Thursday, January 8, 2009

The Unsung Addiction: Compulsive Eating

Elizabeth Zelvin

Every year on January 1, millions of Americans resolve to diet and lose weight. Each year, by January 15 or February 1 or some other date, most of those millions have broken their New Year’s resolution. They tell themselves they need more will power. Others succeed in eating less and more healthily, reach what dieters call goal weight, and within a short time go back to eating the way they did before. They vow not to gain back the weight lost, but they do, because they cannot sustain a moderate way of eating.

Why don’t diets work for so many people? Why do so many return again and again to a practice that has always failed for them? An addiction model of compulsive overeating and related eating disorders, such as bulimia, provides a more convincing explanation than individual weakness. Addictions are compulsive behaviors that start by providing such benefits as immediate pleasure and relief from uncomfortable emotions, follow a progressive course, are characterized by the psychological defense of increasing denial, and end up with the addict unable to stop, although the compulsive act or substance may cause severe adverse consequences in every area of life: health, relationships, and the ability to lead a normal productive life.

Not every compulsive overeater is obese. But obesity is one cause of the intense shame that sufferers from eating disorders experience. Obesity is considered comical in our culture. It is always open season on fat people, who are subject to jokes about a condition they can’t help that would be considered unacceptable if applied to, say, racial minorities. Among survivors of sexual abuse, fat becomes a way to hide out from unwanted attention and their own sexuality. Such survivors are especially vulnerable to agonizing shame.

Bulimics, whose compulsive behaviors include both binge eating and purging behaviors such as deliberately induced vomiting, compulsive laxative use, chewing and spitting out food instead of ingesting it, and excessive exercise, are prisoners of the intense pressure on people in our culture to look slim and fit, whatever the cost. And the costs of bulimia can be extreme: consequences can range from severe dental problems to vocal cord nodes to throat or esophageal cancer.

Diet clubs that focus on achieving a particular amount of weight loss through self-control and a depriving way of eating fail to understand the compulsive nature of addiction. Deprivation leads to resentment and rage and eventually, another cycle of bingeing or compulsive purging. The idea of a diet as deprivation encourages the dieter to give up completely after a single transgression. It might work a lot better to design a way of eating that the compulsive eater is actually satisfied with and encourage an attitude of gentleness and acceptance of imperfection in carrying it out. The simple but profound notion of “one day at a time” that works so well with recovering alcoholics can also work for compulsive eaters. To a food addict, the prospect of life without, say, chocolate is a nightmare, just like the prospect of life without booze to an alcoholic. But for someone who can’t have one without eating the whole box, maybe not having any today is possible.


Sheila Connolly said...

Above the fold headline in the Boston Globe today: State readies campaign to fight obesity epidemic. Yeah, we've got a problem.

I think our bodies are wired to eat more than is good for us, so in our current sedentary world, we're always fighting our biology. I wish I had an answer for that.

Julia Buckley said...

Liz, this comes at a timely moment: my doctor called and told me I had high cholesterol. :0

I've struggled with weight for most of my adult life, and it does in fact stem from my love of food (especially delicious fatty food, the staple of my European forbears) and a never-fully-formed ability to stop when satisfied.

This will be a good starting point for me to address those issues again, before my doctor forces me to take medications I really don't want.

sexy said...