AAT: Points of Intervention

Author Linda Craighead in Appetite Awareness Workbook describes 7 specific points, where we can either stray from normal eating or get back on track. I'll list those points, quote Linda's explanation and/or suggestions, and describe my experiences.

(1) Getting Too Hungry: " ... if you are too hungry when you start eating, it is difficult to stay aware and stop at moderate fullness."

I can ignore hunger until I walk into the kitchen. Then I feel famished, don't want to wait to eat, and often snack as I prepare a meal. At the table I overeat the food I prepared, because I really wanted the prepared food, but filled my stomach with stand-up snacks during preparation. Sometimes I can just stop when I feel full, even if I don't eat much of what I prepared. More often, I feel 'deprived' and eat that meal beyond moderate fullness.

(2) Breaking Food Rules: "Even if you do not overeat, you may become upset with yourself if you eat something that you consider too fattening or you eat at the wrong time. You may say to yourself, "What the heck," after breaking a food rule and then overeat or binge ... If you replace food rules with flexible guidelines, there are no food rules to break."

Even though I have 7 food allergy restrictions, I NEVER binge on my allergy foods, because I dislike painful allergy reactions from eating those foods. However, if I restrict foods, which don't give me uncomfortable symptoms, but which I don't consider 'healthy', I create 'food rules'. Unless there are immediate consequences for eating those foods (like gut pain or reflux), I can't restrict 'safe' foods without feeling 'deprived' and eventually binge on those foods, until I remove my 'rules'.

(3) Ignoring Fullness: "The experience of satisfaction is largely psychological and only partly related to your appetite regulation system ... Stomach fullness signals are weak. At first you hardly notice when you start to feel full ... the fullness signal does become stronger as you become more full. Unfortunately, for most people, feling full means feeling close to 'stuffed' ... You lack awareness of early stomach fullness signals (because) ... When you focus on the taste of food in your mouth, you are not attending to fullness. In addition you may have overeaten so often that you no longer recognize early fulless signals ... Many peole do not pay attention to fullness while they are eating (but) notice it after they have become uncomfortably full ... Some peole prefer feeling overfull (and) ... don't feel satisfied until they experience significant stomach fullness."

What really helped me from this section was separating 'satisfaction' from 'fullness'. If I don't choose to eat exactly what I craved, I want to ignore my stomach fullness, so I can eat the food I craved after I'm full. I often value psychological satisfaction over 'fullness'. I know I can have both if I carefully choose what I eat according to my cravings. However, I often save my 'craved' food for 'dessert' after I'm already full from other foods. Or I can get up from a physically filling meal, seek a 'sweet taste', and eat to the point of uncomfortably full, rather than eat just a 'taste', when I don't physically need more foods. Once I'm full, I have no physical signal to stop, other than extreme discomfort. So I'm learning that when I feel full, but still crave specific foods or tastes, to tell myself "Too late. Plan to eat that at your next meal." I also suspect that expecting dessert or a sweet taste when I'm overly full, may be a way of distracting myself from discomfort. I now realize that any additional food will make me MORE uncomfortable.

(4) Eating When Food Is Available: "The real problem with eating when food is available is that youa re likely to ignore fullness. You weren't hungry to begin with, so it won't take very much food to go past moderate fullness ... Minimize mindless eating--the times you eat just because the food is there, and it isn't even that special ... Eating when food is available might be eating for pleasure, it might be a habit, or it might serve an emotional purpose. In any case, this kind of eating feels quite normal ... but, eating when not hungry promotes weight gain."

My most challenging 'eating when food is available' is continuing to eat what's on my plate after I feel moderately full. I'm no longer hungry, but I'm already full. So the only stopping point is absence of food on my plate. If I can accurately judge how much food I need for a meal and serve myself exactly that much, I won't feel overly full as I 'eat when food is available'. However I would feel more comfortable is I just let my 'moderate fullness' cue tell me when to stop eating.

(5) Emotional Eating: " ... is only a problem is you do it too frequently, or if you aren't able to stop at moderate fullness ... When you start eating because you are upset, you want to eat until you get some relief from the feeling. The amount of food it takes to alter emotional states is more than the point of moderate fullness ... when you eat for emotional reasons, you are more likely to choose comfort foods. If you break a food rule (by eating those foods), you may then end up bingeing ... Once you learn that food is an effective way to alter your emotions, you are flikely to use that strategy more ... often. (Then) the association between eating and feeling bettter becomes very strong ... (which) is what most people mean when they say they are 'addicted' to fod. When you feel bad, you know that eating will make you feel better, at least for a short period. Thus, you experience intense desires to eat (or even binge) that are similar in many ways to the cravings of addictions ... When you eat a moderate amount and you don't feel better, it's very tempting to think that a little more might do it (make you feel better). Emotional eating often turns into overeating or a binge."

I suspect 'emotional eating' describes how I eat when I feel slightly uncomfortably full, but crave more food. I want to 'feel better' psychologically, even though I KNOW more food will make me feel WORSE physically. I occasionally binge when I feel deprived of favorite foods (which I have restricted as 'less healthy' than other foods). I feel less psychologically deprived, when I binge on restricted foods and ignore how binge eating deprives me of physical comfort.

(6) The What the Heck Response: " ... is most often described as a feeling of intentionaly giving up control for a moment, or of not caring what you eat iat a given time ... an important intervention point (because) you must cross this point to start bingeing. If you break a food rule or overeat, you STILL have to trigger the 'what the heck' response to turn the episode into a binge. At this point, you can make a different decision ... you can choose to tolerate the negative feelings associated with overeating or breaking food rules and stay on the normal eating path ... (so) you don't compensate by purging, exercising or stricter dieting. When you are quite worried about your weight, you are vulnerable to the what the heck response ... (which) is a result of ... all or nothing thinking. Events or feelings are categorized as either good or bad, right or wrong, perfect or terrible. When you are subject to this way of thinking, once youdecide you are bad, then eating more can't make you feel any worse. Giving up or losing control actualy provides you an immediate sense of relief from your efort to maintain control, even though you eventually feel more like a failure for having given in."

I can sooo relate to that 'oh what the heck' moment of decision, when I decide that I tell myself I no longer care about stopping at comfortable fullness, when I tell myself that eating as much as I what of anything I want (especially foods I have arbitrarily restricted) matters more than learning to obey my physical fullness cues. However, my 'oh what the heck' decision always depends on a decision to compensate by purging.

(7) Plan to Binge (or Overeat): "The problem with planned overeating (at a social occasion or as a special treat) is that you may still feel bad as you are doing it and then give in to the oh what the heck response ... Women don't usually plan to binge unless they have completely given up trying to control their weight or they have a plan to compensate for the binge ... Planned binges are far more common among individuals who plan to compensate by purging or by excessive exercising ... Those compensatory behaviors ... allow a person to escape some of the immediate negative consequences of bingeing. However, they create other, usually even more serious, long-term health consequences."

I recall holiday dinners when I planned to overeat, but felt so guilty that I continued to overeat while cleaning the kitchen, so that purging seemed inevitable. Purging regularly (though less often as time passed) caused one irreversible consequence, tooth erosion, which necessitated lots of crowns and other dental repair. Most other consequences were reversible or greatly minimized as I decreased purging episodes. So I want to tell people who rationalize purging, because the damage has already occurred, and say 'what's the use of learning to eat normally?', that normal eating can reverse the consequences of reflux, swollen facial glands, indigestion or other gastrointestinal problems, unless you have undiagnosed food allergies or intolerances. However, avoiding purging while eating normally will let you recover from symptoms caused by binge/purge episodes. Then you can recognize symptoms caused by other gastrointestinal conditions.

I'm learning from AAT that using stomach cues to decide when and how much to eat will prevent physical discomfort and psychological regret from eating according to psychological cues. I can still eat foods I crave and soothe myself emotionally, if I eat only when I'm hungry and stop when I'm moderately full. The next AAT chapter will clarify stomach signals.