Why people struggle to eat better (Part One) – survival mode and immediate satisfaction

14 Aug 2024

If people are almost always stressed and not eating healthy food, what happens? How do mental health and unhealthy food link? Daily Maverick speaks to two mental healthcare professionals to find out.

You are what you eat, and it may be worsening your mental health — but it may not be your fault.

A total of 18.3 million South Africans live in extreme poverty. Most people face ongoing stress with unemployment, crime and gender-based violence, and the legacy of inequality from the apartheid regime. A third of the population has experienced a common mental disorder in their lifetime, and about one in four people get treatment.

“There’s so much environmentally that is setting a person up for failure,” says Alexi Trninic, an occupational therapist who also works with trauma patients. “If you’re in a government hospital and they tell you to eat better, but people cannot afford to — whether because of money, time, availability of fresh produce, storage, electricity — it’s an ask that people are not going to prioritise.”

South Africans live in hypervigilance — a mental state where you are on guard against perceived or real threats — Trninic says, whether it’s the fear of crime, keeping your job, or money worries.

It’s survival mode for most South Africans, and people turn to instant gratification or finding food to fill the stomach.

Investigations link eating a lot of ultra-processed foods with greater risk of disorders, diseases and premature death. They have found links with physical illnesses, but also depression, cognitive decline, and dementia.

The cycle of poverty

A study looking at the psychological legacies of intergenerational trauma examined pregnant people in 1990 in Soweto, Johannesburg. They followed the children’s mental health for the next 18 years. They found prenatal stress predicts greater vulnerability to the impacts of future stress with teenagers. In other words, epigenetics (the environmental influences that change how genes are expressed) have a part to play in childhood development.

The younger the mother and the more stress the household experienced, the greater the chances of their children developing mental health issues. And social support did not help against the long-term psychiatric impacts of prenatal stress.

“There’s not enough research on intergenerational issues in South Africa,” says Anele Honono, a clinical psychologist and eating disorder specialist. “A lot of it happens in families, where we sweep things under the rug. How many intentional, meaningful spaces have we had where we unpack our history, after ’94?”

A study found that poverty was associated with an increased likelihood of difficulties of daily living. Those who had three events of economic hardship during a 17-year study were at greater risk of depression, more likely to be cynically hostile, lacked optimism about the future, and reported more cognitive difficulties.

The sum total of stressors add to persistent background stress, and change how people respond to new stress. The many stressors linked with poverty and health issues mean that excess chronic stress gets in the way of looking after health.

Mood regulation

With mood regulation, there’s a concept coined by Dr Dan Siegel called “the optimal zone of ‘arousal’”. In the optimal arousal zone, or “the window of tolerance”, we can deal with different stresses and feelings without becoming so “dysregulated that we act out, or so under-regulated that we shut down”, Honono says.

Research has found that eating disorders map on to this window of tolerance, Honono says. Often, people who present with the “act out” type of behaviour (hyper-arousal) tend to be the people who self-harm, have PTSD, or borderline personality disorder, as examples. Those who tend towards hyper-arousal usually fall under binge eating disorders or bulimia.

A systematic review of brain imaging of different eating disorders found that parts of the brain are hyperactive in bulimia patients, and are probably involved in abnormalities of impulsivity and emotion regulation. With binge eating, parts of the brain are linked to dissociative strategies and addictive aspects. Eating disorders often co-occur with anxiety disorders (53%), mood disorders (43%), self-injurious behaviours (21%) and substance use disorders (10%), as well as medical conditions such as obesity, diabetes and celiac disease.

Adverse Childhood Experiences are seeing or experiencing violence, crime, a parent with mental health issues or untreated addiction. These experiences will play a role in a lot of adult choices, Trninic says. People may dissociate, watch TV while eating, or go to the bar to get drunk. After becoming the norm, it’s difficult to change habits.

Experiments show that for some people, the same reward and pleasure centres of the brain triggered by addictive drugs like cocaine and heroin are also activated by food, especially foods rich in sugar, fat, and salt.

Like addictive drugs, these foods kickstart the feelgood brain chemicals, such as dopamine. Those reward signals may override the body feeling full and satisfied, so you keep eating even when you’re not hungry. DM

Read part 2 of this article here.

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South Africa

The cycle of poverty

Mood regulation