Exam Room Nutrition: Nutrition Education for Health Professionals

Mini Series | A Provider's Guide to Helping Patients Lose Weight: Part 3 | End Emotional Eating

January 25, 2024 Colleen Sloan, PA-C, RDN
Exam Room Nutrition: Nutrition Education for Health Professionals
Mini Series | A Provider's Guide to Helping Patients Lose Weight: Part 3 | End Emotional Eating
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Show Notes Transcript Chapter Markers

 It's not just about what your patient eats, but why.  This week we’re unpacking ways you can help your patient navigate stress and emotional triggers that derail their health journey.  Join me, Colleen Sloan, on the third episode of this 10-part series to help guide your patients on their weight loss journey.

If you're a primary care provider looking to enhance your nutrition counseling skills or simply seeking a refresher, join me as we make our patients healthier, one exam room at a time!

Grab the companion PDF at examroomnutrition.com/weightloss, and let's confidently guide our patients towards their best lives in 2024.

10 Principles of Intuitive Eating

Mindful Eating: The Art of Presence While You Eat 

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Speaker 1:

You do not rise to the level of your goals, you fall to the level of your systems. Your goal is your desired outcome. Your system is the collection of daily habits that will get you there. This year, spend less time focusing on outcomes and more time focusing on the habits that precede the results. That's a quote by James Cleary in his book Atomic Habits. You're listening to the Exam Room Nutrition Podcast mini series called A Provider's Guide to Helping Patients Lose Weight. I'm your host, colleen Sloan. I'm an RD turned PA, and my goal is to give you the nutrition education you never had in school to help you be a more confident, compassionate clinician. This is part three of a 10 part series, and last week we discussed why BMI shouldn't be the only metric you're measuring to track patient success. This week we're unpacking ways you can help your patient navigate stress and emotional triggers that derail their health journey. As a quick reminder, if you would like my notes on this series, I have created a companion PDF for you that summarizes each and every episode. You can find that for free at examroomnutritioncom. Slash weight loss. That's examroomnutritioncom. Slash weight loss. I know you're thinking, colleen. I thought this podcast series was about weight loss. Why are we talking about solutions for stress and emotions? I promise we'll get to the nutrition and diet specifics next week, but helping your patient's plan and set up strategies for coping with stress and emotions is crucial if they are going to succeed in their weight loss journey. One of the biggest reasons people fail in their weight loss journey is they get stuck on the diet, binge diet, merry, go round. Think about your patient's weight loss history. They desire to lose weight. They find a diet that's usually very restrictive. They can stick to it for a little while because having a routine and systems is helpful. But then, bam, something happens Good, bad or otherwise and they stop eating those foods permitted on their diet and then they stay stuck in their previous eating habits. And round and round. We go on this cycle. But what's really going on here? Some trigger whether it be stress or emotions, good or bad cause the patient to turn to food for comfort. Patients are trying to use food as a solution to fight an emotional problem. Unfortunately, as we know, that never works. Other causes of failed attempts at weight loss include fear of failure, having an all or nothing mentality, unrealistic goals and stress, just to mention a few. But for the purpose of today's episode. We're going to address emotional and stress eating and how to help our patients prepare for the inevitable fact of life that life happens Okay. So what exactly is emotional eating? It's defined as eating for reasons other than hunger, to escape, numb, change or amplify our feelings in response to positive or negative emotions. Notice how I didn't just say negative emotions. Now let's look at some of the common emotions that cause us to eat when we aren't really hungry. First of all, negative feelings, such as sadness, guilt, frustration, anxiety, anger, stress, loneliness or fear. These negative feelings are often caused by major life events, such as a breakup or divorce, job layoff, death in the family or other relationship troubles. Number two, positive feelings like happiness. This is commonly seen when we use food as a reward for achieving a promotion at work or receiving a good grade at school. Number three, boredom. No explanation needed here, right? I mean, how many times have you reached for a handful of chips just because they were there? Or consumed a whole box of Oreos while watching a movie? And lastly, stress. Psychologically, food is associated with comfort and stability. Food is also something we can control. So, even though life may seem to be spiraling out of control, the food we eat, when we eat it and how much we eat are all within our own strict control. This can be a powerful source of comfort and stability to those who lack comfort and stability in their daily lives. Emotional eating typically drives people to crave foods that are high in calories, carbohydrates and fat, because those foods tend to be highly palatable. Eating to resolve emotions doesn't actually ever work. Actually, quite the opposite ends up happening. The patient just ends up feeling guilty, angry with themselves and frustrated with their diet, which ultimately ends in hopelessness and further emotional eating. All right, now that we understand what emotional eating is, how can we help our patients? We're going to get very practical here, so come back to me if you're multitasking. First, we need our patient to identify their trigger. It is very important for your patient to know exactly what is causing them to emotionally eat Stress, boredom or a happy or sad emotion. A good way to identify patterns in eating is to start a food and mood journal For a few days. Have your patient record what they ate, when they ate it, why they ate are they hungry, bored, lonely and what emotions they felt prior to eating. It's also really important for patients to distinguish between cravings and hunger. Patients need to learn if they are actually hungry or just craving a food. The cause of a lot of late night binge eating is because patients are underfueling throughout the day, so they are truly hungry by the end of the day and their body is sending them signals to crave high fat, high calorie foods. Knowing the difference between a craving and true hunger can contribute to greater self-awareness. Cravings are usually sudden, temporary, a mental response to a situation. They typically involve immediate satisfaction, followed by guilt, and often times only certain foods will satisfy. Hunger, on the other hand, is gradual and permanent. It's a physiological response to a need and it involves satiety followed by satisfaction, and usually any food will satisfy. So we've talked about having our patients identify their trigger and understand cravings versus hunger, but I think it's important to stress that our patients cannot use a food solution for any emotional problem. That's why the eating-related tips and food rules don't work for everyone. Because it assumes the behavior is due to a lack of self-control. Remember, eating is human nature. Wanting comfort food is normal. Instead, the real issue is the uncomfortable emotion patients are feeling that's causing them to turn to food as a coping mechanism. It is vital that patients learn to target the underlying emotion that's causing them to eat in a way that's productive and that actually addresses the emotion itself. Simply stated, patients need to learn how to feel and find. Feel their emotion and find a solution. First, feel the emotion. This is where identifying the trigger and writing it down is an important first step. This needs to be done without judgment or guilt. Teach your patients to take a moment, recognize the reason they are eating and write it down in their Food Mood Journal. Next, find a productive solution. Remember the problem is emotions, not the food. So we need an emotional solution to an emotional problem. This is where patients need to choose a better coping mechanism than food. There is no right answer here, because it all depends on the emotion a patient is struggling with. But here are some helpful strategies for coping with some common emotions. If they're struggling with stress, suggest they do some breathing exercises, like box breathing. If they meditate or say a prayer, maybe take a 5 or 10 minute walk. Do some yoga or journal. If they're struggling with loneliness, suggest they join a local church or a club. Maybe they can volunteer or get a pet companion. Maybe they can text, call or video chat with a friend or loved one. If your patient finds that they go to food because of happiness or celebration, suggest a non-food reward like getting your nails done or buying a new golf club. Maybe go dance or exercise or even call a friend. If they're sad, maybe suggest starting a grateful journal and every day have them write something that they are thankful for. Or go for a walk, listen to or maybe watch comedy to uplift your mood. If they're bored, suggest they find a hobby or learn something new. Maybe clean or organize a closet. Call a friend you could write letters to a family member or watch a movie or read a book. If they struggle with anxiety, suggest they do some deep breathing or progressive muscle relaxation. Maybe consider journaling. Go for a walk, invite in a friend or consider reaching out to a counselor or therapist. Learning how to cope with something other than food is the key to a lifelong healthy relationship with food. Now, before I move into getting into the details of the principle of mindful eating, I want to pause here and remind you of the importance of evaluating whether the patient is suffering from an eating disorder. Consumers don't always have to be significantly underweight or deemed failure to thrive to be considered to have an eating disorder. Binge eating disorder includes reoccurring episodes once a week for three months, where a person consumes a large amount of food in a short amount of time and feel as though they can't control what or how much they are eating. Other common characteristics that may be present include eating to the point of physical discomfort, feelings of guilt, embarrassment and shame, eating in secret or eating more quickly than normal. While diagnosing an eating disorder may or may not be within your scope of practice, if you have any concern for your patient, I would highly recommend referring that patient to a mental health professional to give them the individualized care they deserve. Being a patient with an eating disorder on another diet only worsens the problem. Alright, I want to close by explaining two main strategies you'll hear in navigating emotional eating, and that is mindful eating and intuitive eating. Now, by no means am I an expert in either of these. However, I think it's important for you to have an understanding of their differences and similarities and how you can incorporate their framework into your practice. The term mindfulness was defined by John Kabat-Zinn as paying attention in a particular way, on purpose, in the present moment and non-judgmentally. Kabat-zinn was the original developer and leader of the Mindfulness-Based Stress Reduction Program at the University of Massachusetts Medical School in 1979. Mindfulness, actually a practice based in Zen Buddhism, is a popular way of self-calming and a method for changing eating behaviors. I'm going to read a quote from an article titled Mindful Eating the Art of Presence While you Eat, which can be found in the 2017 Diabetes Spectrum. I'm going to link to it in the show notes below. It says Mindful Eating paying attention to our food on purpose, moment by moment, without judgment is an approach to food that focuses on individual's sensual awareness of the food and their experience of the food. It has little to do with calories, carbohydrates, fat or protein. The purpose of mindful eating is not to lose weight, although it is highly likely that those who adopt this style of eating will lose weight. The intention is to help individuals savor the moment and the food and encourage their full presence for the eating experience. Mindful eating brings mindfulness to food choices and the experience of eating. It helps us become aware of our thoughts, feelings and physical sensations related to eating, reconnecting us with our innate inner wisdom about hunger and satiety. While this sounds straightforward, the process can be quite complex, especially for those inclined to multitasking. Intuitive Eating was founded by two dietitians, evelyn Treboly and Elise Rush, in 1995. It is an evidence-based mind-body health approach comprised of 10 principles. Intuitive eating is a weight-inclusive, anti-diet approach aligned with the health at every size movement. It involves aspects like physical activity, body respect, rejecting the diet mentality and using nutrition principles without judgment for informed food decisions and well-being. Mindful eating is considered a tool, while intuitive eating is an entire framework comprised of 10 principles to achieve overall well-being that extend even deeper than mindful eating. Let's discuss their differences and how they can be incorporated into your patient encounters. Eating mindfully is about bringing full awareness to each plate or bite of food. It begins with the first thought about food and lasts until the final bite is swallowed. Some of the following suggestions will be useful in teaching methods to eat mindfully. Before reaching for a food, automatically stop and take a moment to notice what you are feeling. Are you stressed, bored, angry or sad? Are you lonely? Are you actually physically hungry? Be mindful of your feelings. If your desire is not about hunger, do something else more appropriate for the desire. As we discussed earlier. Eat intentionally and only eat. Put away all other distractions and pay attention to your food. Savor each bite and think about the food's flavor, texture and smell. Chew thoroughly and, after each bite, check in with your body to see how you are feeling. Have you had enough? Do you need more? Is it time to stop? Then move on to whatever you have chosen. You can teach your patients how to be more mindful when they are eating, as a helpful tool to stop emotional eating Now. Intuitive eating helps the patient unlearn the negative messages about food and eating that society has taught them to believe. Through the following 10 principles, a patient will learn how to make peace with food, listen to their body and honor their hunger. For the sake of time, I won't go into details for all 10 principles, but I have included a link in the show notes if you want to learn more about intuitive eating or become a certified intuitive eating counselor. Here are the 10 principles of intuitive eating 1. Reject the diet mentality. 2. Honor your hunger. 3. Make peace with food. 4. Challenge the food police. 5. Discover the satisfaction factor. 6. Feel your fullness. 7. Cope with your emotions with kindness. 8. Respect your body. 9. Live healthy. 10. Honor your Health. I love that these principles help patients make food choices that honor their health and taste buds without any feelings of guilt. It reminds patients that they don't have to eat perfectly to be healthy, but they encourage consistency. Progress, not perfection, is what counts. You can easily help your patient put these principles into practice with a 10-day challenge where one principle is focused on each day. Another exercise you can suggest your patient do as part of planning for their health and weight loss journey is to get a piece of paper and draw a line down the middle, to make two columns and, on one side, list out known triggers for overeating and, on the other side, write one to two solutions they could realistically do. Remember we cannot solve an emotional problem with food. We need an emotional solution for an emotional problem. I'll close with another quote from the book Atomic Habits. Your identity can hold you back. I'm terrible with directions. I have a sweet tooth. I'm bad at math or it can build you up. I'm the type of person who doesn't miss workouts. I finish what I start. I read every day Build habits that reinforce your desired identity. Alright, that's it for this week. Next week we dive into macronutrients, their function and why a balance is key. I hope this series has been helpful. Please shoot me a DM on Instagram at Exam Room Nutrition and let me know. Until next time, let's continue to make our patients healthier, one exam room at a time. I'll see you next week. As a quick reminder, if you would like my notes on this series, I have created a companion PDF for you that summarizes each and every episode. You can find that for free at examrimnutritioncom. Slash weight loss. That's examrimnutritioncom. Slash weight loss.

Understanding Emotional Eating and Helping Coping
Mindful Eating and Intuitive Eating