Dear Dr Ash,
I’ve had a lifelong problem with yo-yo dieting, going from 12 stone to 17 and then back again throughout my life (I’m 47), which has persistently made me unhappy. When svelte I’m the life and soul of the party, have no problem attracting lovely women and generally feel happy. But then gradually my weight creeps up, my girlfriend drops me and I feel like a giant slob who lacks all motivation. My default mode is binge eating and no packet of biscuits or tub of ice-cream is safe. Every three or four years I find the momentum to embark on an extreme diet (I’ve tried pretty much everything from Atkins to veganism to the carnivore diet) and they all work for a bit. At first, I’m a devoted disciple and I feel euphoric at the sudden weight loss, but after the initial high some form of ennui sets in and I revert to binge mode. My sister tells me I’m eating to cope with childhood unhappiness (I’m the youngest and our father left when I was eight, then I was bullied at school) and she’s concerned that I’m currently back at the heavy end of my weight spectrum. But when she tries to talk about it, I lose my temper. I didn’t talk to her for three years last time she brought the subject up. I know you’ll suggest I do more exercise, but I’m pretty consistent on that front. I’ve been a hiker and a regular tennis player since student days but don’t seem to lose weight this way.
Demotivated of Cumbria
Dear Demotivated,
Your letter reflects a deep sadness around food and what you perceive as your failure of willpower, and my heart goes out to you. You are framing this as an emotional issue that affects your health; it may be more useful to frame it as a health issue that affects your emotions.
Bear in mind that no aspect of our lives has been more distorted by commercial culture than the way we think about food. Our family life is recognisably ancient, as are our sexual identities, our quarrels, triumphs, politics, and the ways we think about wealth and status. But the way we eat would be, in most cases, unrecognisable to our ancestors. Our bodies evolved in a world of resource scarcity, one in which we spent many hours actively hunting and gathering low energy-density foods. Nothing in the 200,000-year history of our species prepared us for our first encounter with a Big Mac.
Nothing in the 200,000-year history of our species prepared us for our first encounter with a Big Mac
The brain systems that regulate hunger and satiety have been shaped by that evolutionary history, and they are intricate, delicately-balanced and complex. Two hormones, ghrelin and leptin, tell an important part of the story. Ghrelin is made in the stomach and it makes us feel hunger. Its counterpart leptin is made by fatty tissue and makes us feel full.
These hormones normally regulate each other very well. Ghrelin prompts us to eat until the stretch response of a full stomach shuts it off. Leptin works the other way: when levels are low we feel hungry, and as we make more fatty tissue leptin rises and we feel full. With a normal diet everything stays nicely in balance.
But when we are exposed to highly-processed foods, our hormonal systems become unhinged. The stomach becomes insensitive to stretch and continuously produces ghrelin. Continually high levels of fat make the brain insensitive to leptin. The entire system becomes disregulated. As a result, the brain’s dopamine system, which gives us a feeling of pleasure and satisfaction, also goes haywire. Food no longer produces joy in the way it used to. In fact, joy in general doesn’t work the way it used to. This leads to an unending cycle of eating to alleviate craving and depression, then excessive eating paradoxically causing more craving and more depression.
You are experiencing the yo-yo effects of your hormonal systems swinging wildly around looking for a balance point. You’re probably right that some of this may have started with emotional issues in your childhood, but blame and lamentation won’t help you to feel better now. Rather than embarking on difficult diets or even deep introspection, I suggest you follow author Michael Pollan’s pithy and straightforward advice: eat food. Not too much. Mostly plants. He conjures a joyful relationship with food that’s more sustainable in the long-term.
Best wishes,
Dr Ash
Dear Dr Ash,
My husband and I have a joint bank account and in theory we share bills and household tasks and parenting. But he’s oddly possessive about our supposedly shared car – and has been like this about past motors. He insists on overseeing the choice of the cars we buy, even when I’m not keen on particular models. Somehow his feelings about the manufacturer, the engine and the design always trump mine. I feel he’s always subtly – or not so subtly – trying to stop me from using it, even though it’s nothing fancy (a ten-year old BMW 318). And I’m not even a bad driver – my worst offence has been a speeding penalty for going at 40 mph in a 30 zone. But he’ll do anything to stop me using it, insisting on taking our son to his football matches and getting cross if I want the car for weekend outings. It’s clear this isn’t “my” car and I have to ask him permission to use it, like a teenager to a parent. After putting up with this for fifteen years I suddenly find the situation intolerable. What can I do?
Frustrated of Cheltenham
Dear Frustrated,
I grew up in a car-obsessed town in the American Midwest, a place where Henry Ford’s legacy still looms large. This is the land of drive-thru restaurants, drive-in movie theatres, drive-thru medical clinics and even drive-in churches. So while my memories of that time have faded, I vividly remember riding around in my friend Brian’s beat-up ivory Chevette, a tiny sputtering thing with Heartbeat City by the Cars permanently stuck in the eight-track tape deck. I also remember Pam’s massive blue boat of a Chrysler, which used to rock dramatically from side to side whenever she went round a bend. My friends may have grown older and more distant, but their cars remain close.
The brain literally treats the car like an extension of the body
By the standards of my hometown, I’m certainly not a “car guy,” but I am aware of the outsized role that cars play in my feelings about status, freedom and individuality. These ideas were well-framed in the early twentieth century by the German philosopher Martin Heidegger, who argued that the nature of a tool is defined by the capacities and interests of its user – that a tool is, in some way, an extension of a person’s conception of themselves. Contemporary neuroscience goes even further, suggesting that when we use a tool like a car, the brain’s “body schema,” the map that relates parts of the body to each other, might actually expand to incorporate the vehicle. The brain literally treats the car like an extension of the body. If your heart has ever skipped a beat when you think you might have gouged your car’s paint, you’ll be familiar with this feeling.
It may be that, in these dimensions, you and your husband view the car differently. For you the car sounds like a functional necessity, while for him it may feel much more than that. If that’s the case, then your conversation needs to be more emotional than practical. Sometimes, as post-Freudian psychologists say, a cigar is just a cigar – but sometimes there is something deeper going on.
Best wishes,
Dr Ash
