By: Elyse B. Falk, MS, RD, CDN

Are you really hungry?  Is it real hunger where your stomach is rumbling and/or you feel dizzy from not eating for a while?  Or is it emotional hunger where you are eating because you are feeling either upset, lonely, stressed, etc?.  I have found these questions to be extremely useful when working with CEDAR clients who have been diagnosed with Bulimia and/or Binge Eating Disorder.  

Most clients come into nutrition therapy with the expectation that their favorite foods are going to be taken away and will be forbidden forever.  While this is not entirely true, it is not uncommon to temporarily remove certain trigger/unsafe foods in the beginning of therapy.   Once the client feels safe and confident, trigger/unsafe foods will be added back slowly over time and as the person can comfortably tolerate and enjoy them.  Sometimes, the client will bring the trigger food into the session with me and we will eat it together thereby giving the client the opportunity to learn how to decrease their anxiety around the food and allow the experience to be pleasurable.   During these particular sessions, we can talk about the flavors that the previously forbidden food brings to the mouth, how the mouth feels and finally how it feels going down the throat.  The client can talk about how the food might taste differently over the course of eating it, the texture of the food as it changes while being chewed, and how to be mindful of chewing rather than eating rapidly and thereby diminishing the entire experience.   We can sit together after food is gone and talk about what feelings the food may bring up within the client.      

An important goal of nutrition therapy is for the client to understand and trust that all foods can fit into their diet. There is no such thing as good or bad food.   Another important goal is for the client to really get in sync with their hunger and fullness cues and understand these cues.  Just taking a few moments to ask themselves the following questions before they eat are strategies used to assist with their road to recovery.

Am I Really Hungry?  

Is it physical hunger?  

When was the last time I ate?

Did it have a combination of carbohydrate, protein, and fat?

Am I light headed, dizzy, or faint?  

Is my stomach rumbling?  

What am I hungry for?  Something salty or sweet, protein or fat?

            OR

Is it emotional hunger?

How am I feeling as I start to eat?...Lonely?  Stressed?  Anxious?  Nervous?

Giving the client a food log to record their food intake and hunger/fullness levels is extremely helpful in identifying and making the connection between their physical hunger and body sensations, their cravings and their feelings.  The food log also helps the client identify what their hunger and fullness feels like and track these feelings throughout the day.  The goal of this exercise is to teach the client on how to avoid becoming too hungry before a meal and how to avoid getting too full at the end of a meal.  In time, this will help the client become confident in identifying their hunger and fullness cues and recognizes the need for spacing meals and snacks in order to avoid over or under consumption.  Education about what the body needs to remain healthy is part of nutritional counseling.  The client learns the appropriate food combinations (a carbohydrate, protein, and some fat) they need to satisfy themselves without overdoing it.