Helping Patients Who Eat for Emotional Reasons

Eating for reasons other than hunger is a nutrition and health-related behavior that many registered dietitian nutritionists encounter when working with patients and clients. Whether addressing weight management goals, overcoming disordered eating, or counseling through other health concerns, emotional eating is not an uncommon complaint, and it may manifest in different ways.

Eating may be used as an outlet to express a variety of emotions, including but not limited to sadness, loneliness, stress, or anxiety. The "Easily Enticed Eater" is one of the behavior patterns addressed in the book, Six Factors to Fit: Weight Loss that Works… for You! The authors indicate that individuals who feel a loss of control with food and have a tendency to overeat can be influenced by:

• Food cues in the environment
• Foods that are more calorie-dense
• Using food as a tool to provide emotional comfort, and
• Cravings and the pleasure obtained from foods.

For individuals who relate to these influences, it can be helpful to identify and encourage methods for managing emotions that do not center around food, such as mindful physical activity, meditation, connecting with a friend and taking time for self-care activities. Self-monitoring may also be an effective tool for those who rely on food for comfort. Taking time to journal thoughts around food and feelings may be helpful to identify patterns and make behavior changes.

Regardless of the strategy used for counseling or weight management, it's also important for the RDN to evaluate whether eating disorder (ED) symptoms and behaviors exist during the nutrition assessment.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders added a separate diagnosis for binge eating disorder (BED). Criteria includes reoccurring episodes where a person consumes a significantly larger amount of food than would be traditionally consumed by others in a similar timeframe and circumstance. This is accompanied by a feeling of lack of self-control while eating. Other common characteristics that may be present include eating to the point of physical discomfort, feelings of guilt, embarrassment and shame, eating in secret or eating more quickly than normal.

While it is not the RDN's role to diagnose an ED, being aware of a possible ED can help with the treatment plan, including a referral to a mental health professional which is essential to the recovery process. It also plays a fundamental role in forming the nutrition treatment plan.

Stress management, self-awareness and self-care activities all can have a role in treatment, whether or not the patient is working through an eating disorder.

References:

• Kushner RF, Kushner N, Jackson Blatner D. Chapter 6: Easily Enticed Eater In: Six Factors to Fit: Weight Loss that Works… for you! Chicago, IL: Academy of Nutrition and Dietetics; 2020: 118-147.
• Setnick, J. Chapter 1: Eating Disorders and the Dietitian In: Academy of Nutrition and Dietetics Pocket Guide to Eating Disorders, 2nd Ed.. Chicago, IL: Academy of Nutrition and Dietetics; 2017: 1-18.
• Hackert AN, Kniskern MA, Beasley TM. Academy of Nutrition and Dietetics: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Eating Disorders. J Acad Nutr Diet. 2020;120(11):1902-1919.e54.