Food Addiction, Eating Disorders and “Normal” Overeating:  What’s the Difference? Presented by: Sandee Nebel, LMHC Preside...
<ul><li>Understand the difference between “normal” overeating, eating disorders and food addiction </li></ul><ul><li>Revie...
<ul><li>The Problem </li></ul><ul><li>The Solution </li></ul><ul><li>What Works </li></ul>OVERVIEW “NORMAL” EATER (WITH OB...
<ul><li>The  PROBLEM  is  physical: </li></ul><ul><ul><li>Weight </li></ul></ul>“ NORMAL” OVEREATER (WITH OBESITY)
<ul><li>The  SOLUTION  is  physical : </li></ul><ul><ul><li>Medically approved dieting </li></ul></ul><ul><ul><li>Moderate...
<ul><li>What Works : </li></ul><ul><ul><li>Willpower </li></ul></ul><ul><ul><li>Bariatric Surgery </li></ul></ul><ul><ul><...
<ul><li>The  PROBLEM  is  physical  AND  mental-emotional </li></ul><ul><ul><li>Binge eating, restricting and/or purging o...
EATING DISORDERS <ul><li>Binge Eating Disorder </li></ul><ul><li>- Recurrent binge eating </li></ul><ul><li>- Sense of lac...
EATING DISORDERS <ul><li>Bulimia Nervosa </li></ul><ul><li>- Recurrent binge eating </li></ul><ul><li>- Recurrent compensa...
EATING DISORDERS <ul><li>Anorexia Nervosa </li></ul><ul><li>-   Refusal to maintain normal body weight </li></ul><ul><li>-...
<ul><li>The  SOLUTION  is  </li></ul><ul><ul><li>mental-emotional   </li></ul></ul><ul><ul><ul><li>Develop skills to cope ...
<ul><li>WHAT WORKS : </li></ul><ul><ul><li>Moderation (along with feeling the feelings) </li></ul></ul>EATING DISORDERS
<ul><li>The  PROBLEM  is  physical ,  mental-emotional  AND  spiritual  (i.e. – 12 step solution as with alcoholic and dru...
<ul><li>The  SOLUTION  is  spiritual ,  mental-emotional , AND  physical. </li></ul><ul><ul><li>Abstinence from binge/trig...
<ul><li>WHAT WORKS : </li></ul><ul><ul><li>Surrender  to a food plan which eliminates addictive foods </li></ul></ul><ul><...
<ul><li>Dieting to lose weight </li></ul><ul><ul><li>Assumes you need to take control </li></ul></ul><ul><ul><li>Focus on ...
<ul><li>DIETING </li></ul><ul><ul><li>Focus on putting distractions out of mind </li></ul></ul><ul><ul><li>Time frame is l...
<ul><li>DIETING </li></ul><ul><ul><li>The best plans are straight forward and reasonable (i.e.,  sugar in moderation elimi...
COMPARISON BETWEEN EATING DISORDERS AND FOOD ADDICTION RECOVERY WORK <ul><li>EATING DISORDER </li></ul><ul><ul><li>Traditi...
<ul><li>The obese “normal” overeater can diet successfully. </li></ul><ul><li>The morbidly obese “normal” overeater is an ...
<ul><li>Anorexics, bulimics and binge-eaters are successfully treated by a range of therapies from CBT to expressive, as w...
<ul><li>Medication Management for ED </li></ul><ul><ul><li>SSRI’s </li></ul></ul><ul><ul><li>Topamax </li></ul></ul><ul><u...
<ul><li>Some food addicts have few underlying issues apart from their chemical dependency on food. </li></ul><ul><li>These...
<ul><li>We see concurrent obesity, eating disorder and food addiction. </li></ul><ul><li>In these cases, when food addicti...
<ul><li>Diet and exercise alone do not work. </li></ul><ul><li>Therapy alone does not work. </li></ul><ul><li>Successful l...
<ul><li>There are many variations in food plans. </li></ul><ul><li>Common addictive foods that must be abstained from incl...
<ul><li>Similar to other chemical dependence </li></ul><ul><li>See charts 6 and 7 </li></ul>FOOD ADDICTION IS PROGRESSIVE
<ul><li>Present in the late stage food addict </li></ul><ul><li>Present in other late stage addictive disorders </li></ul>...
<ul><li>A decade ago, there was little scientific evidence that food addiction exists as a chemical dependency. </li></ul>...
<ul><li>Genetic Evidence: A UCLA study showed obese people who binged on simple carbohydrates, had the same D 2  Dopamine ...
<ul><li>Brain Imaging Evidence:  Pet imaging studies show that loss of control overeating and obesity produce changes in t...
<ul><li>Evidence of Opioid Involvement:  Several studies show that excess sugar intake produces endogenous opioid release ...
<ul><li>Evidence of Cross Addiction from Alcohol to Food:  There are several studies that show those who are addicted to a...
<ul><li>Evidence of Malfunction of Serotonin:  Serotonin as well as dopamine is involved in food addiction. </li></ul><ul>...
Case Study <ul><li>20 year old male </li></ul><ul><li>5 year history of alcohol abuse </li></ul><ul><li>7 year history of ...
Case Study <ul><li>28 year old female </li></ul><ul><li>10 year history of amphetamine abuse </li></ul><ul><li>14 year his...
Case Study <ul><li>32 year old alcohol and cocaine addicted female in residential treatment </li></ul><ul><li>Night eating...
Additional Information <ul><li>History of ED? </li></ul><ul><li>History of obesity? </li></ul><ul><li>Evidence of purging?...
Differential Diagnosis <ul><li>“ Normal” Overeater </li></ul><ul><li>Eating Disorder – BED or Bulimia </li></ul><ul><li>Fo...
Workup and Treatment Plan <ul><li>Labs </li></ul><ul><li>Food history </li></ul><ul><li>Therapy </li></ul><ul><li>Bathroom...
Case Study <ul><li>35 year old female </li></ul><ul><li>15 year history of alcohol dependence and abuse </li></ul><ul><li>...
Case Study <ul><li>48 year old female </li></ul><ul><li>“Weight issues as far back as I can remember” </li></ul><ul><li>Re...
THANK YOU
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Food Addictions Aug 2008

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Food Addictions Aug 2008

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

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