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Dr. Margaret Gaglione

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Weight Loss Today by Dr. Margaret Gaglione


Teaching strategies for eating well is an important part of obesity management. Individuals who are at unhealthy weights are often not fully aware of the unsupportive behaviors they exhibit. Many of my patients will tell me that their biggest triggers for overeating are emotional stressors, mostly negative; boredom; anxiety; fatigue; frustration, or their inability to effect change. Most will readily admit that it is not "hunger for food" that is driving them to overeat at the wrong times.

Making concrete analogies can often be a useful tool to help patients modify their behaviors. I use the analogy of two tool boxes, one an intellectual tool box and the other an emotional tool box, to contrast skill sets that are used in making decisions. Here is a sample dialogue that I use when teaching about the trap of emotional eating.

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Me: Pretend I have two tool boxes: one I have labeled the intellectual tool box and the other I have labeled the emotional tool box. I would like you to tell me which box I should use if I have to make a business decision?

Patient: (100% of the time): intellectual tool box

Me: Very good. Letís change the scenario and pretend I have to make a parenting decision where my child wants me to be their friend and I really should act as a parent. Which tool box should I use?

Patient (90% of the time): intellectual tool box

Me: Very well. Okay, now here is a situation for you. Pretend you have had a stressful day, would you use your emotional tool box or your intellectual tool box?

Patient (100% of the time): emotional tool box

Me: Is food in your emotional tool box? What foods are in your emotional tool box?

Me: Very well. Let's look at two statements and I want you to tell me which tool box is being used in the following situation:

My kids have driven me crazy all day. I deserve to eat half this cake. (emotional tool box)

A glass of red wine would complement this seafood dish. (intellectual tool box)

Encouraging patients to move food and alcohol into their intellectual tool box and out of their emotional tool box is a way to start the conversation of behavioral modification. If patients are unaware that they use or how often they use food to calm themselves, and or comfort themselves, they will not be able to change their behaviors.

The second part of the dialogue is to help patients to fill their emotional tool box once they have moved food and alcohol out. It has been surprising to me how many patients have been stumped by the question, "Other than food, (or alcohol) what calms you down, makes you feel better?" Providing guidance and encouraging patients to think about other activities that they enjoy are very important to help them build a cadre of resources to draw from when they are stressed and fatigued. Healthy tools might include: exercise, taking a nap, listening to music, meditatation, funny jokes, watching a comedy, or spending time with others. The goal is to have a full emotional tool box, filled with behaviors that will help induce health, not cause one to gain weight.

Dr. Gaglione is the medical director of Tidewater Bariatrics in Chesapeake. She is a board certified Internal Medicine physician and a Bariatric specialist.

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