1. PROBLEMATIC EATING (RE WEIGHT LOSS) Dr Madeleine Tatham Consultant Clinical Psychologist Norfolk Community Eating Disorders Service/ Weight Intervention Norwich (WIN) m.tatham@nhs.net

2. Problematic eating behaviours Snacking between meals and snacks Grazing Food choices Skipping meals and snacks Night eating Over eating Emotional eating Binge eating

3. Binge eating (disorder) DSM 5 classification: Recurrent episodes of binge eating. Characterised by: Eating an objectively large amount of food in a discrete period of time A sense of lack of control over eating during episode (i.e. cannot stop) Binge eating episodes are associated with 3 or more of Eating more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not physically hungry Eating alone because feeling embarrassed by amount eating Feeing disgusted with oneself, depressed or guilty after eating Marked distress regarding binge eating Binge eating occurs on average at least 1xweek for 3 months

4. Over-eating vs. binge eating ( C Fairburn) “Large” amount eaten Amount eaten not “large” but viewed by person as excessive “Loss of control” present Objective binge episodeSubjective binge episode No “loss of control” Objective over-eatingSubjective overeating

5. Eating in response to emotions Positive / negative feelings If don’t learn to regulate emotions and / or have low tolerance (e.g. anger, boredom) Blocking behaviour (Eat) Secondary emotion (e.g. depression) Don’t manage feelings Trigger (e.g. argument) Primary emotion (e.g. anger) Weight gain

6. Understanding eating patterns and behaviours Monitoring Current intake – structure, quantities, choices Thoughts – plans, decisions Emotions – e.g. anger, boredom, loneliness, sadness, anxiety Context – environmental, interpersonal Historical review Family eating patterns Regulation – food as reward, comfort etc. Early problematic patterns - comfort eating / secret eating

7. Distinguishing binge eating from other types of problematic eating Use monitoring sheets Amount of food Emotional feelings Questioning Do you feel out of control when you’re eating? Do you think about food all the time? Do you eat in secret? Do you eat until you feel sick? Do you eat to escape from worries, relieve stress, or to comfort yourself? Do you feel disgusted or ashamed after eating? Do you feel powerless to stop eating, even though you want to? NOT helpful to ask “do you binge?”

8. Problematic eating - common issues Automatic behaviour (i.e. learned habit) Mindlessness Planning Self-regulation Emotional regulation Cognitive style – e.g. “all or nothing” & “permissive thinking”

9. First steps – regulate eating Planning Monitoring Decisional sheets (e.g. if I eat outside my plan…..) Stimulus control measures Mindful eating Distraction techniques

10. More advanced strategies Emotional regulation (CBT/DBT) Mindfulness Problem solving skills Stress management Assertiveness

11. When to refer onwards? If binge eating / eating disorder – refer to Norfolk Community Eating Disorders Service For mild eating problems – refer to Eating Matters For peer support – refer to Beat (Binge eating support groups) For stress, anxiety, depression etc. – refer to NSFT mental heath services (i.e. Wellbeing service, A&A team)