Change The Way You Think About Food

“Sarah” (not her real name) remembers one particularly argumentative telephone call from her ex-husband a few years ago, a call that really set her off. “I felt so uncomfortable and inadequate,” the 57-year-old Vermont-based social worker remembers, “the thought of candy just popped into my mind, and I couldn’t get rid of it. It was almost as if I was having two conversations. One was with him, fighting, and the other was with myself, saying, ‘When can I go out and get that candy?’” Long after she’d hung up, the visions of sweet treats remained, tempting and specific: “It was Pepsi, and three different types of candy,” she recalls distinctly. “Pull-apart Twizzlers, Skor bars and Butterfinger bars.” Though it was the middle of a workday, Sarah couldn’t concentrate on her work or think of anything else until she went out and bought the candy and soda. “I ate them all in my car, really fast,” she remembers. “And then, like always, I felt terrible about myself for being so weak.”

The shame and remorse led Sarah to keep going, onto a second binge. “Once I started, I figured I’d blown it anyway, so I might as well have everything I like.” She stopped at a McDonald’s drive-through and ordered the works—burger, fries, soda; on another day, she might have ordered a pizza or subs to be delivered to her house. Either way, it ended as it always did: with her stuffing herself with food, alone and ashamed. “I took in thousands of calories without even feeling it,” she recalls.
A binger most of her adult life, Sarah’s weight fluctuated as she alternated binging with extreme dieting. “I’ve been as much as 250 pounds, and at my thinnest, around 125,” says Sarah, who now carries 215 pounds on her 5-foot-6-inch frame. After nearly two years of counseling and weight-control group sessions at the Vermont Center for Cognitive Behavior Therapy (VCCBT)—along with daily, conscious effort—she has finally gained the upper hand over what she eats, but not always. “I’m in control of my eating 90 percent of the time now,” she says. “I have to struggle with it every day.”
The “Almost Eating Disorder”

Sarah is typical of most of the patients seen by Elena Ramirez, Ph.D. (co-founder of VCCBT) in that her eating patterns frequently spiraled out of control, but not nearly enough to qualify as having a classic eating disorder like bulimia or anorexia. Nor does she fit the profile of a more recently recognized problem, binge eating disorder, or BED—which features regular bulimia-like binges but without its “purging” behaviors (like vomiting and laxative abuse). “I see a lot of people with subclinical eating problems who fall between the cracks,” Ramirez explains. Many, like Sarah, “use food to distract themselves from negative emotions like anxiety, fear or anger.” Some, she adds, are serial dieters who have been so restrictive about what they can or can’t eat that when they finally do give in to that forbidden bite of pizza or chocolate, “they think they don’t have any control at all, and just eat everything in sight.”