Why people struggle to eat better — survival mode and immediate satisfaction (Part Two)

By Lillian Roberts

20 Aug 2024

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

Alexi Trninic, an occupational therapist who also works with trauma patients, says one of the less known feedback loops is how diet plays into mental wellbeing. All mental illness is genetics plus environment, and she says the environment plays a huge role in South Africa.

“If I’m trying to survive day to day because of stress, I’m going to put less energy into something else, and that becomes diet. Instead of going for something healthy, I go for a quick snack or something that’s super processed because it’s cheaper, it’s easier, it’s convenient.”

Trninic says this will end up affecting mood, concentration, and how people engage with everything else in their lives.

“It’s going to be a factor in that feedback loop; that cycle of poor diet, high stress, to poor health outcomes, to reduced mood,” she says. And poor health usually means more time spent at hospitals, less time at work, more money on medications or travel.

She overarchingly describes depression as a pattern of hopelessness, distorted thinking, pessimism, loss of interest. With that comes changes in weight, sleep, and concentration. Whether it’s depression, chronic stress, or burnout, Trninic says the body tries to cope. One of the coping mechanisms is ultra-processed foods. Food can cause a dopamine release, making us feel better. It’s comforting, like a bandaid, but it is not feeding our internal microbiome and gut health.

Evidence has shown that eating large amounts of ultra-processed food leads to lower water intake, and higher intake of food additives. Additives like artificial sweeteners, emulsifiers and colourings harm gut microbiota. Gut health has been linked to mental health conditions like anxiety and depression — the worse your gut health, the worse your mental health.

Additives combined with fat, salt, and sugar, create extremely tasty foods, which may be addictive, and then eaten excessively. Ultra-processing damages or destroys the whole food structure, negatively affecting food absorption, bioaccessibility, and inflaming gut microbiota.

People will do things that don’t take as much “mental battery”. But, by eating something that feels good in the short term, they fall into a shame and depression spiral. It’s a sneaky, vicious cycle, Trninic says.

“Willpower is a finite resource. If you’re having to manage in survival mode, you’re not going to be focusing on care of self.”

Individual versus environment

How do we interrupt this cycle of poor mental health and unhealthy food?

“It is one of those impossible questions because humans are accumulations of our experiences,” says Trninic. An example she gives is alcohol. While it leads to worse health outcomes, higher rates of depression and anxiety, you cannot go anywhere in South Africa without seeing an advertisement for alcohol, or go to a social event without being exposed to it.

South Africa has largely transitioned to a Westernised diet, with less reliance on subsistence agriculture, more dependence on the retail sector and the staggering availability of the fast-food sector.

Ultra-processed foods are convenient, practical, and usually made to be eaten anywhere. They are sold as snacks, drinks, and ready-to-eat/heat meals, so as a 2023 study highlights they displace freshly prepared home-made meals. Along with these characteristics, they are amplified by aggressive and sophisticated marketing — leading to changing norms, especially among vulnerable consumers, like children.

Anele Honono, a clinical psychologist and eating disorder specialist, says that because we have moved to a fast-paced society (with easily available food that isn’t nourishing), access to good food is a political issue.

“We can educate as much as we want. But when we go to the shops, if that’s what’s being sold to us, it feels like something that has to happen with legislation, the big thinkers and big rulemakers, to really infiltrate industries.”

Honono says mental health services in South Africa are limited, so prevention and widespread conversations about mental health are key.

“People need to have a new insight to make better choices where they can, but unless those better choices are made available, we’re going to be that McDonald’s generation.”

Honono says the environment also needs to make it possible to implement what psychologists are trying to do.

The socially acceptable way to self-soothe

Honono echoes Trninic, that people go for quick relief with food because it’s accessible, even if they know there are long-term negative consequences.

“That’s why we can look at issues like drug addiction or other impulsive behaviours with empathy, because those are simply tools that people are using to try to cope with life. Most people are not trying to be self destructive. They’re trying to cope with what they’ve been dealt, the best they can.”

Similar to drug use (which helps people escape emotional distress and escalates over time), eating disorders become their own self-sustaining monster. People “relapse” with overeating because there are underlying issues that were never addressed, Honono says. And most people go for socially acceptable ways of self-soothing, like opening the fridge.

With about 10% of Honono’s patients, she sees the development of an eating disorder in well-adjusted adolescents with fairly stable families. The other 90% have emotional regulation issues, psychiatric or systemic issues in the family, with parents who were not raised in supportive households. It continues generationally. She goes beyond just treating the adolescent, and refers parents to counselling with someone who understands eating disorders.

“That work still has to be done in the background so that it doesn't move from being an eating disorder to another type of problematic behaviour later on. If you just discharge them having worked on disordered eating, they often circle back with a different technique later on, with substance issues or very erratic relational issues.”

Since the end of the apartheid regime, some families have begun to earn decent money, while previous generations of black and brown people were extremely poor.

“Now there’s a big emotional disconnect where money is replacing relationships, and people aren’t talking about that. Families think: ‘I am providing financially from my own background what I think you need,’ and missing a lot of what you need, which is the emotional element.”

Small changes, self-compassion

On an individual level, Trninic says the idea is to make small changes that suit someone’s socioeconomic status and life context. Instead of a sweet fizzy drink, get sparkling water, or instead of slap chips, make veggies.

Reducing carbs and sugar means you’re already winning. She says that with depression, anxiety, trauma, ADHD and more, there’s a link to better mental health with lower carbohydrates and less sugar.

While there is an obesity epidemic, we don’t want to lean towards body-shaming, Trninic says. The goal is to be as healthy as possible, within realistic parameters. Eventually, with small changes, your body will start to crave the healthier things.

“It’s history, it’s the system, it’s education, it’s socioeconomic status, it’s resources for mental healthcare. But what research has shown is that even if you can give a person ‘this is how to eat healthy’, they’re not going to follow it if they’ve got bigger fish to fry.”

Non-judgment, self-forgiveness and self-patience, Trninic says, will make a long-term difference in mental health, rather than a crash diet.

So, one bite at a time. DM

Read Part 1 of this article here.

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South Africa

Individual versus environment

The socially acceptable way to self-soothe