Deanne Talks

Obese Children Are Not The Enemy?

2012-01-16T06:33:00.000-08:00

This was the title of a message from a "working think tank" which landed in my postbox this week. This is supposed to be promoting "Integrity and Dignity". What? Where does the enemy word come from?

At the same time I met an authoress and journalist, Tanith Carey who has written "Where Has My Little Girl Gone? How to protect your daughter from growing up too soon." We had a conversation about weight problems in children.

I have it on good authority from a very good friend that it's hard being the mother of an overweight child. Everyone will look at the parents and say;
"Why don't you put him on a diet" when some of us know that dieting only makes an overweight child fatter in the long run. Much fatter.
"Don't let them eat ice cream" - when all of their slim friends are eating ice cream and no-one gives a damn. Anyway, restricting food only makes it more desirable, so how do you get the balance right?

"Make them do more exercise" when you take them swimming and they just want to waft like basking dolphins in the shallow end or play around like the other children.
"Give them healthy lunchboxes" when they ALSO go into the cafeterias at school and swap carrots for chips with their friends.
"Switch off the TV" when their self esteem is shaky anyhow and they want to be tweeting and Facebooking or following East Enders like all their other friends.

"Help your child to grow out of their weight problem by keeping their weight steady as they grow". Easier said than done, anyway do you want to be weighing the child every week and controlling everything they eat and do?

Some parents are lazy and some are thwarted by the culture at large and some are ignorant. My friend whose authority I lean on, knows everything there is to know about healthy eating and activity, and lives in a healthy environment and his very fat child loves fruit and vegetables.

Working with an overweight child is a very, very complex task. Parents need help because they can feel like a bad parent if they have a fat child. The parent needs help and support to deal with their shame.

Experts have to stop talking in generalisations about what to do. Some children have a much harder job than other children managing their weight and the situation is going to become worse before it gets better, if at all. If a parent is worried about their child's weight problem they need personal advice and sometimes that advice may be to do very little for the moment.

Food for thought.

Men Worry Too

2012-01-06T04:25:00.001-08:00

It comes as no surprise that according to an article in the Times today, men talk about diets and worry about their weight. It's not just the young ones either. Most of the men I know who are old enough to be grandfathers are trying to control their weight. More than half of them are trying to exercise more. Is this really a dangerous decline in body acceptance or is it more about trying to stave off ageing. After all, now that we aren't all dying young from smallpox or famine, we have the challenge of trying to stay active and keep up with others as we grow older. The best way of doing that is to take responsibility for our health.

The Times tells us that a minority of men are trying to manage their weight by vomiting or by taking laxatives. I knew that when I started counselling over 30 years ago, so it doesn't come as a surprise either. Many men do not come for help because they don't view purging as a dangerous psychological problem or feel ashamed to have " a woman's illness".

Dieting doesn't cause eating problems but will lead to some people developing a very toxic relationship with food. Also, obesity is a clear health risk that shortens life. It makes sense to take stock of your lifestyle if you are overweight or very sedentary. The question is; how do we get the balance right and live a flourishing life?

To Detox Or Not To Detox, That Is The Question

2012-01-05T05:46:00.000-08:00

I wonder how many of you out there are thinking of detoxing, exercising, doing Dukan and purging yourself of the excess food and drink that comes your way at this time of the year.

Have you noticed how many ads there are for weight control and cleansing which are in your face right now? Weight Watchers have produced a 3 minute ad which calls directly to all the guilt buttons in people who arent a perfect size 10. The Times are running a series by some crazy person who calls upon the Fat Bitch mentality to motivate people to take on the True Grit of daily workouts. Not dieting? Not detoxing? Not running 5 miles a day? Shame on you!

I have an Facebook page for National Centre for Eating Disorders and it horrifies me that all the ads that are on the right side of the page are for instant tummy flatteners, diet products and quick fix weight loss products that are mad, bad or dangerous.

You don't need to detox, just take care of yourself, eat generally healthy food and go for some walks to admire the scenery not shed the calories. Its not a crime to be unfit - yes, really. A healthy mind will promote a healthy body so focus on that first and foremost.

We need a helpline for people who feel that they are in danger of being buried by the January avalance of detoxing and bootcamping programmes. Do yourself a favour. Just say NO.

Happy New Year. Make this the year you put eating disorders behind you.

Amy Winehouse: New Poster Girl For Anorexia?

2011-08-08T09:17:00.000-07:00

I did wonder if Amy had an eating disorder and while everyone made a fuss about her drug abuse, she really may have succumbed as a result of eating disorders rather than drugs. Yesterday, writing in the Times, Caitlin Moran described how little Amy ate (just Haribos, it seems) and how much exercise she did (treadmill for hours apparently). Moran writes “with an eating disorder like that, you’d have all the tolerance for drink and drugs of a newborn baby”.

Winehouse’s eating disorder was as clear as the nose on your face, it hardly matters whether it was anorexia or bulimia, the damage can be just as bad. Drugs are nirvana for people with eating disorders because you just don’t get hungry. When you go into rehab, you just feel fat when the drugs wear off, or you get very hungry as their effect starts to wane. This makes recovery feel very unsafe, so having eating problems gets in the way of being on the wagon.

Why do I feel cross; Winehouse was the queen of cool for some people, the girl on the edge, who wasn’t supposed to care what people thought. But all the time, behind that bravado, her real pain was the pain of everyone else who has an eating problem, the wish for absolute conformity by being as thin as all the other poster girls like… Cheryl Cole. I wish she had the courage to come clean about it, to help those she has left behind.

Children With Anorexia

2011-08-03T05:20:00.000-07:00

There is a new little girl in our family and like many people I hope that she will not start worrying about her weight by the time she is only 5 years old.
Children as young as 4 or 5 can notice the weight of other children and silhouette studies dating back for at least 30 years show that fatter children receive fewer nominations to be a chosen playmate. I have asked why this is so and haven't had any good insights from my colleagues. After all, size zero pop stars are a recent phenomenon, aren't they? So let's just assume some atavistic reason why even young children stigmatise the overweight.
I have been aware for many years that nursery school age children can complain about their simply caused by the wish to be thin, and it generally shows its ugly face in children who are deeply anxious and burdened with a wish to be perfect in all things. Having parents who are open about their food and weight issues or dietary quirks doesn't help.
Tanya Byron writing about children and body image troubles in the Times pointed out that obesity is a major health risk to children and this should not be forgotten in the current panic about anorexia. Our children are getting more obesity and more anorexia it seems, how on earth will we get the balance right?
The BBC want to find some families with children who have had, or have anorexia. If you know someone who would be prepared to take part in a documentary, contact The National Centre for Eating Disorders on 0845 838 2040 or email admin@ncfed.com

The Death of Amy Winehouse

2011-07-27T07:58:00.000-07:00

There is a great deal written about Amy Winehouse this week and I like many others have been drawn to listening to her music. We have had the typical musings about the waste and costs of drug addiction and the importance of rehab and other forms of treatment.

But did anyone ever consider that she may have suffered as a consequence of low weight. I was struck by her early photos and she was clearly a very different size and shape in her teenage years - chubby even.

There is a very strong link between bulimia and addictions, in particular alcohol in both sexes. A lesser link, but one none the less, between anorexia and addiction. The presence of body image problems makes it harder for someone to recover from an addiction. When you stop using, you may gain weight or start feeling fat. This is partly because you start experiencing emotions in your body where emotions must be felt.

If you are bulimic or anorexic, the health risks of addiction are magnified. With poor nutrition, the heart can simply stop beating.

We have yet to discover more about her untimely death. But why haven't I seen any mention of an eating disorder yet? Perhaps?

Body Image, How Do You Feel About Your Body, Continued.

2011-07-15T09:08:00.000-07:00

I have been writing about the media and bodies. How do we get the balance right between encouraging people to take responsibility for their eating in this food filled society, versus promoting eating disorders?

This quite topical, today an article in the Daily Mail proposed to have fat children put into care. One obesity expert, Kelly Brownell said that some parents are lazy and some are thwarted and some are ignorant. So there we are. It's a very contentious solution.

I have listened to many proposals for managing media images to prevent body dissatisfaction. They seem like small solutions to big problems, such as putting health warnings on airbrushed pictures. Or being absolutely frank about the amount of airbrushing that has been done. I do not think this will be popular with celebrities.

Some schools offer media awarness training for adolescent pupils, but these are few and far between. So, we are what we are, a culture saturated with images with bodies that can never stay slim enough, perfect enough or slim enough to measure up for long. Not all of us are suffering because of this but some people are. If you think that your thoughts about your body are driving you mad, call us 0845 838 2040 or read about body image in our time on our information page. http://www.eating-disorders.org.uk/ We can help.

Body Image And The Media: Getting The Balance Right

2011-07-13T02:40:00.000-07:00

In a previous life I worked as a marketing executive for a major magazine publisher. Magazines sell to niche markets by providing content that the market wants to read. This content doesn’t always make people feel happier. Psychologists try to make people happier. There is an uneasy marriage between these two roles. Magazines have been slated for their portrayal of very thin, emaciated women. And they are now being condemned for their obsession with celebrity weights and body shapes.

There is no point in trying to categorise the media as good or bad, its purpose is to mediate between the individual and his culture, provide targeted information and forge invisible connections with like-minded people, at the very least. Magazines appeal to our dreams and possibly bring to the surface our greatest anxieties so that they can help us to do something about them.

So it has to be their purpose to create insecurity about our size and shape then provide solutions like yet another weight loss plan. This leads to some contradictory features like a recipe for chocolate cake alongside an article on how to lose weight fast. Magazines have been like this since I was young, but there are some recent, more worrying trends. The one that most comes to mind is a growth in the number of publications aimed at men's fitness and health. They are remarkable for their front pages showing muscled torsos with the well defined 6-pack. Undoubtedly many of these photos have been digitally adjusted. But men are increasingly senstitive about their bodies too and many are taking steroids to try and build up muscle and lose fat. That can't be good at all.

Women's magazines have deflected the argument that they are responsible for "an epidemic of anorexia". They argue that anorexia is not a slimming illness and to some extent they are correct. Notwithstanding, a social conscience is creeping in with respect to correcting harms. In 2009, Alexandra Schulman, Editor of Vogue wrote to to designers urging them to provide samples in reasonable sizes – size four rather than size zero; well it is a start.

The media is also giving us good quality information via documentaries, dramas and helplines to address potential harms. Yet this can also lead to some confusion. With conflicting concerns about the obesity epidemic and the eating disorder epidemic, some of the information we get is muddled. People say to me, I don't want my child to get fat but I don't want to risk her getting an eating disorder either. How do we get the balance right?

To be continued........

If you have concerns about body image, body dysmorphic disorder and eating concerns visit http://www.eating-disorder.org.uk/. We could save your life.

Obesity Surgery: North Staffs NHS Trust & Mr Condliffe. Barking Up The Wrong Tree?

2011-07-11T04:03:00.000-07:00

http://www.bbc.co.uk/news/health-14084455

This gentleman has been refused obesity surgery and is appealing the decision of the North Staffordshire NHS Trust. He claims that he will die if he doesnt have it. The Trust says that he isn't fat enough yet. Many people overeat to gain weight so that they can qualify for the surgery. Then they have to undereat to prove to the Trust that they are capable of managing their diet.

Heyho.

Mr Condliffe who wants the surgery needs to understand that the surgery isn't a panacea. If he has a bypass or the gastric sleeve his diabetes will go away and he will lose a lot of weight for a while. He will have to eat a very modified diet and he won't be able to turn to the jam butties very easily if he is stressed. If he doesn't sort out his relationship with food, he could get in trouble down the line.

On the other hand if he has a gastric band, it may be a total waste of money.

North Staffordshire NHS Trust could have saved itself a great deal of time and money if it had paid The National Centre for Eating Disorders for Mr Condliffe to have an eating disorder assessment. This would have cost them about £55. If Mr Condliffe is eating for comfort a great deal, a course of eating disorder treatment would have gone a long way toward dealing with his weight problems and also his diabetes. His family would also benefit from the knock on effects of his counselling - in terms of their overall lifestyle and his ability to exercise.

Who is to blame here when someone gets into such a fix? Is it the GP who treats the diabetes but doesn't provide the help for the underlying problems with food? Is it the Trust who doesn't see that a course of counselling costing, say, £500 - is far cheaper than everything else? Why is everyone barking up the wrong tree?

Would someone please find a way to get this Blog to North Staffordshire NHS Trust and to Mr Condliffe and I will offer this gentleman an eating disorder assessment free of charge. Call 0845 838 2040 or email admin@ncfed.com

Body Image: How Do You Feel About Your Body? Continued..

2011-06-28T12:18:00.000-07:00

In 1982, a psychiatrist called Peter Slade wanted to rename the eating disorders as body image disorders. Most of you are familiar with the terms anorexia, bulimia and compulsive eating disorders. But while eating disturbance is what you get on the surface; Slade argued that the term "eating disorders" is akin to calling pneumonia a coughing disorder or measles a spots disorder. His view – which is shared by modern thinkers, is that starving, sometimes to death; purging, compulsive exercise, yo-yo dieting, obsessive weighing, taking slimming pills or steroids if you are male, and adopting strange eating plans like avoiding all meats and dairy foods; - all this is just a reflection of your altered perception of bigness, fatness and too much-ness from which you may be continually trying to escape in order to feel better about yourself.

But even those of us who don’t have eating disorders are somewhat unforgiving about the way we look. So how does it all go wrong?

Body image is subjective and open to change by social influences and personal social experiences. Most people on the planet have a reference group that furnishes information about the ideal appearance. In this country it is arguably a tall thin coat hanger and in Burma it is a very long neck. In all cultures, beautiful is the same as good . We are surprised to find a loving heart inside Beauty’s beast and its only lovely Cinderella or wafer thin Kate who gets a Prince.

For most of us, our first reference group is in the home: with parents who might feed you instead of giving you a hug, or diet and rebuke themselves and name-call other people for their fatness. I bet you have heard them say "she's put on weight" a hundred times. You may have a bother or sister who teases you for being fat. If your best friend happens to be thinner (or stronger if you are a male) your body evaluation may shift. If you are taller or shorter than other people, if you have experienced abuse or violence at the hands of another person, you may turn your anger and sadness against your body which was the subject of their harms.

But what we see in the home is only a reflection of what is in our wider social world. Nowadays, it is the norms and aspirations of our society that we find reflected and, to some extent guided by a pervasive media which reaches deep into our lives. This media gives us clear messages that what is valued is youth and slimness that most of us will never reach. That’s OK, ideals were never meant to be attainable – that’s what makes them ideal!

But we are led to believe that our failure to get our appearance right means that we are weak, lazy, or unwilling to take of ourselves properly.

And where that takes us is,.... to be continued.

Body Image: How Do You Feel About Your Body?

2011-06-24T04:12:00.000-07:00

I consider that my body shape is....?
When I think about my body I feel....?

The most real thing about us from the beginning is our embodiness - we sense our body even before we are born and have a natural knowledge of what is going on inside and outside of us. After we are born, we know if we are falling or comfortable, fed or empty. Something in our guts grips us when we are afraid and we put things in from outside which give us alternatively a sense of wonder or disgust. As we grow and mature, all of our experiences of bliss and dejection are felt - not in our head - but in the way the body works. Bliss is interpreted when our heart turns over warmth cascades up from our centre, and our pulses race, dejection will be felt as a pain in the heart, the hunch of your shoulders or a gripping in the throat.

Freud said that our first ego state is a body one; thus it is in the body that we first have our sense of self and how it is different from not-self.

Because we are embodied beings, we all develop opinions about our bodies which are both ABSOLUTE in terms of experiences like pain and comfort; and RELATIVE in terms of how we look. We may think of ourselves as tall or small, old or young, ugly or beautiful. But, in relation to what? Small in relation to what? beautiful in relation to what? How we behave, dress and relate to others has much to do with our body opinions and what those opinions mean to us. If we feel ugly, and if it is matters, we may hide away from other people, stay at home rather than go to a party and take holidays in an igloo. If we feel attractive we will dance on the table and walk tall in our clothes.

The natural sense of our body is basic to our survival. Pain alerts us to the fact that something is wrong. The adrenaline rush when you see a tiger enables you to freeze so that it won't see you or alternatively propels you to run away.

But, sometimes, our natural experience of the body goes wrong. If anyone reading this has broken even their finger for a while, you become your finger, it seems to be bigger and more troublesome than it is. So our sense of the body is more than just feedback about what is going on in it. Our body sense becomes a big part of our sense of self. Sometimes, nothing is wrong with the body at all, but it comes to feel wrong and our natural wisdom goes astray. We are separated from our natural sense of self. It is in this type of ground that eating disorders can set in.

to be continued......

Obesity Treatment: Enthusiasm and Desperation

2011-06-22T04:02:00.000-07:00

Last week I led a 3 day course on managing weight problems. It was really interesting and the delegates, some with long standing weight problems themselves brought many good ideas into the room. The issue of helping people to be motivated was raised. It’s one thing trying to persuade someone to lose weight, and it’s quite something else to help someone to be fully committed to the hard work that weight loss involves. Goodness ! it would be hard for me to lose half a stone, how much harder to lose even more.

It’s easy and hard to lose weight. You can lose a few pounds without even touching your fat stores. A few days of eating very little will remove a great deal of water and stored sugars from your body. People think they have lost weight and congratulate themselves but nothing has really changed at all. Losing fat is something else entirely and floaty-light- fat is so energy-dense that you use up very little to meet your daily energy needs. Your motivation must be realistic and stand up over time in the face of the stresses and strains of life.

We mustn’t confuse motivation with enthusiasm or desperation. Wanting to lose weight is not the same as wanting to stop eating your favourite foods. It’s now clear that obesity is a long term medical condition which is self perpetuating and which needs lifelong management. Some people might be better off not trying at all. If people engage in dietary oscillations, like eating little all week and feasting at weekends, they will regain their weight. If people do not move around a great deal, they will regain all their weight. If people return to baseline behaviours, like keeping crisps at home for the children, they will regain all their weight. Unless healthy behaviour becomes intrinsically gratifying, people will regain all their weight.

Susie Orbach said that fat was a feminist issue. I think we have moved on. It’s a commitment issue, with enthusiasm and desperation playing very little part in changing behaviour at the end of the day.

Binge Eating and Food Addiction

2011-06-22T03:03:00.000-07:00

I have done a short presentation at a medical conference "Addiction and the Liver" in London. My topic was to discuss the link between food addiction and binge eating; a big subject for a short presentation. The weblink for the presentations is: www.mahealthcareevents.co.uk/addliver/0611/presentations. No login is required. Scroll down to find my name and the presentation is there. I prefer the view that binge eating is more complex than an addiction and a great deal of what we believe to be emotional eating is in fact driven by thoughts and the feelings that arise from those thoughts. But people think that its only about feelings. I feel a mega blog coming on, so perhaps another time.You can read all about binge eating on the information page of our website http://eating-disorders.org.uk/

Children and Body Image: How to Help

2011-06-10T04:33:00.000-07:00

Here is another useful opinion piece. Food for thought. Pass it on, the wiser we are the more we can share out wisdom with others. What was it like in your own home. If you have a parent who does a lot of fat talk, time to get it to stop, dont you think?

http://www.independent.co.uk/life-style/health-and-families/features/mummy-will-i-get-fat-2284966.html

Getting there is another thing entirely. If you have a parent or your child has a grandparent who parades their own unhelpful opinions about weight and eating, get in touch. Visit http://www.eating-disorders.org.uk/ or email admin@ncfed.com for advice.

Children, Body Image, Eating Disorders & Sexualisation

2011-06-10T04:05:00.000-07:00

Sexing up our children is in the news this week. One mother is reported to be buying her 7 year old "breast surgery" (to implant ping pong balls?).

In girls particularly, there is a link between early growing up, sexualisation, low self worth and eating disorders. So there you have it, there is no way to twist away from that one. Buy your child the wrong clothes or send her out to play in make up and you get what you get down the line.

My little grandgirl loves to wear my necklaces and I think it is wired into children to mimic their parents, they cuddle their teddy bears and put them to bed. This kind of play practising is what helps them to grow up. But how do we get the balance right? It is OK to play with our children in the park or take them out for bike rides. But when we show them that mummy "has" to go to the gym, or when we show them that "mummy isn't eating carbs today" we cross over the line. Children are like sponges, they soak in our own insecurities and our own self doubts and embody these as their own body hatred.

I have had many young people with eating disorders who find their parents' obsessions with running, workouts and exercise toxic, although they dont know it. They resent this behaviour in their parents - it sends out the wrong messages about what it is to be a relaxed human being. Because they can't admit to their resentment, they simply feel ashamed, not knowing why.

Please let your kids be kids, and, get a life. Say no to things which aren't suitable for 8 year old girls. Don't be drawn into competition with parents. Read a good book, take a walk in the rain, eat good food without dietary quirks and read the article below which says it all.

http://www.dailymail.co.uk/femail/article-1380585/The-children-hate-bodies-How-half-year-old-girls-think-theyre-fat-parents-stop-dangerous-obsession.html#ixzz1OrujmhCJ

Worried about your child, email admin@ncfed.com or visit http://www.eating-disorders.org.uk/

Binge Eating Treatment

2011-06-08T03:51:00.000-07:00

Let food by thy medicine and let medicine be thy food, said Hippocrates more than 2000 years ago. How right he was. Its an important part of treatment for binge eating and I've been saying this myself for years.

Tomorrow I give a lecture on the treatment of binge eating and food addictions. I will be making a case against regarding binge eating and even compulsions to eat food like chocolate as an addiction.

There is a lot to say in half an hour. Its not helpful to view people as carbohydrate addicts or anything similar. Our eating is driven more by what we believe about food, what we say to ourselves when we start to eat it. Ive blown it now.... this will make me fat.... I shouldn't be having this.... I can't control this. These thoughts do more damage than any property inside the food. If we treat compulsive eating with abstinence programmes, we only make desirable food seem even more desirable and forbidden.

Treating binge eating is complex. We will use food as medicine - thanks, Hippocrates! We work with emotions, help you manage relationships, we will correct poor body image and transform unhelpful thoughts so that they dont propel our eating. We know what to look for and what to work on. Everyone is different, so if you purge we may need to add some therapy and if you have very low self worth we would have to do something about that too. If you accept yourself better you feel more in control.

Need help? Eating can be fun and rewarding. Food is life. Visit http://www.eating-disorders.org.uk/binge-compulsive-recovery.html If you binge eat and it is ruling your life, we can help.

Visit To BOSPA- British Obesity Surgery Association

2011-04-28T02:27:00.000-07:00

Yesterday I did a talk at a self help group for bariatric (obesity surgery) patients in Chsiwick. My talk was called "What is normal eating anyway?" I guess I should be blogging about this sooner or later.

There were some pre-ops there wating for surgery or just getting some information and some post-ops talking about their experiences. The common theme from the post-ops was that the surgery had changed their lives; they were walking miles and wearing clothes that had been in the attics for years. The gastric banders were certainly less successful and the gastric sleevers and the gastric bypassers were equally happy.

Now for many of them it is early days and as time goes by they have to confront some obstacles. I was so sad that there aren't many people with the wisdom and training to help them emotionally speaking. One soul was angry with me for being there talking to them in my slim body, she felt that I would have no idea at all what she was going through. She is a deeply compulsive eater who ate 20 easter eggs over the last weekend and she has been refused surgery until she has "dealt with her eating disorder" but how is she supposed to do that?

Everyone is talking about "getting CBT" or she has "had CBT" and it didn't work. But CBT does not work for everyone, if that is all the therapist is doing - there is only 50% success rate with CBT alone. So, we need to take each person, one at a time and bring a whole range of skills to the table which can be built around a package of treatment that will focus on the eating disorder mindset at its heart but can also provide help with feelings, trauma, lifestyle and empowerment.

Don't you think? Email me if you have a view on this - see above and remember to visit our website www.eating-disorders.org.uk to see what is going on.

Top Tips For Working With Eating Disorders: Counsellors Must Get Anxious Too

2011-04-21T08:25:00.000-07:00

I wrote a few days ago that clients must be a little and sometimes a lot anxious for therapy to work. We therapists must be able to tolerate our own anxiety too.

My own experience mentoring therapists is that can get very anxious. Someone may be losing a lot of weight and nothing the therapist does seems to stop this from happening. Someone with bulimia may be reporting very frequent purging. Someone with anorexia is gaining a little weight and then there is a setback; weight goes down, someone seems to “stop trying”.
Or a person with a weight problem is doing very well. The therapist is anxious, can she keep it up? The client seems to be a little less motivated; is she heading for a relapse?

Carers’helplessness can make a therapist very anxious too. The carer come to us saying “This therapy isn’t working! My son/daughter won’t talk to me! Why aren’t you able to stop her or him from losing weight now!”

Or maybe our client tells us that their parents seem to be at war with each other. Why has a parent bought their anorexic child a gym club membership for Xmas? What on earth is going on?

Therapists can get very anxious because they simply do not know what to do next with someone who seems to be very stuck; we start off by considering ourselves as the client’s white knight and then we start thinking of ourselves as a bad therapist. None of this anxiety is going to help the client in the end.

One way of preventing anxiety is to suspend any emotional interest in recovery, weight loss - or even weight gain if it comes to that. This surprises people. Surely is it natural for us to praise the anorexic who gains weight and to praise the obese person who loses it? The whole slimming industry is based around rewarding people for weight loss - with gold stars, medals and badges of honour. We pat anorexics on the back for weight gain, which they hate - and only confirms to them that they might be getting fat.

And surely it is useful for us to want our people to recover? Yes, but we must have personal investment in this. Our clients must want it – not us! So we must simply be willing to stay beside them on this journey. While praise and criticism may work a little in the short term, it hardly helps in the long term. By rewarding weight, for example, we are rewarding the wrong thing – people are not always happy if you reward weight change because you are not rewarding what really counts, their efforts, or their willingness to learn new things. You are simply teaching them to look to you for praise and to be scared of your disapproval if they fail. This is hardly good practice and it does not teach people how to motivate themselves when the going gets tough.

This kind of struggle for position with a therapist was well described in a recent conversation with a therapist who had this to say about her anorexic client:

“The Client made me feel like I wanted to rescue her and not be yet another person who let her down. This level of anxiety required containment as was achieved through the establishment of a relationship that was one of listener yet provider of education, settler of tasks and presenter of hope.”

The therapist needs to deal with the fear of letting the client down because sometimes our clients come with impossible expectations of therapy and a therapist that can never be met. It is clear that therapists can be neither to be the white knight nor the abuser. If we focus too much on being good enough for our clients we may miss what the disorder is communicating about our client and their motivations.

By the same token it isn’t really helpful to get anxious if weight falls during recovery from anorexia. It could just be a blip and we need to wait and see before getting in to a panic. Weight does not always follow a straight line and it is better to wait and see what is really going on. If I am working with someone whose weight is truly falling week by week, I tend to stay calm as a cucumber. I would say “the Voice seems to be shouting at you at the moment. What do you feel you would like to say to it?”If weight is going really low, I might say something like this “It seems to me that one way of taking care of yourself is to get so weak that you will have to go to hospital. Another way of taking care of yourself could be to eat a little more. I wonder which of those feels best for you.”

So we therapists need to be able to tolerate uncertainty (Waller 2010 CBT Today) without panicking. If we are worried about the weight of a client we are not able to focus on what the undesired change is telling us. It is much harder to be half way recovered from anorexia than it is to be in denial about how unwell you are. You may have gained weight, but you will have lost everything that the disorder did for you without feeling any of the benefits - yet.

If someone seems to be stuck, there are many reasons why this is so. Taking supervision is a very good idea of course and sometimes you may have to consider putting therapy on hold. You can say “We have come as far as we can – for now”.

And if someone fails with yet another weight loss plan you are coaching them in - it could be that you are not in touch with everything they believe is bad about weight loss. One obese person confessed to me that he felt that people who don’t let themselves overeat at holiday times “are boring”. Why would he want to be like that? The therapist panics and misses the opportunity to listen to what the client has to say.

An anxious therapist is one who gets easily angry and into blaming mode: they aren’t trying; they aren’t ready: they are rebellious and naughty. This therapist is not resourced and will not serve their client well. If I am mentoring an anxious therapist I will turn my attention to the therapist’s anxiety rather than the client’s apparently difficult behaviour. What does this anxiety remind you of? What are your beliefs about uncertainty?

Calm down and let the bad ideas go, and maybe something inspirational will come to you both. From ”sufferers” out there in the community, some with long standing problems and some just newly captured by an eating disorder, I hear a lot of bad things about therapists who get angry and abusive, who give people clearly inappropriate treatment, or unwelcome labels without thinking what they are saying or what that will mean, who haven’t listened, or who simply do not speak the unique language of an eating disorder. How can any eating disorder therapist fail to understand the Voice? Most of this boils down to anxiety. We all need to be able to tolerate anxiety without panicking.

Having An Eating Disorder: What Does It Mean About You?

2011-04-12T04:19:00.000-07:00

Melanie Reid who writes about her spinal injury in The Times says; … the world is split into people who moan and people who don’t. I have heard enough moaning in the past 12 months to last me a lifetime. In this regard, I refuse, ever again, to spend time with anyone who complains continually about the weather, their job, their relationship or their appearance. These people are death to the soul; they suck the oxygen out of the air; they need to be avoided at all costs. …….. avoid people too stupid to appreciate what they’ve got. Like loud and aggressive persons, they are vexations to the spirit.

So, are people with anorexia or bulimia stupid?
Or, vexations to the spirit?

On television recently I said words to this effect. People with anorexia are sensitive, even before the illness they find it hard to cope with the slings and arrows of life. And this brought forth a sort of rant from someone, let’s call her Jane. She said to me, you are saying that anorexics are weak, you are undoing all the good I am trying to do trying to get people to understand this illness! I work as an Ambassador for B-eat and you are undoing all my good work!!! My reply to her was lengthy.

So, are people with anorexia or bulimia weak?

And, in OK magazine this week, there is a story of a footballer’s wife who is fading away and refusing to eat, having got rid of some baby weight plus a great deal more. She admits to having anorexia and who knows what else she is doing to herself. She threatens, if anyone comments about my weight loss I will stop eating even more. Now here’s the thing; mature people do not punish people who reach out to show their love, do they? If someone says to me “You look tired, are you working too hard” I say to them “Thank you for caring”. Her anxious friends are damned if they show their concern and they are damned if they don’t.

So, are people with eating disorders infantile or immature?

One person who wrote to me recently said her therapist views her as having a “mental health problem”. Another therapist suggests that she suffers from “Body Dysmorphic Disorder. Because of the shame she feels about these unwelcome labels she is unable to continue with treatment. She chooses to wake up every day trapped in the prison of her eating disorder and her preoccupations with food and weight, rather than be labelled as a mental case.

So, are people with eating disorders mentally ill?

An eating disorder charity says “it’s not about food, it is about feelings”. I heard myself say this on ITV as well. We talk of using food or starving to medicate pain or block feelings that cannot be expressed. I have found that some of my people seem to have “too many feelings” and use binge eating or purging just to calm themselves down. Purging can be the only way you know to get those feelings out.

So, are people with eating disorders “in pain”?

Experts who write textbooks for each other say all kinds of things about people with eating disorders and call it “research findings”. They associate eating disorders with many different pathological presentations. If we are to believe this research, we would view people with anorexia, bulimia and compulsive eating as being either:

Addicts?

Damaged?

Personality disordered?

Narcissistic – desperate for attention and desperate when they don’t have it in the way they want?

Dependent- always needing approval from other people?

Autistic?

Insecurely attached; meaning not very good with relating to other people?

Having autonomy fears - which means that they aren’t able to grow up, separate from their families and live “normal lives”?

Experts, even those with eating disorders themselves, pre suppose that there is something very wrong with eating disorder sufferers and bend over backwards to be kind and do everything they can to help the person with self esteem. Even in the field of obesity work, there are experts who designate all emotional eaters as food addicts with poor attachment skills.

And experts do not generally view the person with an eating disorder as very strong, no matter how much they can manage hunger pangs. We call this perfectionism, which is always couched in derogatory terms. We may secretly wish that someone could simply lighten up.

And, that feels to me like a slap in the face with a wet kipper too.

Or are people with eating disorders amazing, strong, creative, intelligent people who have been captured by an evil spirit? It sometimes feels like that to people looking on. If that were so we would have to accept that someone with an eating disorder is enslaved.

When I see someone with an eating disorder, whether it is anorexia, bulimia or binge eating disorder, I try not to make assumptions about what is wrong or right about them. Yet it is hard not to see predictable patterns in each disorder. Our sufferers are generally misinformed about food, dieting and weight. They know a lot about calories but very little about the science behind appetite and weight control. As to the rest, there is a great deal of fear, panic and anxiety. Closely followed by shame, misery and guilt. There is a huge amount of self talk about food, weight and diets. There may be a great deal of purpose in managing food but very little self confidence, something which we all aspire to in life.

There is a trail of people in the wake of the sufferer who are confused, angry or worried. Eating, it seems, is a relational issue. So the collateral damage of an eating disorder is very far and wide.

So what does it mean about you if you have an eating disorder? I say this. Stop worrying about the labels for a start, because these labels do not capture what it means to be human and imperfect. I am not sure that we can quest for recovery, or even desire it, until we have looked inside ourselves to find out “what my eating disorder is saying about me, personally”.

Perhaps we all need to accept our shadow side, name the bad as well as the good, the weak with the strong, the evil and the angelic, so that we can become the master of our fate.

Denial in Bulimia Nervosa

2011-04-08T07:05:00.000-07:00

It’s normal to want to be in control over our eating habits. It’s normal for some people to want to let go of that control some of the time like at Christmas time or when you are having a picnic with friends. It’s very normal for some people to eat a horribly bad diet full of junk food, because they like the taste. Perhaps they think that people who eat healthy food are boring? I often wonder if they are in denial about how dangerous their eating habits really are, when they tuck into their ready processed trans-fatty laden foods. But who am I to judge? If we all ate what is best for us, the economy would collapse. Who would be left to buy chocolate flavoured coco pops or one kilo chocolate bars?

On the other hand, since I have just written a blog about Orthorexia which invited some dissention, I wonder how many healthy eaters out there are in denial about the emotional issues that are behind their dietary rules. When it comes to food, we do the best we can with the resources we have at the time.

So, there is lots of denial around and so what, anyway. Experts say that where bulimia is concerned, denial isn’t really an issue because sufferers are already fully aware that their control over eating has been undermined. They know that they have a problem, and they know that normal people don’t do what they are doing -which is why they take such trouble to hide their rituals. I guess that last sentence doesn’t apply to Jockeys – where purging is normal, or models who teach each other all the tricks for staying thin so that they won’t be accused of looking fat.

People in the early stages of bulimia may be in denial about their behaviour. They don’t yet know it has a name. They almost certainly don’t know that what starts as a way of controlling weight gain quickly becomes an addiction. In the beginning, it is something they control and it ends up controlling them. They never know when they will think they have eaten one bite too many and will have to get rid of it as soon as they can. They certainly don’t know that what begins as a way of controlling food turns into a way of managing feelings. They are denial about their ability to stop.

They also deny to other people that they are doing anything unusual and go to a great deal of trouble to cover things up. Spraying perfume in the bathroom or playing the radio to mask the sounds of purging are common tactics. Pretending to your boss that you have a stomach upset is better than saying you have taken too many laxatives. This makes sense; few of us would want to admit to doing things that would cause us shame.

Denial has a lot of different meanings. People can think that what they are doing is okay because they lack the information which would help them to think differently. Many people who vomit or take laxatives think that this is a really good way to control their weight and they are therefore terrified to stop. Purging is a wonderful weight gain strategy in the long run and many bulimics gain a great deal of weight. This is because purging affects the appetite chemistry of the brain and purging interferes with the body’s ability to burn off calories.

The word “denial” implies, however, that even with the right information people say “this doesn’t apply to me” or “I don’t believe it” or “what I am doing now is better than any alternative that comes to mind” or “I don’t have a problem and can stop whenever I like”.

Perhaps the most interesting form of denial is to say “I know I have a problem but I am not sure I want to do something about it”. Therapists call this “ambivalence” and they are anxious to turn this into a real desire to change. We can understand ambivalence by turning our attention to the benefits of having an eating disorder. For one thing, purging allows us to have what we like without having to pay for it, to have our cake and eat it, so to speak. Taking laxatives helps get rid of everything that feels bad and dangerous and that mustn’t stay inside.

Bingeing and purging isn’t just a way of getting rid of food, it gets rid of feelings as well, and it helps us to get on with our day. I have often thought that purging is a kind of communication. It says what someone is unable to say, such as “I hurt, I am angry, I feel confused, I can’t cope with this, I hate you because you are more popular than me”.

And people can also be very ambivalent about change because they aren’t convinced that their problem is all that serious. One person put it like this:
“I found that - the part about me having a very serious eating disorder - hard to listen to ..because I physically look totally fine so I have been saying if it were that serious then I would surely look as if I have one when I don't and ….eating disorders are mental health conditions so if they are right and I do have a serious case of bulimia then I actually have a mental health condition and I feel really uncomfortable about that…”

So here we have two aspects of denial, one about whether the problem is serious enough and one about being willing to accept what the bulimia might mean about you.

Regarding seriousness, let’s make no mistake. Bulimia is not just about getting rid of food. Everything is affected, your brain, your fertility, the cells in the throat and mouth, the damage to the gut. Blood tests tell us very little about what is changing in our cells so it may be years before the damage shows up. It’s much the same as smoking. You can live a long life with bulimia – of course, but I doubt it will make you very happy. I don’t call to health risks to persuade people to change. On the other hand, bulimia makes you gain weight very easily and that does make people with bulimia very uneasy.

If you want to deny the seriousness of bulimia in case it means you have a mental health disorder, take heart that some bulimics DON'T have serious mental health problems. And some normal eaters DO have mental health problems so why bother to get into a strop about labels. I will have to another blog about that!

An eating disorder - whether you think it serious or not - is something that stops us from having to pay attention to what isn’t working underneath. It’s easier to think that you have an eating problem which isn’t really going to do you much harm, than it is to grapple with a problem that is really painful. Many bulimics have had a history of serious invalidations, unhappy childhoods, struggles coping with an alcoholic parent or abuse from other people which they were powerless to prevent.

For these reasons, I do not fight against denial nor do I assume that my enthusiasm for recovery will be taken up by my clients. Some people have been upset with me for so-called labelling people as bulimics, anorexics or orthorexics. At the end of the day it is about people, not about labels and it's about figuring out how to help someone to be happier. I know that purging, starving and binge eating helps someone feel safe but isn’t a recipe for a happy life; it is happiness and a meaningful life that is always in my focus.

Criteria For Recovery From Eating Disorders A Reader Request

2011-04-07T03:14:00.000-07:00

Someone has asked me if there is a definition for recovery. What do you think recovery means? What does it mean to you? Recovery to me meant that eating did not rule my life. Many people think that recovery is about gaining weight if you are anorexic or stopping symptoms like vomiting or taking laxatives. The good therapist knows that recovery is much more about the person than their weight or their eating disorder symptoms. Recovery is helping a person to reclaim what has been surrendered to the illness. This means finding their potential, their trust, their sense of safety, their ambition or purpose and their ability to manage their feelings and connect properly with other people. But the following can do for a start.

Does not take laxatives
Is able to express their emotions (verbally)
Does not feel too fat
Self esteem is no longer dependent on weight
Does not punish herself after a meal
Has a realistic image of herself
Can eat three meals a day
Has no binges
Does not vomit after dinner
Does not use diuretics
Is not obsessed by food and weight
Is able to express emotions (non-verbal)
Is able to handle negative emotions
Is not isolated
Feels no need to slim excessively
Does not exercise excessively
Does not use slimming pills
Accepts appearance
Is in touch with their own feelings
Has a positive experience of their body
Has adequate self-esteem
Is able to handle positive emotions
Is not depressed
Amount of calories is normal
Heartbeat is normal
Is able to handle conflicts
Sleeps normally
Is able to make contact with others
Has some friends
Is not extremely perfectionistic
Dares to express a different opinion

Finally, recovery is when the person can accept his or her natural body size and shape and no longer has a self destructive or unnatural relationship with food or exercise. When you are recovered, you do not use eating disorder behaviours to deal with, distract from, or cope with other problems. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size or reach a certain number on the scales.

Top Tips For Eating Disorders: The Client Must Be Anxious for Therapy To Work

2011-03-30T03:48:00.000-07:00

People with eating disorders present with dietary chaos. There is starving, dieting, stuffing, purging, feasting and fasting, lots of coffee and diet drinks. This changes the body, assaults the brain, including appetite systems, fosters weight instability and leads to many of the emotional symptoms like depression which people bring to treatment.

Part of our work is nutritional rehab. This will help the body to burn energy rather than store it as fat. It will help with feelings and appetite control. For binge eating-purging clients we have to bring structure into the diet. We have to deal with strange beliefs about food such as “I am addicted to chocolate” and beliefs about good and bad foods. People with anorexia will believe “If I eat a piece of toast I will gain 5 lbs”. They believe “If I start eating again I will never stop”. People who binge think “If I eat a normal diet my weight will shoot up”.

Changing eating and other habits, like constantly weighing yourself, or constantly checking yourself in the mirror is a very scary thing to do. But how can you learn that your worst beliefs will not happen unless you are prepared to test them out? You may well be right about your convictions. However, If you can let a good therapist be your guide and agree to experiment with change slowly and purposefully, you may find that your fears were just imaginings.

They key for a therapist is to explain to their people that recovery depends on doing some things that will make them anxious. We must always remember how hard it is to change any habit, even the smallest ones in our own lives. We can negotiate with people what level of anxiety is manageable so that they can test our some new behaviours one week at a time. For example, next week you will eat regularly even if you binge. Or, next week delay for 5 minutes before you agree to purge. Or, next week how about having a glass of milk first if you feel the need to binge.

The changes have to be enough to make the person anxious about the outcome but not so great that they are too scared to try it.

Acknowledgement, Prof. Glenn Waller CBT Today Dec 2010

Getting to Grips With Orthorexia: A Media Frenzy

2011-03-24T08:14:00.001-07:00

I was asked to do an interview for the BBC on the subject of Orthorexia and since then, all hell has broken loose. There have been attacks from members of the public and health professionals about purportedly describing the quest to eat healthy food or even vegetarian food as a mental health disorder. I have even been accused to trying to promote the obesity epidemic by demonizing healthy eating.

Duuh!

The term “orthorexia”(correct appetite) was first coined by Stephen Bratman who observed some typical ways of thinking about food among people who had worries about the properties of food and its ability to do them harm. I didn’t need Bratman to teach me something I had noticed anyway among people who I met in my work with eating disorders. Orthorexia isn’t just about weight, it can be just an obsession with healthy eating as well as worries about weight in disguise. So, I agree that it is helpful to have a name for something with which I was familiar, because of my experience with people of all weights struggling with control of food.

In the course of my work I have met overweight clients who wouldn’t eat more protein because “I am vegetarian” and “I am also allergic to dairy foods” and “wheat makes me bloated.” I treat people who were binge eating and who had spent years “food combining” and going from one healthy diet plan to another; like the Stone Age Diet or the Fit For Life Diet. I noticed that some people bury the need to control their weight by a conviction that they are just trying to be “healthy”. Most diet books these days are published as healthy eating plans like the Metabolic Typing Diet.

I have seen orthorexic patterns expressed among vulnerable young girls who convince themselves that animal products would make them gain weight. This is often the start of a slippery slope. Although convincing themselves that this was “healthier” they went on to develop anorexia or bulimia.

I then saw it really taking hold as a result of celebrities and the media promoting the message that you are a good person if you go on a detox after holidays; and it is so easy for detoxing to become a way of life. Something you feel you cannot do without.

I have tried to point out many times that this thing "orthorexia" is not a medical condition. Mental issues defy attempts at categorisation because people come in many different packages. Anyway we must make a distinction between people who like to eat healthy food like me, without extreme ideas and rules, compared with people who have very rigid patterns of eating because of religion, weight control issues, ethical values, health issues and real or perceived health fears. Orthorexia is not just a description of behaviour, it is really about underlying motivations and the need for some people to escape from underlying fears by turning to the control of food in some predictable ways.

The need to eliminate certain food types, such as meat or wheat, or food groups such as all carbohydrates or all fats, resonates with anxiety disorder, obsessive compulsive disorder and even delusional disorder in some people. Delusional disorder is where people have extreme ideas about contamination or badness of certain foods. It is simply grist for the mill of anxious people that there are genuine health concerns about the foods we eat, to which attention might be paid.

I am often asked how many people there are with orthorexia. I have no idea, since not being an official “condition” no-one has developed a test for it with clinical validity. However, I see aspects of orthorexic thinking in a great many of my friends and colleagues who are adapting their diet, who have just happened to become uncomfortable with eating certain foods or who are convinced that certain foods will do them harm.

Experts have called “orthorexia” an “escape from anorexia” by helping people who “cannot starve” to find alternative ways of controlling food. The underlying common features, shared by both conditions, and which have nothing at all to do with food, are about finding ways to deal with things that lie beneath. Individuals with either condition are likely to have unmanageable feelings and negative core beliefs which are managed by control of food and weight.

How do we know that these are similar conditions? People with anorexia and orthorexia – even those who are not underweight – have similar characters. Both tend to be highly perfectionist, anxious, rigid, fearful of mess, have ascetic (purity) beliefs and even underlying fears of maturity. They also have a narcissistic need for status which can be acquired by having an unusual diet. People with orthorexic thinking often wear their eating choices as a “badge of pride.” It is no accident that the majority of people with anorexia are also vegetarian, with a suicide rate 57 times higher than we would otherwise expect.

Regarding the discomfort about vegetarianism: well, please don’t misinterpret what I am saying about its links to orthorexia. In a recent reply to an indignant writer, I proposed that while omnivorous eating is wired into our physiology, I accept that as humans we overlay moral and also emotional choices to our instinctive appetites. But where food and other choices are concerned, I believe that none of us is truly aware of the reasons why we do what we do. The research literature on the psychology of vegetarianism is interesting and begs to be read, especially by psychotherapists who work with the general public and who may be orthorexic themselves. I worry that conventional psychotherapy training does not require students to disclose and reflect on their own relationship with food. I am even more worried about eating disorder specialists who may be orthorexic, because these experts need to help sufferers feel comfortable with eating a wide variety of foods.

Spectacularly hidden

So orthorexia is hard to capture in single sound bites or short paragraphs written in the press. It’s one of these things which is widespread and yet spectacularly hidden because it comes in many guises. It only becomes a problem when it affects physical health due to nutrition deficiencies or it affects your social life to such an extent that you lose your friends, your social life, or become so obsessive that you know you have a problem. Most people do not want to change.

When looking for the cause of orthorexic faddism, (as opposed to food choices which are motivated by other things), we can see it everywhere in the society we live in. If you are not emotionally resilient, if you have body and weight issues and low self confidence, you will be vulnerable to all the messages about toxic qualities of food, foods that will make you gain weight or foods which are dangerous to eat side by side.

There are too many experts diagnosing food allergies or food intolerances which may not exist and who blame food allergies for making you fat. There are too many people telling you that eating meat will affect your health. Food faddism, disguised as nutritional misinformation has crept into the sports and fitness field, causing people to rely on supplements and on strange diets to make you fit, boost your endurance and build your muscles while making you lean. Even the food industry is getting in on the act. Not everyone is captured by this whirlpool of advice but it has a bad effect on some. Orthorexia can even start at home, when a boy or a girl sees a parent taking on strange eating plans.

I have chosen to be interviewed about orthorexic thinking because we need to legitimise- with a name if necessary - some patterns of eating that cause physical harm or which affect a person’s life. Some people become so obsessed with food that they can’t function properly anymore. These are people who cannot eat out unless they take their own box of food. These are people who are scared of eating carbs. Extreme cases get the headlines but there are many milder ones.

We do not need a genuine mental health concern to be clouded by people writing indignantly that they are not orthorexic just because they choose to eat organic food. The following questions might help you know if you or a loved one has the condition.

• Do you spend a great deal of time studying facts about food or food and health?
• Do you read a lot of books or visit websites about diets or healthy eating plans?
• Have you eliminated certain foods or food groups from your diet. If so, which?
• Is your diet solely organic?
• Would you describe yourself as interested, or obsessed about eating healthy food?
• Do you eat flexibly or do you have to plan your eating?
• If you were stuck somewhere and only unhealthy food was available, would you be able to eat it just once?
• Would you feel extremely guilty or anxious about eating foods on your forbidden list?
• Do you feel superior because of your eating choices or restraint?
• Does eating differently from others enable you to feel special?
• Do you have bad feelings about eating out, at social occasions where you cannot control the food?
• Do you refuse social invitations because you do not wish to eat the food?
• Do you feel that avoiding certain food groups (like carbohydrate) will help you control your weight?
• Are there foods that you think are bad to your health or bad for you – other than foods generally acknowledged as unhealthy or fattening such as “chips?”

There is no foolproof test for orthorexia, but answering yes to most of these questions suggests that someone has signs of it. There is little chance that people will go to a therapist and ask to be “cured” because there is a heavy investment in keeping the status quo. Eating habits are resistant to change, and, why start eating food that is going to make you feel afraid?

Eating disorders are not just about food of course. But if I have a client with an eating disorder who is also orthorexic, I may find them difficult to treat unless they are able to let go of some of their beliefs so that they can have a balanced, relaxed relationship with food.

Getting Better – Wanting Versus Doing And Denial In Recovery

2011-03-16T10:22:00.000-07:00

I’ve just written about denial in eating disorders and something has led me to a great deal of thinking about the difference between treatment and recovery in eating disorders and anorexia in particular.

Focusing on anorexia for the moment; Professor Chris Fairburn has described 3 phases of treatment, the first being getting the person to accept there is a problem and weight restoration; the second being psychological support and the third is prevention of relapse– with overlaps between these processes.

This is all very well if you are working in a treatment setting and wanting quick results or any results at all. But this doesn’t quite meet the needs of someone with a long standing problem who decides to get better on their own.

I meet many people who have had an eating disorder for a very long time. They may have been in treatment for a very long time as well. It seems to me as if this “treatment” has largely been focused on helping the person to WANT to get well. In other words, all the re-feeding, trips backwards and forwards to hospital, conversations, explorations of the past and meetings with the family, swapping of psychotherapists and encouragement from dieticians are just stepping stones in a process whose end point is helping the person to want to do things which are impossible with anorexia – such as eat with other people, or, have a child.

I am known for not caring whether someone is fat or thin and I don’t pat people on the back for eating more. At the end of the day, whether someone is able to eat more is their choice and their fate. Some people can function well, sleep well and lead a normal life at any weight.
But, if you have had anorexia it is ONLY weight restoration to a BMI above 20 that will even start to reduce some of the symptoms of anorexia (obsessions, excess hunger, feeling fat, sleeplessness, low mood and infertility). And it is only staying at a higher BMI for quite a long time that will make these symptoms go away. The bottom line for this awful illness which is not about food is, “stay thin, stay ill, no matter how much psychotherapy you do”.

While anorexia is not about food and weight “underneath” it takes a sustained period of eating to start the process of recovery.
So once a person has reached the turning point of wanting to get well, recovery is much, much harder than staying in the golden cage of the illness. For example; weight seems to go on first on the tummy and then will go to where it looks best after a while. Eating will be very scary. How on earth can someone do this on their own?

Recovery isn’t just about eating more calories, whether someone gets better depends on how that nutrition is delivered. This must be done really caringly, to ensure that the right balance of carbs proteins and omega fats are eaten. Depression is more likely to set in if the balances aren’t correct.

I have also found that people want to recover while continuing to avoid meat, eggs or fish. For people with eating disorders, vegetarianism is usually a symptom of anorexic thinking which can make it very hard to get all the right nutrition and “food for the brain”. Recovery thus also means targeting orthorexic thinking which is possibly the hardest thing of all and most fiercely resisted by the person who is trying to get well. This is denying the need to confront the orthorexia, which is the anorexia in another guise.

So how can we help people who have decided to do it on their own? Time and time again I find that people start strong and slip back when the going gets tough or when they confront the predictable effects of eating more for a while. Without the right support, they may go back to wanting to recover instead of doing the hard work which recovery entails. Denial sets in, like going on holiday without planning how to keep an eating plan on track.

What then is the right kind of support? I suppose I would have to ask the person what kind of support they really need. How do we get the balance right with giving the right kind of empathy, time and guidance together with some hard talk - such as “beware of pretending to yourself that this or that (like orthorexia or planning to run a marathon for charity) is not a problem.

Recovery from anorexia and fighting the anorexic voice is the bravest thing one can do. It’s like asking a mouse to fight a lion. Why aren’t there more websites giving active 24/7 support for people who have engaged with that fight instead of all those other awful sites.

How To Form A Habit

2011-03-09T03:35:00.000-08:00

In the eating disorders training I put great emphasis on the simple need to change habits in order to help enable change in the relationship with food. This is because this relationship, which contains many subsidiary habits ( like how to binge, purge, buy food, where we eat and how we eat) is only part of a greater hierarchy of “being” habits which defines how you function in your personal life and your life with other peole.

Health psychologists are interested in habit change for obvious reasons: to assist people in breaking unhealthy habits while helping them adopt new ones. They call on a great number of theories about habit formation but no-one appears to have studied habits systematically as they are formed. NLP suggests that 20 repetitions of a behaviour are likely to make it stick. (Where did this come from?)

What all people seem to acknowledge is how hard it is to change habits. This is partly due to brain architecture, habits are laid down in neural pathways to fire automatically, giving rise to preferred ways of thinking, feeling and behaving in response to circumstances. The automatic firing of these neural networks frees up the brain to respond to more pressing and unexpected matters.

Habits are also hard to change because of the values associated with the performance of certain behaviours. If you are trying to get someone to refuse that extra piece of cake, it might conflict with that person's belief that restrained eaters are boring.

Habits have a great many components which must be taken into account. For example, giving up an unhelpful habit like nail-biting is not quite the same substituting one habit for a different one. I might add a habit rather than change one, for example if I decided to start eating apples for tea but continue to eat a bar of chocolate as well.

A researcher asked a group of 86 undergraduates to do a health related behaviour once a day for 84 days (like eat a piece of fruit with lunch or do 50 sit ups after morning coffee). She studied the patterns of habit formation. The findings were as follows:

• Early repetitions make it more likely that the behaviour becomes automatic.
• There comes a point where more repetitions don’t increase the chance this will become a habit. The best automaticity takes about 66 days but there are huge individual variations.
• More complex behaviours take much longer to form a habit.
• Missed days don’t seem to affect the chance of developing a new habit but “too many” missed days do have an effect.

What can we infer about making and breaking habits?

I don’t think we have learned very much. For one thing, the habit change was randomly suggested by the researcher and tells us nothing about the effect of each person's indivdual beliefs about the new habit or what is the mediating effect of self efficacy beliefs relating to the adapted behaviour.

So it’s back to basics. We have to help people become more flexible to promote health behaviour change. We still don’t know what it takes to make a difference.

With acknowledgement to ThePsychologist & the October issue of the European Journal of Social Psychology.

How To Manage Diet Talk If You Have An Eating Disorder

2011-03-07T05:31:00.000-08:00

Talking about diets is part of everyday life. It’s in the press, on TV with the Biggest Loser series and it’s in fitness magazines, largely disguised as the quest for better health. On one of my trainings, a delegate told me that she had spent a 5 hour train journey listening to a group of girls talking about nothing else but dieting and ways of losing weight. Talk about diets starts in primary school and women can talk about diets for the rest of their lives. Even 90 year olds talk about diets, those that worked, those that didn’t work, those that are in today’s paper. The new weight loss wonder of the day.

It seems like talking about diets makes you part of a club. Membership of this club is admitting that you don’t feel you look right and you are trying to do something about it. There is companionship in this kind of club; we are all in it together. People who are not in the club can feel like outsiders. If diets don’t interest you, you are in the minority. If you are slim, people will say “well, you don’t have to worry”. If you are fat, they will imagine that you are not looking after yourself.

The more we talk about diets, the fatter we are getting, so talking about diets is a waste of time unless you are stuck for something more interesting to say.

People with eating disorders have a hard time listening to talk about diets. It’s bad enough thinking about ways of controlling your weight all the time without having to hear about yet another miracle diet that is helping your best friend of colleague “lose loads of weight”. Perhaps you will panic and think “maybe I should be doing this”. Well hold that thought, because the chances are that the diet won’t work. Nearly 99% of all diets don’t work in the long run. And I mean ALL diets, including those which happen after Christmas or those which come stamped with a seal of medical approval.

If you are recovering from an eating disorder, the chances are that you have been helped to give up dieting and work on your relationship with food, and with yourself. This can feel very scary. People with anorexia who are trying to recover say “why am I being told to give up restricting food, look at all those people out there all obsessed with diets and all trying as hard as they can to lose some weight. Why, if they see me eating they will suppose I’m greedy. ” It’s enough to make you want to go right back to where you were.

If you have had bulimia, or binge eating problems, you will surely be helped to use food to re-nourish yourself. You will have to re-learn how to eat all the danger foods without going out of control. How difficult it is to hear people say that this or that food is fattening and forbidden. Perhaps your friends are boasting that they aren’t eating carbs, or that you should only eat protein after 4 o clock in the afternoon. Perhaps they are telling you that their latest diet is only organic food or that wheat will make you fat. You may think of yourself as a bad person if you don’t do what everyone else is doing. But what they are doing is usually crazy.

So, dieting talk is very hard to hear when someone is trying to recover from an eating problem. What then can we do about it? I suggest that we need to develop a different way of listening to this talk without reacting to the feelings about what we are hearing. Here are some solutions and doing them gets better with practice.

When you hear talk about diets

1 Say to yourself “diet talk is boring and a waste of time and energy.”
2 Tell yourself “I’m Ok and I am learning to do things differently now.”
3 Remind yourself “A life on diets is a life badly lived.”
4 Remind yourself “Diet books only make money for the author.”
5 Remember that people who lose weight on any diet usually put it all back on again.

When you feel anxious around diet talk and dieting friends

1 Give yourself a mental hug and repeat “I approve of myself” (even if you don’t).
2 Tell your friends (in your head if necessary) that it’s better to work on your relationship with food rather than go on another diet which will only make your relationship with food even worse.
3 Take a very deep breath and wait for the feelings to pass, they will pass.
4 Remind yourself of all the reasons why you are giving up the dieting hoax.
5 Seek out someone you trust to talk about your feelings before doing anything else.

If anything else has worked for you, email Deanne on admin@ncfed.com and we will add this to our blog.

Binge Eating – Now, There’s A Mouthful.

2011-03-06T05:48:00.001-08:00

In today’s image obsessed world, we’ve all at some time wished for a svelte body or defined torso. Size zero is the new size eight and the photos in magazine are flawlessly perfect. It’s therefore little wonder that cases of anorexia and bulimia nervosa are tragically on the rise as people feel compelled to achieve the beautiful but impossible. As familiar as these conditions are, however, another, even bigger, darker problem, is far less recognised and understood: Compulsive Overeating.

It's estimated that around 1 in 4 adults suffer from binge eating problems at some time in their lives. I call it the Cinderella problems because it isn’t as sexy to the media as anorexia or bulimia. These problems are considered illnesses while binge eating is thought of as just being greedy and out of control. But I would guess that it kills more people than anorexia and bulimia combined, yet it still remains widely unacknowledged. Many sufferers do not seek help, either because they feel too embarrassed and ashamed, or because they don’t realise support is available.

I would even go so far as to say that it’s the emperor of eating disorders. It’s a double problem in terms of mental health and weight and, furthermore, it has serious health implications."

Compulsive eating goes under various names, such as “food addiction, binge eating disorder or Ednos (eating disorders not otherwise specified). Now, there’s a mouthful.

Whatever name we give it, there is an uncontrollable urge to eat, in some cases very large quantities of food, usually in a mindless state and in a short space of time. Milder forms of compulsive eating can involve smaller quantities such as going backwards and forwards to the fridge, or picking or nibbling. There are usually cravings for food seen to be forbidden, like chocolate or cereals. Most people say that they aren’t hungry, they just need to eat. Some people just nibble all the time. Night eating is a problem for some people. Many sufferers binge to suppress or distract themselves from difficult feelings such as stress, depression, anxiety, low self-esteem and self-loathing.

Indulging on on high fat, high sugar foods has a number of benefits. It can feel like a treat as well as a punishment. These foods at the same time offer comfort as the sugar provides a rush and foods such as chocolate trigger the release of endorphins that lifts mood. When compulsive eaters do not purge after a binge, many are overweight or obese despite the fact that they usually try to control their weight with one slimming diet after another. One person recently expressed her issues with me thus: I am only in control if I am on a diet, but I can’t seem to stick to a diet for long. Every diet, you name it I’ve tried it, but I am fatter than ever.

So – what is compulsive eating? I see it as a skewed relationship with food in which overeating occurs as an unhealthy coping strategy to deal with difficult emotions – TOGETHER WITH a mindset characterised by unhelpful beliefs and attitudes about food, weight, dieting and the self. The last point is important. To say that binge eating is JUST about feelings is not correct.

For one thing, binge eating can be induced by extreme weight-loss plans. Research shows clearly that dieting gives rise to cravings and binge eating in anyone, even if they are emotionally healthy.

Spotting the signs
One of the reasons it has taken so long to recognise binge eating disorders is because it is difficult to define what is a binge. After all, “One man’s binge is another man’s meal.”
What constitutes a ‘binge’ and defines Binge Eating Disorder varies greatly from one person to the next. While some people will be or become overweight, others might not. For many people it stems from an emotional trigger, but again, not always. Jade says, “BED is a troubled relationship with food, but you don’t always have to define it.”
To spot the signs of compulsive eating, ask yourself the following questions, but keep in mind everyone is different:
• Do I eat much faster than normal at times?
• Do I eat until feeling uncomfortably full?
• Do I eat a large amount of food when I’m not hungry?
• Do I eat alone or secretly due to embarrassment about the amount of food I consume?
• Do I feel guilty, shamed or disgusted after overeating?
• Do I feel I eat more than I need?
• Do I feel abnormal?
• Do I feel ‘taken over’ as if by another presence in respect of eating?
• Do I try to compensate for overeating by dieting or restraining food?
• Do I feel in control when surrounded by my favourite food?
• Do I feel insecure if I can’t eat my favourite foods?
• Do I eat mindlessly, in a rush as if I don’t taste it, or erratically
• Does eating interfere with and/or control my life?

It’s really not that difficult to treat. We concentrate on building up the person so they feel in control and strengthened. This can be achieved through some mental flexibility training, nutritional rehab, communication skills and stress training.

But we must have some focus on food. To change a relationship with food we first must look at it closely. We monitor patterns in binging to see what causes them. The binging patterns begin to inform the sufferer about their eating behaviour and help them to understand the emotional and other triggers.

If the triggers are emotional, or about buried emotions which are not being expressed, we must identify these feelings and help someone to deal with them more appropriately. If the triggers are about beliefs, such as feeling as if you have “blown it” if you eat a biscuit, people need to learn how to manage their thoughts. So keeping a log of your thoughts and your feelings is as important as keeping a log about food.

It’s also important to do some nutritional rehab. to beat compulsive eating, and this does not involve staying away from all sugar and white flour as suggested by some addiction programmes. Regular eating small snacks is helpful at first and we can use some new exciting methods for appetite sensitivity training and teaching mindful eating skills which can help people to feel in control surprisingly fast.

Eating control is also a family issue. We all feel that we should crack our problems on our own, but the support of family members can work a treat. It’s helpful not to have temptation in the house like crisps for the children or cake for your partner. Seeing these foods is too much temptation for everyone, not just binge eaters and your family would prefer you to be happy more than they need these treats.

When it comes to weight loss, there is no quick fix. If you don’t treat the eating disorder, you will be less likely to stick to a healthy-eating plan. Or, if you do lose weight, you won’t EVER keep it off. In other words, if left untreated, binge eating will leave a person’s chances at weight loss almost zero. And if they do succeed, in two years it’s almost 100% likely they will have regained.

If you think you might be suffering from compulsive eating, consult an eating disorder specialist. General counselling wont sort you out. Always check they have the relevant qualifications and experience. You can contact me, Deanne Jade on 0845 838 2040 or at www.eating-disorders.org.uk

Denial- Friend or Foe In Eating Disorders

2011-02-22T08:36:00.001-08:00

I’ve been asked to blog about denial so here we go.
Denial is what happens when someone insists that they do not have a problem with food, usually in response to the concern of carers or friends who may notice that weight is low or that someone isn’t eating very well.
Some writers suggest that “denial is something that exists in the counselling room”. In other words the person who has a problem may know that there is a problem but doesn’t really want to be helped right now.

Let’s take some possible scenarios;
They do not trust that therapist.
They are afraid of getting fat or losing control.
They get benefits from their eating control such as feeling special and powerful , or getting some attention from loved ones – who would want to stop feeling these things?
They feel ashamed of their eating behaviour, especially if they are binge eating or purging.
Or, the anorexic voice drowns out the voices of concern from other people. This voice tells them that they will feel a little better if they lose a bit more weight.

Denial- any of the above - is more likely to be present in a person who is thin. Bulimics for sure know they have a problem although they may not want to admit to it. At the same time, denial can be real – not knowing that you have an eating problem and not knowing that you are very ill. Some people who are in recovery say that, looking back, when they were in the grip of their eating disorder they were so compulsive and obsessive with food, exercise and eating rituals that they had convinced themselves that they were fine. It was as if they had been taken over by an alien being, and only if they collapse might they begin to accept that they are weak and ill.

Even then, a few days of rest convinces them that they were just overtired and can continue doing what they were doing before. We use things like muscle weakness tests to help convince some people that they are weak and that they might need to get some long term help.

I see denial around me in a great many forms. I see it in people who choose unbalanced eating patterns and who are convinced that they are allergic to certain foods, or that they can’t eat meat because they “really love animals”. I see denial in people whose gym or running patterns are a front for an addiction to exercise and perhaps the only way that they give themselves permission to eat. I also see denial in people who say that they are “working on their problem”, by going to therapy and talking, but they may refuse to turn talking into action; probably because they are terrified of change.

I also see horrible and selfish denial in parents who insist that their child doesn’t have an eating disorder. The child is just doing a lot of sport and is getting along very well at school thank you very much. God forbid that this family has a problem. Let’s not rock the boat. On the other hand, about half of all the calls I get are from worried carers, saying “how can I get my daughter/son, wife and even parent to accept that they need some help”.

Us therapists have a hard time with denial; we either call it “unconscious incompetence” or we say that someone is really “in denial” when what we mean is that we haven’t the sensitivity, the skills, the patience, the pacing and the ability to bring ambivalence, fear and resistance to the surface and deal with it safely.

So how do we sum up all the above; perhaps to say that we are all in denial to some extent about the motives for doing what we do. We might be in denial about our eating habits, our use of alcohol, or the effects of too many late nights. There isn’t a one-size-fits-all solution to the problem of “denial” but if anyone out there has some stories or some perspectives to add, please email me on admin@ncfed.com. Please!

Top Tips For Treatment : Focus On The Core ”Cognitive Problem”?

2011-02-15T05:13:00.000-08:00

“The core.... problem here is the over-evaluation of food, shape and weight as threats. This manifests as beliefs such as ‘If I eat normally my weight will rocket out of control and I will never be able to stop it".”
The eating disorder mindset is very much more complex of course. There are many other beliefs which affect our behaviour with food, such as beliefs about good foods and bad foods, binge foods and safe foods and making a tragedy out of eating an extra piece of toast. Even a fat person who thinks “I will die if I do not get my treats” suffers from a distorted mindset.
It might be useful to create a whole library out of all the beliefs we encounter in someone with an eating disorder. Some of these beliefs are really just the reflection of the “real issue” underneath, which is feeling out of control. Poor self regard, feelings of ineffectiveness, mistrust of others and worthlessness are the real source of the “cognitive problem.”
We must be careful not to dismiss some of these ideas. People do have differences in their “normal appetites” and there is a place for primary disturbances of appetite in how we think about eating disorders. This means that many people have to live in a continual state of mild restraint in order to control their weight. Is that “normal eating?” I may eat “normally” and I hardly think about food and weight. But I am pretty convinced that if I were to eat exactly what I wanted, I would be heavier than I am and possibly mildly overweight, which carries health risks. Saying “no” to an extra piece of cake is par for the course and part of the way we must respond to the world we live in if we are to avoid gaining a great deal of weight over time.
So, all psychotherapists must reflect on what normal eating really is before leaping to change mindsets, and that is a whole new essay. We need to discuss the idea of normal eating with our clients before we help them to amend their ideas. Many people with anorexia do not value “normal eating” because of other values associated with normal eating such as “people who eat what they like are greedy and disgusting”.
Or, conversely, some people with weight problems may not wish to eat normally if they believe that “people who eat what they like are fun loving and sociable”.

Professor Waller (CBT Today Dec 2010) states that if what we are doing does not explicitly target these beliefs it is not “CBT for eating disorders”.

The eating disorder practitioner needs to know more than CBT if treatment is to work. CBT while crucial does not work on its own for all people, especially for anorexia. It seems to me that framing up a therapy as belonging to a specific treatment model is safe for therapists, so when we have a new tool such as “mindfulness” we call it “Mindfulness based CBT” or, if we add emotional tools to our treatment we can call it “Cognitive –Emotional Behaviour Therapy”.

It really scares me however, to think of how many therapists don’t know or understand the principles of mindset change or how to do it. Empathy, giving our clients unconditional positive regard and even working on self esteem or early trauma isn’t enough. We owe it to sufferers to understand every aspect of how they think, how they process information (such as through the filters of all-or-nothing thinking) and how this affects their behaviour, before we should consider working with them.

Top Tips for Working with Eating Disorders: It Helps to Know Some Physiology

2011-02-07T05:49:00.000-08:00

Its crucial, not helpful, to know some physiology. Glenn Waller writes in CBT Today Dec 2010 that we need to be able to give people "key information" about their eating disorder, the effects of starving and laxative abuse. Do you really get rid of everything when you purge? Are all calories the same? Is all fat wicked? Are carbs as dangerous as we are led to believe? What is the connection between your emotions and your eating habits? What are the secrets of what diet drinks do to your body? What does normal eating "look like?"

And what does dietary chaos do to your ability to control your weight? Can you turn your body into a fat-making machine just by drinking a lot of coffee? What is the role of the thyroid and does it matter? What is the chemistry of appetite? Does fullness predict weight gain? How can you manage a diabetic with an eating disorder?

How complex do you need to get to be sure that you know enough to be useful?

The eating disorder practitioner who practices constant CPD about the physiology of food, weight and appetite is the only practitioner doing their patient justice. You need to know a great deal across a wide range of rapidly changing fields, where even specialists have difficiulty keeping up with latest thinking.

Knowing the information is one thing. Knowing when and how to communicate relevant facts is something else. Using the information to help transform behaviour, some experimentation, some risk taking on the part of your clients, is the final must-do. Knowledge ONLY becomes power when it is felt in the muscle.

I have put up some useful information online to help your clients, such as on how much do you really need to eat and the effects of undereating. Visit http://www.eating-disorders.org.uk/information.html

What Do You Want Me To Write About?

2011-02-06T15:14:00.000-08:00

Please followers let me know if you would like me to write about something YOU are interested in for a change. You can email me at deanne@ncfed.com

Top Tips for Working with Eating Disorders: Are You A Coach or Therapist?

2011-02-04T09:18:00.000-08:00

This point was raised in CBT Today Dec 2010 by Prof Waller. I introduce all my eating disorder trainings by asking this question. Eating disorders are usually treated by people who describe themselves as therapists because, after all, therapy is about healing the sick, or making ill people well. And therapists do therapy, which is what they are trained to do.
I don't like regarding all people with eating disorders as fundamentally sick. Much of their behaviour makes sense. The person with anorexia sees most women trying to lose weight. Fat people get such a bad break in our society that it almost makes sense to purge if you have eaten too much so that you can stay in control of your weight. It is quite normal for a binge eater to have cravings because dietary chaos makes their blood sugar very unstable.
Prof. Waller suggests that we should coach people to be "her (or his) own CBT therapist" so that the client can make good use of the hours they are on their own, over and above the hour or so they have in the room with their counsellor. I agree and yet feel that this means a great deal more than being a coach.
Do we concur with the view that CBT in its many guises is the best we can do so far for working with eating disorders? Yes, since we are working to change behaviour, and to change the eating disorder mindset and the emotions which inform behaviour, whether this refers to starving or binge eating on chocolate.
Changing the eating disorder mindset requires us to be a guide, to help our clients cope with their lifestyle, and a teacher to provide useful information to deal with myths about nutrition and calories.
But information on its own is only useful when a person has the skills to use it appropriately - so we may need to teach some basic skills such as relaxation or problem solving skills and communication skills to help people become more effective and able to use the information which we have given to them.
When we work on the eating disorder mindset, we also confront some important barriers to change such as how much you feel you need to weigh in order to accept yourself. To do this, we have to help a person to know and realise their deeper aspirations in life rather than simply attend to the eating disorder aspirations of being in control of food and weight. This subtle task is more about being a mentor for change by opening out possibilities which were not there before.

So, coach or therapist? Definitely both and more, and even being a bit of a magician wouldnt come amiss, although the evidence base for conjouring is not yet there.

Remember The Carers (And Try Not To Blame Them)

2011-01-17T06:51:00.000-08:00

Carers can be a valuable resource in helping the patient to change. He adds that educating them in the treatment model can help them to assist the patient.There are now a great many books written specifically to help the parent help their loved one to fight the eating problem.
Therapists are taught not to attribute blame to families and to consider them a useful treatment resource. I can still remember, however, when family therapists such as Minuchin and Selvin Palazzoli claimed great success in treating anorexia by targeting unhelpful patterns in family behaviour such as detouring (avoiding issues) enmeshment (not giving the patient "space") and putting a nice face on no matter how you feel.
Families factors are also known to increase the risk of someone getting an eating disorder. There may be weight specific pressures such as mothers who go on diets and who are always groaning about their size, fathers who reward their daughters for losing weight, brothers or sisters who tease each other for being too fat, or even mothers who are overweight and their daughter says to herself "I surely do NOT want to look like you when I grow up!"
And there are pressures associated with eating disorders that come from families, like pressure to succeed, parents who teach their children to behave like adults all the time, and parents who put out messages that it is not acceptable for the child to have any feelings.
Personally, I have read hundreds of life stories from sufferers and from counsellors who want to specialise in treating eating disorders, many of them have had their own experience of anorexia, bulimia or binge eating. Sometimes I say to myself no wonder this person had an eating disorder when I read what has gone on in a family, the lack of caring, the abuse, the cruelty, the awful examples of weight control behaviour that has passed from mother to child.
Then I meet parents who bring their child for help and I ask myself, why is it the father who more often than not brings their daughter, while the mother is "busy" and the mother who usually brings their son because father is "busy" and do these patterns mean anything where the eating problem is concerned?
Many carers call us up at NCFED and beg us to give them some advice about how to help a loved one who is clearly suffering but will not admit to it. We have discovered, by experience, that even the most reluctant sufferer will come to accept some help if the parents come together to get some support for themselves in coping with the eating problem. This will often lead to an extended period of counselling for either the carers or for the sufferer. And how many eating disorder counsellors know what is going to be helpful?
So we rise to meet this need in the following way. We have some information on our website which can be useful for carers. There is a carers page and some information on our information page about how eating disorders are to be treated. http://www.eating-disorders.org.uk/helping_carers.html
We are also offering a 1 day Masterclass in Counselling Carers in April 2011 and hopefully also in 2012. Check out http://www.eating-disorders.org.uk/information.html and please come and join us on what should be a really helpful and inspiring day.
Acknowledgement to Professor Glenn Waller writing in CBT Today December 2010

More Top Tips For Eating Disorders: How Important Is The Working Alliance?

2011-01-04T09:03:00.000-08:00

Professor Glenn Waller writing in CBT Today, December 2010 says that a good working alliance is necessary but not sufficient to bring about change in eating disorder symptoms. He says that despite the commonly held belief that this relationship is a key agent of change, the benefit attributed to the working alliance is "relatively small".
I agree. I have met hundreds if not thousands of sufferers who have not recovered despite getting along really well with their therapist. I have met people who are so good at doing therapy that they can deflect the therapist from the real work of change with all kinds of diversion tactics. If we tell a sad enough story we might even find therein reasons why we have an eating disorder but it may not really be the truth.
As a trainer I have suggested that being a good listener while being important, may sometimes deflect from the work that must be done to elicit and change the eating disorder mindset. Everyone needs to tell their story and the story must be heard - but sometimes listening must give way to questioning, guidance and teaching new skills including skills for thinking , or thinking about thinking as well. Some of the techniques of eating disorder treatment are not very person centered at all (though they can be delivered with respect for the person who can "become").
I hope that therapists can suspend the need to be liked by their clients. The eating disorder client knows how to manipulate and sometimes wants to take a diversion from the issues that need to be faced. It is better to know the skills that eating disorders really respond to - so that respect for the therapist's competency can grow into the client's own self respect and self regard.
As Prof Waller says, there is evidence that when clients do change as a result of proper clinical practice the working alliance is enhanced, not the other way round. If you want to be liked, get a puppy. If you want to be trusted, be congruent.. If you want to help people change, know your stuff. Know nutrition, cognitive therapy, emotional resilience training, body image work, lapse prevention, when to stop listening and interrupt.The rest will follow.

How To Lose Weight At Christmas Time

2010-12-30T04:20:00.001-08:00

Get flu;

Motivation Is Not An Infectious State: More Top Treatment Tips

2010-12-23T03:21:00.000-08:00

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.

Assessing Eating Disorders Properly: A Commentary.

2010-12-08T07:57:00.000-08:00

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.

The Anorexic Voice: A Deafening Whisper Away

2010-11-30T08:17:00.000-08:00

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

Fat, Sugar and Happiness, Taxing Issues Continued

2010-11-23T07:54:00.000-08:00

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.

Fat, Sugar and Happiness, a Taxing Issue

2010-11-19T04:52:00.000-08:00

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.

Anorexia, Orthorexia And Autism

2010-10-20T06:57:00.000-07:00

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.

Food For Thought

2010-10-17T09:55:00.000-07:00

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/

Figures Of Lightness

2010-10-13T09:29:00.000-07:00

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.

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

2010-10-05T04:13:00.000-07:00

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?

Do People Really Think That Eating Disorders Are Silly?

2010-10-03T03:16:00.000-07:00

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.

http://www.eating-disorders.org.uk/

Helping People To Get Help or, Anorexia Porn

2010-09-29T08:12:00.000-07:00

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.

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

2010-09-25T07:41:00.000-07:00

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.

http://bonitanorris.blogspot.com/

Last Chance Saloon - Weight Loss Surgery Revisited

2010-09-15T08:48:00.000-07:00

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

Your Mouth, Your Body, Your Choice

2010-08-26T11:57:00.000-07:00

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?"

Who Knows Best About Weight Loss?

2010-08-25T04:12:00.000-07:00

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?

2010-08-25T03:48:00.000-07:00

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?

Views About Emotional Eating

2010-08-24T06:02:00.000-07:00

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

Why Do Some People Put On Weight Easily?

2010-08-24T05:13:00.000-07:00

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/

Appetite Changes In Anorexia

2010-08-20T07:59:00.000-07:00

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.

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

2010-08-19T13:58:00.000-07:00

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

Workshop : Key Issues In Overweight And Obesity

2010-08-18T02:55:00.001-07:00

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 13^th 2010

Fee £155

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.

SEMINAR PROGRAMME

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.

YOUWILL LEARN:

_ 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

Appetite Sensitivity Training For Comfort Eaters

2010-08-13T07:03:00.001-07:00

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.

However.....

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”.

Vanessa, Comfort Eating And The Gastric Band

2010-08-12T04:13:00.000-07:00

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.

The First Ever Clinical Trial of Diet and Nutrition?

2010-08-09T02:59:00.001-07:00

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.

Bulimia - The Demon Within

2010-08-05T04:25:00.001-07:00

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

www.eating-disorders.org.uk

Eating Disorders Awareness Week Video

2010-08-04T05:34:00.000-07:00

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

2010-08-04T02:48:00.000-07:00

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

Bariatric Surgery And Ethics

2010-08-03T10:02:00.000-07:00

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.

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

2010-08-02T05:20:00.001-07:00

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?

2010-08-02T04:43:00.000-07:00

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.