A Harm Reduction Model for Loss of Control Eating

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In considering the use of a harm reduction model for those with loss of control eating behaviors, this post is a follow-up to last month’s post, "Cravings, Loss of Control, and Dietary Restraint." In substance use treatment, a harm reduction model targets moderation, thereby decreasing the harmful consequences of their use that may not require the complete buy-in of an abstinence-only approach. For eating disorder treatment, I have often worked with individuals with chronic and enduring anorexia who ask me to help them stop purging or using laxatives, yet are not ready or committed to gaining weight. This seems like a straightforward approach to harm reduction, yet when working with loss of control eating disorders, it’s a bit more of a slippery slope. How do we create structure to reduce cravings and help the mindfully challenged brain without poking the fearful and instinctive parts that counter with binge eating?

Harm Reduction

Harm reduction involves employing limits and boundaries that keep us out of the weeds when we are the most vulnerable to our habitual brain. The mere mention of boundaries feels restrictive to the food insecure and those with histories of diet trauma and weight bias. Yet, continual loss of control perpetuates feelings of defeat and shame. Our goal is to reduce fear and instill confidence in one’s ability to care for themselves.

A Compassionate, Science-Based Approach

Over time, I have developed a compassionate and science-based approach that involves five keys to its effectiveness.

1. Adopt a mindset of weight neutrality and intrinsic mindfulness.

Removing the judgment of weight and size as an extrinsic measurement of “progress” when making behavioral changes helps focus one’s value on self-care and regard. The motivation for change becomes an intrinsic measure of “feeling good” rather than “being good” or acceptable. Learning to tune into how the body responds to food by closely monitoring hunger, fullness, cravings, energy, clarity, discomfort, and other interoceptive feedback becomes the focus. The goal is to move toward food and body with curiosity and respond compassionately. Weight is a measure of gravity and the body’s business, not ours.

2. Understand the science of the body’s drive for survival.

Understanding the craving mind and other biological processes governing our drive to eat is powerful. It is vital to replace any moral or pejorative labels our culture has attached to food consumption with mindful empowerment. This decreases the shame that propels the binge eating cycle. It includes having respect for food insecurity, which is the fear of not having enough food. There is a part of us, whether historical, emotional, or biological, that fears being controlled, trapped, or otherwise deprived of our life force. It provides a new paradigm for changing food behaviors: to calm our fear responses.

Examples of this involve feeding ourselves predictably with balanced macro and micronutrients and eating to satiety with foods that signal the body’s mechanisms of fullness. This includes being mindful of foods that increase inflammatory responses in our body and brain, affecting our mood and overall wellness.

3. Accept and respond to the desire to eat comfort foods.

Many foods are symbolic of love and connection and are woven into the fabric of our families and culture. These foods bring richness to life and have a purpose. Abstinence from these foods creates an emptiness that manifests over time into rebellion and the fear of missing out.

Unfortunately, the food industry has made trillions from this understanding. These highly palatable foods are typically combinations of sugar, salt, and fat. They are processed and manufactured to lure us into overconsumption. Our culture of "fast and easy" has made these foods everyday staples rather than carefully crafted family recipes that are prepared or baked and brought out for Sunday dinner or holidays in celebration of being together.

Those with loss of control issues with food may use these foods to comfort and soothe in a regulatory manner, often compulsively, alone, or in secret. In fact, mindless consumption of these foods degrades the food experience and reduces it to a drug-like substance. These foods are best eaten mindfully in the context of connecting and making memories with others.

The goal is to understand our attachment to these foods as a needed substitute and create our own boundaries in how we consume these foods, not in giving up these foods altogether. Mindful eating can help us celebrate these foods or simply decide that we really don’t like them enough to seek them for comfort.

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4. Develop an ability to identify vulnerabilities and respond with a predetermined plan.

Understanding our vulnerabilities to mindlessness is key. Everyone has their own “bandwidth” or physical and emotional resilience. Because of this, mindful or intuitive eating has its limits.

Many of my clients have problems with attention deficits or have highly sensitive nervous systems that simply shut down their ability to make value-based decisions at certain times. This opens the floodgates to automated habits often driven by fear and survival. Therefore, many have difficulty with loss of control when stressed out or tired. This is the reason our resolve diminishes in the late afternoon and evening.

Once we understand our limitations, we can act accordingly. This is not something you will learn right away, like the age-old concept of willpower. This is physical and must be managed skillfully with compassion.

A two-directional approach is needed.

First, we need to adopt skills to regulate attention and energy. Once we notice hyperarousal, pause and slowly calm the body back into its window of tolerance. This preserves our bandwidth through self-regulation. We also face environmental and social choices to conserve and protect our energy.

Second, put in place boundaries that protect and reduce harm when we accept mindlessness. For instance, when in a more resilient state, create some value-based guidelines to maintain focus. Examples might include deleting food delivery apps, not keeping certain binge foods in the house, or unpairing mindless habits like eating in the car or in the recliner in front of the television. This is where preplanned food options come into play. Remember: Change will evoke fear and the learning curve is slow, so be kind and compassionate with yourself in this process of reducing harm.

5. Closely monitor and calm fearful responses.

Anytime we create boundaries, even if it comes from our own resolve, feelings of depletion, scarcity, and rebellion start to poke their heads above the surface. Befriend the fear. Validate the feelings and use a self-care voice to comfort and de-escalate the anxiety.

The goal is to calm down first and then make the choice. We can’t make value-based decisions if we are in hyperarousal. And there is always a choice. Being in charge of your eating choices is essential to disengaging fear responses.