So we have learned what works, we have learned what doesn’t work. We have also learned how to eat the food that works. What about eating emotionally?

The Lap-band does not fit well around the brain, and the band isn’t meant to. But the Lap-band does give you an opportunity to reflect about what you eat. The Lap-band gives you a tool that allows you to limit the amount of food you can eat, so you can use this tool to retrain yourself about portion sizes, as well as think about the food you are eating.

Lap-band surgery is a first step to begin thinking about what choices you make

This is called “mindful eating,” or “reflective eating.” The Lap-band gives you the opportunity to consider what and why you are eating the food in front of you. Like crossing the street, “stop, look, and listen,” is another way to consider “mindful eating.” In other words, with the Lap-band, you need to eat slowly; your new mantra should be — slow, small, and easy.

Many people who are overweight eat quite fast. By quickly shoving food in the mouth, they have little time to consider the consequences, and it becomes all too easy to consume a large quantity of calories without thinking. It becomes easy to eat food that has a high quantity of calories — or what we call “calorie dense”. Not thinking about what they eat does not absolve them; unfortunately the body is still a perfect calorie counter. Eating too fast leads to another bad habit, that is, having to drink a lot of liquid with the meal to help move the food along.

The Lap-band forces you to slow down when you eat. You cannot eat too fast, and indiscriminate eating can harm the Lap-band. Foods that can cause obstruction of the Lap-band, like pizza, breads, pasta, or some processed foods, can even lead to band slippage — meaning that piece of pizza could lead to another operation to readjust the, or loss of the Lap-band. Overeating and throwing up frequently is a recipe for Lap-band slips.

The Lap-band is a first step to begin thinking about what choices you make. It is the culmination of small choices that make the difference over time. The lifestyle changes required now are small daily changes that boil down to the simple question: “What do I want more, to be thin, or to eat something that is less nutritious?”

Perfection isn’t required — but awareness is. Pizza isn’t the enemy, nor is peanut butter, or cheese, or fatty meats. Being aware of what you eat, and being mindful of the consequences is the first step to overcome emotional eating.

Emotional hunger – the hunger in your head

Sometimes we call emotional hunger “head hunger.” Thinking about why you are eating is a useful exercise: boredom leading to random eating, or being upset with the job, the spouse, the boss, or being lonely and thinking that the M and M’s are your best friend (kind of a cannibal then aren’t you?). It could be rebellion — thinking you are so deprived that you must eat that one thing — because perhaps your rebellion should be to free yourself of the need to eat the item. Is there a gratification with eating the ice cream, or is the delayed gratification of fitting into one size smaller worth it?

Imagine if you had a choice to eat the food in your refrigerator and gain the weight, or throw the food out, and not? Difficult choice isn’t it? Not when you think about it in that regard. Do you want to gain that fat? If it is in your refrigerator, where will it end up?

It is no wonder that we respond to stress by eating

There are differences between emotional hunger and real hunger. Head hunger occurs at anytime — it has nothing to do with feeling full. It can be triggered by emotional stress, by triggers at home or at work.

Why do we have “stress” cravings? In the history of humanity real stress has been because of starvation. In the “dark ages” getting another meal was the focus of life, there wasn’t stress about a job, or a boss, or a sister-in-law, but if you cannot eat — that is stress. So, the idea of stress being a job, or your teenager who spends too much time on the internet, is new to humans — and how do we respond — stress is not new. Our bodies still think that stress equals starvation. Famines were the rule of the day for many centuries — you want stress — try a famine. Those who lived were those who were able to store effectively in a famine.

So it is no wonder that we respond to stress by eating. We have thousands of years built into us saying that if we have stress, it must be hunger, and if we are hungry we must eat. This even applies to when we have a meal sitting before us.

Imagine starvation — true starvation, where food isn’t available to you. You have stress because your existence is threatened by starvation. Now you have food before you — a lot of food. What is the reaction? The reaction is to eat every bit of it, because if you don’t there might be another time of starvation again.

Take the Tlingit Alaska Natives. These were the American Indians that lived in Southeast Alaska, British Columbia, and along the Washington coast. They had abundant food sources available to them — lots of salmon, lots of berries, plenty of food to hunt. Obesity among modern day Tlingits is less common than obesity among Pima Native Americans. Pimas were people who lived in the Sonoran desert. Sometimes there was a lot of food, and often, as is the way with the desert, there were famines. Who survived? Those who could store food. Is it any wonder that in modern times, where famines are not around and an abundance of food, that the highest levels of obesity are seen among the Pimas? But that need to store food efficiently wasn’t required among the Tlingits.

The reaction to stress is unchanged, but the source of stress has changed in modern society. The reaction to stress is to eat — and people who can store food effectively will store what they eat during stress. Then again, if you are worried about your job, or your kids, or your parents — and you are stressed — doesn’t it make sense that it is going back to that primitive reflex that you need to find food to eat, because stress really is starvation.

There are the “stress hormones,” like cortisol. Some unscrupulous people have tried to convince people that by getting rid of excess cortisol that you will get rid of “unwanted belly fat.” That is a lot of bunk mixed with a bit of science. Here is the real story: when under stress humans do release extra hormones, among them are the stress hormones. If we give extra hormones, people gain weight, and they gain it because the appetite is increased. Anyone who has been prescribed prednisone will tell you that their appetite has increased tremendously— ok, time for a story:

Over ten years ago I got meningitis and as a result had developed severe headaches. I recovered from the meningitis, but for weeks afterward I would develop severe headaches. I remember going to my favorite steak restaurant in town, and eating a bite or two of everything, but just not having any appetite at all. A couple of days later I was placed on a high dose of steroids. Went back to my favorite steak place, and I ate the entire meal, plus some – and over those few weeks I was on steroids gained 20 pounds.

The pills that claim they will get rid of excess cortisol are simply bunk. The bunk that these charlatans try to sell is that these pills get rid of steroids and you will lose weight. The only weight you will lose is the excess cash you are carrying in your wallet. Those pills do not get rid of excess cortisol, nor do they block its production, and because food supplements are not regulated, they were allowed to advertise freely until recently. Still, stress does cause people to eat more, even if they are not hungry.

So the question is – how can we tell if we are eating because of stress

…or if we are eating because of hunger? With the Lap-band there are a few clues:

First, you only have to eat a small amount to be satisfied. Notice I did not say “full,” but satisfied. There may be an entire banquet in front of you, but the goal is to eat to the point of satisfaction. What you do not want is to feel uncomfortably full, or to where you need to loosen the belt, or to any level of discomfort. You want to eat a portion to be satisfied, and that is it. The key, then, is eating a portion – do not eat to a feeling— eat to a portion of food.

If, after a meal, you have the urge to eat, it is time to consider the trigger for wanting to eat. Is it real hunger? Are you bored? Are you at work, and having stress about the job? Are you at home – not that there would ever be stress at home living with teenagers.

One reason you do not want to skip meals is that a trigger of real hunger and if you combine real hunger with stress this leads to overeating. By not skipping meals, and not setting off the trigger of “starvation,” you avoid the temptation to overeat.

The key to head hunger is that it will arise at anytime, regardless of having just eaten and feeling satisfied.

Why do smokers, who quit smoking, gain weight? Because taking a smoking break is a great way to get rid of stress, and take a time out. When deprived of the “time out” and getting away (because non-smokers rarely go to the smoking area and chat with their smoking friends) — the common reaction is to eat something. The lesson to learn from smokers is to take breaks away from stress — if it is a short walk or perhaps taking a few minutes from work to personally deliver a memo — getting away from the stressful situation is a great way to avoid emotional eating.

Do you have a dog? Dogs are great stress relievers — because they are always happy to go for a quick walk. By the way — dogs love walks, and if you are letting the dog walk you, I highly suggest you check out “The Dog Whisperer,” on the National Geographic Channel — Caesar Millan will show you how to properly walk the creature. We believe so much in dogs that we have a dog in our practice — Diego, a certified therapy dog. If patients don’t like dogs, well — we send them to our colleagues.

The key to emotional eating is to find another mechanism to cope with the stress. Walking works well, or any form of exercise. It gets you away from the stress and allows you to spend time pondering the day.

It is also important to not skip meals — adding emotional hunger to real hunger is a dangerous combination that leads to overeating. But if you are not hungry, then don’t eat — we find that eating two or three meals a day is fine, but not more.

There is a difference between physical and emotional hunger

…and a number of psychiatrists and patients have helped to put this list together:

Physical Hunger

Physical hunger is gradual. Emotional hunger comes on in a rush. With physical hunger you may hear your stomach rumbles. One hour later, it growls. Physical hunger gives you steadily progressive clues that it is time to eat. But sometimes you hear noises from the Lap-band, and those are simply band noises—they are not hunger. Sometimes the noises from the Lap-band trigger the sensation of hunger—an old behavioral (Pavlov response).

Physical hunger is open to different foods. With physical hunger, you may have food preferences, but they are flexible. You are open to alternative choices. You can eat something healthy, and be satisfied.

Physical hunger is based in the stomach. Physical hunger is recognizable by stomach sensations. Your stomach, and your upper pouch are empty, and with that you might feel gnawing, rumbling, emptiness, and even pain in your stomach with physical hunger.

Physical hunger is patient. Physical hunger would prefer that you ate soon, but doesn’t command you to eat right at that instant. It is subtle, not strong.

Physical hunger occurs out of the stomach telling the brain it is empty, and that it is time to fill it. . Physical hunger occurs because it has been four or five hours since your last meal. Although if the Lap-band is not properly adjusted, it may occur earlier. If you find that you are becoming hungry between meals consistently you might consider having an adjustment.

Physical hunger involves deliberate choices and awareness of the eating. You have time to consider a meal, and are not driven to the sensation of being starved. With physical hunger, you are aware of the food on your fork, in your mouth, and in your stomach. You consciously choose whether to eat a small portion of food, and are not driven to eat too much.

Physical hunger stops with eating a small amount. If you eat slowly, and you feel full, you have had physical hunger.

Emotional Hunger

Emotional hunger is sudden. One minute you’re not thinking about food, the next minute you’re “starving.” The hunger comes on suddenly.

Emotional hunger manifests with a craving for a certain food. Typically a food that has provided comfort to you in the past (for me it is ice cream, for my office staff it is chocolate). With emotional eating, you crave that particular food. You rarely will crave a carrot.

A former heroin addict described emotional hunger to me: He said that when he needed a fix he could taste the bitterness of the heroin first, and then he sought to go out and get a fix. The same is true with emotional hunger, An emotionally based craving, it begins in the mouth. It is not based in your stomach.

Emotional hunger is urgent. Emotional hunger urges you to eat NOW! There is a desire to instantly ease stress with food.

Emotional hunger is paired with stress. You want to escape the stress, and take comfort in the food, you want to leave, go to the vending machine, the kitchen, someplace.

Emotional hunger involves automatic or absentminded eating. You begin eating some food – ice cream, or cookies, or potato chips, and you find you have had far more of them than you would have if you had the choice. It is called absent-minded eating; it is from your brain, from your stress. When you are simply physically hungry and have wanted a cookie — you can have one, and enjoy it. It is a conscious deliberate decision.

Emotional hunger does not notice or stop eating, in response to a sensation, or to a small portion of food. With emotions you can overcome the sense of satiety — because being satisfied with a small portion of food is not the issue, it is almost a compulsive behavior.

Emotional hunger feels guilty about eating. There is a cycle of shame – you feel shame that you ate something, and it becomes easy to give up. With real hunger, and the conscious decision to eat an item, there is no shame involved.

There is a mixed emotional-physical hunger. If you have waited too long to eat, you find that you have physical hunger combined with emotional hunger. This is the time to slow down. You can eat way to fast, way too much, and become way too uncomfortable. It is best when you are delayed for a meal to load up with a bit of water or fluid to take the edge off so that you do not make the mistake of over filling your pouch.