Interview with Karen Koenig, LCSW, M.Ed.
Compulsive Eating Disorder Specialist

Karen Koenig is the author of The Rules of Normal Eating, Nice Girls Finish Fat, and The Food and Feelings Workbook and she answered these questions on September 15, 2010. See the bottom of this page for her full biography and professional experience.

Q From the time I was a very small child I would go to bed praying to wake up skinny. That child's prayer turned into a silent desire to find some "magic" to help me lose weight. What do you say to people who are looking for magic?

A I say that I deeply regret to inform them that there is no magic and that there are only baby steps for me, them and everyone else on the planet. I explain how change is a slow process so that we can integrate new behaviors and attitudes properly and keep moving on. If they're looking for magic, they need to go to a magic show because there's none in the real world, only illusion.

Q Your book is called The Rules of Normal Eating. Are there really a set of rules for eaters to follow?

A Yes, four rules: 1) eat when you're hungry, 2) choose foods that will satisfy you, 3) eat with awareness and for enjoyment, and 4) stop when you're full or satisfied.

Q People talk about food addiction, binge eating, compulsive eating, compulsive overeating, emotional eating and I'm sure there are more terms. Are they all the same? Can you clarify the meaning of these terms for us?

A A binge is clinically considered eating more food than the "average" person would several times a week in a two-hour (or so period), with resultant thoughts of regret, remorse, shame and self-disgust.

Compulsive eating is eating without awareness or much enjoyment, attacking food on autopilot. Compulsive overeating is a redundancy.

Emotional eating is eating to avoid or lessen external stress or internal distress (ie, emotional upset).

Food addiction can happen with sugar -laden foods which trigger the release of dopamine, the feel-good chemical, in the brain. Scientific research has gone back and forth for years on whether sugar is addictive. My understanding is that there is a cause-and-effect dynamic proven with rats. I'm not so sure about humans. Much of what disregulated eaters call physical addiction could be from psychological dependence.

Q One of the worst features of an eating problem is the perpetual chatter from the voice in your head. How do you suggest that people deal with this?

A Write down the repetitive chatter and examine its themes: you're a victim or a failure or however you perceive yourself. Look for underlying irrational beliefs embedded in self-talk, then reframe those beliefs to make them rational and repeat them instead of the irrational chatter. Especially to be banned are words such as should, must, ought to, have to, am supposed to, need to.

Q I believe that shame is a contributing factor to most serious eating problems and until that shame is externalized, recovery is difficult. Do you agree? What are your thoughts on shame?

A Disregulated eating on a regular basis is shame-based. Overcontrolled eating is to avoid shame and feel in control. Out of control eating manifests the shame externally. The shame is actually within the person and must be addressed for the shameful eating behaviors to stop.

Q People often comment about thinking about food and eating all of the time in a self deprecating and somewhat joking way and it leads to a conversation about food and weight and cravings, but not a serious conversation. How would you approach someone like this, when you sense they are in pain and trying to reach out?

A Know your audience. Not everyone can talk about their food issues. Make attempts to talk about eating problems only with people who will understand or whom you believe will be able to discuss the problem appropriately. Be honest, be serious, be vulnerable and let people know what you want from them in a conversation (eg, advice, support, information, mutual sharing, a place to vent,validation, etc.).

Q In your book you say that "It is hard, hard work to unlearn decades of unhealthy thinking and habits and then develop and relearn healthy replacements; it takes the courage of a lion, the ferocity of a bear, and the patience of a saint!" How do you start to eat normally. What is the first baby step?

A The first step is different for everyone. You can't duplicate someone else's process. And there may be baby steps in different arenas--food and otherwise--happening at the same time. For example, you tell someone about your eating problems while you enroll in a yoga class while making a list of your negative chatter and reframing irrational beliefs. All of these could be first steps.

Q After so many years of eating craziness how do you begin to get back on track?

A It depends on whether you've ever been on track. Some people have had eating problems since early childhood, while others developed them only after giving birth or after menopause. You begin by wanting to be different and hoping you can learn to be.

Q How do you prevent yourself from getting discouraged while tackling such an overwhelming challenge?

A You will get discouraged; that's a given. It's not preventable. The question is how do you sustain motivation in spite of discouragement. You do that by not judging your failures, relapses or mistakes, by only being curious about why they happened and problem solving about how you can do things better in the future. You recognize that change happens incrementally and takes a long time, much longer than you'd expect. You practice patience, self-compassion and curiosity and learn the life skills you need to make eating "normally" easier.

Q What role does body image play when you are trying to find your way to "normal eating".

A It helps to stay in the present rather than think about how you used to look or may look again. It's important not to think about how other people might judge your body and to ignore, as much as possible, absurd cultural norms for thinness and beauty. Self-love and acceptance are essential. Acceptance means you love your body as is even as you are working to have it look differently. Reducing shame goes a long way toward not projecting it onto having a perfect body.

Q When people think that they have a weight problem, a diet is the obvious solution. Even when people know that their problem is deeper than simply eating more calories than they metabolize, they still think that dieting is the answer. How do you lead people away from the dieting cycle when it is so ingrained in the American psyche?

A I give them statistics about diets not working, help them understand the gender, genetic, biochemical, and cultural issues involved, and ask them to look to their own experience. If diets haven't worked for them in the past, they're unlikely to work in the future. I remind them that diets have failed them, not that they have failed on diets.

Karen R. Koenig, LCSW, M.Ed., is a licensed psychotherapist, motivational speaker, and international author who has specialized in the field of compulsive, emotional, and restrictive eating for 30 years. She received a B.A. from Boston University, an M.Ed. from Antioch College, and an M.S.W. from Simmons College School of Social Work. Currently she lives, teaches, and practices in Sarasota, Florida.

She is a co-founder of the Greater Boston Collaborative for Body Image and Eating Disorders and a former member of the Professional Advisory Committee of the Multi-service Eating Disorder Association of Massachusetts. During the past three decades, she has taught and made presentations to venues such as the adult education centers of Sarasota, Florida and Boston and Brookline, Massachusetts, Bayside Center for Behavioral Health, Boston Women Communicators, Women on the Scene, American Business Women's Association, Florida Writer's Association, Minnesota's Breast Cancer Awareness Association, and Lake Austin Spa. She has conducted professional trainings for the Multi-service Eating Disorder Association, the National Association of Social Workers, the Massachusetts Dietetic Association, the Massachusetts School of Professional Psychology, T.W.I.C.E. Educational Seminars, Simmons College School of Social Work, and Feeding Ourselves.

Among other publications, her essays and articles have appeared in Social Work Today, Social Work Focus, The Newsletter for the Society for Family Therapy and Research, Positive Change, Attitudes Magazine, The Boston Globe, The Boston Herald, The West Roxbury Transcript, Equal Times, and Single Living. Her books have been translated or are being translated into Chinese, German, Portuguese, Polish, Romanian and Spanish.

Her website is eatingnormal.com

Healthy Eating Support Home