Dr. Andrew Siegel on Helping People Who Can’t Stop Eating

by mortylefkoe on July 24, 2012

Morty: Hi this is Morty Lefkoe with our podcast on emotional eating for this week. I’m very happy to have as our guest Dr. Andrew Siegel, who is a physician and educator. He’s going to talk to us about all of the different ways in which a healthy lifestyle can be useful for those of us who just can’t stop eating. You might discover some interesting ideas that you haven’t had before on how you can do that.

He’s written at least one book that I know of called Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. So let’s get right on with our talk to Dr. Siegel and see if he has some ideas for people with an emotional eating problem.

Andrew, Maybe you can help us come up with some ideas. And thank you for being here.

Andrew: Thanks. Absolutely my pleasure. Thank you for inviting me.

Morty: I noticed you’re casual tonight. You just came back from your long day at work and you got comfortable. I’m glad you did that. So let’s just have a little conversation. Where do you live and operate from?

Andrew: I live in Richwood, New Jersey. Right outside New York City.

Morty: Okay, very good. I’m actually going to be there in a couple of weeks. I used to live in New York and I now live in San Francisco. I’m going to go back for a week and become a real tourist. So I’m looking forward to getting back there.

Andrew: Fantastic.

Morty: So how did you get interested? You’re a doctor and you say you’re a surgeon, an educator. How did you go from being a general practitioner and a surgeon to getting involved and interested in the area of emotional eating?

Andrew: Well I’m actually a urologist and one of my passions is preventative medicine, preventative health, wellness. For years, I’ve recognized the importance of healthy eating, exercise and other measures that can be taken to avoid the doctor and avoid the hospital. That is really how I got interested in eating, longevity, and general health.

I realized that one-third of my patients are overweight, one-third of my patients are obese, and one third are of a healthy weight. It’s not just my patients, it’s a rampant and highly prevalent problem in the United States.

I also recognized, when being introspective, that I am an emotional eater. I’m healthy as can be–I exercise daily, I’m a good eater. But I recognized that here I am, a very healthy person who’s a practitioner of wellness and preventative health measures and yet under many circumstances I find myself eating when not actually hungry.

If that’s the case, then what’s happening to these people who are overweight or obese? Actually, when you break eating down, there are three general reasons why somebody brings food to mouth. One of course is genuine hunger. Another is circumstances that are often beyond our control–you’re at work and there’s a tray of donuts out, you’re at a religious celebration, you’re out to dinner with friends, et cetera. And the third is emotional eating. And I think it’s huge.

In my own situation, I often find that if I’m extremely stressed, extremely fatigued, I seek solace and comfort through foods. Even though I’m genuinely hungry, I find sometimes as well that if I’m put in a situation where I’m not particularly satisfied, happy or fulfilled, I will come home late at night and seek fulfillment through filling my stomach.

Morty: Yes, that’s how it works. Okay.

Andrew: It’s basically maladaptive. In my case I’ll come to work, I’ll exercise, I’m generally a really quite healthy eater. But I realize that if that’s the case with a healthy, fit person, then what’s happening with the average person? One who’s not nutritionally conscientious, who’s not a daily exerciser? In a world where stresses predominate and get worse every day?

So that’s really what got me interested in the situation. So what I started doing was casually asking some of my patients a simple question. It’s: “Under what circumstances do you eat when you’re not genuinely hungry?”

And I started tallying this information. I wanted to know what they ate, what the circumstances were, if the eating satisfied their need and soothed them afterwards, and what were the ramifications afterwards. Did they feel guilt, did they feel satisfied, etc.

I planned on interviewing about hundred people. It wasn’t just patients. It was friends and family. Anybody I came in contact with. All races, all religions, all ages, all weights–skinny, heavy, obese.

Morty: And what were the triggers you found?

Andrew: I think the largest trigger is stress. Stress, anxiety. Depression. Sadness. Unhappiness. Boredom. Fugue. Fatigue. Remarkably consistent. It’s mostly negative emotions that drive maladaptive eating behaviors.

Interestingly enough, negative emotions tend to be quelled with unhealthy foods. Negative foods. Don’t get me wrong, on occasion happiness and positive emotions drive reward eating. “I’m going to celebrate with an ice cream, I’m going to treat myself to this.” So any range of emotions can demand eating in some form or another.

Morty: In my work I’ve discovered that there were what I call triggers and rewards. The triggers are negative feelings like nervousness, boredom, loneliness, depression, stress, et cetera. The ones you’ve mentioned, I’ve actually found out about twenty-one or twenty-two.

In addition to that, you can also be conditioned with rewards. When you want to celebrate–when you want to give yourself pleasure, when you want to reward yourself–you can actually be conditioned to want to eat for reward. Just as well you can be conditioned to need to eat to deal with negative feelings.

So I’ve got pretty much the same experience as you do. I’m just sort of tracking along to see if you’ve got something different than me. So far we have found the same thing that there are triggers to deal with negative feelings and we also are conditioned to eat to achieve, to attain positive feelings.

Andrew: No question about that.

Morty: So where did you go from there? So now you’ve got all this information and you found out what the triggers were. What did you do then?

Andrew: I basically put this information together and I wrote a book about essentially what drives us to eat when we’re not hungry.

Listen, although I’m very interested in psychology–I’m a psychology minor in college–I am not a psychologist. I’m not a psychiatrist. I do not do therapy with individual patients. I just have a profound interest in wellness and health and I think this is an important subcomponent of it.

I’m very interested in nutrition. Exercise as well. And I’m very very interested in why we eat when we’re not hungry in a non-emotional basis because I think that’s a huge problem as well.

Morty: Do you actually find that? Because the one thing you’ve said so far, it’s a minor disagreement. But when you say there are three things when we eat: when we’re genuinely hungry, when there’s emotional eating, and circumstances.

Because I have found that people who eat because the food is there at parties etc. do not do that if there’s not an emotional component. That people who are in that third of normal eaters do not eat just because they’re at the party and there’s food. If they’re not hungry and there’s a big buffet, they’ll have a little bit and as soon as they’re full they’ll stop. Whereas emotional eaters will continue eating.

So I don’t know that circumstances as such would have a normal eater eating. If there’s food around and you’re not hungry, if there’s not some emotional thing going on, I’m not sure that circumstances as such would have you eat. Maybe, but that’s not my experience.

People who say that to me, if I look and say “What are you feeling when you eat?” There’s some belief, there’s something there. For example, “If I don’t eat it now, it won’t be there later” and “The way to be accepted is to be doing what everybody else is doing.”

But there is some belief or trigger that’s involved when somebody’s eating when there’s food around. They’re not just eating just because there’s food. Because many people do not just eat because there’s food.

Andrew: I fully agree with you that if you are an emotional eater and you’re put in a situation where you’ve got ready access and exposure to food then you are going to be the one likely to consume. But by the same token, if I’m sitting there on break at the surgery center and there’s a plateful of bagels or donuts out there, it is–I call it temptation eating, opportunistic eating, social eating, habit eating. I think those are all factors that come into play.

I am not saying I abuse the situation. I have a bite or two. But I do think in America there’s a lot of eating that goes around by the water cooler in offices. You might be right, that underlying that, there are emotional reasons for this.

Morty: Well, you have actually done a survey of over a hundred people so let me ask you. Did the people who say that they don’t gain weight, that their eating is normally healthy, that they do not consider themselves emotional eaters, who basically have all the signposts for normal healthy eating–did those people also eat just because there was food around?

Andrew: Yes, largely so. And I truly feel that we are all at some level emotional eaters. We bring our emotions to every situation which we are involved in. I think that humans literally bring their emotions to the table and some have much better control than others do.

I basically think that on a most primal level locating back to infancy, there was a time when we were frightened infants bursting with emotions and fears. And we were soothed and sought solace by breastfeeding by our mother, by oral pacification. And I think what happens is we grow old, we grow older, but deep inside there is still this sense of oral stimulation as a means of providing relief from anxiety, worries, tension, and pressure that lives on.

Morty: That could very well be. That very well may be true for everybody. I’ve never asked people who don’t come to me with an emotional eating problem the kind of survey that you did. So I find people who are obviously emotional eaters. And their emotional eating is part of their circumstantial eating.

It’d be interesting for me to start asking my friends who basically say food is no big deal for them, that only when they are hungry and they never eat when they’re not hungry: “What do you do when you’re at a buffet or a party and there’s food around and you’re not hungry? Do you just say ‘I’m not hungry’ or do you eat some of it anyway?”

It’d be interesting for me to do some research myself and see if there’s such a thing as circumstantial eating apart from emotional eating. That very well may be, I will check that out. I thank you for raising that.

Andrew: I’ll give you another example. Something that I call accessory eating. Which in my terms is eating that is linked to activities. Almost Pavlovian association. For example, going to the movies and getting popcorn and soda and candy. Or just sitting down at night and watching television. And turning on the television and having a compelling need to eat something, whether you’re hungry or not. Almost a conditioned response. I think that it’s an entirely common phenomenon.

The other thing I wanted to mention too is that in surveying a hundred people or so, there are people who are emotional non-eaters as well. I failed to mention that. People who deal with stress by avoiding eating. And then there are those who are over-consumers. It’s very interesting, the wide range of how we metabolize our feelings.

Morty: Yes. So in your practice, you do not then treat emotional eating. You wrote a book about it. You have some ideas on it. But you actually don’t work with people to help them with emotional eating. The only way you’re trying to help people is via your book, not with your practice. Is that correct?

Andrew: That is largely true. But when I see any patient, I really try to treat them as an integral whole and I deal with weight issues and eating issues. I will send people to the nutritionist, I would refer people to a psychologist. When I think that condition arises, I do a plot of nutrition and exercise and some aspects of emotional eating. I try to do what I can do.

But once again, I am not a therapist and the thrust is the book.

Morty: Well that’s fascinating because everybody that I’ve interviewed so far have sort of been a private practitioner or an author who still has some sort of course or private practice or working with some institution. So far you are the only person who has actually written a book about it almost like as a hobby, as an interest, as a contribution you wanted to make to people because of the extent of the problem. Even though it’s not something you worked on yourself.

So hopefully we could get some people to take a look at your book. The book is called: Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food and it’s by Andrew Siegel. S-I-E-G-E-L MD.

You can get some information about what Andrew’s come up with in terms of what did he discover in his interviews with a hundred people, and from his practice with people where he talks to people about their general well-being, their nutrition, their general health, their exercise et cetera. So it sounds like this book is going to have a lot of very interesting information even though Andrew doesn’t work with people directly. You only get to see him if you’ve got a problem with urology. Other than that, you’re going to have to find somebody else.

But it probably is very worthwhile to take a look at the book. I’ve got a bunch of books on eating and I can’t catch up with all of them. But given what you’ve said so far, it’s real small. It’s only a hundred and twenty-eight pages so I think I’m going to try and get through it myself and take a look. It sounds like you’ve got some really interesting ideas in there.

Andrew: Thank you Morty.

Morty: Anything else you’d like to say to our audience about what you consider the solution to be? You say you don’t work with people yourself, you refer them to therapists and so on. But given what you’ve identified as the problem, do you have any specific ideas if you were just giving advice before somebody saw a therapist? What would your basic advice be? Your basic solution to the problem of emotional eating?

Andrew: Well I find that a lot of emotional eating–and also circumstantial eating–tends to be mindless eating. You lose focus, you’re not paying attention. You’re in another world. So I always think that first and foremost, making an effort to be mindful is extremely helpful. Try and understand or ask yourself these questions: “Why am I eating?” “What am I eating?” “How am I eating?” “When am I eating?” These are all significant questions.

When somebody suffers from these issues, the use of a pen and paper–a diary if you will–can be extremely helpful. Essentially writing down what you eat, why you’re eating. And if it’s not for genuine hunger, is it satisfying the emotional hunger? What are the ramifications afterwards? If it’s stress, is your stress relieved? Are you more stressed afterwards?

I’ve found that a good majority of people who are stress eaters for example end up with a secondary stress based upon the overeating from the initial stress.

Morty: Yes. People feel guilty when they do not want to eat and say “I’m not going to do it again” and then they end up doing it. You then end up with more negative feelings when you’re done as a result of having eaten. I see that all the time.

Andrew: What I’m trying to say is that I think being aware, being conscious, being mindful, trying to understand the introspective is first and foremost. There are whole hosts of behavioral tactics and strategies that I think can be employed also. I think I have twenty or twenty-five or thirty in the book. Little things.

One thing for example, I call “Vaccination and Inoculation”. Which means you’re in the office. It’s somebody’s birthday party and they’re going to carve up an ice-cream cake. And they carve it into eight big pieces. Well you’re trying to lose weight, you’re overweight, you’re stressed, you’re tired, you’re at work. You want to be social and join everybody. You don’t want to look like an anti-social pariah. So “Vaccination and Inoculation” is have a little piece. Have a vaccination. Have an inoculation. So you don’t end up with a disease. The obesity disease. Things like that.

There are a whole host of minor things that can be done. If you can’t deal with the situation fully on a mindful basis, you can at least try to re-engineer your environment in such a way that you are less likely to succumb to mindless eating, emotional eating, etc.

Other good management protocols are, for example, if you are stressed and you find yourself going to the refrigerator and you must eat here. Take what you want but the rest of it as I’ve just mentioned, eat something else. Have something healthier. Teach yourself to enjoy eating a piece of fruit. Another possibility is instead of eating to quell emotional hunger, use an alternative activity. Exercise for one. It releases the same dopamine and opiates in the brain that eating a Cinnabon does, for example.

Morty: Well it sounds as if this is very exciting. You’ve got a whole bunch of techniques that might be very useful to a lot of people. So again, it’s Promiscuous Eating by Dr. Andrew Siegel. S-I-E-G-E-L. Let’s see if we can get some of our listeners and the people reading the transcript of this to check it out.

Thank you so much for giving us a few minutes of your time at the end of a busy day at the office. I will let you know when this thing is up but I think a lot of our readers are going to find this really fascinating.

Thank you Andrew, I really appreciate it.

Andrew: Absolutely my pleasure. Thank you.

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