Understanding and Overcoming Binge Eating

John Horton:

Hey there, and welcome to another episode of Nutrition Essentials. I'm John Horton, your co-host with registered dietitian Julia Zumpano. How's today treating you, Julia?

Julia Zumpano:

I'm feeling great today, John. The sun is shining, couldn't be happier, especially about today's topic. We're going to talk about binge eating, which is quite a common type of eating disorder.

John Horton:

Well, and I know it's common, and it's also one of the most misunderstood, minimized or even hidden eating issues that are out there. And I know that's why we felt like this was just such an important topic to bring to the podcast.

Julia Zumpano:

Absolutely. I see my patients struggle with this all the time. And just bringing light to it, understanding it, understanding how intricate and how deep of an issue it can be. It's so rooted in so many different emotions and thoughts, feelings and environment that we're going to dig into. I think it's so important to understand and be able to help find help.

John Horton:

Yeah. I mean, there are physical and emotional effects that come with binge eating.

Julia Zumpano:

Absolutely.

John Horton:

And we're lucky today that we have somebody here to talk about it who may be one of the biggest experts that we could find. And I know, Julia, you have a really close relationship with her, so let us know who we're talking to.

Julia Zumpano:

I am so honored and happy to announce that Dr. Susan Albers will be joining us today. She is a clinical psychologist at the Cleveland Clinic Women's Health Center. She's also a New York Times bestselling author and nationally recognized as an expert in eating issues and mindfulness.

John Horton:

And if you've ever heard Dr. Albers talk, you know that we are in for a treat today and in for a lot of learning. So let's get to it.

Welcome to the Nutrition Essentials Podcast, Dr. Albers. I've got to tell you, you have been at the top of our guest wishlist ever since we started the show.

Dr. Susan Albers-Bowling:

Thank you for having me. I'm excited to talk about this topic. It's something I'm very passionate about.

John Horton:

Well, and it's something that involves all of us. I mean, we all eat. Our bodies are kind of naturally programmed to want to eat. It's kind of why we feel hungry all the time. It's kind of that natural prompt to keep all of our systems operational. But there's also this emotional connection to eating, too, and that's the thing that can kind of lead us astray from time to time.

Dr. Albers, I know you have devoted so much of your career to helping folks understand and manage that emotional connection. Why is this such a struggle for so many of us?

Dr. Susan Albers-Bowling:

It is a struggle. Food is not just fuel. From the moment we are born, we learn that food is also care, connection, comfort and soothing. And food plays a lot of different roles and jobs in our lives. It helps us to grieve, to celebrate, to entertain us. And for many of us, food is also love. It's a love language that we all speak. So because it plays so many different roles in our lives, it can become incredibly complicated.

John Horton:

Yeah. Well, and one of the ways it becomes complicated is when we get into binge eating, which is what we're going to focus on here today. And I think to get things started, let's kind of define binge eating. Because we've all had those moments where you're having a day and all of a sudden you house an entire bag of potato chips or that ice cream carton all of a sudden is empty. There's kind of a range of binge eating and as far as where you need to be concerned about it, right?

Dr. Susan Albers-Bowling:

It is. It is important to define what binge eating means because we often throw out that term “binge” in a very light way. We binge-watch television shows. So sometimes, we can normalize that word and not really understand what it means. There's a difference between overeating and binge eating. Overeating is an experience, and we all experience it from time to time. Every now and then, we may overeat at a party or if there's a food that we enjoy.

Binge eating is different in that it has a component of feeling out of control. The criteria for binge eating, if we define specifically what it is according to the clinical diagnosis, is that it is eating a large amount of food within two hours on one occasion for a week for three months. And this is one part of the criteria. But the second part is also that it causes significant distress, the inability to feel as if you could stop. And so that's what really distinguishes the difference between overeating, which we all experience from time to time. And binge eating, binge eating is just, you feel like this compulsion that you tell yourself to stop and you keep going. It's very difficult to put on the brakes.

Julia Zumpano:

I would say, Dr. Albers, with just inpatient care, it is really difficult sometimes for a patient to determine whether or not they do have binge-eating disorder. And I think your point of that loss of control is really the key piece there. Do you feel like you're out of control when you're eating? And then, is it coupled with some emotional aspects, like shame or guilt or sadness or disgust or whatever the feeling may be? So I think that was the key piece that when I am screening for binge-eating disorder, those are the signs I'm looking out for.

Dr. Susan Albers-Bowling:

Often, we'll ask people to define what a binge means to them because in the criteria, they say an amount that's larger than other people may be eating. And we also experience what is a perceived binge, that you may be eating something, a bowl full of carrots or something, and have that sense of feeling out of control. So it's not just eating large amounts of food or fast food or sweets or things like that. It's that sense of feeling out of control that causes distress that is what defines a binge.

Some other characteristics are eating faster than usual, eating when you're not physically hungry. With my clients, often one of the number one things that they express to me is this feeling of shame and distress and secrecy. I've had clients who talk a lot about being in a relationship with a partner for years and years and their significant other has no idea because it's such a secret experience and causes such distress that they keep it very to themselves.

John Horton:

Do they hide it? I mean, is that one of those things that where you're getting up in the middle of the night and doing it or kind of doing it on the sly?

Dr. Susan Albers-Bowling:

Absolutely. It could be in the middle of the night. It might be hiding some of your binge foods in your car. It might be eating, restricting at a restaurant or eating very little, ordering a salad and then coming home and eating in secret. So it doesn't always have to be in secret, but because it often carries such a guilt and shame, it often is an experience that is in secret. How it often feels on the inside is often this: my clients will experience this tunnel vision. It creates a sense of relief or escape from how they're feeling in the moment. And it can often feel very numb at times.

John Horton:

How many people have the clinical part of it versus how many of us are kind of dealing with it from time to time?

Dr. Susan Albers-Bowling:

Binge-eating disorder is one of the most common eating disorders, and people are often surprised by this. It was actually created to be an official diagnosis in 2013. Before that, they kind of lumped it underneath eating disorders not otherwise specified. And then, thankfully, they established a criteria and a specific label because so many people can identify with this disorder.

What's interesting as well is that there's an equal number, almost an equal number of men and women who experience binge-eating disorder, and it affects everybody of age, race, class, across the board. So there's no one typical person who is somebody who presents with binge eating and because it is often very secretive in nature, it's underdiagnosed in many ways.

But there are many things that create a high risk for people who are struggling with binge eating, such as family history, maybe you have anxiety or depression. A lot of my clients will talk about anxiety and depression, and sometimes we have to piece apart which came first, chicken or the egg of depression causes binge eating or binge eating is underlying some of the depression and anxiety. So there are many different factors that contribute, which makes it very complex in a lot of ways to diagnose.

John Horton:

I know when we were talking ahead of this podcast, Julia, you brought up how you often see binge eating kind of tied to dieting, which is something … it kind of blew my mind when you said that because that wouldn't be a connection I'd make, but it sounds like that can kind of be a trigger. People, maybe they make themselves overhungry because they're cutting things out, and then all of a sudden, it kicks off these episodes.

Julia Zumpano:

Absolutely. So binge-eating disorder is commonly associated with any restrictive behavior, restrictive when it comes to food, whether you're restricting certain food groups or just restricting food throughout the day, skipping meals, and it can lead to this masked hunger. Your hunger cues can be offset and unrecognizable.

So oftentimes, patients with binge-eating disorder don't feel hunger and they don't recognize the feeling between hunger and satiety. Those cues are thrown off, which then dysregulates their eating habits, and it could stem from initial restriction of whatever it may be for a dieting purpose and then leads to dysregulation of appetite, and then can often lead to these binge episodes because we haven't eaten all day, we may be stressed, we sit in front of a comfortable place, we're at a comfort place with comfort food, and it's easy to get out of control. And as Dr. Albers said, it's kind of you're in the zone, you kind of space out and don't even recognize what you're doing. And a lot of it can be influenced by, again, how much you're eating, how restrictive you are and how restrictive you have been over the years.

Dr. Susan Albers-Bowling:

I would agree with that. Dieting is one of the number one triggers. When I'm working with a patient and I ask about … we're diving into their binge eating, they often give me a list of all the diets that they have tried. And for exactly the reason that you mentioned of that if we restrict our hunger and it becomes all we focused on … it's a little bit like holding your breath. If you hold your breath and you're underwater and then all of a sudden you come up, you're going to be gasping for air in the same way you do with binge eating, that it comes back and full force, and you are looking for anything that is going to help to satisfy that hunger. So it makes sense that dieting and restriction lead to binge eating. It's kind of like a pendulum, restriction and binge eating.

John Horton:

Yeah. It kind of sounds like, once you get off balance, it throws your whole system off and you're more prone to doing these sorts of things.

Julia Zumpano:

And I think it's also interesting that patients don't really recognize that that's a contributing factor. They're just always trying to search why they do it, and they've been restrictive for so long or they just think that's the only way to do things is that they don't recognize that that is a contributing factor. So as a dietitian, a dietitian's role in this situation is really to establish better eating habits, to create better schedules, better meal plans, better structure around meals. It's really to reteach those hunger cues and reassess when you're hungry and when you're not and really reteach those feelings back again.

Dr. Susan Albers-Bowling:

And that's a key. It's such a surprise often to many clients that regular and routine eating is key to helping to reduce binge eating. Exactly as you're saying, it helps the body calm down and the brain says, "OK, we don't have to panic when we encounter food because food is still coming." And if we are restricting, then all your brain can focus on is food. With my clients during their experience, and as I'm interviewing them, I ask them, "How much of your day is focused on food? How much are you thinking about food?" And many of them will say that it takes such a significant portion of their day. They may be thinking about food 60, 70% of the day. It takes up so much of the focus and energy. And that restriction can only make that number go up.

John Horton:

All of this I hear, and it just makes me think that we have such a complicated relationship with food and eating. I mean, it's very love-hate. I mean, there's things that we love about it. We crave it, we want it, brings us some joy, and then it also causes a lot of angst.

Julia Zumpano:

Yeah. I mean, a goal here is to create a good relationship with food and whatever food you're either eating — whether it's healthy or unhealthy — it's being able to understand your relationship with food and how to control it so it doesn't control you.

Dr. Susan Albers-Bowling:

And our modern world makes it so difficult to eat in a mindful way and really in a lot of ways encourages binge eating. Because we are often consumed by technology, we are scrolling, we're distracted while we're eating. And all of this modern life, technology, stress, it drowns out our ability to listen to our hunger, experience taste satisfaction. And when our attention is taken away from the table, we don't hear what's going on on the inside. So it's understandable that in the context of our world, it is so difficult to eat in a mindful way and can be a slippery slope into binge eating.

Julia Zumpano:

Absolutely. Everyone's eating on the go, they're eating in their cars, they're eating at their desk, there's convenience foods. It's almost a rarity to sit together as a family or even a gathering of friends to enjoy a meal. And those are things that are so essential when it comes to understanding hunger cues and appreciating the food you're eating and taking time to slow down and then recognizing those hunger cues and those satiety cues.

John Horton:

We're going to dig into mindful eating a little bit deeper into this podcast here, but while we're on the binge eating topic, we've kind of talked about it and kind of identified the problem and how you can identify it and things like that. What happens, though, if you do regularly binge eat? This isn't just a “we're worried about your pantry getting empty” here. I mean, there are some real health risks that come with this sort of eating pattern, correct?

Dr. Susan Albers-Bowling:

There are, but the effects extend beyond weight. Studies have shown that with binge eating, there's a higher incidence of issues around sleep, GI issues, cardiovascular issues and Type 2 diabetes — all of these health issues. And in my office, we talk about those health issues and health concerns, but one of the things that pops out even more is the practical implications and the psychological and emotional consequences that occur. My clients talk a lot about how binge eating may make them miss social events. They may not want to go or isolate. They may spend a lot of time or money on binge foods. It may impact their relationship because they're keeping a secret or they're distressed about how food plays out in their relationship. But the one that stands out to me the most is often missing social events. I can think of a client who didn't want to go to a graduation party of a close friend because they knew that there was going to be food there and it was going to tug on this urge to binge.

John Horton:

So in that case, is that just they see the food, they're presented with it, and you physically just can't stop eating it?

Dr. Susan Albers-Bowling:

Typically, it's not just about food. The food is often the last stop. When we look at the incident around binge eating, there's a lot underneath the surface. I talk about it like an iceberg of that the food's at the top or the binge, and there's so many different layers underneath. And so our work is often figuring out what happened in the binge and looking at all the different factors that may have triggered it or led up to it.

Julia Zumpano:

It's more that those social events may trigger that event of a binge or may trigger these thoughts and emotions around food, or they may feel overwhelmed with all the food that's around and these thoughts and feelings around it.

John Horton:

Well, the emotional part is so key, and I know we wanted to dig in a little deeper on that. Dr. Albers, I know you've talked about there being two key points that kind of drive emotional eating.

Dr. Susan Albers-Bowling:

Yes. Emotional eating and binge eating overlap quite a bit. Emotional eating is eating in response to an emotion you may have. It may be stress, anxiety, loneliness, boredom, and it's not just negative feelings; sometimes it's positive feelings as well, wanting to keep those feelings going. The part that is different from binge eating and emotional eating is that it doesn't have that feeling out of control. That's one of the primary differences between the two. Emotional eating is one of many triggers of binge eating. When we look at the different triggers, I like to use the acronym BEFORE to help clients to go through what triggered this event. Most important, before we get started at looking at those triggers, though, we want to understand the pattern, but we do it without judgment. There could be no judgment at all. My motto is always to be curious, not critical, as we're looking at these triggers.

B is body. Were there any triggers related to your body that caused this binge eating, such as were you overly hungry? Were you tired, exhausted, was your body run down?

E is emotions. What were you feeling? Were you feeling anxious, which is often an indication of binge eating? Stressed, lonely? We use the acronym HALT. Were you hungry, anxious, lonely, tired? That's always a good one to help to distinguish what emotions are driving it.

F is for food rules. Was there any restriction going on? Were you in a diet mode? Was that something that may have contributed to the binge behavior?

O, other people, like we were talking about with that party event. Were there any social factors that may have led to the binge, or contributed, I should say? For example, eating with someone else who was eating a significant amount or being encouraged by someone else to eat or feeling lonely.

R is routines. We have a lot of routines that sometimes keep that cycle of binge eating going. For example, at night, maybe you put the kids to bed and then you engage in binge eating, or as you're driving home, you stop on the way and pick up some food, or sitting on the couch at night. So there could be a lot of routines involved that continue on the cycle of binge eating.

And then finally, Environment, looking around your environment. Is there anything in your environment, such as seeing food on the counter or having a cabinet that has some of your binge foods in it?

So we walk through all of those different triggers to help us to decode what was this binge telling you underneath that you really needed in that moment?

John Horton:

Now, Dr. Albers, I know you said that triggers was one of the big key points. And the other one, which I thought was really interesting, was defining what is being served by you doing this emotional eating. Can you kind of explain that out a little bit?

Dr. Susan Albers-Bowling:

The emotional eating or binge is often serving a deeper purpose. It is numbing a feeling. It is escaping a feeling. Sometimes, it is escalating a feeling of maybe you're feeling happy and you want that feeling to keep going. Binging is a very quick way to change a feeling that you're having that is in some ways, it may be uncomfortable, but it's very quick. Studies have shown though that eating, while it works really quickly, it dissipates just as quickly. In fact, some studies say that that good feeling or relief that it gives is about three minutes and then it moves on. So it's pretty fleeting of a feeling.

John Horton:

I want a little more out of my ice cream dish than that, in three minutes. I got to be honest.

Dr. Susan Albers-Bowling:

I do want to acknowledge that it is OK to soothe on occasion with food. I want to make that really clear because food does work to soothe, and we have to acknowledge that, that it feels good. And every now and then, soothing with some ice cream or a food that you really enjoy is perfectly OK.

Where it becomes the issue is when you turn to food as your only source of coping. And in counseling, what we do is we want to build a bigger toolbox. Soothing is one tool, and it's OK to use that here and there, but when it becomes your only tool in that toolbox, that's when it often turns over to being a comfort to a problem. So I just wanted to note that it's OK now and then to soothe with food.

Julia Zumpano:

I use that as well. And oftentimes, when a patient comes in to see me, they think I'm going to take everything away. “OK, here we go. I had my last meal last night and I'm here to start my new life of boredom and not eating anything.” And that is the exact opposite of what my goal is as a dietitian. We're here to help you understand what food does to your body, how to better time meals, how to organize your day and your meals, and then, really importantly, most importantly, understand and enjoy those foods you really love and be able to have them on a regular basis and find joy and pleasure in them, but recognizing the appropriate amount and the appropriate time and how often, et cetera. So there is so much joy that comes out of food, and I think that is such a key piece that's so important here is no one ever wants to take the joy out of food. We're actually helping putting the joy back into eating and into food.

Dr. Susan Albers-Bowling:

And that's a great point. It's not about eliminating food or reducing food. It's about changing the way that you relate to food.

John Horton:

Dr. Albers, I read one interview with you, and I love this point you made, just when you connect emotions to food, and it's how we even talk about eating. And we often say, "What do I feel like eating?" And that instantly gets to where it's an emotionally driven act that we're doing. Do people need to readjust that thinking a bit to get a healthier approach to what they're doing?

Dr. Susan Albers-Bowling:

It is extremely helpful to be more mindful of the way we talk to ourselves about food. And it's interesting when we really listen, the words that we use are very telling about how we treat ourselves, how we think about food and our actions. For example, when I'm talking to clients, and they say things like, "I have a cheap meal," I already know that there's a lot of guilt or shame around food, or if they're saying good or bad foods, those words are very telling, and they play very automatically in the back of our brain, almost like background music. And unless we're mindful of them and bring them to the surface, we don't really hear them, but we're still acting on them. So I listen really carefully with clients and help them to see and identify which words are helpful to them, and then which words might be not as helpful. Anything around criticism, shame, judgment, that all shuts down their ability to work through a lot of these issues. Self-compassion, being mindful, even being neutral can be helpful in observing their experience.

Julia Zumpano:

Dr. Albers, it's funny you say that because I hear that all the time. “OK, I'm done with my education.” And then, the client or patient says, "Well, what about a cheat day? And how do you feel about a cheat day?" I'm like, "Well, I don't feel that there should be any cheat days because there's no reason for you to cheat. We're just eating, we're enjoying food, we're enjoying. If you want an ice cream cone, just enjoy it. You don't have to feel like you need to cheat. It's something that we can build and include, and I want you to have, and I want us to include it in the plan. So there's no need to cheat. This is just eating, enjoying eating and enjoying all the food you want to include." So I do feel like those cheat days can more promote those binge eating behaviors, whether it's just a one time, but it's that restricting again, and then that binge on whatever you want that certain day or time of day, whatever it might be. So I completely agree with the thought process of just really not allowing yourself to create negative wording around eating and only create more positive.

Dr. Susan Albers-Bowling:

And it's so automatic. It is part of the way that we've been taught to talk in our world that we don't even realize that it is impacting our actions, our thoughts, our feelings, because it's often part of normal chit-chat or we hear it in TV shows, and so it becomes very normalized. And typically, as I'm talking with clients and we gently bring that to the surface, "Oh, did you just hear it?" I mean, we don't even realize that it's happening.

John Horton:

Well, and this is where I love when you often talk about mindful eating, and it's really kind of reexamining, I guess, our relationship with food, our habits and things like that. Dr. Albers, I know this is your … you made your whole career out of this and you explain it so well, so I don't even want to get in the way. Kind of walk us through what mindful eating is.

Dr. Susan Albers-Bowling:

And there are many components to treating binge eating. Mindful eating is one of them. And I'm so passionate about it, and so I'm glad to tell you about it. Mindful eating is not a diet. There are no recipes or specific rules. It is about eating with attention and intention. It's about paying attention to all of the different components around eating and being aware of them. So the good news is that for many people, they don't have to change anything. It's just shifting your awareness to all those internal cues that are happening. And there are so many around what you're thinking about food, feeling, your hunger and fullness sensations. And what mindful eating does, and why it is one of the antidotes to binge eating, is that it creates a pause between the urge to eat and the action. And in that brief pause, if we can slow it down a little bit — because binge eating is very automatic, it's very routine and happens very quickly — so if we can slow it down and create that pause, it gives room to ask all those questions. How am I feeling right now? Am I enjoying this food? Do I even like this food? What do I need? All of those questions can happen in that pause. And so notice that we're not saying don't eat, we're just saying eat in a different way and to slow it down quite a bit.

John Horton:

Think about it a little bit. You said be mindful, run it through your head. What am I doing? Why am I eating this? And that kind of helps that whole process where you're not going to then maybe overdo it.

Julia Zumpano:

A quick tip that I use when it comes to this, just if I find patients are eating quickly or I'm eating quickly, I switch my utensil to the non-dominant hand because it just naturally slows you down. So that's just one piece that I've always taught, it's just take a pause, of course, put down your utensils between bites, of course. But even just the switch just makes you think about, you have to think about what you're doing and how you're eating and how you're using that fork to pick up what's on your plate.

Dr. Susan Albers-Bowling:

It's a great exercise to try because people are often surprised when they put their utensil in the opposite hand that it feels different, just like if we put a pencil in our non-dominant hand. And so it's a great exercise to even make you aware of, wow, this is challenging to do it in a different way.

John Horton:

Dr. Albers, you had talked, too, about the five Ss of mindful eating, which seem to lay things out really well. Can you walk us through those?

Dr. Susan Albers-Bowling:

The five Ss of mindful eating are very helpful for people to get started. If you want to try out mindful eating, here are some principles that can be helpful. Some of them sound simple, but they are much more difficult and complicated once you try them.

The first S is to sit down. Think about how often we are standing over a counter eating, walking while we're eating, leaning against the sink. Sitting down helps to focus your attention. It also creates a boundary of saying to your brain, "We are starting to eat." And so again, it's not to not eat, but sitting down helps us to give our attention to the food we're eating. My motto is always “Eat off your feet.” So if you're going to have a snack, take it to a table and sit down. And your body registers food in a different way when you're sitting. It processes it in a different way as well.

The second S is to slowly chew.

John Horton:

I'm bad at that.

Dr. Susan Albers-Bowling:

Me, too.

John Horton:

I eat so quickly.

Julia Zumpano:

I'm so bad at that. I know.

Dr. Susan Albers-Bowling:

Our world doesn't help us either, does it? It kind of rushes us along. I think about kids in their school day, how short of a time they often have to eat, or our lunch break, we don't have a lot of time. What's important about slowly chewing and can be often challenging is that it gives our body time and our brain time to register what we're eating. When we're eating quickly, we don't taste it. We don't allow our body to tune into the signals it's giving about hunger and fullness. So it's not about a specific number of chews because sometimes clients will ask me, "Should I eat a certain number of chews?" No, it's just about slowing it down. One thing you can do is when you're eating with other people, notice their pace and try to eat just a little bit slower.

Julia Zumpano:

I used to try to pace myself with my daughters because they're such slow eaters. I'd be like, "OK, just pace yourself. They're still only a couple bites in and I'm halfway through my meal." So that helps a lot.

Dr. Susan Albers-Bowling:

And kids are naturally mindful eaters until they get all of the signals from the world to eat quickly and hurries them along. So choosing somebody who is a slow eater or pacing yourself, because we tend to naturally, according to research, eat in tandem at the same rate as other people, unconsciously, we're not even aware, even with strangers.

Number two [three] is to savor each bite. And this is making sure that you're paying attention to the taste, the smell, the aroma, the texture of food, because we can eat an entire plate of food and not taste one bite. So making sure that we're really tasting it can change our experience of it, even our satisfaction level. Studies have shown that when we are more satisfied by the food that we eat and we pay attention, we actually enjoy it more and naturally eat less.

Julia Zumpano:

You tap into your senses here, right? So you're trying to look at, OK, let me stop. What does this food smell like? What does it feel like in my mouth? What does it taste like? What does it remind me of? So I do think we work a lot with patients and really recognizing what that savor means. You're really trying to utilize sight, taste, sound, smell, all of them.

Dr. Susan Albers-Bowling:

And the emotions that come up when you tap into your senses is sometimes surprising. You take a piece of chocolate and you deeply inhale. Usually, we're popping it in our mouth. We're not really ... if you smell that chocolate, sometimes it brings up a lot of emotions or thoughts or feelings. So tapping into those can be really helpful. And studies have shown that that first bite that you have is actually the most flavorful because it's a new sensation to your tongue. So if there's going to be a bite that you really pay attention to, that first bite is an important one. And sometimes when we pay attention, do we like it or not, we're sometimes surprised by that first bite if we really pay attention. You may like it or you may not. I call it the likability factor. Make sure you tune into do I really like this food? Is it something I'm enjoying?

Number four is to simplify your environment, and this is removing any kind of distraction in your environment that may be competing for your attention. So maybe it's swiveling away from your desk while you're eating, maybe it's putting your phone aside. And one of the myths that people often have is that you have to eat in complete silence. That's not it. It's just making sure that you are tuned in while you're eating and taking a few minutes before you eat to do that. And simplifying your environment also may be not eating in a chaotic environment and maybe sitting at the table. It also may be helping you to eat healthy foods by placing them in convenient places. One of the easiest things that people can do is put a fruit bowl on their counter and because we're creatures of convenience and when we see it, we tend to eat it. So that's simplifying your environment. Your goal is to eat more healthy foods. Putting it on your counter can be-

John Horton:

…my wife does that to me all the time. I mean, there's constantly cucumbers cut up there and I'm like … that's probably where I get about half of my fruits and vegetables when she leaves them on the counter.

Julia Zumpano:

I do that to my kids all the time. I mean, it's constantly out, fruits and veggies, fresh produce. They're always hungry, so they're walking by grabbing a couple. It's funny when you take a look and the whole tray's gone, which is great. One thing I also wanted to add is with the simplify, too, when you do simplify and you're with someone else, like you said, you don't have to eat in quiet, but eating with others, having conversations naturally promotes mindful eating. It naturally promotes you to speak, to take time, to chew, to conversate and to really pay more attention to the meal. So if you can to plan to eat with a coworker, plan meals around family and friends. So I think that's really an important piece, too.

John Horton:

It sounds like it'll slow you down a lot, too, because we're talking about not wanting to eat so fast. If you're in the middle of a conversation, you're going to be talking and then taking a bite and it just works in that way.

Dr. Susan Albers-Bowling:

The last S is to smile between bites. And many of my clients will kind of giggle or smile when I say that particular tip. And I explain it in this way. That smile helps to create a pause between bites. We want that pause, and in that pause, to check in with yourself: Do I want the next bite? Not to do it automatically the next bite, but to ask yourself, How am I feeling right now? Also smiling, even a fake smile releases chemicals to the brain that we are feeling happy. So it can also reduce some emotional eating as well. It's also a reminder of that satisfaction factor when you smile. Am I smiling? Am I naturally smiling because I'm enjoying what I'm eating? It's a good reminder.

John Horton:

So run them down again, I was going to say the five Ss. We have to sit down, slowly chew, savor, simplify and smile. I mean, that seems like a pretty easy formula.

Julia Zumpano:

I love those. I use mindful eating very often in my practice, and I know the other dietitians at the Cleveland Clinic do as well.

I do have a question for you, though. So when you have a patient coming in with binge-eating disorder, do you use mindful eating in tandem with just general good eating practices, like improving meal timing and improving meal consistency and meal balance, meaning macronutrient balance, or is mindful eating something that we should work up toward and really focus on the basic foundations of good eating habits first and then build in mindful eating in later?

Dr. Susan Albers-Bowling:

That's an excellent point. At the Cleveland Clinic, I'm often working in a team approach, and that's one of the wonderful things about working at the Cleveland Clinic is working with the dietitians, that your role may be helping people to structure their meal plan and figure out routine eating for them, whereas we're working on in psychology more mindful eating, the psychology. We may also be working with their physician as well.

So sometimes, this happens in tandem, where what you're saying is incredibly important, that having real food, nutrient-dense food, regular eating is important for mindful. It's much easier to eat in a mindful way when your brain is focused and nourished. So working with a dietitian is often incredibly helpful if you need some help structuring those meals and figuring out what to eat. Oftentimes, my clients will say, "I got the mindful eating part. I know how to do it, but I don't know what to eat." So I'm more of that how do you eat, and dietitian is often the what, but I know you work on mindful eating as well. So they really go hand in hand with each other.

The other things that we work on, too, is changing your thoughts around food. We were talking about that language of how you talk to yourself, the all-or-nothing thinking. We build that bigger toolbox of other ways to soothe yourself without food. We talk about self-compassion. We may also be working on stress management, depression, treating some of the depression or anxiety that may be underneath some of the binge eating. So mindful eating is one component of it. Making sure that you are eating a nutrient-dense diet, incredibly important, but there can be also other factors as well.

John Horton:

Julia, so when you do have patients come in, and they're dealing with some binge eating issues, are there certain foods or, I guess, places you direct them, like, "Hey, try this sort of eating approach or focus on these foods, which might help you then move past some of these issues?"

Julia Zumpano:

Yes, absolutely. Well, the first thing I'll look at is we do a diet history. So I look at meal timing. I ask them when they eat their meals and at what time. So first, I'm looking at timing. Are they timing their meals appropriately? And “appropriately” would be eating within the first couple hours of waking up, so one to two hours, eating every four to five hours, and spacing meals appropriately that way. Now, that doesn't have to be perfect. If you're hungry earlier than that, of course, eat, but the issue is more of not eating versus eating too much and too often. So we see more restrictive all day. So that is my first step, is I create a better schedule, a better eating schedule. And if a patient is working in the hospital, we have a lot of patients that work in night shifts, so I help them create an appropriate eating schedule for their life, for their lifestyle, their sleep and wake cycle.

And then after we create a better schedule, I will create better balance to those meals. So we've talked about balance on these podcasts before. It's the importance of your macronutrients, so making sure you have a healthy complex carb, a healthy fat, and adequate amount of protein at each meal. So if you're eliminating one of those major macronutrients, your body is going to feel deprived. It's not going to get the nutrients it needs. It's not going to get the good balance of your blood sugar, hormones, or hunger cues. I mean, your hunger cues are hormones, so we need to feed that body appropriately for everything to work right. So that is the other piece is we're really creating better balance of meals that can sustain you until the next time you eat. And again, understanding what that hunger cue feels like. So not allowing yourself to go to the point where you're ravenous, getting to the point a couple steps before that to have an appropriate meal to avoid that binge.

John Horton:

And it sounds like if you take those steps, if you're consistently eating a healthy diet, when we talk about these things that, I don't want to say cheat, but everyone will understand what I'm talking about there, when you have those other foods you're tossing in that may be not the healthiest.

Julia Zumpano:

More indulgences. Yeah.

John Horton:

The indulgences, yeah.

Julia Zumpano:

Yes.

John Horton:

The good, I'll say the good stuff in life.

Julia Zumpano:

Great indulgences.

John Horton:

Yeah, the great indulgences. But you can work those in then. and you shouldn't feel badly about it. It's one little indulgence as part of an overall healthy diet.

Julia Zumpano:

We should never feel bad about what you're eating. That's the key, whether it's an indulgence or not. So even if you're eating unhealthy food all the time, we're trying not to create negative feelings around eating. But if you're eating it mindfully, eating an appropriate portion, and trying to create better balance, you are going to be less inclined to want and desire those foods, and you'll have a better self-regulation between indulgences and nutrient-dense food.

Dr. Susan Albers-Bowling:

We can eat any food in a mindful way. We can eat carrots mindfully. We can eat chocolate mindfully. That's the good news about mindful eating. We can bring it to any food that we want to eat. And it's slowing it down, eating with an intention, and noticing. how do the carrots, how do the chocolate impact our body, how does it impact our emotions, whatever it is that we may be eating.

John Horton:

This has been an incredible discussion all the way through, and we laid out what binge eating is and just all those kinds of emotional components that come into maybe driving it, and then how we can mindfully eat to maybe help keep those at bay.

If we just have some final takeaways from both of you as far as your advice to people if they think they're dealing with a binge eating situation, what they can do, and the hope they can feel going forward.

Julia Zumpano:

My number-one recommendation would be to seek help. So seek help. If you feel like your eating is out of control, you're not alone. We have trained professionals that can help you and get you to a better place. So I think most importantly, talk to your healthcare provider, see a wonderful psychologist, a dietitian, get in touch with a healthcare team that can help you.

Dr. Susan Albers-Bowling:

Binge eating is incredibly complex, and it is not easy to overcome sometimes by yourself, and that is perfectly OK. I work with individuals who are CEOs, celebrities, manage families, classrooms, are incredibly successful in their lives, and struggle and feel powerless around this particular issue. So I want to leave you with the thought of that this is very treatable. I've seen many patients over the years overcome binge eating and really change their relationship with food, enjoy food, savor food, have a much different relationship with food, feel much more in charge of their decisions. So there are many resources, as we mentioned, at the Cleveland Clinic, and as well as some other national organizations, but there are wonderful dietitians. Your PCP can sometimes point you in the right directions, as well as psychology. So my hope is that for anyone listening that they try some mindful eating today. Whether you have binge eating or not, I think that we can all use the skills of mindful eating to enjoy, savor and enjoy our relationship with food.

John Horton:

Thank you both so much just for everything today. I mean, the wisdom you guys passed along was just fabulous. Dr. Albers, this is exactly why we were so eager to get you on the podcast. You explained this so well and really give folks the feeling that they can do something about any of these issues and just have a better relationship with food.

Dr. Susan Albers-Bowling:

Thank you so much for having me. As I mentioned, this is an area I'm incredibly passionate about, and I believe that we can all eat in a more mindful way. So eat, drink and be mindful.

Julia Zumpano:

Thank you, Dr. Albers. What a pleasure and an honor to be with you here on this podcast.

Dr. Susan Albers-Bowling:

Thank you so much.

John Horton:

Julia, I have to tell you, that conversation was about as fabulous as I expected. And I really feel like we broke down how complicated an issue binge eating can be, but also, how there are some really basic kinds of simple solutions you can use to address it.

Julia Zumpano:

Absolutely. I think first of all, just recognizing that it's an issue, it's a concern, it's common, and recognizing how simple it can be to treat if you just really break it down, and knowing that we have phenomenal health professionals that are here to help, psychologists and dietitians and physicians that really work together, and this issue is very treatable.

John Horton:

Well, and that's the biggest thing. I think anyone listening to this who is maybe concerned that they have some issues with food and with how they're eating should feel a little hope if they listened the whole way through that they can work through it either by going through the steps that you and Dr. Albers outlined or by reaching out to work with a registered dietitian or a psychologist.

Julia Zumpano:

Absolutely. And regardless if you have concerns or issues with food, mindful eating is something that can benefit anyone and everyone. Like we mentioned, there's so many health benefits to it. So even just starting to eat more mindfully.

John Horton:

Use your other hand, right?

Julia Zumpano:

Yeah.

John Horton:

Give that offhand a little bit of time.

Julia Zumpano:

Exactly.

John Horton:

All right. Well, if you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, eat well.

Speaker 4:

Thank you for listening to Nutrition Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/nepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.