anxiety overeating and weight loss 2

Anxiety, Overeating and Weight Loss: How to Manage

August 10, 2018

Anxiety is extremely common among patients who are considering bariatric surgery. In a recent study, over 80% of pre-surgical bariatric patients met criteria for a psychiatric diagnosis (anxiety, depression). Of those patients with a psychiatric disorder, 46% had anxiety (Duarte-Guerra, et al., 2015). People with untreated anxiety lose less weight after surgery (Edwards-Hampton, et al., 2014).

Anxiety can present in several different forms. Some people complain of poor sleep, excessive worry, feeling out of control, and dwelling on the worst possible outcomes of situations; while others note increased heart rate, palpitations, shortness of breath, dizziness, chest tightness, sweating, and increased muscle tension.

Emotional Eating

When a person feels, fear, sadness, loneliness, boredom, and anger, it can be easy to reach to food to help soothe these negative emotions. Emotional eating is eating when you are not hungry, and can happen when people attempt to distract, suppress, or cope with difficult situations.

People often deal with stress by eating.  Negative emotions can be triggered by day-to-day stressors like finances, relationship troubles, work difficulties, parenting struggles, or large events like the death of a family member and job loss. Eating can become an automatic response to a stressor or a negative emotion so that one does not even think about what they are doing.

Over time, emotions can be so tightly linked to eating patterns that individuals to do not necessarily identify the underlying emotion. Because eating and emotions might have been linked for years (maybe even since childhood), these eating patterns become difficult to change.

Eating Patterns Can Impact Weight Loss & Weight Regain

Before weight loss surgery, people can have certain maladaptive eating patterns. Some of these, such as grazing (eating small amounts of food throughout the day), overeating, and binge eating (eating large portions of food and feeling out of control of eating) can undermine individuals’ success after weight loss surgery.

Unfortunately, bariatric surgery does not necessarily curb psychological cravings for foods (Sudan, et al, 2017), nor does it necessarily change emotional eating patterns. Emotional eating after weight loss surgery leads to less weight loss and can lead to weight regain.

Tips For Managing Distress and Reduce Emotional Eating

Addressing distress and changing health behaviors can be easier said than done. Once you address the underlying triggers for maladaptive eating patterns, it can be easier to change the unhealthy behaviors. Listed below are some helpful tips to reduce physiologic anxiety, distress, and develop healthy coping mechanisms necessary for achieving and maintaining your weight loss goals:

Identify Triggers for Eating
It can be very useful to keep a log of your food, thoughts, and events for a short period of time (one to two weeks). When you eat, itemize the food, list the emotions, thoughts, and events that you experienced before starting to eat. By logging your food, thoughts, and emotions, you might find that there are “riskier” times during the day for maladaptive eating. You might also find that particular emotions or events have been linked to eating.
Identify Alternative Coping Mechanisms
Once you have a better understanding of your triggers, list other activities or ways to deal with those emotions instead of food. For example, grazing at night might be triggered by a desire to relax and self-soothe after a difficult day at work or with the children. Be proactive and purposeful about selecting to engage in an activity that will help you to meet that emotional need during your risky times.Alternative coping mechanisms could include going for a walk, listening to music that changes your mood, progressive muscle relaxation, seek support from a friend or family member, make a gratitude list, use a relaxation app, and purposefully schedule a break.
Prior to opening the refrigerator or pantry, ask yourself “Am I Really Hungry?”
This will help you to catch yourself in the moment and to slow yourself down from engaging in automatic maladaptive eating patterns. If you are not hungry, then cho0se something off of your coping mechanism list to meet the unmet emotional need.
Slow down your eating 
Set a timer for 20-30 minutes and use this time to increase your chewing (20-30 chews per bite) and put your fork down between bites. You will find that you will get fuller off of a smaller amount of food. This will help you to reduce overeating during set mealtimes.
Local support group
Ask your bariatric program if they are aware of a local support group for bariatric patients. Support groups are a wonderful way to meet individuals who have been experiencing similar difficulties on their journey after bariatric surgery. It is also a way to problem solve with other bariatric patients and to learn ways to manage stressors.
Professional help
Psychotherapy and psychiatric treatment can be useful to help you identify triggers for maladaptive health behaviors and develop an individualized plan to address these underlying issues. Mental health treatment can also help to identify barriers to health behavior changes and assist you in making achievable behavioral goals.


References

Duarte-Guerra, L., Coêlho, B., Santo, M., & Wang, Y. (2015). Psychiatric disorders among obese patients seeking bariatric surgery: results of structured clinical interviews. Surgery, 25(5), 830-837.

Edwards-Hampton, S., Madan, A., Wedin, S., Borckardt, J., Crowley, N., & Byrne, K. (2014). A closer look at the nature of anxiety in weight loss surgery candidates. International Journal of Psychiatry in Medicine,47(2), 105-113.

Sudan, R., Sudan, R., Lyden, E., & Thompson, J. (2017). Food cravings and food consumption after Roux-en-Y gastric bypass versus cholecystectomy. Surgery for Obesity and Related Diseases, 13(2), 220-226.

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ABOUT THE AUTHOR

Sarah Galloway received her Ph.D. in Clinical Psychology from the University of Virginia. She joined Frye Regional Medical Center in 2015, with her primary focus of building an integrative Behavioral Medicine service line. Dr. Galloway conducts pre-bariatric surgery psychosocial evaluations, as well as individual and group treatment. Treatment focus includes improving candidacy for surgery, promoting health behaviors, and behavioral weight management for patients before and after weight management surgery.