Coping Without a Coping Mechanism
Call it stress eating, comfort eating, emotional eating, or whatever you want. Food represents so much more than an act of consumption. Many people use food to get through life’s daily stressors or to numb themselves from the feelings they don’t want to feel. But what happens when this method of coping is abruptly taken away?
Meet Jane,* a 42-year-old busy mom of two young kids here in New York City. When I first met her around Thanksgiving, she was exhausted and tired of the yo-yo weight loss journey. A self described “emotional eater,” she took comfort in food. When feeling stressed, she craved crunchy food for a physical release. When sad, she craved smooth, soothing chocolates. When angry, she craved carbs and would “raid” the pantry closet. If she felt lonely, she’d eat in secret overnight. Sometimes, she’d feel bored or want a “rush,” and found herself ordering food delivery from her phone.
She had gained 35 pounds since having children, and both her weight and stress levels continued to rise.
When we met to discuss our goals for treatment, she was more interested in behavioral changes for weight loss than working on the underlying emotions. We tailored a customized 12-week behavior-adaptation plan, focusing on behaviors and not the accompanying feelings, to aid weight loss alongside her GLP-1 medication.
Using my tailored, time-limited protocol aimed at weight reduction, she began to lose weight.
Midway through our treatment, Jane called me. She was so happy with her diminished appetite and weight loss -- and didn’t see a need for cognitive-behavioral therapy. She said there was no need to address the “underlying emotions” because her cravings had significantly decreased.
Over the next few months, I’d hear from Jane periodically. She’d update me, saying that it was great to start fitting into her pre-maternity wear again.
Two months ago, I again heard from Jane. Things were “not going well at all.” She said she wanted help and that her mental state was “worse than ever.”
Why? I thought things were going so well because of diminished cravings. Had she maintained weight loss? Yes. Yet she wanted help because she was feeling “down, depressed and anxious…worse than ever.” Her initial feelings of elation over weight loss had quickly turned to dread.
She said that she still had feelings of anxiety, irritability, and low mood. Only now, she could not turn to food.
The temporary escape of helping oneself to a helping of guilty pleasures almost always ends with people feeling worse. And with the meteoric rise of Ozempic and similar GLP-1 drugs, a new phenomenon has emerged. A reverse effect of sorts. Some people are depressed about their inability to comfort themselves with comfort food because they constantly feel full. They’re now craving the unhealthy escape that brought them to this course of treatment in the first place.
Also, she missed the rush of a craving and satisfying that urge.
The problem is not the medication. To the contrary, the efficacy of GLP-1s speaks for itself. The real issue is a lack of emotional support. At Well by Messer, our holistic team-based approach includes the incorporation of cognitive behavioral therapy. I teach patients healthy, alternative behaviors to help them get through the day without having to rely on a caloric crutch. We also examine distress tolerance and emotion regulation strategies, how to cope with cravings or the lack thereof. Our patients learn to change their mindsets while also changing their bodies.
Mentally preparing our patients for this seismic habitual shift is vital to long-term success in their wellness journey. And we work with patients each step of the way. We work on handling the difficult feelings. We target emotion regulation, distress and frustration tolerance, and other ways to feel excitement.
Armed with new coping strategies, our patients can get back to enjoying the benefits of these weight loss drugs without thinking of them as a double-edged injectable sword.
*Name changed
