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Food Addictions Aug 2008
 

Food Addictions Aug 2008

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    Food Addictions Aug 2008 Food Addictions Aug 2008 Presentation Transcript

    • Food Addiction, Eating Disorders and “Normal” Overeating: What’s the Difference? Presented by: Sandee Nebel, LMHC President White Picket Fence Counseling Center, LLC Stacy Seikel, MD Board Certified Addiction Medicine Board Certified Anesthesiology
      • Understand the difference between “normal” overeating, eating disorders and food addiction
      • Review recent literature on food addiction
      • Understand treatment of food addiction
      OBJECTIVES
      • The Problem
      • The Solution
      • What Works
      OVERVIEW “NORMAL” EATER (WITH OBESITY), EATING DISORDERS, FOOD ADDICTION Philip Werdell, copyright, 2007
      • The PROBLEM is physical:
        • Weight
      “ NORMAL” OVEREATER (WITH OBESITY)
      • The SOLUTION is physical :
        • Medically approved dieting
        • Moderate exercise
        • Support for eating, exercise and lifestyle change
      “ NORMAL” OVEREATER (WITH OBESITY)
      • What Works :
        • Willpower
        • Bariatric Surgery
        • Diets
      “ NORMAL” OVEREATER (WITH OBESITY)
      • The PROBLEM is physical AND mental-emotional
        • Binge eating, restricting and/or purging over feelings (use food to numb or medicate feelings)
        • Unresolved trauma
        • Possibly weight (sometimes underweight, sometimes overweight, sometimes normal weight)
      EATING DISORDERS (EMOTIONAL EATER)
    • EATING DISORDERS
      • Binge Eating Disorder
      • - Recurrent binge eating
      • - Sense of lack of control
      • - Eating fast
      • - Eating until uncomfortably full
      • - Eating when not hungry
      • - Eating alone
      • - Feeling disgusted about eating
      • - 2 days/week for 6 months
    • EATING DISORDERS
      • Bulimia Nervosa
      • - Recurrent binge eating
      • - Recurrent compensatory behavior
      • to prevent weight gain
          • vomiting
          • fasting
          • laxative use
          • exercise
          • diuretics
      • - Twice a week for 3 months
    • EATING DISORDERS
      • Anorexia Nervosa
      • - Refusal to maintain normal body weight
      • - Intense fear of gaining weight even when
      • underweight
      • - Disturbance about body weight or shape
      • - Denial of seriousness of low body weight
      • - Absence of at least 3 consecutive menstrual
      • cycles
      • The SOLUTION is
        • mental-emotional
          • Develop skills to cope with feelings other than restricting, bingeing and/or purging
          • Resolve past trauma and irrational thinking
      • The SOLUTION is also
        • physical
          • as with the “Normal” Overeater (with obesity) (diet, exercise, support)
      EATING DISORDERS
      • WHAT WORKS :
        • Moderation (along with feeling the feelings)
      EATING DISORDERS
      • The PROBLEM is physical , mental-emotional AND spiritual (i.e. – 12 step solution as with alcoholic and drug addicted).
        • Physical craving (false starving) produced by eating addictive foods
        • Mental obsession (false thinking)
      FOOD ADDICTED (CHEMICALLY DEPENDENT)
      • The SOLUTION is spiritual , mental-emotional , AND physical.
        • Abstinence from binge/trigger foods and abusive eating behaviors
        • Rigorous honesty about all thoughts and feelings
        • A disciplined spiritual program (12 Step)
        • And the mental-emotional and physical solutions
      FOOD ADDICTED (CHEMICALLY DEPENDENT)
      • WHAT WORKS :
        • Surrender to a food plan which eliminates addictive foods
        • Surrender to rigorous honesty about thoughts and feelings
        • Surrender to whatever structure and support is needed
      FOOD ADDICTED (CHEMICALLY DEPENDENT)
      • Dieting to lose weight
        • Assumes you need to take control
        • Focus on physical recovery
      • Abstaining to be in recovery
        • Assumes control by will alone is not possible (addictive foods take over brain)
        • Works on mental-emotional and spiritual recovery as well as physical recovery
      THE COMPARISON BETWEEN DIETING AND FOOD ABSTINENCE
      • DIETING
        • Focus on putting distractions out of mind
        • Time frame is limited-you lose weight and you are done
      • FOOD ABSTINENCE
        • Focus on sharing thoughts and feelings that are in the way and dealing with them
        • The time frame is one day at a time for the rest of your life.
      DIETING AND FOOD ABSTINENCE (CON’T)
      • DIETING
        • The best plans are straight forward and reasonable (i.e., sugar in moderation eliminates craving).
        • The work is a matter of willpower.
      • FOOD ABSTINENCE
        • The best plans sometimes seem paradoxical (i.e., eliminating sugar decreases craving).
        • The work is to gracefully surrender.
      DIETING AND FOOD ABSTINENCE (CON’T)
    • COMPARISON BETWEEN EATING DISORDERS AND FOOD ADDICTION RECOVERY WORK
      • EATING DISORDER
        • Traditional eating disorder therapy assumes the problem is not the food .
        • Biopsychosocial (emphasis on psychological)
      • FOOD ADDICTION
        • Food addiction recovery work assumes the problem is the food, as well as feelings, trauma and sometimes weight.
        • Biopsychosocial (all are emphasized)
      • The obese “normal” overeater can diet successfully.
      • The morbidly obese “normal” overeater is an excellent candidate for bariatric surgery.
      IN SUMMARY: “ NORMAL” OVEREATER
      • Anorexics, bulimics and binge-eaters are successfully treated by a range of therapies from CBT to expressive, as well as guidance from a dietician, and sometimes medication management.
      IN SUMMARY: EATING DISORDERS
      • Medication Management for ED
        • SSRI’s
        • Topamax
        • Luvox
        • Naltrexone
      IN SUMMERY: EATING DISORDERS
      • Some food addicts have few underlying issues apart from their chemical dependency on food.
      • These people are successful in 12 Step programs and can be successful from the beginning without much need for additional professional support.
      IN SUMMARY: FOOD ADDICTED
      • We see concurrent obesity, eating disorder and food addiction.
      • In these cases, when food addiction is advanced, we have seen success when the food addiction is treated as the primary disease, along with therapeutic interventions for the eating disorder.
      HOWEVER, MORE COMMONLY
      • Diet and exercise alone do not work.
      • Therapy alone does not work.
      • Successful long term recovery from food addiction almost always begins with abstinence from the offending food(s) and “weighing and measuring” if the problem is volume of all or some foods.
      TREATMENT OPTIONS FOR FOOD ADDICTS
      • There are many variations in food plans.
      • Common addictive foods that must be abstained from include sugar (most common), flour, wheat, fat, etc.
      • There are varying “degrees of abstinence” (see chart 5).
      FOOD PLANS FOR FOOD ADDICTS
      • Similar to other chemical dependence
      • See charts 6 and 7
      FOOD ADDICTION IS PROGRESSIVE
      • Present in the late stage food addict
      • Present in other late stage addictive disorders
      • Must be addressed in order for treatment to be successful
      ADDICTIVE (BIOCHEMICAL) DENIAL
      • A decade ago, there was little scientific evidence that food addiction exists as a chemical dependency.
      • Today there is abundant evidence.
      • Some of the most convincing evidence includes the following slides:
      SCIENTIFIC EVIDENCE OF FOOD ADDICTION
      • Genetic Evidence: A UCLA study showed obese people who binged on simple carbohydrates, had the same D 2 Dopamine receptor as has been found in alcoholics and other drug addicts.
      • E.P. Noble, MD, et al, 1994
      SCIENTIFIC EVIDENCE OF FOOD ADDICTION (CON’T)
      • Brain Imaging Evidence: Pet imaging studies show that loss of control overeating and obesity produce changes in the brain similar to those produced by drug of abuse.
      • Mark Gold, MD, et al, 2004
      SCIENTIFIC EVIDENCE OF FOOD ADDICTION (CON’T)
      • Evidence of Opioid Involvement: Several studies show that excess sugar intake produces endogenous opioid release and dependency.
      • Adam Drewnowski, et al, 1992, Carlo Calantuani, et al,
      • 2002, Nora Volkov and Roy Wise, 2002
      SCIENTIFIC EVIDENCE OF FOOD ADDICTION (CON’T)
      • Evidence of Cross Addiction from Alcohol to Food: There are several studies that show those who are addicted to alcohol are often helped to recover by abstinence of both sugar and alcohol.
      • A.R. Lefever and M Shafe – 1991, Katherine Kitchem and
      • L. Ann Mueller - 1986
      SCIENTIFIC EVIDENCE OF FOOD ADDICTION (CON’T)
      • Evidence of Malfunction of Serotonin: Serotonin as well as dopamine is involved in food addiction.
      • A. Katherine, 1996
      SCIENTIFIC EVIDENCE OF FOOD ADDICTION (CON’T)
    • Case Study
      • 20 year old male
      • 5 year history of alcohol abuse
      • 7 year history of binge eating
      • General anxiety disorder
      • 5 attempts at outpatient therapy (refused higher lever of care)
      • Overweight as of middle school (puberty, inactive for months due to fracture in foot and misdiagnosed heart condition)
      • 5’9” – 210#
      • Lives with biological family and in college
    • Case Study
      • 28 year old female
      • 10 year history of amphetamine abuse
      • 14 year history of bulimia nervosa, restricting, over exercising, excess caffeine, major depressive episodes-recurrent
      • 6 attempts at inpatient treatment, including 1 year hospitalization, 18 months halfway house
      • Average weight
      • Divorced family of origin, step families, raised by other family members
    • Case Study
      • 32 year old alcohol and cocaine addicted female in residential treatment
      • Night eating
      • Normal weight
      • Hoarding food
    • Additional Information
      • History of ED?
      • History of obesity?
      • Evidence of purging?
      • Baseline weight?
      • Family history of ED or obesity?
      • History of trauma?
    • Differential Diagnosis
      • “ Normal” Overeater
      • Eating Disorder – BED or Bulimia
      • Food Addict
      • Hyperphagia from cocaine withdrawal (cocaine detox)
    • Workup and Treatment Plan
      • Labs
      • Food history
      • Therapy
      • Bathroom buddy
      • Eliminate trigger foods
      • 12 Step meetings
    • Case Study
      • 35 year old female
      • 15 year history of alcohol dependence and abuse
      • 5 year history anorexia nervosa
      • 1 attempt at inpatient treatment
      • Substituted iced tea for alcohol in treatment
      • Overly involved with food prep in treatment setting
      • Married with children
    • Case Study
      • 48 year old female
      • “Weight issues as far back as I can remember”
      • Repeated attempts at weight management including 12 Step programs with food plans
      • Married with children
    • THANK YOU