Dear Dr. Debug:

My 35 year-old, unmarried son has put on a lot of weight in the last few years. He is 5 feet 7 inches tall and weighs about 320 pounds. As his mom, I have been very worried, and have encouraged him to get help. So far, nothing has worked. He tried a couple of weight-loss programs but dropped out early. Recently, I decided to get into counseling myself because I want to figure out if there is something about my family that has played a part in his overeating. Signed: Hoping For A Solution.

Thank you for writing! I commend you for your willingness to investigate how family and emotional issues might play a role in your son's obesity. Such a weight gain will likely have significant adverse effects on your son's health. Experts estimate that "emotional eating" is the primary cause of overeating about 75% of the time. The remaining 25% of people who overeat engage in binge eating or have contributing medical conditions.

Loneliness, anger, hurt, depression, stresses, social difficulties, and self-image problems can lead to overeating. Emotional eating often has identifiable triggers. Sometimes, the trigger can be obvious when it is related to a social difficulty, like an argument or hurt feelings. Often, however, triggers are less obvious and may be related to what I call "skeletons in the closet," which are older, unresolved hurts and anger.

As you noted, your son has tried weight-loss programs but dropped out early. This is a sign that his overeating is likely related to emotional issues. One of the first steps that can help your son figure out what is going on is to keep a food diary. A food diary is not just a record of when and what you eat, but also what thoughts, emotions, and stressors are present just before and while eating. Keeping a food diary helps to identify patterns of eating.

After triggers and patterns are identified, then it is a matter of breaking the pattern, which involves developing alternative responses to triggers. The alternatives are any kind of behavior that does not involve eating, such as reading, listening to music, going for a walk, playing a game, talking to a friend, doing chores, or doing any other activity that allows a person to distract their attention from the urge to eat.

Unfortunately, such efforts at distraction are often not enough to keep someone from giving in to the urge to eat. The next step in attempting to stop emotional eating behavior is to delve deeper and utilize relaxation techniques, meditation, and/or counseling.

I support your plan to seek counseling, not just because I am a psychiatrist, but because more often than not, a family's particular methods for dealing with feelings are part of the learning experience that plays a significant role in the expression of an eating disorder. Some families don't have good skills and techniques for allowing feelings to be talked about in a relatively non-judgmental, supportive environment. Some families are soaked in too much criticism and hurt. Some families don't use the word "love" very often, or are otherwise not very warm or affectionate.

A significant study published in early 2004 showed a strong correlation between certain ways teenagers handled anger and their risk for obesity. Teenagers who were angry, but did not express it or those who expressed anger a lot and lost their temper frequently, had more weight gain problems. Generally, anger is a result of hurt. One could conclude from the study that unresolved hurts and anger often lead to ongoing overeating behavior .

When you get into counseling, I encourage you to look at these types of emotional issues and any "skeletons" that may be in the family closet. I hope this helps. -- Best wishes, Dr. Debug.