Appetite Awareness Training

Introduction

Appetite awareness training (AAT) emerged from Dr. Linda Craighead’s years of research and clinical work helping people figure out how to feel better about the way that they eat. The AAT workbook was published in 2006.

The basis for cognitive and behavioral interventions for eating problems is to have the client self-monitor in a way that requires them to write down everything they eat each day. The purpose of this self-monitoring is to draw your attention to how you are eating so that you (with the help of your clinician) can figure out what is not working for you and can develop a way to eat that works better. There is nothing inherently problematic about self-monitoring. It is in fact the most powerful tool that anyone can use to change their own behavior. However, it's been discovered that recording what one ate put way too much emphasis on the kind of food eaten and not enough emphasis on a person's eating decisions, which were, ultimately, what needs to change.

Problems with keeping a food journal:

Some loved keeping food records but became too dependent on this external source of control; from past experience, they gained weight whenever they weren't monitoring very carefully, which has created the fusion of tracking and weight change.
Others experienced an increase in their distress and compulsivity around eating.
Some refuse to do it
For some, this is reminiscent of dieting

The majority of the clients reported that they were more willing to do appetite monitoring and that it focuses more on what seems important to them. Clinicians often report how much better they feel about asking clients to monitor appetite rather than food.

To the client: "This approach is different from many other strategies you have tried. Let’s give it a whirl! What have you got to lose?! Humor me!"

Client testimonial: “When I first started appetite monitoring I was pretty skeptical but desperate for help. I followed through and stayed dedicated and it turned out to be very helpful. It puts you back in touch with your body and helps you realize when you’re hungry and when you’re not. The appetite monitoring was definitely one of the most important things that helped me get on the road to recovery!”

Chapter 1 ~ Today's Food & Weight Dilemma

In today’s world, it’s not uncommon for individuals to blame their life’s problems on their weight or shape. One may think, "If I were thinner or had a better shape, I would be happier." Learning to eat in a way that feels natural and comfortable is very valuable; it is the goal of this book and it's possible that your weight or shape changes to a degree. It's also possible that you may never be completely satisfied with how you look, and solving your eating concerns is not going to make all your other problems go away. The reality is that changing your weight may make less of a difference than you anticipate.

Fortunately, once you start feeling better about the way you eat, you will have more time and energy to focus on changing those aspects of your life that have greater potential to make you a happier and more fulfilled human being.

THE DEVELOPMENT OF EATING PROBLEMS Babies are the ideal eaters. Adults obviously cannot eat exactly like babies because we must eat a wider variety of foods to meet our nutritional needs. However, observing how babies learn to eat is very informative. Babies learn to regulate the amount of food they eat before they have to face choices between different types of food. When a baby feels hungry, she cries until someone responds to her demands. If the baby is allowed to eat as much as she pleases, she will nurse until she is full and stop on her own. Eating is such a positive, soothing experience for babies that they often nurse themselves to sleep. If a baby gets a little too full, she may naturally regurgitate as she is burped. For babies, being too full does not feel comfortable. If a baby is interrupted during a feeding before she feels even moderately full, she will resume nursing if allowed to do so. If she is not allowed to do so, she is likely to cry and demand more. However, if she is interrupted just a little before she would have stopped on her own, she is not likely to be upset. She can be easily distracted with a toy or game. A baby whose intake is overly restricted is likely to be irritable much of the time. Feeling hungry is not a pleasant state.

Observing this natural process is very instructive. Nursing mothers do not know exactly how much a baby eats, so they can interfere only minimally with the baby's natural regulation process. As you can see, we are all born with a biologically based appetite regulation system that is designed to regulate the amount of food eaten. As babies transition to table foods, they are exposed to our current food environment.

Young children typically regulate their intake to obtain appropriate, but not excessive, calories as long as they are given access to a variety of foods. Overeating becomes more of a problem as children get older and they are pressured to clean their plate even when they aren't hungry. Caretakers may also cause problems by restricting a child's or adolescent's food too severely. When a child feels deprived, she is likely to start sneaking food or overeating whenever food is available. Over time, children experience an increasing number of social and emotional situations that teach them what, when, and how much it is appropriate to eat within their culture and within their family.

Most people believe that dieting (in conjunction with exercise) is the most effective way to achieve the figure they desire. However, when you become overly focused on achieving an ideal figure, you spend excessive amounts of time, energy, and money on dieting and/or exercise. Often these efforts end up interfering with more important aspects of your life. Obsessing about food and eating is a manifestation of disordered eating. Many people never meet the criteria for a diagnosable "eating disorder," but they become anxious and depressed, and they upset their family and friends by dwelling on how badly they feel about their weight. Some individuals become isolated because they avoid social situations in which they are expected to eat. Some neglect their friends or their work in their pursuit of thinness. Excessive concern about weight and appearance can make you far more miserable than your actual weight.

For many, excessive exercise is now as problematic as excessive dieting.

AN EPIDEMIC OF BODY DISSATISFACTION The clashing trends of increased actual weight and lower ideal weights have created a society in which most girls and women are at least moderately dissatisfied with their weight or shape. Dissatisfaction with one's body is the norm. Surveys of many different groups of females indicate that the majority, perhaps as many as 75 percent, are somewhat dissatisfied with their bodies. Thus, most women spend a lot of time thinking about weight. Very few women over eighteen are naturally so thin that they can maintain a weight below the normal range without enduring chronic restriction or excessive exercise.

For this book, dieting means the voluntary restriction of any type or amount of food for the purpose of losing weight or preventing weight gain. Dieting implies that you would prefer to eat differently if your weight would not be affected.

Body dissatisfaction (not health concerns) is the main reason people diet. Severe and chronic dieting is the problem because dieting is the most common reason individuals begin binge eating.

THE PARADOX OF THE THIN IDEAL There is a fine line between working hard to achieve a goal and becoming overinvested in a specific method for reaching that goal. When you are overinvested in one method, you are unable to recognize or accept the reality that this method isn't working, so you fail to consider alternatives that might work better.

The ultrathin and thin-fit ideals are harmful because women become overinvested in achieving those ideals. They lose sight of the real reasons they want to be attractive. In most cases, the harder a woman tries to be that thin, the more it eludes her. In many cases, the most obvious of which is anorexia, if a woman actually achieves her goal, it is at a high cost to her physical and mental health. She fails to realize that she isn't getting the desired benefits of achieving a very low weight. Usually, she does not recognize the health risks that she is incurring.

For example, a young woman thinks she will become more popular, find a boyfriend, and be happier or more self-confident if she is thinner. However, getting and staying thin takes up so much of her time and attention that she ends up alienating her friends and cannot find or maintain a satisfactory romantic relationship. Men may find her attractive initially, but they are turned off when they discover that she is so insecure about her appearance (and herself).

OVERCONCERN WITH WEIGHT OR SHAPE Severe body dissatisfaction, however, leads to chronic unhappiness, insecurity, low self-esteem, and social isolation. Body dissatisfaction is related to the importance a person puts on their physical appearance, and the degree to which weight determines their perceived self-worth.

Women who are overly concerned with weight and shape often don't feel significantly better even if they are thin or have succeeded in losing a substantial number of pounds. The over-concerned woman never believes she is quite thin enough and she remains dissatisfied with some aspect of her shape, even if she feels all right about the number that comes up on the bathroom scale.

ACCEPTING YOUR WEIGHT AND SHAPE In appendix C, I discuss further the concept of accepting your current weight and shape. Accepting does not necessarily mean that you have arrived at your desired weight; you may still prefer to be thinner. Accepting simply means that your weight does not make you so unhappy that your quality of life is diminished. It also means you do not avoid or put off activities because of your weight or body. Regardless of your body shape/size, accepting your current body is still a better option than remaining distressed about it. Accepting where you are right now is the most effective way to work toward where you want to be. You will be better able to work toward your goal if negative emotions (blame and shame) do not interfere with your efforts.

THE BIOLOGY OF WEIGHT LOSS Biology provides very little help in the fight against weight gain; our bodies are set up to protect us from possible starvation, not from an excess of food. Your body responds the same way whether you restrict your intake voluntarily (diet), or whether your food intake is limited by an inadequate food supply (famine). In either case, your body becomes more efficient in order to survive with less food. This response is an advantage when food is actually scarce, but makes it very difficult to lose weight on purpose or to stay significantly underweight.

Chapter 2 ~ The Appetite Awareness Training Solution

AAT can be part of the treatment plan for almost any kind of disordered eating pattern.

The basic principles of AAT are simple.

you take charge of your eating decisions so that you are not as vulnerable to external cues/environmental signals to eat or to diet.
you work with your internal appetite signals instead of attempting to fight your biological weight regulation system. My motto is "Don't fight Mother Nature. She has the advantage. She will eventually wear you out. She will win!"

You may be pleasantly surprised to find that you can make peace with your appetite and your body.

Willpower as it relates to dieting requires constant effort and attention; consequently, it is extremely difficult to maintain. People who rely on willpower usually become overly preoccupied with maintaining a high level of control over their eating. This limits the attention they can give to other important parts of their lives. This is ultimately not very satisfying.

You need a moderate amount of so-called willpower to commit to learning AAT. Initially, you will need to practice diligently to shift away from your current eating patterns. However, AAT helps you tune back into your body, so you rely more on automatically generated body signals and less on willpower. Relying on body signals means that less attention will be required to maintain your new eating pattern. Nonetheless, it still takes some effort to stay attentive and respond to your signals. However, unlike willpower strategies, AAT seems to get easier and easier the longer you do it.

AAT is designed to help anyone who does not feel good about the way they eat. It doesn't matter if you have an eating disorder or are simply tired of spending so much of your life worried about eating and weight. This program is particularly effective in helping people stop binge eating and reduce preoccupation with food. It can also help you reduce overeating and feel generally more comfortable with eating.

Acceptance doesn't mean you give up on yourself. You are encouraged to highlight your physical features, as well as your unique personal qualities. When you honor all the best aspects of yourself and make peace with what you cannot change, you will be ready to experience life as a more fully integrated person. to experience life as a more fully integrated person. You can live richly, making the most out of all life's possibilities.

HOW THE AAT MODEL WORKS AAT begins with a model that describes the various reasons an individual starts, continues, and ultimately stops eating. The model illustrates how the three most common problem-eating paths differ from normal eating and identifies seven specific intervention points where you can start making different decisions about eating. This model does not explain why you developed your current eating patterns; it just helps you figure out why you eat (or don't eat) and why you stop (or don't stop). AAT teaches you to analyze what happens each time you eat, which I refer to as an eating episode. You figure out what led you to eat and what led you to stop eating. This is a much easier task than trying to come up with the "original" reason you have an eating problem, or trying to find a simple "solution" to your eating problems. In AAT, you tackle one eating decision at a time, and you get better and better at making more effective eating decisions. Do you eat mindlessly, with little awareness of your decisions or do you obsess about every bite you take? In this program, you are going to change the way you make decisions to start and stop eating no matter which end of the spectrum you lie on. You also have to make decisions about the types of food you will eat, but AAT focuses first on learning to make better decisions to start and stop eating. Once you are able to regulate the amount of food you eat, you can decide whether or not you want to alter the type of food you choose to eat. There are many reasons to start with regulating the amount you eat. First, changing preferences for how full you feel is much easier than changing preferences for the types of food you eat. Second, learning how to stop eating effectively is going to do more to reestablish your sense of control over eating. Third, when people try to change the types of foods they eat to low-fat or low-calorie food they tend to compensate by eating more. When you eat more "diet foods," you may or may not end up eating significantly fewer calories. Hence, an exclusive focus on food type is not an effective way to control your weight. AAT can help you alter preferences for types of food (see chapter 8), but only after you can regulate the amount.

LET YOUR STOMACH BE YOUR GUIDE The most fundamental concept of AAT is that you learn to use internal, stomach-based signals to make decisions about eating. Obviously, you have to first notice your stomach signals. Thus, the first step is to identify the two critical stomach signals: moderate hunger and moderate fullness. Since you have a history of restricting or overeating (or both), you have learned to ignore or override these signals that can be your best allies. When you wait as long as possible to eat, you are tuning out the moderate hunger signal. When you binge or overeat, you are tuning out the moderate fullness signal. You must now tune back into these signals. Once you can easily identify the signals, you can start using them to make eating decisions that feel better and work better. You can then commit to using stomach signals instead of debating about what you want or don't want to eat, or about what effect eating some specific food will or will not have on your weight. Once you have established this new strategy for making eating decisions, the process of eating normally can be maintained with a moderate degree of attention and effort.

With normal eating you are strongly encouraged to enjoy whatever food you decide to eat. Food serves two functions in your life.

It provides necessary nutrition to keep you healthy, thus prevenging you from feeling aversive hunger sensations.
Food give you pleasure. Eating, like sex, is one of the most basic human needs. You wouldn't think of trying to take the pleaure out of sex, would you? So why do that with eating? Having a positive mind-set about the role of food is an essential element of the normal eating path.

THE NORMALIZED OVEREATING PATH The normalized overeating path is when you continue to eat past your moderate or comfortable fullness signal. Our biological system is set up to respond to the sight and smell of food, not just to sensations of hunger. It is quite natural for a person to eat just because food is present. It is also perfectly normal to start eating in order to feel better or to celebrate. Our biological system is setup to respond positively to food. Unless you have learned to have negative reactions to eating, food reduces tension, fatigue, and a number of other unpleasant feelings. Food can also enhance positive feelings.

For example, you are full from a substantial dinner and your favorite dessert is served. Emotional cues can also be quite strong. For example, when you are feeling lonely, bored, and depressed you treat yourself to a sundae. The goal of AAT is to honor your body and stop at moderate fullness no matter why you start eating. When you can maintain this boundary on amount, you will stay on the normal eating path instead of ending up overeating or perhaps triggering a binge.

Our social environment makes overeating the most difficult path to eliminate. Food is an important aspect of most social occasions.