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One Reason Patients Don’t Follow Doctors’ Orders: The Emotional Barriers to Weight Loss

May 26, 2011



by Tricia Greaves, President, The Nelson Center for Emotional Healing


Consider that people who struggle chronically with their weight may be emotional eaters who are using food as a way to soothe pain and manage stress. Despite appearances to the contrary, the unhealthy choices patients make aren’t necessarily motivated by sloth or foolishness, but instead are driven by deeper emotional reasons.

Overeating is an easily-accessible and socially-acceptable activity that can begin as a pleasurable way to take the edge off and develop into a pernicious addiction. Just as an alcoholic has lost the ability to “moderate” his drinking, so, too, the emotional eater can’t moderate or control food choices or quantities. In addition, the treatment for most substance-based addictions is complete abstinence from the substance, yet a food addict can’t ever stop eating altogether. 

Unlike the alcoholic who usually starts drinking in early adolescence, the emotional eater typically begins self-medicating with food much earlier in life, thus making the addiction even more primal than the alcoholic’s. Buried childhood pain, loneliness, sexual desire, and anxiety caused by lack of appropriate emotional responses to adult responsibilities are many of the forces that drive the overeater to seek the safety and sedation of food. 

The reason patients don’t follow admonishments to “eat less” is because they can’t. According to Maslow’s hierarchy of needs theory, when a person is desperately fighting to meet perceived emotional deficiency, she does not have the drive to focus on higher-level needs such as appearance or health considerations. Psychologists and psychiatrists concur that eating disorders are among the most difficult mental illnesses to treat and have abysmal treatment statistics: 20% of patients will die prematurely from complications related to the eating disorder (and this statistic does not even include statistics of obesity-related death), and 80% of those receiving treatment relapse1, 2, 3 

Another critical reason your patient can’t follow your prescriptions is the fundamental lack of self-worth that chronic overeaters usually suffer. This translates into desire to be healthy but no fortitude to make the necessary changes because the self-soothing they receive from food is too great. 

In these cases, excess food serves to stabilize emotions; a restrictive diet leaves an overeater without the support she has come to rely on from food. While many people can “white-knuckle” weight-loss for a time, statistics show that 98% of people who lose weight end up gaining it back within five years. Recent research studies have also shown that sugar is equally addictive to cocaine4. For someone who is emotionally and physically addicted to food, it is a near-impossible dependence to break. 

The environment in which patients live also plays an integral role in being able to make lasting changes to improve their health. Patients who live alone may lack the emotional support necessary to sustain lasting changes, while a spouse can undermine weight loss efforts because they feel threatened about needing to make changes themselves. 

Tuning into some of these emotional factors will help patients feel confident that you understand and care about them. By being an ambassador of your patients’ emotional as well as physical health you will help ensure their long-term success. 

Tricia Greaves is the President of The Nelson Center for Emotional Healing, which offers workshops and concierge services for overcoming addictions, food issues, and emotional problems. To learn more about the emotional barriers to compliance, you are invited to join us for our upcoming workshop on June 4th, either in person or via live-streaming over the internet. For more information please visit (For discounts for professionals please call 310-384-6317.) 

  1. Maslow, Abraham (1954). Motivation and Personality. New York: Harper. 
  2. The Renfrew Center Foundation for Eating Disorders, “Eating Disorders 101 Guide: A Summary of Issues, Statistics and Resources,” published September 2002, revised October 2003, 
  3. National Association of Anorexia Nervosa and Related Eating Disorders (
  4. Lenoir M, Serre F, Cantin L, Ahmed SH (2007) Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698. doi:10.1371/journal.pone.0000698