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Thursday, 23 December 2010

Motivation Is Not An Infectious State: More Top Treatment Tips

Prof Glenn Waller offering top tips in CBT Today, December 2010 points out that our enthusiasm for the client's recovery will not rub off on the client. He suggests that we should keep focusing on whether change is actually happening rather than expecting it to happen because someone says they are about to change or because we believe they should.

So how will you learn if recovery is actually happening? Perhaps you cannot be sure so you have to suspend your expectations and wait.

I have learned to be patient. When you have a partner, home, lifestyle or eating disorder it is really hard to change. One of my NLP mentors once told me that he takes the following line with addicts - "I insist absolutely that you keep your addiction until it has been replaced by something more useful".

For this reason, I don't reward what people expect me to reward. I don't reward weight loss in people who want to lose weight and I don't reward weight gain in people with anorexia and I don't pat someone on the back when they have had a good eating week. I prefer that people keep doing what they are doing and help them find some helpful options for thinking and doing things differently now and then. People simply cannot recover until they have reclaimed what their eating disorder has stolen from them or when they have build a resource which, by being absent, led them into the eating problem in the first place. This resource might be confidence, compassion, or a feeling of belonging. Whatever.

Recovery from an eating disorder does not happen on the therapist's agenda. It is like a baby learning to walk. You can't force it. When the baby is ready, he or she will just take off. If you try to hurry her, she will fall.

Wednesday, 8 December 2010

Assessing Eating Disorders Properly: A Commentary.

Prof. Glenn Waller, eating disorder expert, has written a bunch of top tips for people working with the eating disorders in the Journal of CBT, December 2010. His first tip is “Monitor and work with physical and psychiatric risk.”

He points out that there is no substitute for a good assessment of such risk. Many psychotherapists don’t do this if they aren’t trained to work properly with these problems. They may say “it’s not about food, it’s about feelings”.

But many people have serious health risks associated with their eating behaviour. Bulimics risk heart and kidney problems. Binge eaters might be suffering from diabetes. Food is chemistry not just calories and ingesting large amounts of sugar puts enormous pressure on the pancreas. Purging leaches potassium from the cells, stopping them from burning energy. Being very thin can cause the inside of your bones to turn to jelly, interrupting the supply of the cells that keep your blood from flowing and your heart from beating properly.

People with anorexia are 57 times more likely to commit suicide than people of any age who do not have the illness. We have to consider them at psychiatric risk. We have to test them for clinically active trauma, for hidden cases of self harm, for depression or for exercise activity that may cause them to collapse.

People do not start developing eating disorders because they are vain or stupid. Losing or controlling weight starts off as a solution for feeling better; and most of us are delighted if we look slim or lose a little weight. But if dieting and weight management goes out of control, the solution becomes the problem that can kill you or ruin your well-being.

Prof Waller recommends you to be a good Assessor. Check out www.iop.kcl.ac.uk/IoP/Departments/PsychMed/EDU/downloads/pdf/RiskAssessment.pdf

But why not come on our specialist training courses. For expert CPD visit http://www.eating-disorders.org.uk/professional-training.html  or call us on 0845 838 2040 to discuss your training needs.

Tuesday, 30 November 2010

The Anorexic Voice: A Deafening Whisper Away

When I first started working with eating disorders, psychotherapists debated fiercely about what led an anorexic person to experience (not see) themselves as fat. We observe this phenomenon in other starving populations including concentration camp victims and people who deliberately restrict their calories “to prolong their lives”. (Vitousek, 2009). More recently, psychologists in Oxford (Shafran, and others, 2006), have described an attitude distortion known as “thought shape fusion” thinking which is common in people with OCD - i.e. thinking about something is equivalent to doing it.

This means that for restrained eaters, even thinking about food leads someone to the conclusion that they are very likely to get fat or, more strangely that they are fatter. Some people who eat just a piece of Kit Kat feel instantly fatter. This delusion appears in restrained eaters of all weights.

But until very recently, few experts acknowledged the contribution of the Anorexic Voice to the experience of feeling fat and the additional role of this Voice in maintaining the terror of eating for anorexic people.

We all talk to ourselves. Today I told myself that it would be a good idea to clear away the breakfast dishes before starting on this article. Reflecting on this inner conversation led me to the conclusion that it was a fairly quiet neutral whisper inside my head and I was not hearing voices. Many people who are not psychotic hear voices outside themselves. If these voices are not troublesome nor persecutory it’s not a big deal; it’s more normal than we imagine.

But the Anorexic Voice is a different kind of beast. It can only be described as a presence which exists for everyone with anorexia and which offers directions, instructions, (such as running 5 miles daily before breakfast) persuasions and opinions specifically about food, weight and the self. When someone is losing weight the Voice will suggest that the person will feel better if they lost just a little more weight, no matter how thin they already are. The Voice tells them that they are doing well if they comply, but the Voice turns angry if they violate its rules. It may call them fat, a pig, stupid and a failure.

When and if the anorexia begins to hurt the sufferer, for example by making them tired or weak; or if they dimly understand what it is costing them and their loved ones, a person may start to consider trying to get well. The Voice will then inform them that it will punish them for these treacherous opinions and make them suffer if they start to change. It does so in a malevolent manner like an evil spirit trying to wreak vengeance upon them.

We call this presence a “Voice” rather than an idea or thought because as weight decreases it becomes concrete and real. My anorexic clients have taught me that it may lodge inside the head, perhaps in a particular location at the front or back of the head. It can even seem to be outside the head, most usually to the front or side. They have described the Voice as female or male, shrill or deep.

Most people with Anorexia are startled yet relieved when I ask them about this Voice; they are afraid to disclose it willingly since people might think they are insane. It requires us to reflect on whether anorexia is a form of psychosis and some people who support the notion of “forced feeding” indeed describe the illness as “a particular kind of psychosis creating a compulsion to avoid treatment, or to only accept treatment which is designed not to work.”

Knowing about the existence of the Anorexic Voice changes the dynamic between patient and therapist, since we can start to talk to the person who is caught in the grip of the illness and talk in a different way to the Voice - as if they are separate entities. If you fail to do this then the only person you are doing therapy with is the Anorexic Voice. It is this Voice that explains the resistance, the games and the so-called denial that is the hallmark of anorexia.

For this reason I have always said that there are 3 people in the room when I work with anorexia, me, the sufferer and the Anorexic Voice.

Here is what one recovered anorexic lady said to me about the Voice.

He (my doctor) understood that it was not I but the anorexia that he needed to “attack” and make ME strong to be louder than (his) voice. Talking with the doctor I realised for the first time (after 10 years) that it was not that I was bad, but it was anorexia in me who was making me think that I am and I began to understand the anorexia was always there “the voice” and it just grew louder. But this professor’s voice was louder than his - so much louder that it reached ME. And for the first time I experienced a little peace!

The Anorexic Voice is thus partly responsible for the experience of fatness and the dreadful self concept of sufferers. It is woven into the other factors with maintain the illness such as pro-anorexic beliefs, personality and family factors; all providing together a template for existence for the sufferer. It is all these factors which make Anorexia a complex illness, still poorly understood and remarkably difficult to treat. We try to address all the maintaining factors, such as providing useful information, re-feeding the client, fostering flexibility, helping families, confronting perfectionism and so on. But there are many perfectionists, rigid and obsessional people with weight concerns who don’t develop anorexia. For that reason I have often wondered whether the Anorexic Voice is the glue that holds all the other maintaining features together.

So we have to do something about The Voice in treatment almost right from the start. So what do we have to do about it? One suggestion would be to weaken it, another would be to strengthen the individual so that they can see it for what it is and fight it; a third possibility would be that it may remain where it is but the person doesn’t really respond to it any more- it matters less. In accounts of people who have recovered from Anorexia, they say the Voice tends to ebb and flow, becoming more compelling at times of stress.

What follows is a checklist of things which could be useful in weakening the power of the Anorexic Voice.

1 First getting a good description of it, its location, gender and colour, the qualities of the voice and the words it says. Show that you understand the Voice by saying things like “Some people tell me that they have a Voice telling them that they are fat and weak if they do what the therapist says. It tells you that the therapist just wants to make you fat Is that true for you?”

2 If the client is resisting change in therapy, the therapist can say “The Voice must have been shouting at you particularly hard this week Is that so?”

3 Ask the client what they would like to say to the Voice. The Voice would have been very kind to them when they were losing weight well, it seemed like a friend. Now it became their persecutor. Ask about the qualities of “a good friend” and find out what the client would like to say to “bad friends”. Many anorexic people doesn’t really know the difference between good and bad friends because of bad past experiences.

In addition to this, keep separating the Voice from the person. If someone says “I can’t eat more I will get really fat” (a typical anorexic thought) say, “Now this is what the Voice is saying, what do you think?” Repeat this conversational style over and over again until the patient is doing it for themselves without prompting.

4 If you are skilled in NLP you can play with the qualities of the Voice and see what effect that has on it. Here is an example:

A client of mine felt unable to eat any fat, “not even a walnut.” I asked about the Voice and she described is as being like a big black bowling ball filling her head. You know that one walnut is not a big deal I suggested, where is your voice that talks more common sense? It’s outside my head she said, its like a whisper I can hardly hear.

Lets do a game, I said, try and get the bowling ball out of your head and put it somewhere in the room where you can see it in your imagination. OK? Now can you still hear it? Oh yes, it’s just as bad, she said.

Imagine that you had a dial in your hands that can change the colour of things. Now what happens if you change the ball to yellow? Its weaker she said but still as bad.

What happens if you rotate the yellow ball I said… Oh! She offered, I can’t hear it at all!

And where is your own voice now?

It’s in my head, she said, I can hear it much better. It says walnuts are quite OK.

Next time the Voice starts shouting, perhaps you can do what we just did.

And the girl went home and she ate two walnuts, and seems to be doing very well.

5 I have asked clients to draw a picture of the Voice and something that can attack the Voice. One girl brought in a can of fly spray (which we then painted “Buzz Off” to attack the buzzing voice) and another girl drew a picture of a golden hammer.

6 Third wave therapies are really useful to deal with irrational and delusional experiences such as the Anorexic Voice. This is because irrational ideas with powerful emotional content such as shame, terror and pride are usually not accessible to rational therapies. Here is where EFT and/or Mindfulness skills help the sufferer to cope with the Voice. EFT releases the emotional content of the Voice and its associations with past experiences of failure and lack of coping. Mindfulness skills enable the sufferer to do things differently.

7 Remember that these strategies take time. The lower the BMI, the harder it is for the brain to process and utilise new experiences. The therapist must be patient and work gently to foster the alliance with the patient against the Anorexic Voice which notwithstanding will sometimes and unexpectedly appear in the guise of the client’s best friend - even when things appear to be going well. At such times, do not fight the patient or give up, or think the treatment isn’t working. It is not your job to “win the battle” – because then you can lose it. Take supervision to help you figure out the best way to help the client recognise their bad friend for what it is.

For help and support with anorexia visit http://www.eating-disorders.org.uk or call 0845 838 2040

Tuesday, 23 November 2010

Fat, Sugar and Happiness, Taxing Issues Continued

Having written about junk food and instant Happiness a few days ago, I was startled to see an article about the very subject in the Sunday Times. It's topical, because David Cameron wants to know how happy we all are through establishing a General Well Being Index and by seeing how this changes as our financial environment evolves.

Cognitive therapists say that heaven and hell exist only in our own minds, but many writers make a direct link between economic circumstances and our perceived quality of life. What frustrates me is the lack of good information about the link between economic QOL and obesity, although a link is implied only via the effects of prosperity, eating styles and activity levels. The factor that is not taken into account is the link between purchasing junk food behaviour and general levels of well-being.

Social research suggests that Happiness is tied to local issues, such as the view from one's window, the number of street lights, the presence of trees in the road and the number of addicts in the local population. We have already been told that people walk more in avenues and on precincts with flowers than they do in graffiti covered streets. But no one made the direct link between impulsive eating and  Happiness because its probably too fluffy to take seriously. Do people with nice views from their window eat less fat and sugar than those who look out over a row of semis?

No-one seems to have an answer to the obesity epidemic, despite a raft of Govenment initiatives such as Fit For Life. The British Psychological Society is about to come up with a working paper on obesity, lets see what they can up with which is new. We are fine on theory and could do better with practical strategies I believe, so far. Paul Ormerod, economist and author of Why Most Things Fail suggests that we just don't take some things into account when we target problem behaviour such as overeating or under-exercising. And we cant even agree what the real problem with obesity is - greed or sloth - so if we cant figure it out, our patients havent got a hope.

So back to the tax on sugar and fat. It's not too nebulous a concept to put into practice. Let's start with soft drinks and all the sugar in baby food and cereals. Email me at admin@ncfed.com if you would like to have your point of view.

Friday, 19 November 2010

Fat, Sugar and Happiness, a Taxing Issue

Apologies for being away from my blog for a while. Now here is a big thing. Panorama has visited the thorny subject of taxing junk food. Will this help to stem the obesity "epidemic"?

This subject has been debated in the All Party Parliamentary Obesity Group which I attend from time to time. This group has representatives from a variety of organisations such as Diabetes UK and the British Heart Foundation, as well as obesity experts and eating disorder specialists such as myself.  Thus far the group has voted against such a tax. I think we need to revisit the subject.

One of the NCFED's members (James Lamper) argues  (I think) against a fat tax on the basis that it may not change behaviour. After all, if you are addicted to chocolate because of how it gratifies you, a few pennies more may not be enough to get you eating apples instead. And chocolate/sugar addiction is a real problem, especially for women whether they are fat or thin. For some "addicted" women, the only way to manage their compulsive eating behaviour is to purge, or go on and off diets all the time. And many buy these foods for their children as an excuse to eat the food themselves; we call it "passing on the problem."

Eating behaviour is very complex. But it does not happen in a vacuum even if we look at the biological roots of cravings for fat and sugar. James rightly points out that part of our drive for high fat-sugar food is explained by the part of our brain which responds to the combinations of fats and sugars in junk food with a sense of gratification and pleasure . Our "reward brain" responds in exactly the same way to the chemicals in alcohol and drugs. In other words we get a fix from junk food which may override the effects of paying more for it.

Why do so many of us turn to instant gratification to get us through the day?  The answer may be rooted in issues that have nothing to do with food at all.  Psychologists such as Oliver James and the writer Bryan Appleyard separately have written about increasing levels of Unhappiness in our culture which give rise to a deep sense of angst and powerlessness. We trace this general Unhappiness in a culture of plenty to issues  like a breakdown in community and family cohesion, and visible and vast disparities between the super rich such as footballers and those who live an ordinary life - even if that life is reasonably comfortable. In other words, having it all is not making people Happy.

These issues of Happiness were debated with the comedian and psychotherapist Ruby Wax on This Week -November 18th and no amount of political effort, budget cuts and so on has made much of a difference. In other words, even during times of prosperity and full employment, Happiness levels are at an all time low in the UK.

It may be because of this that people reach for short term solutions to help them feel better. Food is all round us and it is readily available and costs very little.  You can have instant gratification in an instant which is much easier than going for a massage, much less painful than doing an hour on the treadmill; much less costly than going for a ride on your personal jet.  It is the availability of these foods that are part of the problem.

Without any doubt, increasing the cost of certain foods will have a big effect on national consumption and will have an effect on the national waist line. But demand may fairly inelastic among the group most at the mercy of their insatiable appetite for treats. 

So a fat tax will do us all some good but not necessarily those people who may need to control their eating most.

I admit that my blood ran cold when I listened to a sample of the overweight public give their own opinions about the junk food tax. One woman insisted that it "was not fair" to penalise the poorest members of society who are those most reliant on cheaper food. The same woman insisted that if she was to buy her children broccoli they wouldn't eat it and she was then forced to buy the kind of food (chicken nuggets presumably) that they would polish off. Jamie Oliver has done his best to educate such people that good, wholesome food can be cheap, healthy and palatable but he has a long way to go.

Perhaps money will talk louder to this very resistant group of people, and I am all in favour of it - we have to start somewhere. But it is a political hot potato that no Government may be prepared to grasp. Can you imagine an army of fish and chip owners marching on Whitehall?  A greater challenge comes from deciding which foods to tax. For example if we were to tax high fat foods we would have to tax cheese, walnuts and salmon. If we target high sugar foods, we might have to put a tax on dried fruit.

And the powerful food lobby, manufacturers and supermarket behemoths such as Tesco would fight back with all the money at their disposal. They might sell their chocolate at special prices just as they promote alcohol at less than cost price to drive up sales.  Kelly Brownell, Professor of Psychiatry and eating disorder/obesity expert has discussed these issues in his book Food Fight. Unless something drastic happens, things will get worse and the poor public doesn't have a hope.

Kelly suggests putting a heavy tax on sweetened soda drinks. The avereage British child drinks about two glassfulls a day "hardly the problem that it is made out to be" in the words of a representative of the British Soft Drinks Association.  But that is 14 teasons of sugar per child per day. So yes, it is a serious problem - add this to sugared cereals it's akin to giving a child a long acting poison.

So, lets find a way to make it happen. We aren't trying to solve the problem of compulsive eaters, food addicts and people who are more interested in eating what they like rather than being mindful of what they shovel into themselves. A tax on sweetened drinks would be a start. The rest would follow in time.

As one person put it, if all change happens on a scale from 0 to 10 the biggest step is that which is between 0 and 1.  Lets be brave and support such a tax. If you want to sign up send an email to admin@ncfed.com
stating your position.

Wednesday, 20 October 2010

Anorexia, Orthorexia And Autism

I was marking an essay today with a man who feels very proud of himself because he tries to stick to a very rigid diet with very little wheat and no fat and a whole range of forbidden foods. He periodically binges when his willpower fails and feels it is a sign of what a weak person he must be.  He isnt underweight and now realises that he has a serious problem in his relationship with food.

That got me thinking about orthorexia and anorexia its cousin. The latest thinking is that anorexia is a form of autistic spectrum disorder. That kind of figures to me, since everyone I see with the illness is driven, perfectionist, pays intense attention to detail and likes things to be predictable and ordered. We don't tolerate mess and uncertainty very well and go round with a high baseline level of anxiety.

Like people with autism, the anorexic can be easily disgusted by the idea of certain things like food contaminated with fat or by certain textures and smells.

Orthorexia is thought to be a  variant or escape from anorexia. The choice of a limited range of foods appears to be motivated by concepts such as "love of animals" or the desire to eat a healthy natural diet. All of these are understandable motives, but personality studies consistently show common features between the anorexic personality and the person who feels compelled to eat a very healthy diet and who feels bad if they cannot follow their strict food rules.

The other clue about this kind of eating is that it is often a proxy for weight loss.

So does a focus on food really handle these problems properly? Experts now think that the core problem is some kind of executive failure in the brain which causes a failure to handle all the information flows correctly. In other words there is some kind of disconnect between the information coming in and the ability to manage and respond to it flexibly.

So what we see in the room with anorexics and orthorexics is poor thinking flexilbility, poor problem solving skills, too much attention to detail, high anxiety, a compulsion to get it right which is paralysing (because you can never get it right) and great rigidity. If it ain't working, just do it more but never change.

 "Cognitive Remediation" is supposed to help with this and one good benefit is that it doesn't focus on eating habits- which in any case are heavily defended in anorexics and orthorexics alike.

This kind of treatment involves exercises like finger tapping and rhythmically clenching and unclenching hands. The client may think you are silly but at least he or she will not make you their enemy.

CR is supposed to be helpful, but we do not have any up to date research about it. The autism connection is interesting however and I think we may need to go further with it. Perhaps more of us are "autistic" than we think.....or perhaps we need to give "autism" a different name.

Sunday, 17 October 2010

Food For Thought

Wanna starve?
The brain needs 500 calories per day but it also needs nutrients to make the right connections. if we dont get the calories and the nutrients, our capacity for learning diminishes and our capacity to make the right responses deflates. We become rigid and inflexible. We can't make good decisions.

So what does the brain need? Sugar first of all, we get that from carbohydrates like bread, rice and fruit.
It also needs water, and amino acids from proteins like meat, chicken and fish. These amino acids help the brain to make the transmitter chemicals that help us to be human, experiencing love, fear, excitement, motivation and connection. The brain also needs antioxidants like Vitamin C to protect the brain from the damage caused by all the work it does.

But the brain also needs fats in the form of essential omega fats, in particular omega 3s found in oily fish and seeds and some nuts. The only way of getting these fats is from our diet. Without these fats, the transmitter chemicals cannot "dock" into the receptors that are designed to  take them and so the brain cannot feel them and do its proper work.

Some of these transmitter chemicals control our appetite, so if the brain cannot feel these stop-eating messages you will continue to feel hungry even if you think you have eaten enough for now.

So, don't count calories, feed your brain and it will thank you in spades.

Have you seen our other eating disorder related articles?  Log onto our information page at  http://www.eating-disorders.org.uk/

Wednesday, 13 October 2010

Figures Of Lightness

Today it is announced that children account for 1 in 3 admissions to hospital for anorexia, bulimia and other eating disorders. That is not quite correct.

NHS statistics show that girls and young women remain the worst affected. Of 2,579 admissions to English hospitals in the year to June, 882 (32%) were patients under 18 and of those 31 (1%) were under 10 years of age including 11 boys (33% of this group);  367 (14% of all admissions ) were aged 10-14. In the group 15-19 years,  698 (93%) admissions are girls and 49 are boys

Does this point to any remarkable trends? I think the answer is "no".

Working with the figures, less than 1 in 6 hospital admissions are under 14 and it is only these I could stretch to call "children". Children tend to be admitted to hospital because they are new cases, have less body fat which puts them in more danger, and are under the control of carers.

We already know that among the very young a greater proportion of sufferers are boys and their problems are associated with anxiety disorders and obsessive compulsive disorder. But the admission figures show that boy cases are very rare.

With 2 in 3 patients being adult, I expect that these are chronic cases with long standing problems and possible recurrent crises. The adult body can withstand and adapt to low weight better than the body of a young person and an adult can refuse to go into hospital despite the concerns of others.

I would be interested to know more about this adult group. What proportion are new cases and what proportion are chronic for example?

Only this week the Guardian ran a piece headlined "The new anorexics: big increase in eating disorders in women after the age of 30". Experts link these adult onset eating disoders in women in their 30s, 40s and even up to their 60s to feeling under pressure to look young because of exposure to the age defying older females in the media like Madonna and Sharon Stone.

(If I had Sharon's money I would look pretty young as well!)

I think that we are all guessing about the numbers and the reasons. Personally, I think that eating disorders are more likely to arise in someone who already had problems when she was young. But I would like to know more.

If you have had a NEW eating disorder in your adult life please get in touch with me. Email admin@ncfed.com and tell me your story.

Tuesday, 5 October 2010

Do People Really Think That Eating Disorders Are Silly, Continued?

I have to change my opinion following my last blog about how people feel about eating disorders.

Reading some research yesterday it would appear that people do view eating disorders more negatively than other mental health conditions including schizophrenia, at least in some aspects. People with eating disorders are viewed with significantly more negative stereotypes overall, and in particular they are viewed as more unhealthy, more disgusting, more vain and more isolated that are people with depression, OCD and schizophrenia. And yes, there was a high level of agreement that the eating disorders are self inflicted conditions.

But there are also positive stereotypes associated with eating disorders, such as being focussed, and  having high standards  - suggesting that positive and negative stereotypes can exist together and do not cancel each other out.

We have a job to raise awareness of these conditions. Why? So people can get the treatment they need and can come forward rather than suffer in silence. This can be done by having awareness days, memorials, fund raising actitivities and so on. The result of all this is that far more people know about eating disorders than they did when I started my eating disorder career.

But publicity brings our attention toward the worst of eating disorder symptoms. You cannot really talk about anorexia without showing the lengths some people go to as a result of the illness. We cannot talk about bulimia without pulling attention to its symptoms, which are highly unpleasant. A teenage girl at one of my PHSE sessions in school fainted when looking at a short film clip of someone binge eating from a pan full of spaghetti, and I never dared show the film again.

We have had many years of exposure to the reality of eating disorders with public awareness campaigns, reality TV shows and even sensitive portrayal of the disorders in TV and radio "soaps."  The cost of such portrayals is to unwittingly reinforce the negative stereotypes of these problems.

So how do we get the balance right?  Will more media exposure help people to get help sooner or prevent them from getting help by raising the stigma associated with their problem?

Sunday, 3 October 2010

Do People Really Think That Eating Disorders Are Silly?

B-EAT suggest that many young people with eating disorders are failing to come for help because young people believe that eating disorders are silly. They also feel that there is a lot of stigma attached to having an eating disorder. Meanwhile Nigella Lawson has expressed horror about the number of young people going on diets. I have been asked by the British Psycholgical Society to comment.

Things have changed a lot since I started working with eating disorders in the late 1980s. Now many people know what eating disorders are because of publicity in the media, with both male and female celebrities coming clean about their difficulties with food. There is now a great deal of PSHE in schools about these subjects. Indeed, some people wear their mental health and eating issues as a badge of pride.

At the coal face however, we still have problems. There are problems with GP sensitivity, if not awareness and difficulties getting the right treatment fast. Nigella Lawson is right, almost 9 out of 10 young people diet at some point to lose weight but there is a thin dividing line between dieting and a chronic problem with food.

So it is really no wonder that some people who are very thin believe that they are really no different from all the other dieters around them. And my experience is that a lot of people do not regard eating disorders as silly; even people who know that they have anorexia do not always understand their illness so how, they suppose, can anyone else? It is thus human nature that what we cannot make sense of, we fear, scorn or dismiss as unimportant.

As far as denial is concerned, bulimia and binge eating are by far the majority of eating disorder cases and sufferers are well aware that they have problems which they long to overcome. The terms “bulimia" and "compulsive eating” are useful in legitimising their symptoms and offering hope for change. And in anorexia, fear and mistrust motivate the difficulty accepting that you may be in need of help.

All mental health problems carry stigma, and yes, especially eating disorders, which are still regarded as self- inflicted by the public at large. We can correct these misperceptions one person at a time with the right messages and education. I think we are doing a good job.


Wednesday, 29 September 2010

Helping People To Get Help or, Anorexia Porn

I was on the ITV 1 Good Morning programme today with two girls who are in recovery from anorexia. To illustrate how bad anorexia can be, they showed a photo one of of the girls, taken when she was only 3 stones in weight and close to death. The girl is now a healthy weight and despite never having menstruated, now has a healthy baby boy.

Some people say that showing such pictures is shocking and unnecessary. They say it trivialises and sensationalises anorexia and would cause harm to some watchers.

I am not so sure. It just doesnt have much emotional impact to say I have had anorexia really badly and now I am well. They say that a picture is worth a thousand words.

Personally, I am more upset by scenes of gratuitous violence in the visual media than I am upset by the "ana" pictures that inspire some people on pro-anorexia websites.

How else can we portray the madness and the pain of anorexia and how it affects some sufferers? When I have the answer, I will blog again.

Saturday, 25 September 2010

If I Knew Then What I Know Now - Bulimia My Torment

Can warnings from a former bulimia sufferer help vulnerable people to avoid going down the eating disorder route?  Bonita Norris, who has climbed Mount Everest both literally and in her experience of bulimia wants to tell her story in schools to help people who have the illness feel supported and hopefully to prevent others from going through the hell and misery that has come with her illness. And I would like to help her.

The discomfort that leads to bulimia doesnt hit quickly. It creeps up on you like cats paws until one day you are on a diet and the next day your control has broken down. Then, not only are you going to get fat all over again, you experience yourself as weak and pathetic to have given in to your most desired and feared foods. You dont know that binge eating is a normal response to dieting - you just blame yourself and you will do anything to stop yourself from gaining weight.

And if somone were to tell you not to go on a diet and you are just 15 and feeling just awful about your appearance; what will you do? Will you listen with your heart as well as with your ears to the warnings of people who have been there too?

This is the dilemma that faces me in my eating disorder prevention work. The desire to be in control is normal and people who get into eating disorders have serious issues with control, coping, and living up to their own enormous expectations. They look at other people and they are sure that they just don't measure up. When you are just 15, you dont know about issues like boundaries, eating disorder thinking, you have no idea that feeling fat is really being full of feelings that cannot be expressed. You don't know how to deal with constant assaults on your fragile self esteem and you don't know how to look in the mirror with a compassionate gaze.

Therapists need to read the stories of people who are coming out on the other side of their eating disorder and can see it for what it really is. This helps us to understand. Telling the story is also the way that the sufferer can start to heal. I wonder how the story can help a 15 year old who hates her thighs and who wants to be the thinnest girl in the room. I would like to know if the story can help a 20 year old who is in the throes of her illness and who feels that she cannot survive without her disorder.

I would like to share Bonita's blog with you and help her to raise money to help her dream. One message I have for Bonita is that bulimia can be cured in such a way that it will never come back. It doesn't have to lurk in the dark corners of your world.

We all need to live a dream that is not dictated by the demands of an eating disorder. There is no space for eating disorders when you follow a dream. Healing lies here too. 


Wednesday, 15 September 2010

Last Chance Saloon - Weight Loss Surgery Revisited

Professor Finer has said forget the diets, they don't work for most people. Weight loss surgery will have to be made available to most people who need to lose weight in the future. He is not talking about the gastric band, this is the full monty - gastric bypass surgery known by various other names by obesity experts.

TV programmes and magazines used to focus on the horror aspect of weight loss surgery. We had stories about people who had to sit and have a teaspoon full of soup while watching their partners tucking in to a banquet at the local Chinese restaurant. Now, celebrities such as Vanessa Feltz and Anne Diamond have succumbed to the gastric band and are telling the world how glad they are to leave behind the struggle of their relationship with food on the cutting room floor. This will mean that many more people who are tired of yo-yo dieting will feel that it is normal and acceptable to choose surgery as the ultimate solution for their weight and eating problems.

Surgeons are getting better at doing weight loss surgery; they are doing more of it and talking to each other about what works best. That can't be a bad thing at all.   I have personal experience of good success stories and I have heard of things that can go wrong - some colleagues who warn us of greatly increased suicide rates among people when all the euphoria of the early weight losses is over. I have also heard stories of weight regain in some people who have done the surgery, in some cases at great personal expense.

Counsellors are very opposed to gastric surgery. They believe that overeating is a symptom of something that cannot be brushed away. There are associations of overeating with managing trauma and dangerous emotions. Fatness can be a useful defence in someone who is posibly afraid of being vulnerable at a lower weight. One person said to me, "if my boyfriend left me, I could blame the weight. If I was slim I would have to blame myself".

Compulsive eating is not a contra-indication for weight loss surgery. Surprisingly, many people who binge eat find that the compulsions disappear after their operation at least for a couple of years.  It is only then that weight loss slows up or eating difficulties begin to reappear. It has to make sense therefore to do some eating disorder counselling for the bariatric patient. But very few get it.

Gastric banders who are compulsive eaters do less well. Because their stomach is still intact the appetite may not wane and we hear stories of people who try to cheat their band by eating foods that slip down easily like ice cream. It has to make sense for these people to have some pre surgery eating disorder counselling too. But very few get it.

Bariatric counselling is a specialist area. If you want the surgery or if you want to help people who are desperate to lose weight, get in touch. The number is 0845 838 2040

Thursday, 26 August 2010

Your Mouth, Your Body, Your Choice

At the end of the day, is this the best way we have of motivating people to manage their weight? After all, when you are standing in the kitchen at the end of the day eating a toast and butter sandwich, no-one else but you is putting it into your mouth.

But are you really just one person? Inside your head, different "yous" compete for dominance over what you will do, feel and say at any one moment in the day. One moment you are the responsible adult and the next you are letting loose your inner child.

To say that what you eat is "your choice" assumes that you have options. Many fat people consider in their rational mind that there are options for eating, drinking, managing celebrations and socialising with others with regard to food. After all, who is the grown up here?

But the emotional mind may believe something entirely different - that you have no options at all for what you put into your mouth, and how you manage your weight. Inside this part of your mind reside all the memories, the longings, the old messages about food and deep secret beliefs of your heart which may undermine your options one by one. Remember the old saying..."The heart has its reasons that the mind knows nothing of."

So where does this leave the notion that we all have choice and that we are all capable of exercising it? Is fat really "an optional issue?"

Wednesday, 25 August 2010

Who Knows Best About Weight Loss?

Did anyone see that programme in the series "Who Knows Best"?  I couldn't  believe the professionals in the programme. One alternative practitioner working with the "thinking" versus a boot camp exerciser defined as "two of the UK's leading experts in weight loss". Hello?

What we saw of the "thinking" approach was some visualisations based, I believe, on NLP and a great deal of tapping using Thought Field Therapy. The so-called Experts were less interested in their clients than they were in their own performance. By the end of the six week experiment they were basically telling their clients, please do this for ME so that I won't lose the contest. It may be good television but where are the ethics in this for these unfortunate subjects?

Short term weight change is very easy to achieve and I would have expected the boot camp expert to win the contest because he managed to get the client on her feet, buring calories every day. But this was not a moral victory for the alternative therapist who claimed that she was working with the obesity mindset. I would have liked to see where these clients are two years down the line.

Working with obesity is complex. Helping someone to move around more consistently and helping them to think and relate differently to food and exercise needs a great deal more expert help. People with serious weight problems who don't like their situation need a much more intelligent approach.

They need a practitioner who understands and can apply the models of health behaviour change, cognitive behaviour therapy, motivational therapy, EFT (not Thought Field Therapy which is old-hat) and even some of the techniques of NLP. Really digging down into the issue of emotional eating would be the icing on the cake. Why didn't the programme advisors come to me?

Fat - to coin a phrase, is a financial issue. There are lots of treatments out there making people very rich but very few experts know what they are doing. For the ultimate look at what really can work for people with weight problems, come along to my Essential Obesity - Psychological Interventions training - for details visit http://www.eating-disorders.org.uk/

Why May Holiday Overeating Make You Fat?

Asa Ernesson at the University of Linkoping in Sweden has done some research showing that brief periods of overeating contribute to long term gains in fat mass - even if weight is lost after the period of overeating. In other words, if you diet to get into that red dress for Christmas, then eat or drink anything that isn't nailed to the flooboards when you are on holiday, you are making it hard for yourself to stay in control of your weight down the line.

We all like to let our hair down on holiday. It's normal to want to let go of all the worries that dog us in the day to day routines of our lives. We overdo the wine and want to sample all those new foods and cool ourselves down with  big ice creams without caution. We don't need to concern ourselves with getting up to go to work, feeling fresh the next day. We rush round the supermarkets at holiday times to fill our trolleys with chocolates, fruit puddings and double cream.

I think of this as party-pooper research. It shows us that we will pay for our brief moments of just having a little harmless fun. Even if we flagellate ourselves with diets and exercises after our holidays, the damage has been done.

Well there is it; these findings will not go away. Researchers at the National Weight Control Registry have come to very much the same conclusions anyhow. People who maintain weight loss are those who eat consistenly pretty much all the time and they don't have patterns of boom and bust, feast and fast.

The problem is - how to give this kind of information to my weight loss clients without adding to the disappointment they already feel about having to restrict their favourite foods? What do you think?

Tuesday, 24 August 2010

Views About Emotional Eating

http://news.bbc.co.uk/1/hi/uk/3592058.stm the bbc

Why Do Some People Put On Weight Easily?

I have found this interesting research by following the health pages of the BBC. They have reported on studies which have conclusively shown that some people cannot put on weight by overfeeding a normal group of people and also restricting their activity.

One of the subjects said that she vomited the extra food she was supposed to eat and one subject found it hard to eat such large amounts. I also find it hard to eat large amounts of food and this goes all the way back to my childhood so it certainly isn't willpower.

Professor Jane Ogden speculates that genes might have a role to play in what people variously call the "set point" of our weight. There are also variations in the ability of our brown fat stores to dissipate extra energy as heat. Then there are variations in individual metabolic capacity which is a whole other subject to get our head around.

Professor John Blundell at the University of Leeds has also reported on the effects of feeding a high fat diet to male subjects which have shown some interesting and unexpected results.

So where does this leave us in our understanding of people who say "I put on weight if I just look at a packet of crisps!"

They might be right. Psychologists have identifed a form of thinking called "Thought Shape Fusion" thinking where a person thinking about forbidden food irrationally believes that they are going to gain weight. This is turn makes them feel helpless and ashamed, a sure trigger for having the crisps to console themselves or to block the horrible feelings that emerge.

To read the article to go http://news.bbc.co.uk/1/hi/magazine/7838668.stm. And, if you want to learn how to change the subtle and insidious thinking that cuases weight gain in some people and not in others, consider coming on our BPS Approved eating disorders training course seecheck it out at  http://www.eating-disorders.org.uk/

Friday, 20 August 2010

Appetite Changes In Anorexia

What are your views? Email admin@ncfed.com  or comment below

A question from Dr Robin

In a nutshell, I have had the opportunity to briefly work with a 16 year old girl who had been suffering with anorexia. Her body mass index was only 13 when I first met her about six months ago. Thankfully something had switched in her mind and she had insight into her being unwell and realised that she was harming herself by not eating. I was able to give her the usual basic physiological advice and get her eating regularly and incorporating the right variety in her diet. I am pleased to say that her weight has slowly increased and yesterday her body mass index had reached 21. However, her main source of distress is that she still does not feel 'hungry' or 'satiated' and she is fearful that she will never feel those 'normal' sensations again. At first I wondered if much of those sensations would return when she restored much of her lean body tissue. I was wondering whether you could offer me any advice in order to further help my client.

Answer from Deanne  

The issues of hunger and satiation are complex in anorexia and there may be some primary problems with appetite regulation. Appetite disruption tends anyway to persist long after dietary restriction. There are also issues of whether this person is confusing emotional experience with her experience of hunger.

Intero-receptive awareness is a term we use for sensitivity to body signals, which is one reason why people with eating disorders often say they are hungry when they are angry or sad, or otherwise fail to interpret the physical signals of emotion thereby being unable to name their feelings.

I could not predict that her appetite sensitivity will return because she is deflected from awareness of what is really going on somatically by the cognitive-emotional system which is activated by eating, which will be sensed as forbidden even long after apparent recovery. Thus, mindfulness training is also indicated so that she can calm down and pay attention to her body in a non judgmental way.

I hope this makes sense. Good consistent nutrition will also give her brain and body the best chance of working properly.

Thursday, 19 August 2010

Personality Filters For Weight Loss - So What! Or How?

James Lamper (of Weight Matters), our colleague and one of the NCFED therapists shows us a study suggesting the need for differing approaches based on personality filters for the vexed question of how to help people lose weight. We all know intuitively that there are many barriers to weight control; of which character, history, personal resources, skill-sets, support systems etc can help or hinder motivation and outcome success.

Kelly Brownell was one of the first obesity specialists who said that we have to find a way to target obesity programmes more helpfully because one size fits all approaches simply don’t work. The only system we have at the moment is based on a progression of increasingly invasive treatments based on  Body Mass Index. Cognitive Behaviour Therapy would, in this system, be the Gold Standard for the moderately overweight while surgery is the option for the super obese at risk of serious medical complications if nothing else had worked. (NICE Obesity Guidance 2006).

Then, in 2005 or so, the BBC Diet Trials programme conducted at the University of Surrey clearly showed that there are no outcome differences between different types of diet, although there were big individual differences between dieters in the long term. The  conclusion suggested that certain types of weight loss programme could be usefully targeted to character and lifestyle. A person who did not like meal plans would benefit from the low protein approach and the person who needed structure might succeed better the slimming club approach.

Research even points to gender differences with males clearly preferring a health approach with minimum rules and control while women prefer by and large to meet in groups and talk about their feelings.

The British Psychological Society is currently engaging the skills of a Working Party to investigate how psychologists can add to the debate. This working party to date examines the more complex barriers to change such as emotional eating which may, or may not, have its roots in early traumas or neglect. This all begs the question of choosing which treatment pathway to engage our client on and the assessment methods that such a selection process will involve.

The application of the term “metabolic” to personality typing is interesting and reminds us of diets which are based on biological metabolic typing which have sold quite a few books and which could be considered pseudo scientific (in the words of Susan Jebb - a weight loss expert).

The study below is only one model of behaviour change. Research into the management of diabetes points to another category. This refers to the individual whose best way of managing their illness ( putting other important life values in perspective) is to deliberately ignore it even at the risk to health and life. A good motivational practitioner must take all these features into account when helping a person to change. And there is another missing piece and that is the “metabolic typing”  of the therapist and how well he or she is able to adapt to the shifting status of their student.

So here is the study. Do you think it answers all the questions we need to ask about obesity. Or is it another piece of information that we need as therapists to place into our own untidy toolkit?

The Study (reproduced with acknowledgement to James Lamper)

A MicroMass study in the US reveals that while disease symptoms and treatment vary widely among individuals with metabolic conditions, there are remarkable similarities in patients' motivations to change behavior and the barriers that stand in their way. This 'metabolic mindset' offers a vital key to successfully motivating people to make difficult behavior changes.

Here are four types of metabolic patients, their percentage of the total study population, and suggested ways of motivating each:

Cruise Control (19%)

These patients follow their doctors' orders and manage their conditions pretty well, but may not understand the seriousness of their disease or the value of treating it by changes in behavior. This makes them vulnerable to backsliding. Strong and repeated reinforcement is a must, using self-assessment tools that concretely demonstrate the benefits of behavior change.

Taking Charge (30%)

These patients know the risks of unhealthy behavior and actively avoid them. They don't require intense investment or intervention by their physicians. Healthcare providers should engage these patients as advocates and invite them to share their expertise with other patients.

Disengaged (20%)

This group is highly susceptible to setbacks because they feel that improving their condition is beyond their control. Healthcare providers should applaud each small success with these patients and allow them to choose which behaviors to work on, one at a time. They should also plan for relapses.

Overwhelmed (31%)

These patients want to change but don't know how to start. It's important to raise their self-confidence by giving information in easy-to-digest bites, creating step-by-step action plans focused on small goals, and acknowledging their successes.

For obesity training with Deanne visit our website at www.eating-disorders.org.uk

Wednesday, 18 August 2010

Workshop : Key Issues In Overweight And Obesity

Introducing A fabulous one day skills based seminar for counselling therapists
Key Research Issues, Nutritional Interventions & Their Practical Application
TO REGISTER PHONE 0845 838 2040
With Jane Nodder and Deanne Jade in Esher, Surrey on September 13th 2010
Fee £155

REGISTER CALL 0845 838 2040

Obesity is a worldwide public health concern. In the UK nearly 1 in 2 men and 1 in 3 women are overweight. A further 1 in 5 adults, and 1 in 6 children aged between 2 and 15 are obese. This makes the UK population the fattest in Europe and the situation is getting worse. At an individual level, many overweight people feel unhealthy, miserable and alone with their concerns.

Whilst there appears to be no single cause of obesity, there is also no ‘one size fits all’ solution that is right for everyone who wants or needs to lose weight. The obesity practitioner needs knowledge about different weight loss approaches and their relative merits. You also must be able to call upon a range of evidence based tools to manage the issues each treatment pathway will involve.


This training course is designed to inform and empower clinicians in one increasingly important domain of
treatment; which is the influence of nutrition and physiology in the aetiology and management of obesity.
This seminar will focus primarily on interventions for working with adults. It is an excellent partner to the BPS
Approved course “Essential Obesity” and may have implications for the young. It offers suitable CPD for
professionals working with obesity in all clinical settings.


_ How biochemistry and physiology may affect weight management
_ How stress and stress hormones can affect mood, eating and weight gain
_ How gut hormones can influence appetite and weight control
_ Why (and which) nutritional interventions are important for managing weight concerns
_ How to use nutritional interventions to manage overweight and obesity
_ How to integrate the knowledge and skills from the training to your therapeutic practice, safely and effectively

Friday, 13 August 2010

Appetite Sensitivity Training For Comfort Eaters

What is comfort eating? If you eat when you are angry or sad or anxious it is obvious. If you go backwards and forwards to the fridge looking for food and nothing satisfied, then probably you are an emotional eater. But if you eat a bar of chocolate because it is there and you want a taste buzz, is it the same?

People usually call themselves comfort eaters if they eat more than they need. They may even call themselves addicts if they carry on eating when they are full, or are especially attached to a particular kind of food. I wouldn’t mind a fiver in my own pocket for every person who has told me “I’m addicted to chocolate.”

Experts also have ways of thinking about emotional eating. There is indeed a school of thought which marks compulsive eating as an addiction. There is also a school of thought which suggests that emotional eating is an attachment to food as a substitute for more authentic forms of self soothing that comes from good, mutually adaptive relationships.

Then there is the trauma account of emotional eating which suggests that food is the way of managing forbidden feelings such as anger or fear. This account of emotional eating allows for the possibility that some people do not want to feel any of their emotions because of deep rooted feelings of shame. And thus they eat so that they won’t have to feel anything at all.

The link between overeating and feelings is quite clear. We only know we have an emotion when we feel it in the body. Sadness gives me a feeling in the pit of my stomach and anger gives me tightness in my chest. If I do not like feeling angry, eating might take away that feeling and give me a nice warm feeling somewhere else.  If I can’t make sense of that feeling in my chest and call it “fear” I might convince myself I am hungry and go to find some soothing food.

Experts have met the problem of emotional eating by doing “feelings sensitivity training”. There are many steps to this kind of training. The first step is permission to have emotions. The second step is teaching good names for the feelings that we experience in our mind and body too. The third step might help us to know why some feelings are more troublesome than others. And the last important step is learning all kinds of skills to manage our feelings better. Managing conflicts and standing our ground with other people is all part of building emotional intelligence. This will help reduce all kinds of disordered eating behaviour, from calorie restriction to chronic overeating.


There is a possibility that Appetite Awareness Training might help even better for emotional eaters.

Experts give the name “interoceptive awareness”  to our understanding of the changing experiences that happen in the body. People with weight problems and eating problems seem bad at interpreting these signals and are more likely to interpret everything, including emotions, as feeling hungry or having cravings.

The old way of dealing with this is to increase our sensitivity to emotions, to be able in other words to recognise when we are angry and when we are feeling useless.

Some new research suggests that it might be even better to learn how to recognise physical hunger and how exactly to distinguish it from a buried feeling.  A group of researchers in the USA have recently conducted an experiment in which a group of people were exposed to 5 weeks of Appetite Sensitivity Training. All they had to do was self monitor hunger, cravings and fullness sensations for each eating event; and also relate the degree to which they felt positively or negatively after each eating episode to help them distinguish between hunger and feelings.

On week 4 they also self monitored to identify specific emotions triggering urges to eat, with the help of a sheet with emoticons J and feeling words. During this week they were given advice on other ways of managing their feelings.

At the end of the period, participants and controls returned to the clinic to complete the post intervention assessments.

The results were clear. People who did the appetite training did not show much improvement on emotional awareness but they had big changes in appetite sensitivity. They reported fewer urges to binge or cut back on food and better eating control.

Emotional eating is a multi dimensional idea. I believe that any single explanation of it and the treatment that follows will not work for everyone. Clearly, emotional eating is behaviour which must take account of our history, our beliefs and our emotional strengths and weaknesses. But this research shows clearly that Appetite Sensitivity Training might be an important part of therapy and get change fast, even for people with “issues”.

Thursday, 12 August 2010

Vanessa, Comfort Eating And The Gastric Band

Today Vanessa Feltz was on BBC radio 4 to talk about her gastric band operation which she ways is successful in helping her to limit her portion size.  Lots of people will be following her with her weight loss struggles and will be saying if it works for her, why not for me!

I saw Vanessa many years ago;  she was interviewing me just after having lost a great deal of weight. I quailed at the fact that I was telling her that 95% out of 100 people who try to lose weight put it all back on again in the end. I don’t think she wanted to hear that but the years have proved me right.

The gastric band is a reasonably safe operation but like all weight loss surgery it isn’t a panacea for overeating or comfort eating in the long run. Ultimately the person with the gastric band will need some coaching to address her emotional eating because it is all too easy to learn how to out-eat the band.

Most people don’t really know what emotional eating is. It is a common fallacy that eating food we want but don’t need, often compulsively, is “eating for comfort”.  Emotional eating is a catch-all term that means different things. Some people overeat to quell difficult feelings or even to reduce or soothe emotional excitement. In some people the feelings relate to bad events in the past and in other people they do not.  In some people emotional eating is about a difficulty in managing impulses “I have to have this or I will die!” and in other people, emotional eating is about unhelpful meanings and associations with food; this is fun, food is my friend, I deserve this, it is a treat!

In her interview on the BBC, Vanessa spoke about looking for the dessert trolley as soon as she goes into the restaurant. The gastric band won’t change that mindset in the long run because there are limits to how much it can be tightened and adjusted. What really needs adjusting is the brain, to tone down and muffle the core excitement that exists around food and eating.  We can learn how to enjoy food – all of it – without it having to rule our life.

Monday, 9 August 2010

The First Ever Clinical Trial of Diet and Nutrition?

From Daniel 1: 1-16

In the third year of the reign of Jehoiakim King of Judah came Nebuchadnezzar King of Babylon and he set Jerusalem under siege.

The King asked Ashpenaz the master of his eunuchs, to bring him some of the Israelites, in particular the children of nobles and royals. These children had to be able, wise and beautiful, well tutored, understanding the arts and sciences. He wanted to teach them the learning and language of the Chaldeans.

The King said that they should be well fed with his own foods and wine, and after 3 years he would see them.

Now among these Israelites were Daniel, Hananiah, Mishael, and Azariah. Daniel did not want to eat the kings food. He said it would defile him and he spoke to the Prince of the Eunuchs who listened sympathetically to him.

The Prince of the Eunuchs said to Daniel, if you don’t eat the King’s food and you look ill and pale compared to our own boys, the King will surely cut off my head for failing to look after you.

Daniel said to the Eunuch, I will make a bet with you. Take a few boys for just 10 days and give them only vegetables and pulses to eat and water instead of wine, then compare them with the other boys who are eating the King’s rich food and drinking his wine.

At the end of ten days their faces appeared fairer, and they were more beautiful than all the youths who ate of the King's dainties.
So the steward took away their dainties, and the wine that they should drink, and gave them veggies and pulses. And Daniel proved himself to have knowledge and skill in all things as well as in visions and dreams. And thereafter in all matters of wisdom and understanding, the King found him 10 times better than all the magicians and enchanters (and gurus) who were in the Kingdom.

Thursday, 5 August 2010

Bulimia - The Demon Within

I had a call today from a young woman who was interested in one of our bulimia workshops. She asked me if this single day would help her recover from a 15 year illness that has so far resisted CBT, counselling, and even schema focused therapy.

Why do some people find it so hard to recover from bulimia? Psychologists suggest that resistance to treatment infers a personality disorder such as impulsive, narcissistic or borderline personality disorder (you can Google these).  But being categorized in this way doesn’t really help the people who struggle with their illness.

In my experience, bulimia starts as a way of controlling calories. Soon it becomes a way of helping people to block or manage bad feelings. People start bingeing because it gives them the excuse to purge, which is the true addiction. They cannot stop no matter how much they promise “this is the last time…”  The solution has become the problem.

People with bulimia have two lives; the normal life and the bulimia life. The bulimic life becomes the real person doing all the thinking and the planning, the bulimic feelings and behaviours.  In time the person becomes  just the ghost in her “normal life”; he or she is half present for everything that calls for attention.

 No wonder it is so hard to give it up. It feels as if the person as she was doesn’t really exist anymore.  How will she or he cope with life, food, feelings, people, stress - without the bulimia?

I do 3 hour breakthrough sessions for hopeless cases. In treatment for sustained bulimia – see eating-disorders.org.uk -  I would have 3 people in the room; the ghost, the bulimic and me.  I would find a fast way to help the ghost to find his or her voice and commit to battle from a place of strength.  This is because the real person who wakes up knows that this is no way to live. Sometimes this therapy involves very creative tools, such as Emotional Freedom Therapy and NLP.

call 0845 838 2040 for details


          Deanne Jade
0845 838 2040

Wednesday, 4 August 2010

Eating Disorders Awareness Week Video

Hello followers
Take a trip to this link to get what an eating disorder is about: http://www.youtube.com/watch?v=QSqtVDIwnHo

We have 100 eating disorder specialists in the UK and overseas to help sufferers and their carers. Look at the counselling section of our website at www.eating-disorders.org.uk

Airbrushing And The Media

Today the Girlguiding Association has issued a petition to demand that adverts and photos should carry a warning if the picture has been airbrushed.  When I was young and not so young, I used to look at pictures in the fashion magazines and marvel at the length of the model's legs or the flawless complexions of the women of all ages. After reading these magazines, I would often feel like a frump
This is a good example of what we psychologists call "beauty and the beast " thinking. If you see a someone with lovely hair or legs to die for, you automatically think that your own hair and legs are inadequate. These horrible feelings do ebb away but the drip feed effect of believing that there are people out there who are effortlessly perfect will have an effect. We lose the ability to figure out the essence of our own loveliness; we discount it.
So what kind of damage will the media cause? The people most at risk of developing anxiety and distress are the people who"internalise" society's images of perfection and compare themselves all the time to an impossible ideal. Many people dont "internalise"- they admire perfection but find no need to try to live up to it.

Societies have always valued images of perfection and have brought these to the attention of the public through art and sculpture. The images of Rubens and the statues of Michaeangelo celebrate the human body at its best for the time rather than the mundane and everyday reality. Which woman could ever look like the Venus de Milo without a little bit of nip and tuck? The media is just another artform and perhaps we should not try to make it reflect the world as it really is.  Yet I am torn. I treat all the collateral damage, people who are going crazy inside because they hate the way they look. So I would like to see an airbrush kitemark. Yet I value art and freedom of expression; I dont particularly want to look at pictures of Mrs Bloggs next door in her new Dior suit. What matters most is that girls and boys are media wise and know that what you see isnt really factually real. This kind of wisdom starts at home, with parents who find the time to talk to their kids about these and other matters. For information and help visit http://www.eating-disorders.org.uk

Tuesday, 3 August 2010

Bariatric Surgery And Ethics

I listened to a programme on BBC radio 4 today on whether it is ethical to offer bariatric revisions to patients who have jumped the queue by “going private.” There were two people with gastric bands whose ops had gone horribly wrong, the money had run out and they needed extra help. In one person the band had become too tight – almost killing her. The second young woman found that her band has “stopped working” and she had no money to ask for it to be tightened.

Having contributed to the NICE bariatric technology appraisal, I have some thoughts about these issues. The first is that of desperate need. The two girls had done everything they could to lose weight.  They almost certainly had some kind of eating disorder which, by the way, is not a contra-indication for surgery. The quality of their lives was severely impaired despite the fact that they did not quite fit the criteria for inclusion for surgery.

The second issue is all about preparation, which was almost absent for these ladies. There is a  fallacy out there that you have to prove your ability to eat normally and sensibly before having the surgery. If the girls could have done that, they would not have spent money they could barely afford - but they almost certainly had no help to figure out how to manage their lifestyles after the operation.

In both ladies, the gastric band has failed and they are both looking at the gastric bypass now. Even bypass operations can stop working in time and pose their own physical and emotional risks. They are regaining all their weight. Sadly, neither  of these girls know that weight regain is the default position for dieters and not a sign that they are weak or greedy which is the belief system that has arisen from their repeated failures to lose weight.

 For one of the ladies it was clear that overeating junk food is the glue of most of her most intimate and loving relationships. Health psychology teaches us that people only change and want to change if the immediate social environment provides the support and the opportunity to change. It is insane to blame the overweight for being irresponsible when they are faced with a  choice between intimacy and “taking care of yourself properly” . To help a person like this, we have to work with the person holistically  and help her to feel effective in managing the system in which she lives rather than just being a part of it.
I am not against bariatric interventions. I know all the pros and the cons. Einstein told us however, that the solutions we create to solve problems must be far more elegant than we suppose.

I am providing a course on bariatric counselling in September 2010. Visit http://www.eating-disorders.org.uk/ for the details.

Monday, 2 August 2010

What's In a Name - The F(Fat) Word

Fat? obese? humongous? Jelly belly? Overweight?  Will words help people change? I find it hard to use the “f-word” when I train other professionals to help people lose weight. Are we being too careful not to hurt feelings or should we take our cue from Cameron and talk blunt. Anyhow how fat is too fat these days? An interesting debate – does anyone want to run with this….  email admin@ncfed.com visit www.eating-disorders.org.uk

Should Obesity Experts Be Paid By Commercial Organisations?

It is reported that Susan Jebb, obesity expert, is being paid by Rosemary Conley and Weight Watchers to support their enteprises. Many organisations with one eye on the balance sheet and mindful of the public relations outcomes find academics to confer "authority" on their products. Do you think that such organisations should be compelled to disclose what they pay and to whom? Shame on those experts for taking the "kings silver" and for not having the courage to say that everything works for someone, that long term outcomes are pretty much the same for everything, and for not being able to disclose which enterprises are causing harm. I should know - I pick up the pieces. Visit http//www.eating-disorders.org.uk for the views of a psychologist who hasnt (yet) been bought.