cups, scales and spoons become an aid to the untrustworthy eye. For other food addicts, they are addicted to volume – always or frequently wanting more (or less) food even when all reason says their food plan is a healthy portion. In these cases, the cups and scales become a counter balance to unwanted impulses. Paradoxically for many compulsive eaters, weighing and measuring is an incredibly practical way of simplifying a very complex problem, e.g. dealing with a food plan that has a very large number of variables.
Many food addicts who had resisted mightily the idea of weighing and measuring report later that, after they tried it for a while, they found a great relief. Rather than experiencing it as harshly restrictive, they say that they actually feel much freer when they weigh and measure. It helps relieve the obsession with food before, during and after a meal. Compulsive eaters who have weighed and measured know for certain that they have eaten exactly what they committed.
There are variations of weighing and measuring. Some weigh and measure all their food; some will weigh and measure only their protein, starch and dressing Others will weigh and measure at home but not at restaurants or social events. Some will measure their vegetables and starches in a cup; others will weigh them. Some will weigh and measure for the first 30 days, 90 days or a year, then do it only when they feel anxious, notice they are getting sloppy or just want the practice of surrender. There are some with long time, stable abstinence and recovery who have simply integrated surrender to weighing and measuring into their food plan one day at a time for life.
As with bottom lines, the decision about weighing and measuring comes down to individual choice – usually in collaboration with a sponsor – based upon past experience and upon what works and what does not work when it is tried. What is important – as with other parts of a food plan – is to first make a decision then do the spiritual work of staying surrendered to that commitment.
Principle #5: Begin by using the Food Plan that works for others
In early recovery or even coming back from a relapse, we are often ill-equipped to deal with all the choices of a food plan. We just know that what we have been doing has not worked, and we need to try something that has worked for someone else. So, it is not surprising to find many compulsive eaters begin by choosing a sponsor or meeting where they see definite recovery, then surrendering to the food plan that their sponsor or other abstinent food addicts are using.
The food plan might be “301,” or it might be a very specific written food plan that has evolved from a sponsor’s individual experience or it might be a very detailed weighed and measured food plan that has worked for a whole group of compulsive overeaters over time.
When those who were specifically addicted to sugar, flour and wheat wanted meetings together, they formed Food Addicts Anonymous and they also developed another highly structured food plan. Within Overeaters Anonymous, there was also a movement called HOW which was for those who needed more structure and support; part of this structure is a weighed and measured food plan with no sugar, or flour. See Overeaters Anonymous.
Along with many further variations, these plans have a lot in common. They are all sugar, flour and alcohol-free. They all have a specific exchange plan. They all recommend weighing and measuring. Someone simply addicted to sugar, flour and volume could use any of these plans and get abstinent. Yet for others the details are all very important.
Some using the HOW plan have not gotten abstinent until they gave up wheat and looked at the dozens of hidden sugars itemized in the FAA literature. Some have tried the FAA and HOW plans and not gotten abstinent until they eliminated all carbohydrates and followed the even stricter guidelines of Gray Sheet. What all these specific plans have in common, though, is that abstinence is defined both simply (surrender to a whole plan) and in great detail (there is an answer to most of the endless specific questions that come up when abstaining from food.)
Many of those with long time (decades) of abstinence in OA started by practicing surrender to one of these food plans, and many continue to use this more structured approach to abstinence for years and years, If this is the only food plan that have been stably abstinent on, they decide “if it works, don’t fix it.”
Principle #6: A Food Plan focused on issues of unwillingness
Of course, those coming off of a relapse will have some experiences of their own to build upon. Anyone abstinent in the past for a year or more using a specific food plan has some very valuable information about their disease and about a food plan that worked at least physically at that time. The food addict who has struggled for a long time in OA and not been able to put together any substantial period of back to back abstinence also knows a lot; this food addict knows a lot about what does not work.
It makes good sense to learn from this experience, to put down the foods or eating behaviors that were previously surrendered when abstinent, to inventory the relapse experience, and to be rigorously honest about what we didn’t want to do or were outright unwilling to do.
Probably the most important difference between a diet and a food plan is that most food plans include an aspect of surrender. Those on food plans surrender specific food(s) or eating behaviors that they did not want to give up or actually found that they were unable to give up when they tried. They need to surrender to more help and support or, as it is frequently talked about in Twelve Step programs, a Power greater than oneself.
While diets are temporary deprivation for a desired goal, food plans frequently deal with exactly the food issues where we think we will be deprived, even “unacceptably deprived”, if we put them down. This is not unlike the situation in alcohol and other drug addictions. It is common for the addict to think that they “have to have” their drug, that life will not be worth living with out it, even that they will die if they don’t use. This is the nature of compulsive eating and active food addiction, too.
So, unlike the normal eater who is dieting – or even the person with an eating disorder who is not addicted – the food addict needs to deal with deprivation. That is what a surrendered food plan is all about. In fact, a sponsor can often help a sponsee see the way that their food plan is not working by pointing out the specific food they are unwilling to give up or the specific recovery behavior they are unwilling to include.
The purpose of a food plan is to eliminate just those foods and behaviors over which we have in the past been powerless. We do this first by accepting the support of the program (e.g. sponsor and meetings), second by eliminating the most difficult food just one day at time (we can do for one day many things that we think we cannot do for a life time) and then, most importantly by having a very practical spiritual practice (for example, the Twelve Steps) which help us deal with this very problem of willingness.
Beginning the Process of Abstinence
There are two schools of thought about the strategy for surrendering to a food plan. One says that it is best to proceed incrementally. The other says that it is best eliminate all dangerous food and triggers at once. There is an abundance of experience that both of these strategies work well for some people, and many “true believer” arguments that their way is the only way among those for whom their food plan or their strategy has worked.
There are many old–timers who will say very truthfully and helpfully that their abstinence evolved. Maybe they were only willing and able to give up “junk food” or eating between meals at first, but they did, and this showed them both that abstinence worked and that there were further issues of abstinence to which they needed to attend.
Also, there are people who were able to use certain foods in early recovery, e.g., diet drinks, but later the caffeine or the NutraSweet or some other ingredient was something they could not handle; as they would say the disease progresses even while we are in recovery. On the other hand, recovery is also progressive; what we could tolerate physically in early recovery becomes a problem as we recover more mentally, emotionally and spiritually.
There are also old-timers who will say that until they put down all their major addictive foods, they were not able to maintain their abstinence from any of them. They found that when they put down ice cream, they eventually picked up bread, and bingeing on bread brought them back to the sugar. Others found that though they appeared to have control regarding a particular food, e.g. wheat or a sugar-free desert, it was giving them low-level cravings which in the long run made it impossible for them to sustain their abstinence over their major binge foods, or they started overeating with volume.
To the newcomer, all these details frequently appear very confusing. This is especially true because for many compulsive eaters, there are food plans and approaches to food abstinence that work for them but not other food addicts. And, of course, there are often food plans which will not work for them no matter how much other food addicts say that this is the only way. It is clear that while recovering food addicts have a lot to share with each other, we are only human, and this means that we all need a Power greater than ourselves.
We have this piece of advice: action is usually better than inaction. After consultation with those we most trust – and, if we choose, a period of prayer, it is always useful for the food addict to practice surrender. Even if there are ways that we are unwilling to surrender, it is helpful to practice going to the lengths that we can. Even if a particular surrender plan is not exactly the one that will work, it is worth exercising our spiritual muscles. In the matter of food plans, act boldly that learning and grace may abound.
Now About Weight
We compulsive eaters have taken on some very foolish beliefs about weight. On the one hand, some of us have internalized the dangerous social standard that you can never be too thin or have a flat enough stomach. On the other hand, some of us adopted that irrational position that, since there is no perfect weight for everyone, then we can be whatever size we want to be. All of us have harbored our own fair share of crazy thinking about size and body image. So, what are we to do about establishing a goal weight?
First, as in other matters of our food plan, we tried to be honest, open and willing. We needed to take a long, hard look at our history. We needed to consider the feedback and advice of others, including health professionals, especially if our initial response was reactive. We needed to be open to the possibility that our thinking about our weight was inaccurate and a part of our disease. We need to examine any position we hold too rigidly and consider it might be “self-will run riot. ”
Whatever our goal weight turns out to be, we must be willing to grow towards it. Some of us found that when we put our focus on being abstinent one day at a time, the problem of weight took care of itself. Still many of us find that weighing once a month is a healthy reality check. We still need to commit an appropriate number of calories per day. The scale does not lie, but in our disease, we food addicts do. If we are not making progress towards or maintaining a healthy weight, it is likely that we are either lying to ourselves about our food or need to consult a health professional.
Often we needed to rely at first on others who we trust in this matter. If they understand compulsive eating and food addiction, they are likely to say put your focus on surrendering to just being abstinent one day at a time, and proceed on the issue of weight patiently. Only God can judge our ideal weight. Considering our food plan as a spiritual tool and our abstinence as a spiritual practice will lead us to an answer over time.
There is a cautionary note: if you are committing to any food plan, especially to a highly restrictive plan or one of the more structured plans, it is very important to check it with your doctor or a dietician. Food addicts frequently have additional food-related health issues, and they can be important, even life threatening.
For example, diabetics would not be wise to have a food plan that included sugar. Those with thyroid problems may need to calculate their calorie needs differently. Those with hypoglycemia may need to break their food up into five or six small meals. Those who have had intestinal by-pass operations will not be able to eat meals with large volume. Those with specific food allergies will not be able to eat other specific foods, even though they are not addicted to them. Those on medications for any number of other illnesses will need to be sure that their food plan does not interfere with the working of these medications.
The good news is that these strategies have worked for tens of thousands of food addicts, and that if one strategy does not work, you can try another one. There are a couple of general rules: First, generally, it is best to begin working to abstain from what will kill you the fastest; second, if you are unable to abstain when you give it your all, surrender to more structure and support.
What does more structure and support mean in practice?
Going to more recovery group meetings.
Making calls to more people who are abstinent.
Looking seriously at professional support or treatment.
Surrendering to a food plan is often just the beginning. There is also a process of surrender: committing our food one meal or one day at a time. Here again, OA brings the experience of tens of thousands of compulsive eaters over forty years, and probably the most common practice among all the OA’s who have achieved and maintained long term abstinence is the use of a food sponsor.
Using a Sponsor for Food Addiction
As part of a 12 Step Program, a food sponsor is usually another food addict who is abstinent themselves. They are a guide in defining a surrendered food plan. Equally important, they can offer structure and support in the day-to-day practice of surrendering to the plan. One simple common process generally works like this:
Write down your food for the day specifically, before eating
Read your committed foods for the day to your sponsor
Go to any length to keep your commitment (checking back with your sponsor if a problem arises)
Be rigorously honest with your sponsor about whether or not you kept your commitment, after you eat your meals.
As with other aspects of abstinence, there are many variations in practice. Some begin by just committing “bottom lines.” Some people just write their food down and don’t commit it. Some begin committing specifically, but later commit generically. Some write their food down and check in with a sponsor afterwards in order to be accountable. It is useful information, though, that a majority of compulsive overeaters with long term abstinence have gone through a period of time – often a quite long period of time – when they committed their food very specifically on a daily basis to a sponsor.
Committing your food to a sponsor has many advantages. First, it means that we are not trying to deal with our food alone. For those are not able to deal with their food by themselves, this makes a lot of sense.
Second, the process of committing our food and keeping our commitment builds a whole new set of habits and attitudes over time. In the planning, preparing, eating and cleaning up after our meals there are dozens of small actions, many of which need to be changed over time.
Third, the simple act of not making decisions about our food by ourselves is, for the compulsive eater, one of the best ways to practice surrender. Since for many of us a surrendered abstinence is the only thing that works with our food, it is always a plus to develop our spiritual muscles.
In developing a “surrendered” abstinence, many food addicts are taking on the most difficult task of their lives. After all, for many of us, food seemed to be the most important thing in our lives. For others of us, food was a major comfort in times of pain, stress and celebration. For most of us, we only came to to get help when we began to see that we were – or were becoming – completely powerless over food. Many of us had to face the important though daunting task of improving our relationship to God, as we understand God. Seen this way, developing good food abstinence is one of the most important things we can ever do in our lives.
For a few of us, this comes easily, but this is not the rule. For most the process of surrendering to a food abstinence that works is a long, educative process. Some find it useful to see that the process often parallels the process of grief. In fact, we are often grieving the foods we most wanted and the very idea of ourselves as being able to control our own lives. There is a process of grieving, and – while it is not usually a straight and linear path – there do seem to be stages:
Denial
Bargaining
Compliance
Anger
Fear
Sadness
Surrender, i.e., acceptance
That we need to move through each of these stages – and usually keep moving through them – is what makes surrender a spiritual practice. A food plan is a tool in this process.
The Promise? Not just Abstinence but a Life Beyond Our Wildest Dreams
At one time, most of us saw a surrendered food abstinence as hopelessly impossible. If we were to be abstinent, it would have to be with reservations. Then we complied, as best as we could, one day at a time. We found it was possible, but we were angry, afraid and sad. Was this all there was to life? However, when we stayed with the practice, allowed our selves to feel our feelings and kept at working the Twelve Steps, we discovered a serene abstinence. While many of us had to work hard – over and over again go to any length, when this joyous abstinence arrived, we experienced it almost entirely as a gift. That is the wonderful paradox of the program, while abstinence often begins as a surrender we do not want to make, it becomes the key to a life beyond our wildest dreams, and we are grateful.
A food addict is distinctly different than a normal eater or an emotional eater. A food addict has a chemical dependency like an alcoholic or drug addict. Specific foods or food in general can trigger a process of physical craving. The food addict often thinks this is hunger, but it isn’t. It is more like the experience of starvation; the food addict thinks that s/he has to have more food, even if she is physically full and nutritionally satisfied. Sometimes s/he thinks life will not be worth living without a specific food or that s/he’ll die if s/he doesn’t get more food. Neither is true, so the experience of physical craving is actually like having a “false starving.” It is typical once the disease has progressed for the food addict to think s/he will have just one of a food or just one serving, but then once having started eating it wanting to continue to eat more and sometimes start bingeing out of control. For the food addict, craving is often misunderstood as hunger. Hunger and craving are very different.
A normal eater gets hungry when it is time to eat. It is a body signal like a sense of being too hot or too cold. If you do not eat when you are hungry, it feels uncomfortable – just like a person is uncomfortable when the room temperature is too hot or too cold. An important difference between hunger and craving is that the normal eater can live with the discomfort of being hungry just like most people can live with the temperature being a little too cold or a little too warm.
Craving has an urgency to it. When craving strikes food addicts they have to eat. It is like a drowning person under water struggling for breath; there is a sense that one might die if one does not get to the surface and get some air. Food addicts frequently report they have a feeling that they will die if they don’t get to their binge foods. Craving is a distortion of the mind at an instinctual level. The food addicts’ impulse to eat their addictive foods is crossed with a survival impulse: “This has to be done now!”
We call the physical craving of the food addict “false starving.” Unlike hunger, there is this deep urgency and sense of impending danger if craving is not responded to. But when the food addict eats this often does not satisfy the hunger. Rather the craving continues – sometimes even intensifies. It isn’t a real body message, because the person has usually eaten fairly recently and shouldn’t even be hungry, much less starving. The fact that it is a false starving is emphasized by the fact that eating itself can often trigger the craving.
When truly starving people are interviewed, they report a preoccupation with thoughts of food, a compulsive drive to have one or more particular foods, and a willingness to abandon civil and moral rules to obtain food. When food is delivered to true starving communities, there is often a need for police or army guard to keep the starving people from hurting, even killing, each other for food – even when there is obvious assurance that there is enough food for everyone.
Food addicts report lying to parents, close relatives and friends about their eating. Like with alcoholics and other drug addicts, there is a impulse to”protect their stash” at a deep instinctual, often unconscious, level. Food addicts have stolen food as children they have been told not to touch, as babysitters from the family’s home, as school children out of other’s pockets, and as adults off other’s plates. They have eaten possibly spoiled food, food off the floor, food out of the garbage can. They have stolen money from their parents and others to buy food.
Food is so plentiful that these crimes of food addicts are not seen as being as serious as those of drug addicts and the lengths they go to – like holding up a store or stealing a relative’s TV – to get money for their drugs. But the feelings and thoughts inside the minds of food addicts in later stages of the disease can be just as strong, intense and serious to the food addict as ithey are for the heroin or crack addict.
One way to look at this is that there is a simple but important disconnection between the nervous system and the brain like in the experience of dyslexia or being colorblind. A person who is dyslexic sees a word in their mind the opposite way it is printed on the page. The word “was” is seen as “saw” or the word “raw” is seen as “war.” There is nothing that can change this misperception. It has to be identified, accepted and adjusted to. Colorblindness is the same; the colorblind person sees both the color red and the color green as green, for example. This is a reason why we always put the red light on top of the green on traffic lights; people who are colorblind can tell whether ort not to go by checking if the light that is shining is on the top or on the bottom. As with dyslexia, color blindness is sometimes a nuisance, but other times it is really dangerous, and there is not much you can do about it except learn to compensate.
The phenomenon of craving in the food addict is exactly like that. The food addict will really believe s/he is hungry – or, closer to the point, often think s/he is really hungry –when, in fact, his/her body needs little or no more food at all. If s/he is not aware of this, s/he will eat more, often a lot more, than is needed, and, while this might not be much of a problem if it occurs very infrequently, if it becomes more frequent or pronounced it can cause a lot of problems. The first, obviously, is that s/he puts on unwanted weight, and has trouble keeping it off even after serious dieting. Second, the obesity – and often the shift away from good nutrition – put him/her in danger of lots of other health problems over time: diabetes, high blood pressure, joint and back problems, strokes and heart attacks to name just a few. Third, problems with weight can affect one’s self-esteem; repeated failure at dieting can lead to guilt, shame and/or depression. Finally, experiences of eating out of control can negatively affect one’s deepest attitudes and spirit.
For the food addict, all this comes from simply not knowing that you get “false starving,” i.e. that you often think that the most important thing in life is to eat when your body is not even hungry. This is an experience that normal eaters or emotional eaters do not have.
“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”).
