One of my clients this week told me she would never get control of her diabetes because she's addicted to food. She looks at food as the enemy, and believes she's losing the battle.

How do you address the topic of food addiction for your clients with diabetes? Are there specific counseling techniques you've found helpful?

Lynn:
This is something I hear all the time! 

When folks talk about it, they often describe the "call of the refrigerator". 

I often ask them to help me understand if it's a particular food, or as many say it's---all carbs (and chocolate). 
Using Motivational Interviewing techniques we work at identifying areas they would like to try changing and sometimes it's not even food related.

I work at developing communication skills, so sometimes they won't need to use food to help with calming their nerves.

I've not done a lot of reading of the science on this...are there any good articles others might recommend?

 

When my patients tell me they’re addicted to food, I think it’s their way of confessing a lack of control, whether they really believe they are addicted or not. These are often the same people who feel that they have to do everything exactly by the rule book. They don’t seem to grasp the concept of moderation. It’s either “I’m good” or “I’m horrible and destined to be this way forever.” I wonder when they say addicted if they really think that it’s an addiction the way people are addicted to nicotine or heroine. Regardless, this is a difficult area to address. I think building confidence is an important first step. It sounds like you might be doing the same thing Joan when you identify areas to work on that may or may not be related to food. I often ask my patients to describe on a scale of 1 to 10, how confident they are that they can achieve the goal they just stated. If the number is relatively low, we pick something a bit easier to build confidence.

You may find the following links about food addiction interesting. A few years ago, I heard of scientists at Brookhaven National Laboratory studying this. The first I heard about it was the description that an area of the brain in obese people light up on PET scans in response to food the same way that it does in response to addictive drugs in addicts. This has to do with dopamine.

The Brookhaven researchers reported in the Lancet that obese people have fewer dopamine receptors than lean individuals. The inference is that obese individuals may eat more to stimulate the dopamine pleasure response -  the same way addicts do by taking drugs. Here are two links to the Brookhaven site.

Scientists find link between dopamine and obesity: http://www.bnl.gov/bnlweb/pubaf/pr/2001/bnlpr020101.htm

Mere sight/smell of food spikes levels of brain pleasure chemical: http://www.bnl.gov/bnlweb/pubaf/pr/2002/bnlpr052002.htm

I don’t know anything about the Obesity and Food Addiction Summit, but I found this link while I was looking for the others. I don’t know who sponsored the meeting, but the talks look interesting.

http://www.foodaddictionsummit.org/index.htm

I agree with Jill, in my experience, patients who state they are food addicts take things to the extreme, and like to stay on the "im terrible" side of the extreme.  I also try to get to the root of the problem.  Do they find themselves eating at inappropriate times? Do their emotions rule their eating patterns?  We used to have a wonderful therapist who's specialty was behavioral health who could help us with patients such as this, unfortunately we do not have this person anymore. So, if we feel it is warranted, we have a behavioral health center we can refer patients to, although most do not go.

Judy, why do you think people were willing to talk with the therapist on your team, but aren't willing to go to the behavioral health center? We've often talked about the need to find a local therapist familiar with diabetes, but have not been able to make any headway with this.

I think it has to do with the stigma of seeing a therapist.  I believe the patients feel that if they can see a therapist in the comfort of the center then they wouldnt have to go to the behavioral health center with the other patients who are being treated there. I can certainly understand their fears and frustrations and I can see how it was easier for the patients to come to a comfortable, familiar environment rather than go to a new center where they were not sure how they would be received or treated.  Just my theory.

Has any one see the book by Neal Barnard "Breaking the Food Seduction".  I was just watching PBS and there was an promo to purchase this book, along with his Reversing Diabetes, using a vegan meal plan approach.

I saw a person today with type 2 on Lantus and metformin, and her primary issue is emotional eating and/or food addiction. She described many of the black and white types of thinking that we discussed already on this thread.  She initially resisted coming to see 'the dietitian' because she didn't want to hear about what she should or shouldn't eat - she already knows all of that. Knowledge isn't her issue, it's figuring out how to learn new ways of dealing with stress and emotions that lead her to overeating. It was really interesting that during our discussion she was able to pull from many resources:  her yoga teacher encouraging her to slow down, focus on her breath, and get in touch with her body as a way to slow down her mind and decrease stress; her PT for giving her a meditation CD that helps her slow down her racing thoughts and quiet her mind; her chiropactor for for being willing to listen to her rants (as she describes them) without judging her; a therapist who suggested that she give herself permission to eat whatever she wants and then negotiate with herself to find a middle ground as a way to quiet the rebel within her who insists on pushing back against what she 'can and can't eat'.

I'm really looking forward to a follow-up session with her to find out where this journey takes her, and how I can best help her reach her stated long-term goals of eating with awareness and waking up in the morning feeling refreshed and energetic. She really likes to read information and learn all about a topic before she makes any changes in her habits; does anyone have any ideas of books/articles that she might find helpful?

A lot of my patients say they are addicted to food. I can't disagree with them, we need to eat to stay alive!

The problem I find is when people argue that they love to eat, and they love to eat more than other people. Again, I tell them, yes, you love to eat. You need to love to eat. It's an instinct to keep you alive. I tell them other people love to eat too. I even tell them I love to eat.

I work with them to help them understand if they believe they love to eat more than other people need to eat, this actually will make them feel hopeless, as if there is no hope for them.

Realizing that others love to eat also, has been helpful for many of my patients. They don't feel so different and so hopeless.

That's just a piece of the puzzle, but a helpful one that I've found.

Thank you!!

EnJOY!

Joy

Thanks for sharing your suggestions Joy. I heard Michelle May, MD speak at a conference last week about this topic. She's the author of "Am I Hungry", a book that addresses paying attention to our internal cues for eating. I was really intrigued by her talk, and plan to read the book. You can find more info here:  www.amihungry.com  Has anyone read her work, and implemented it in your practice?