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Will Aguila, M.D.

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Why Obesity Doesn't Fit in a Bento Box

Posted: 08/26/11 04:25 PM ET

Do you know what a bento box is? It's a Japanese lunch box that has many compartments. Different foods can be placed in each compartment so that they fit in neatly, do not overlap and never touch each other. I often think that, as a society, we want ideas about obesity and weight loss to fit neatly into a bento box; as if eating right and exercising are all that is needed to lose weight and keep it off.

The "Bento Box Attitude" thinks that if you can't sustain weight loss by these two principles alone then you must be lazy and lack discipline. Any ideas that fall outside of this box are not considered valid and we don't need -- or want -- to deal with them. If it's really that easy, why is permanent weight loss still so elusive? Is it because we want to fit obesity into this little bento box? What happens when we realize that it doesn't quite fit?

Unfortunately, obesity is not meant to be tucked neatly into a compartmentalized box. It's not as easy as "eat less and exercise more." The cravings come from somewhere and there are reasons why they exist. So much of the problem of obesity is above the stomach. It really has everything to do with the heart and the brain. We cherish our foods so much that we choose to shut down the brain temporarily so that we can soothe our heart. This form of temporary amnesia is what we call denial.

Denial is a difficult concept to understand because those who have never been obese sometimes cannot comprehend why anyone could "let themselves go." And many of those who are obese don't want to believe that they are. Putting our heads in the sand will not make this denial go away. We need to understand the problem in order to solve it.

Do we wish for a utopian society where food does not exist and everyone takes a pill for nutrition once a day? Where food is no longer an intricate part of our culture? Such a society, as described by Laura Riley, Food Critic for the St. Petersburg Times, as utopian as it may seem, would not offer us a reprieve from the daily temptation of choosing food to medicate our sorrows.

While exercising and eating better are important, they are but one spoke of the weight loss wheel. I believe that obesity is really a cycle that begins when we learn to medicate our anxiety and depression with food. This overeating eventually leads to guilt as we gain weight and start to experience feelings of failure. The guilt in turn adds to the anxiety that we already have and plunges us deeper into depression, which we comfort with what else? Food. We then find ourselves stuck in the "Cycle of Obesity."

By using this Cycle of Obesity as a roadmap, we can see that if we just treat the overeating portion of the cycle (diet and exercise) we may lose weight, but we are bound to gain it back because we never resolved the emotional triggers that may have made us eat in the first place. Therefore, in order to beat obesity and keep the weight off, we must fix every part of this cycle -- not just the diet and exercise parts.

What causes your stress, anxiety and depression? What guilt do you carry? Some of these issues may have even been cradled since childhood. Ignore these and you are destined to repeat the Cycle of Obesity. Once more, every time you repeat the cycle, your guilt increases as your feelings of failure cause you to overeat even more. I believe that this is why people often gain the weight back and "then some" after going on a diet.

Learning what these triggers are seems like a difficult challenge, but anyone suffering from severe weight problems -- who is not in denial -- knows what his or her triggers are. These triggers are major life stressors such as the loss of a loved one, a very stressful job that leaves no room for personal time, loneliness, an unhappy marriage, a lifelong lack of self-worth and/or extreme perfectionism. Other common causes include childhood sexual, physical and/or mental abuse. By being honest with yourself you can identify the triggers and work out a formula to defeat them.

The Cycle of Obesity offers a good explanation for emotional eating. It also explains why, when you feel like using food for comfort, simply taking a walk, exercising, reading a book, drinking water or other immediate remedies, will have minimal or short-term effects. You have to get to the root of the matter and only by doing something to treat the triggers will you completely break the cycle and conquer your emotional eating.

Here are four things that you can do right now to get started in breaking the Cycle of Obesity:

  1. Write down and identify the major stressors that are causing you to eat. Be completely honest with yourself. Seek appropriate professional counseling if necessary.
  1. Learn to accept failure. If you fall, get yourself up and try again. Do not expect success on your first attempts at anything. Find out what caused you to fail so you don't repeat the same mistake again.
  1. Recruit someone you trust completely to help you with your journey.
  1. Set shorter, more attainable goals for yourself. As you accomplish one goal, move on to the next one. Success builds upon success.

You cannot tuck your weight loss problem neatly into a little box and wonder why it does not go away. To conquer obesity you must understand its root causes and deal with them. Breaking the Cycle of Obesity is definitely possible and it allows you to live the authentic life that you desire. Just remember, the solution is not "one size fits all" and it certainly can't be found in a Bento Box.

 
 
 
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06:07 PM on 09/06/2011
The doctor is right about the fact that obesity does not fit into a bento box. So why is he putting all fat people into another box ? Stress isn't the only reason a person gets hungry. Actual hunger, caused by the symptoms of starvation, which is what dieting causes, is probably the main reason most diets fail. Another major issued the doc overlooks is the long term damage caused to the body by weight cycling. Research indicates that many of the major issues associated with "the obese" are also associated with rapidly losing and gaining weight. The doctor also completely ignores genetic factors, as if everyone's metabolism is the same and if we all just stop stress eating maybe we'd be thin? Please.

Obesity does not fit into bento box, and it doesn't fit into her sad little box either. Health should be the focus of everyone's lifestyle, eating a variety of foods, getting exercise. Weight loss is a distraction and something people often go to very unhealthy means to achieve.
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05:54 AM on 08/28/2011
I think the doc got this one wrong. All the "experts" have been telling me for the past forty years that my weight problem was the result of self-loathing or unexpressed emotional issues. Funny, once I quit eating processed foods, all those "issues" disappeared. It wasn't about my mind set...it is, was and always has been about the food. Portion control of processed foods doesn't work precisely because those foods aren't really food and the body doesn't know what to do with them. Real, living, raw foods changed everything. Within days, all the old cravings disappeared, all the old compulsions to eat when I wasn't hungry disappeared, and -- over a period of months -- all the excess weight disappeared. Easily and effortlessly. It's ALL about the food.
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HerrMonk
Son of Apollo
04:37 PM on 08/29/2011
Good post.

We've become a culture of victims and rationlizers. This article is a good example of that.
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Repubnomore
08:43 AM on 08/30/2011
Congratulations on your success!

I wouldn't say the doc got it wrong - I would say that your experience covers a point the doc may have purposely omitted.

The processed foods you speak of are engineered with the right combination of sugar, salt, and fat to trigger a dopamine high - they truly are comforting. Add in a little H F C S to suppress the hormone that tells you that you're full and voila, you literally can't stop eating.

It's a chicken and egg debate. Some turned to overeating as self-medication. Others became "addicted" due to the dopamine response / grehlin suppression. It's two sides to the same coin.

Rarely do you see both sides discussed in one article. In order to succeed, I imagine you need to be aware of and understand all the information about food and also be aware of and understand your own mental health.
10:11 AM on 08/27/2011
We see so much about "emotional eating." Come on medical people. Talk about what is known about the biological underpinnings of obesity. Talk about the fact that diets DO NOT WORK for the morbidly obese. A morbidly obese person has perhaps a five percent chance of losing to even a point of being modestly overweight using the "diet and exercise" model and maintaining it for just one year, much less for the long term.

A physician prescribing a treatment with a 95% failure rate for any other disease would be sued out of existence. Yet for obesity treatment it's what almost all of you do. This is outrageous.

The only treatments for morbid obesity that have a prayer of moderate to good success involve surgical intervention. The best surgical interventions are the ones that alter metabolism, particularly the subtotal vertical gastrectomy with duodenal switch. The worst intervention of them all thus far is the gastric band, adjustable or otherwise.

There is a lot of evidence available to health care professionals to support this. Yet we virtually never hear about it in the press. All we see are doctors talking about--if we are lucky to find one who doesn't preach "just go on a diet and work out"--is "fix your head."

It is NOT all in our heads or on our forks.
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Repubnomore
09:07 AM on 08/30/2011
Interesting perspective.

"just go on a diet and work out" and "fix your head" shouldn't be mutually exclusive propositions.

The biggest problem right now is the general public's lack of understanding about metabolism and our food supply. Processed foods laced with high fructose corn syrup are a huge contributor to obesity. The fructose is converted to triglycerides and transported to fat cells. This creates inflammation, arterial plaque buildup and body fat. It also suppresses the hormone grehlin that signals when you are full.

Factor in the dopamine response derived from the right combination of sugar, salt, and fat and you have an addictive substance that can't satisfy its desirability. You eat to feel good and your body can't tell the brain to stop eating.

Do people overeat because they are seeking comfort from the food or does the dopamine response create an addiction that causes them to overeat? Understanding this dependency is the only way to consciously change this behavior.

As for surgical intervention, it is likely not recommended because it is unwarranted. If the root cause is psychological / dependency related, it would be like getting a lobotomy to cure manic depression.
05:17 PM on 08/30/2011
What if the root cause is NOT psychological or dependency related? You are grossly oversimplifying, just like 99% of the population does about this.

I'm not going any further on this post because it's clear you have a certain agenda you wish to promote.

There are MANY causes of obesity. There is only ONE currently effective treatment for *morbid obesity*: Surgical intervention. The data are clear in this.

For those who would like to learn more about the best of the surgical interventions, look at www.dsfacts.com (which I do not own and from which I receive no remuneration, in the interest of full disclosure) and learn more about the subtotal vertical gastrectomy with duodenal switch. It saved my life.
09:27 AM on 08/27/2011
I used to be an emotional eater. But when I ate a snack to deal with stress, it almost always featured a heavy dose of carbohydrates -- sugary as in cookies or salty as in chips. Or both. I never broiled a steak to eat as an emotion-triggered snack. Typically, it was something from a bag. This year, I have lost 40 pounds (over 15% of my starting weight) and am still losing. I did it by banishing sugar and most grain (especially wheat) from my diet. In other words, I quit carbo-loading. If I feel a need for a snack -- either out of genuine hunger or out of stress -- I eat a handful of nuts or an ounce of cheese. Or I have a cup of coffee with heavy cream. Funny thing is, I don't eat as many emotion-triggered snacks as I used to. Hardly any now, in fact -- even though, aside from my diet, my life circumstances have not changed. Of course, that's a big "aside." I don't claim this approach will work for everyone, but I do see myself as an ordinary middle-aged American male.
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liberalsrheros
GOP PLATFORM:Mean Talkin Blues. Woody Guthrie
03:50 PM on 08/27/2011
i knew for years that having a loaf of bread in the house meant eventually i was going to go on a binge of sandwich making till i had heal sandwiches and an empty bag. i didn't understand that my body was working against me till fairly recently. any how your experience mirrors my own. lean proteins and green vegetables don't lead to that kind of cycle. keep up the good work and good luck.
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Arya M. Sharma, MD
09:40 PM on 08/26/2011
While everything you say about emotional eating is true - this is sadly not the only or even most common cause of obesity. In other words, although emotional eating is an important and common driver of overeating (as you say), sadly not all obesity nicely fits into the 'Bento Box' of emotional eating.

I can think of countless other drivers of obesity (from genes to medications to peer pressure to injury to poverty - just to name a few) that have little or nothing to do with 'emotion'. This is why I have previously differentiated between 'homeostatic' overeating (e.g. in response to hunger - a very normal but all too common problem) and 'hedonic' overeating (more related to your concept of 'emotional' overeating).

Yes, emotions are important and can contribute to overeating in some people but there are countless other drivers of overeating and undermoving that have little to do with emotions or trauma.

Also, the notion that 'conquering these emotions' will lead to sustainable weight loss belies the fact that maintaining any weight loss with whatever method remains challenging due to permanent alterations in the weight 'set point' - yes, dealing with the emotional drivers of obesity can make weight management easier, but preventing weight regain remains a lifelong 'struggle'.

Removing the root cause of weight gain at best prevents further weight gain but by no means does it automatically translate into sustainable weight loss.
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AngelaQuattrano
I just like to write comments
04:33 PM on 08/28/2011
Indeed, emotional eating is probably a small factor for some and a large factor very few.

But I blame a different type of overeating from your two. I'm not sure what you'd call it. It is eating when you're not hungry. You aren't full but neither are you hungry. The food is right there and ready to eat, and we're conditioned to accept the "need" for people to snack at any time. Nobody ever waits until the next meal to eat anymore. If it's breaktime, you eat a snack, even if you're not hungry. If you didn't bring a snack with you, there is a machine ready to cough up a crunchy, salty, fat-and-carb snack and another to dispense a 16 oz. sugary beverage to wash it down.

We are surrounded nowadays with ready-to-eat snacks, and often people munch constantly according to a schedule that has nothing to do with hunger. They get home from work after a day spent munching snacks, not hungry enough to eat a full meal, and have a snack for dinner, then munch some more while watching television. So many people are never truly hungry.
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Repubnomore
09:26 AM on 08/30/2011
Good point. Food isn't scarce and we aren't as active as we once were.

All of the food choices we're surrounded by aren't healthy. From soda to fruit juices, candy bars to energy bars. All are energy dense carbs with no nutrients that spike blood sugar, elevate triglycerides, suppress satiety, and contribute to body fat.

It's the combination of sugar, salt, and fat that create a dopamine high, ironically, similar to a good physical workout. Do we seek these foods because of the way they make us feel or do we need to feel better about ourselves so we seek these foods?

Until individuals fully understand all the dangers of these processed foods - heart disease, stroke, diabetes - and break the emotional connection with their bad eating habits, energy-dense carbs will continue to be their downfall.
07:44 PM on 08/26/2011
Interesting and thoughtful article. It addresses why weight loss is not as simple as some people seem to think it is

www.feelgoodtracker.com
10:13 AM on 08/27/2011
Actually, it addresses almost nothing about why weight loss is not simple.