Overeating may be in our genetic makeup; a tendency toward stressed-out binging might be part of our evolutionary baggage. Our brains’ reward systems seem obsessively focused on obtaining calories, and our 24/7 eating environment gives them plenty to dwell on. But the good news is that we can overcome these hurdles to become “normal” eaters again, and perhaps even shift our neurochemistry to favor more stable eating patterns—even if we’re genetically predisposed to binge-eat. “Your genes don’t dictate that you’re going to develop an eating disorder, only that you’re more vulnerable to it,” explains Hudson. “A lot depends on environmental factors bringing that predisposition out.” And, while you can’t completely control your environment, “you can work on how you react to it.”
Emotional eating can be managed too. “Because many associations between negative emotions and eating are learned,” says Ramirez, “they can also be unlearned,” with cognitive behavioral therapy (CBT) skills, such as the ones she teaches to clients like Sarah. By focusing on replacing old behavior patterns with new ones, she explains, “you can learn how to manage your eating to the point that it doesn’t feel like an addiction, but like something you have control over.” In some cases, drug therapy—including fluoxetine (Prozac) and other medications that target the serotonin system—can be a useful addition. (Other drugs that target the dopamine receptors are in the works.) “Behavioral therapy can work without drugs, but drugs can’t work without behavioral therapy,” says Ramirez. “A combination of the two can be helpful for many people.”
“The brain is very plastic,” adds Boggiano. The same circuitry that gets activated by learning an association (say, gorging on peanut butter cookies every time you’re late with a deadline) gets deactivated when you break that connection with new thinking and behavior (like calling a friend for a “stress break” instead). Expose the brain to new stimuli, she explains, “and it can start forming new, healthier habits and activation pathways.”
Practicing new ways of thinking and eating has helped put Sarah back in control, steadily and slowly, over the months she has worked with Ramirez. While she has gradually begun to lose weight, she has, more importantly, shed emotional baggage and retrained her brain to think differently. “I’ve learned to take a step back when I’m feeling anxious or upset and talk myself through it, rather than going immediately to food,” she says. “I’ll talk to myself in a positive way, instead of beating up on myself.”
Being accountable for her actions has also been key. Sarah logs everything she eats in a food diary—even on those (now rarer) occasions when she overeats. She keeps “trigger” foods like chips or French fries out of the house, but lets herself enjoy them in manageable amounts at restaurants. She avoids tempting situations like the gas station checkout counter, where candy bars lurk by the cash register; “I pay at the pump with my credit card instead,” she says. She has also “normalized” her favorite binge foods by making them part of her daily eating, and enjoying them out in the open rather than in secret: on most afternoons, she’ll have an 8-ounce can of Pepsi and a small chocolate bar. “That comes to between 230 and 300 calories,” she says. “I just write it down in my diary.”
Recently, Sarah realized how far she had come when she made a “huge” mistake at work that in the old days would have sent her straight to the candy counter. She accidentally hit the “send” button too soon, and an unedited document “went to the wrong person,” she remembers. “It created all kinds of bad feelings between the parties involved.”
But instead of escaping her feelings temporarily by gorging on candy, Sarah faced up to the problem instead and got on the phone. “I admitted to everyone involved that I had blown it and that I was very sorry,” she remembers, “but I also said that I had to move on from there.” By taking responsibility for the problem, she was able to get through the bad feelings without eating over them, and now they’re history.
“I know I’ve got to work at this every day, but now I have the skills to do it,” she says proudly.