5 Steps to Recovery from Food and Body-Image Issues

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If you’ve tried different diets to help with food obsessions, binge eating, or emotional eating, you may have come to the conclusion that your food and body-image issues are not about food. These issues are about how you use food to deal with your emotions, experiences from your past, and beliefs that have resulted from past hurts or traumas. By working on your food and body image issues on a deeper level, you can expect your healing to also be deeper and more sustainable.

Surface-level unwanted behaviors have gotten much worse for many people, for example, during the pandemic. One study showed that limited food access has been triggering for those with eating disorders. The pandemic also increased anxiety rates and the use of food as a way to cope with stress. Isolation, including being quarantining in households where relationships were conflictual or even abusive, exacerbated or led to maintaining of eating-disorder behaviors. Isolation during the pandemic led to loneliness, obsessing over food intake, and an increase in unwanted behaviors such as restriction or binge eating, and compulsive physical exercise.

For all these reasons, it's important to talk about ways to recover. Let’s start with the first of five steps to recovery: stopping surface level behaviors.

Here’s a case of a patient I saw to illustrate (names and details change to protect confidentiality):

Billy had always been a “husky” kid. His parents were both living in larger bodies. Everyone thought that because of Billy’s size, he would follow in his dad’s footsteps and be a football player in high school. When Billy was in fifth grade, his life took an unexpected turn: his mother died of breast cancer. After her death, he began to put on a lot of weight. By high school, he weighed over 300 pounds. In desperation, he decided to have gastric bypass surgery to get the weight off. Initially he lost weight, but over time he found himself unable to stop bingeing despite his doctor telling him he could rupture his new post-surgical stomach. Within two years, he had regained the weight he’d lost. Treating the surface symptom—his weight—did not solve Billy’s problem.

Problems with food or weight are like an iceberg. Everyone can see the ice above the surface of the water, but they can’t always see the larger part of the iceberg beneath the water. What gets everyone’s attention is what’s above the surface—weight, behaviors such as bingeing or overeating, and body dissatisfaction. These behaviors can make life unmanageable, creating financial hardships, medical problems, and general unhappiness. The food and body image problems, and the associated behaviors, are what gets everyone’s attention because they are what you are focused on, what your friends and family know you worry about, and what take over your life. Imagine what your life would be like if you didn’t spend most of your time thinking about your weight, how to lose weight, what you look like, how ashamed you are of your body, what you’re planning to eat, or what you are trying to keep yourself from eating, and so on.

The eating behaviors at the superficial level include overeating; bingeing; dieting; the use of diet pills, diuretics, or laxatives; purging; and emotional overeating. The first step to healing is learning to become more aware of the behaviors. The next step is to begin learning new skills that can help you cope with stress and emotions without using food. This will give you the space to recover who you are (your authentic self) and to learn to understand and cope with troubling emotions in ways that don’t involve food. Your authentic self is the "essence" of who you are and has likely not changed. You may be kind, intelligent and funny; however, your eating disorder behaviors and obsessions can camouflage your authentic self, making you take on characteristics associated with your "eating disorder self"—obsessive, impulsive, embarrassed, self-loathing, shame-based, or other. When you only address the superficial aspects of your food and body image issues, you won't reconnect with your authentic self, but it is your authentic self that can provide the security, safety, and joy you want in your life.

Just as icebergs come in many shapes and sizes, you may find your reaction to addressing your body image and food problems will show up in many different forms. Sometimes when we focus on the number on the scale, what’s on the surface seems so big and overwhelming (“How am I going to lose 100 pounds?”) that you may feel like you are standing on the edge of a cliff and are terrified of jumping off. In other cases, what’s on the surface may seem like something that isn’t too hard to do (“I’ve lost weight before; I can do it again”), but when you start to look deeper—at what’s beneath the surface, at the emotions driving your behaviors, at past hurts and traumas, or even at core beliefs you’ve held dear most of your life—you become fearful and overwhelmed and can’t see a way through. Both reactions are normal and not unexpected.

You may also find that you have a dual or conflicted relationship with these behaviors. For example, you may recognize that certain foods don’t make you feel good, but that you can’t stop eating them. You may binge on sugary foods in the afternoon, then feel sick and tired most of the rest of the day only to find yourself wanting to binge again later in the evening. Eating certain foods may be comforting but may result in feelings of guilt and shame afterwards.

As part of preparing yourself to stop these behaviors, it will help you to become more aware of how food came to represent love, comfort, safety, or whatever it currently represents to you. Until you are able to identify the original connection you forged with food, you will have difficulty breaking the cycle that keeps you stuck: Your mind may think you want to eat because you are hungry, while your emotions are driving you to eat because of long-lost memories connecting specific foods to love, comfort, or safety. This awareness will explain why you couldn’t stop bingeing on certain foods or why you find yourself overeating to the point of feeling sick even though you don’t really want to.

Often the behaviors that are part of the superficial level started when you were younger but only became disruptive as you got older. These behaviors may have been preceded by events in your life that you may not have thought about in years and may not connect to your current problems with food or body image

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Difficult life experiences can often cause confusion between eating for nourishment and eating for pleasure. This can lead us to convince ourselves that we need to treat, reward, or comfort ourselves with food.

We have been taught by the media, our families, and society that if we are in a bigger body—or if we are different in any way from what society deems acceptable (young, thin, straight, etc.)—we cannot have what others have and, most importantly, what we desperately want.

Each of us has within us a longing for our best life, for our dream life. What is confusing is that we have equated superficial qualities of appearance and size, for example, with what they represent for us in our best life. For example, if you believe you have to be thin in order to have the relationship you long for, you may have forgotten what you’re really longing for, which is the feeling of intimate connection and how it would fill your heart. In essence, dreams can be postponed or even shut down, waiting for you to have your perfect body.

What can you do about all of this? Here is some homework that will help you identify and understand these surface level behaviors.

1. Make a list of all your behaviors that are unwanted. Some examples may be:

• Hoarding food
• Binge eating
• Eating in secret
• Emotional and stress eating
• Using laxatives or diuretics
• Skipping meals

2. Next, make a list of the foods you tend to crave, eat as a reward, or eat as a way to rebel against someone or something in your life.

3. Ask yourself what would be missing in your life if you no longer could turn to those foods for numbing, to deal with stress, or to cope with your emotions?

4. Finally, ask yourself and journal about the dreams you’ve put on hold because you’re waiting to have a different body