Overeating As Addiction

I have spent some lively hours debating with others on the Facething whether compulsive eating is an addiction; which asks for some reflection on the nature of the term "compulsive".


Then I did two BBC Radio stints on overeating, debating with two people who were relying on Overeaters Anonymous to help with their food addiction. It seemed that both participants had become "addicted" to eating as a way of dealing with different forms of loneliness, at different times in their lives.


There are not many eating disorder experts who buy into the notion that compulsive eating is an addiction although they agree the following;


1   You can sort of become addicted to sugar because it affects the same parts of the brain as the other suspects like drugs and alcohol.


2    Eating disorders share some features with addictions.


3 People who overeat speak in the language of addictions. "I can't carry on with my day until I have had my fix... I can't stop at one.... I can't stop when I have had enough".


On our website blog I have made a very short case in favour of not leaping to the conclusion that overeating, even quite horrible variants of it, is addiction. It doesn't help our patients to consider themselves addicts. There are lots of reasons for overeating, even the most compulsive forms. We can free people from their destructive relationships with food without you needing all the paraphernalia of overeating fellowships like group meetings, endless talking about food,  sponsors and a lifetime of thinking of your self  as "In Recovery".  Thousands of us used to overeat and  don't now. We are not "In Recovery."  We can help you to stop.


 Check out   http://eating-disorders.org.uk/emotional-eating-addiction/ 

More About The Personalised Diet

The more I look at this programme the more worried I am becoming. There is some good stuff in it. There are strategies that benefit everyone, like eating slowly and mindfully, teaching people to eat while doing nothing else, finding out that many normal people compensate for exercising by doing less later -hoho!


But I am still absolutely flummoxed by the science behind putting constant cravers on an intermittent fasting programme.  Where is the research behind this? We learn that this group of people are always looking compulsively at food, at people eating it, at shops selling it.  I think we need to know more about it. It is like an obsession. Is it just about lacking leptin sensitivity?   Perhaps the ancestors of the constant cravers were trapped in a famine.


Perhaps the constant craver is behaving like an addict. Perhaps the constant craver has problems in the  opioid centres of the brain. Experts call it Reward Deficiency Syndrome.  Why didn't they think about that? The so called experts have PICKED OUT BITS OF THE PHYSICAL PUZZLE which suit their programme. But have they looked at the whole map?




Either way if you are a constant craver it seems to make sense that you need to eat frequently but a diet very high in protein and complex carbohydrate too. You need to wear an elastic band on your wrist and snap it whenever you NOTICE you are looking at food. You need to keep binge food out of the house.


Intermittent fasting will make the cravings even WORSE. Oh sure you will lose weight while you do the diet, but you will become even more sensitive to the sights and smells of food. I've a lot of research to prove this point.


OK I'm not trying to dismiss the whole programme, but I'm also something of an obesity expert and I'm asking valid questions. You people out there also need to be asking questions and wondering if these world class experts may have sold their souls to the BBC for the money they will be making out of this programme. They are telling a sort of lie, which is that a particular DIET suits different types of people while the work they do in the background suggests that many more psychological interventions are necessary for someone to lose weight and keep it off. And these other strategies are not just "CBT"

In Search of The Best Diet For You

In Search Of A Personalised Diet BBC Horizon January 2015. 

Have we finally found the Holy Grail of weight loss?  Is this the way to personalize eating plans which fit the individual and will help them lose weight? An army of world famous weight loss experts cannot surely be wrong. Can they?

Well let’s see.

We are now in the dieting months and I’m already sick and tired of all the diet plans I’m seeing.  There is the Ice Diet being promoted by Peta Bee in the Times – sorry Peta, bad science. And even a diet called EAT! Which is just another variant on the low carb diets.  These diets are one size fits all and take no account of personal genes and nutrient responses. They are designed to fail in the long run, as all fervent followers will discover. 

A few years ago, the BBC ran a diet trials experiment at the University of Surrey which compared different types of diets for success. There was a clear winner which I won’t mention now but the take- home message in the long run is that different types of diet suit different people. People who don't like detail do well with a diet like Atkins, while some types of people do really well with a group approach. But in the long run it’s pretty much all the same. Failure, that is, for most.

So here we have an all-singing-dancing world expert scientific approach that is new. Do people really divide themselves into three obesity types?  The first “cant-stoppers” who are low on gut hormones. The second “constant cravers” who probably lack a good leptin response (science here) to tell their brains they aren’t hungry.  The third, “comfort eaters” who meet the day to day stress in life by using food as a feel-good drug.

Perhaps. They have all lost weight, HURRAY  - but that proves very little; it was poor research design, and the proof of the obesity pudding must surely be in how well they are able to keep it off.  Oh well, it makes good TV but probably very little else.

Professor Susan Jebb is an expert-expert on obesity but has said that losing weight is not a matter of will, but of habits. People have to change their habits for life. I know that, and part of the therapy I do is to help change habits from very deep inside.  This is useful for everyone and flexibility training was missing from the treatment given to these subjects.

But there is a whole new science of willpower – known as self-regulation theory which is available to obesity specialists and which is helping people to use their willpower to change their lives.  This can help comfort-eaters, constant-cravers and cant-stoppers too.  Why was this ignored?   So what’s going to happen to these happy weight losers?  Will they have to stay on their diets for life, an impossible task surely, unless they learn how to exercise their WILL.

I like it when people feel they have done something valuable and positive. Who could fail to be moved when men weep real tears by having help and support. But is this real science when it ignores real psychological strategies that work, like flexibility training and self-regulation training. Is the Intermittent Fasting Regime really the right approach for constant cravers  - WHY- and is group work alone correct for people who have failed to develop better ways of managing the stress of life and living with other people?  Who said it was?

So for me the jury is out.  Some bits of this interesting programme hold out hope for people who cannot lose weight.  It's good for someone to know that they may be lacking in a gut hormone that helps them to feel full.  Its good to suggest that an emotional eater is not just weak-willed and greedy. It may be useful to know that a constant craver might not be feeling leptin in their brain.

But I’m waiting for 18 months down the line to see if you can change habits (as Susan Jebb suggests) by putting people on a diet that suits their “obesity phenotype.”

World experts should know better than to suggest that what they have done is a solution. It is just one of a number of things that must be properly explored in properly designed clinical trials before we can truly discover a personalized solution for obesity. And we experts know better than to think that any single diet can provide a quick fix even when the experts say "genes".

Sugar Addiction

Are you a sugar addict?


Can you be addicted to sugar?




There is a robust review on the subject commissioned for the National Institute of Mental Health in the USA which should settle the matter. There is only  weak association of attachment to sugar among people who diet or restrict carbs, while sugar given freely in a balanced diet may have no influence on behaviour such as escalation, tolerance and withdrawal.

Evidence for Sugar Addiction: Behavioural and neurochemical effects of intermittent excessive sugar intake. Neuroscience Bio behavioural Review 2008 32(1) 20-39 published online 2007 Avena, N., Rada, P. and Hoebel, B.

Psychologically speaking, work on the subject of sugar addiction by Terence Wilson published in Binge Eating, Nature and Treatment edited by Fairburn suggests that the so-called addiction to sugar is largely psychological. People only lose control of eating sugar when they BELIEVE they have eaten sugar, demonstrating NO evidence of intrinsic addiction to the substance at all.

The role of sugar in the hedonic systems of the brain are not equivalent in effect or severity, as drugs like cocaine and nicotine, even though there is an effect on endogenous dopamine.

Sugar is present in many foods such as vegetables, potatoes, tomatoes, lentils and other pulses so eliminating sugar from the diet seems impractical. Sugar is not equivalent in its physical effects as fructose including high fructose corn syrup further confounding the evidence.

Sugar-fat combinations are as potent in promoting the surges of endogenous dopamine as sugar alone if not more so. Thus there is danger in focusing solely on the so-called addictive properties of sugar. Based on a macronutrient analysis of binges by Susan Yanovski in 1998, it seems that it is fat which binge eaters really crave when fat is made palatable by sugar.

Thus while clients talk in the language of addiction to sugar,  the evidence-based success of cognitive and cognitive-emotional / behavioural treatments for compulsive eating warn us of the dangers of focusing on sugar as an addictive substance. Addiction approaches to treatment which ask you to remove sugar and white flour from the diet might be unhelpful. It keeps people well only when they continue to restrict their diet. This approach merely fosters the all or nothing thinking that pervades eating disorder work.

 I used to get sugar cravings long ago, but I know now that it was just too much dieting.  I now eat a broad diet which contains all nutrients including a reasonable amount of refined sugar. And I'm fine.


But if you think you are a sugar addict and need help, call us on 0845 838 2040 OR  visit www.eating-disorders.org.uk

Go Enjoy Your Toast

Carbohydrate phobia is now officially a new psychiatric disorder. No, I'm joking, but Hannah Devlin Science Correspondent of the London Times says that almost half of all women and men are scared to eat carbs, which are an essential part of a normal healthy diet.


Carbs do some very important things in our body which cannot easily be replicated by proteins and by fats.  Not being nutritionally trained, few people really know what carbohydrates really do. They are swayed by rogue messages from daft so-called health professionals.


And few people know how much carb they should be eating. It is about 250 grams per day, but what does that mean? Its actually a bowl of cereal, some fruits and vegetables, a bit of pasta, some lentils and beans and a few bits of toast. Who is measuring?  I don't.


If you drink alcohol, that's where the trouble creeps in since the carbs are dense and the body isn't quite so sure what to do with them.


I've written more about carbohydrate guilt in my website blog. Follow the link to http://eating-disorders.org.uk/carbohydrate-phobia-go-enjoy-your-toast/




And let me know what you think?  If you want to fight your carb phobia and get your life back, I will support you in your fight. Its a crazy world we live in and your carbohydrate phobia might keep you thin and it might not and it will certainly make you less happy.

Avoiding the Big Six To Cure Or Prevent A Weight Problem?

At a recent eating disorders conference on emotional eating, Prof Haslam who is chairman of the National Obesity Forum has stated as follows:

“My advice for avoiding obesity? Stay away from the Big Six: pasta, rice, bread, sugar, potatoes and flour.”

One of the delegates is quoted as saying "Surely humans have been eating bread, potatoes and grains for many centuries – is it really the fault of the humble carb? What he explains is illuminating: that refined carbohydrates and sugars are present in ever-higher quantities in our diets, but they’re hidden. Crisps or pizza or fizzy drinks, for example, are classified as high-fat or high-sugar items, when in fact they’re loaded with carbohydrates. "

Is that so?  There are millions of people who remain reasonably slim who try one way or another to negotiate a clearly obesogenic society. We all live in central heating and this has been implicated in obesity. We sit down a lot and that is implicated (whether or not we try to compensate by going for a morning run). We are upsizing and downsizing and that is implicated too. Don't get me started on the causes of obesity, I could write a book.

So is the problem the hidden sugars in food? Yes, but only if you eat the foods with "hidden sugars" to excess - not by eating the humble carb.  Is there danger in such categorical opinions. (Has he been hi-jacked by the Dukan brigade?)

I weigh about 7 1/2 stones and my diet is largely based around the humble carb. I daily eat bread, slightly undercooked pasta with vegetables (another carb). I eat rice, couscous, barley, honey on my porridge, potatoes with and without skins and a bit of flour here and there for fun. I am highly trained in how the body works and I know that you need a good supply of carbs from many dietary sources. I have many people who recover from obesity while continuing to eat the humble carb.  Prof Haslam you are a doctor too, so where is this nonsense coming from. Recant!

Its really easy with a little knowledge and wisdom to avoid "hidden sugars" and high fructose corn syrups while continuing to embrace the lowly carb. in all its wondrous glory, with the fibre that helps us to maintain a healthy digestion and with the resistant starches that support the flora in our gut.  That reduces obesity too by the way.

I am uneasy about statements such as the one above which fosters fears about food, all or nothing thinking, good and bad food mentality etc which fosters obesity and leads to disordered eating. A professional needs to be careful about opinions? Without qualification?

The 5:2 Diet? Good, Bad or Mad?

Laura and Miriam asked me to comment about the Intermittent Fasting or 5:2 diet which has been attracting rave reviews on the “inter-web”.


Scientists have long known about some of the benefits of fasting for longevity. Fasting reduces levels of hormones like IGF1 (insulin growth factor), implicated in accelerated ageing and age-related diseases like cancer and diabetes. It also seems important to reduce your protein intake, so calorie reduction can’t be attained by eating lots of protein – a la Dukan.

Scientists at the University of Illinois have trialled a variant of continual fasting, which they describe as Intermittent Fasting. In an 8 week programme,  people eat fewer than 600 calories on 2 days a week with eating what you like on the other 5 days. They have claimed that it improves IGF and other ageing markers as well as enabling weight loss. Here I insert a warning, this trial was only for 8 weeks and we don’t know what happens in the long term.

There is a Fasting For Longevity movement in the USA. Members have been studied extensively. While they claim to have no issues with weight and eating, most show similar personality characteristics to people with anorexia and they display all the signs of people with classical eating disorders, preoccupation with food, cravings and high levels of emotional distress.

The 5:2 way of eating intended for longevity has been captured by the weight loss movement. Now there's a surprise!   For weight loss, this isn’t new. In the 1980’s it was deemed useful to eat sparingly during the week and eat everything you like at the weekend. Many people lost weight on this regime and then- hey - they put it all back on again. Feasting and fasting isn’t the good idea that it is supposed to be.

Behind the hype, even the BBC admits that current medical opinion is ambivalent about the benefits of fasting. Psychological opinion concurs. Fasting and feasting drives people into polarized thinking, good and bad day mentality and catastrophic reactions when dietary rules are breached. Apart for providing fodder for the pro- anorexia movement or the orthorexic community, this insensitive publicity may lead people to thinking that they are doing something that they should be proud of, when they may be doing something which isn’t really very good for them at all.

Let’s take some of the research which was NOT given head space by Michael Molesey and his team. A number of robust studies show that after one month on intermittent feeding, experimental aniamals show a series of behaviours similar to the effects of drugs of abuse. They begin bingeing, and during fasting periods there are withdrawal signs indicated by signs of anxiety and behavioural depression together with enhanced longing for sugar.

Brain imaging shows gross and complex changes in opioid systems such as decreased enkephalin expression in the appetitive system in the nucleus accumbens, with reduced dopamine levels (reward chemicals) and increased acetylcholine (stimulating appetite). The net effect is the creation of sugar dependency together with cross sensitising to other drugs of abuse.

Feasting and fasting thus risks bringing forth long term problems with control of food together with the emergence of compulsive behaviours and emotional problems too.

So with humans as with rats and other primates, it’s useless to test one set of behaviours in a vacuum for 8 weeks and present it as a panacea for weight and other issues. Mr Mosely may have felt good on this diet, but it's pointless for the millions of people out there who have eating disorders and for who this diet could make things considerably worse. I have given this issue lots of head space and I conclude that programmes like this are unbalanced and risk creating false hope for anxious people who are trapped in a poor relationship with food. As the man said, “fasting, like eating, is best done in moderation”

The Wrong Treatment

Hi to all my bloggees, I've been away for a while just thinking about what I need to be paying attention to and watching the Olympics.
I’ve just had a 65 year old woman on the phone wondering how much we charge for treatment and if we had a helpline for her to pour out her troubles with lifelong binge eating.

I said, yes treatment costs money and a helpline won’t help you, only treatment will help you.

Have you had treatment before?

I hear that she has had some really good treatment. She has had “counselling”. Her counsellor told her to imagine that there was a bowl of sick in the fridge alongside all the other foods. Her counsellor told her that she would lose her toes if she continued overeating and that being fat made her a bad mother. Her counsellor knew bugger-all about nutrition and the brain. Her counsellor told her just to eat cereals whenever she felt cravings. Duuh?

Then she had really good CBT. Among other things this person told her to imagine that hair was all over her favourite foods. Was this CBT person an eating disorder specialist? She didn’t know.

Now she has spent some time at a slimming club. Her leader suggests that she should eat a whole chicken every time she wants to binge and this will cure her.

This poor soul has gone through this counselling travesty believing that she is a hopeless case. I told her that I was sorry for her, having such appalling “professional” help.

People with eating disorders need  Eating Disorder Specialists. They don’t need ex-sufferers or addiction specialists, or generalists, or therapies not grounded in evidence at the very least. Therapists can only play with their toolboxes when they have the right kind of training. This training must be very long and very deep.

I don’t know whether we will hear from this poor soul again. I hope we do. I hope that she can look inside her purse and come to us to change her life.
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Have you had lousy treatment?  Tell me all about your rogues galleries of bad therapists. We can put your stories up on the blog and stick pins in them. Or just stick pins in them.

The Men Who Make Us Fat

Last night I walked down Marylebone High Street, London. Every two yards there was another place to eat, a Pain Quotidien, a cafe, an epicerie, a Costa Coffee and a cake shop from heaven. People were eating as they walked along the street.


20 years ago I walked down the same street and every 100 yards there was a place to eat and very few people ate as they walked.

40 years ago I walked down Marylebone High Street. There were no places to eat, lots of other shops and no one ate as they walked.

They assume that people who gain weight are weak willed. On the contrary, people who keep their weight stable have to work really hard 24 hours a day 7 days a week to avoid - like bouncing bagatelles- the food they see around them saying "eat me now, you will feel nice, I will give you a lift, you don't need to be hungry -you just need to be wanting a bit of fun and what's the harm in that".

On top of that are the dangers that we can't see; the men who made us fat have inserted them quietly into the food we eat. Corn syrup, tastes so nice but it is food that our body cannot deal with properly. Relax, have a beer, or a bit of ketchup on your chips. It will make you fat while it makes them rich.

Going shopping? Have a packet of crisps, it will reward you for doing all that hard work. They made it big so you would spend more money and feel virtuous because you hadn't bought 2. They knew that you would eat it all up in one go because thats what people do. And while you were scoffing, it made them rich.

Did you know that the food industry has blackmailed, denigrated, rubbished and possibly even murdered the people who wanted to tell you the truth? They have bought or crushed the politicians who could have done something about this. They wanted to make you fat so that you would need what they had to sell you.

And everyone is frightened of taking them on. See that bag of treat sized chocs? See that double caramel flavoured frappucino? JUST SAY NO.

Is Undieting A Good Thing?

This week I have done an obesity training. One of the delegates said I should not be teaching therapists to help people lose weight or restrain their eating. I should be helping people to be healthy at any weight, even very large weights.
There is no doubt that dieting has consequences. Many writers say that dieting leads to compulsive eating and disconnects people from their real appetites. They are right. The first research into the effects of dieting was done by Ancel Keys in the 1950’s. He showed that dieting is linked to food cravings and to abnormal hungers for fattening foods.

A few years later, researchers (Herman and Polivy) have linked dieting to "eating dysregulation and disinhibition". These big words mean that dieters start eating in response to cues like food just being there, or any kind of emotion. People call this kind of eating  "comfort eating". Dieters think about food a lot of the time and another researcher called Kelly Vitousek - in her work with anorexics, concentration camp survivors, and people who restrain their eating for longevity - has shown that this kind of preoccupation is common among food restrainers.

We are all familiar with the kind of thinking that accompanies food restraint. One slip or lapse and the dieter can end up on a slippery slope. She says, I've blown it and carries on eating with a plan to re-start her diet tomorrow or next week. So even thoughts about breaking your dieting rules can lead to a heck of a lot of overeating.
By denying themselves food, dieters make it much more important. Dieters are more likely than non-dieters to turn to food when they are emotionally anxious or depressed. At a recent study carried out in London, female volunteers were divided into three groups, the first went on a strict diet, the second a rigorous exercise programme and the third neither dieted nor exercised. After 5 weeks the subjects took part in an experiment which assessed their food intake while watching a stressful film. Bowls of sweets and nuts were left beside them and they were told to eat as they liked. Women in the dieting group ate far more than the others.

Even thinking about dieting can make you overeat. In anticipation of deprivation to come, dieters’ indulgences “the night before” can reach legendary proportions. The seeming inability of dieters to stop once they have started, stem from the Faustian bargain they make with themselves at the start says my colleague, Sara G.
Undisputed as health risks of dieting are the eating disorders, particularly anorexia, bulimia and binge eating disorder, which can at their most extreme, be life-threatening. It is not surprising that when people with eating disorders do binge, they eat foods deemed forbidden in their dietary systems. Although not all dieters develop eating disorders, serious eating disorders are usually preceded by diets. There are many more people who diet than develop eating disorders, but over-restraint of food has a lot to answer for. So is the solution to give up dieting altogether?

Some writers propose that the solution to compulsive eating is to eat whatever you like including  huge amounts of food previously regarded as forbidden. This is supposed to reduce the attractiveness of forbidden foods, and to stop you from feeling guilty about how hard you find it to control your eating.

The implied promise of undieting is that weight gained as a result of compulsive eating will be lost. It promises that you will regain your innate wisdom of what your body really needs. You will get back in control of foods like chocolate and cookies, and eat them in small amounts again. This is a seductive proposal; after all dieting doesn’t solve the problem of compulsive eating. We are all familiar with the mantra of some of our clients, “Every diet, you name it I’ve done it and I’m fatter than ever”. But might this also be a dangerous thing to do?

I don't think that a knee-jerk return to undieting in overweight people is helpful. For some people, being on a diet is the only way they know of being in control of food. Such people could be described as “diet addicts”. Giving up food restraint altogether may result in rapid weight gain unless appropriate advice is given.

An “un-dieter” eating large amounts of “desired foods” will also risk harms to their health. The eat-all-you-like solution is unethical. If you eat large amounts of your favourite food because someone has told you it is a good idea, you will rapidly develop symptoms that will take you down a long road toward diabetes ......if you don't already have it. That won't help you very much at all.
Undieting won't help change ingrained bad habits such as strategies many people use  in an attempt to offset the calories they are eating. These strategies include drinking diet colas, eating sugar reduced products,  drinking large amounts of tea and coffee or using alcohol to dull the appetite or to deal with low mood states. Is this healthy?  These practices increase bad moods like anxiety and depression -hardly the nirvana that the un-dieting movement suggests.


Dieters can and do lose weight and keep it off. Our solution is to find the strategy that works and a therapy that is holistic. This therapy proudly targets weight loss. And that, as they say, is another story told at my recent training.

Food Addiction Vs. Compulsive Eating: The Meaning Of Overeating:

The statement I often hear that overweight people surely must be “addicted to food” is contentious and offensive.

In 2004 and subsequently in 2006, two separate NICE guidance processes, one on eating disorders and one on obesity attempted to make sense of what psychologists describe as dysregulated and disinhibited eating. Whether this eating results in weight gain depends on the restraint that a person exerts in between episodes of overeating, or the use of compensatory behaviours such as purging which accompany overeating.

Sufferers speak about irresistible drives to eat any food or certain food types such as chocolate - in the context of cravings, low mood states, excitement and a sense that their behaviour is somehow wrong / abnormal. It seems apt to apply the label “addiction” to the behaviour and its motivations because there are many shared features between substance abuse and overeating. These shared features include ways in which “using food or drugs” brings about mood relief, tolerance, withdrawal symptoms, and the activation of similar neural networks, particularly in reward centres in the brain.

Sufferers also describe their experience in the language of addiction such as “I can’t get on with things unless I have my fix”. Or, “It’s like I’m addicted to food, I wish I could just take it or leave it, but it’s never enough.”

The reason why terms such as food addiction, chocolate addiction, binge eating disorder, comfort eating and compulsive eating are used inconsistently in scientific literature are because they are not diagnostic categories. They are simply our attempts to put labels on a rich diversity in human experience and behaviour, which have different meanings to different people (1). They are useful labels because they legitimize the individual’s search for treatment for eating behaviour which they consider at least, uncomfortable and at worse, insane.

For this reason, it is dangerous and incorrect to label the uninhibited eater simply as an “addict”. There is evidence for example, (based on pre load studies with ice cream), that the eating patterns of so-called addicts is motivated more by beliefs about what they have eaten rather than the foods themselves (2). Moreover, the label “addict” is often disempowering, suggesting that you are emotionally sick, with the ever-present danger of relapse. While it is true that there is a poor record of weight loss maintenance in anyone irrespective of where they start from, there are evidence based psychological treatments of “compulsive eating” which have a good and enduring outcome (3). These treatments don’t necessarily lead to losing weight.

Ignoring for the moment the question “what is a binge?”, evidence supports the view that among obese binge eaters there is a greater than average risk of the following; history of trauma, psychiatric illness, mood disorders, history of alcohol abuse, avoidant, dependent and borderline personality disorder (4). But don’t assume that this is true for all obese binge eaters, many of who just got into bad habits, enabled in part by the people who live with them. Or alternatively there are sufferers who have not learned how to manage stress.

So this is why labelling overeaters or even compulsive eaters as “addicts” is nonsense. Careful assessment will pick out factors that may interfere with treatment for weight control. Then, using techniques such as cognitive therapy to deal with the obesity mindset, emotional resilience training, mindfulness work, trauma counselling for some people and nutritional rehabilitation, we can package together a treatment which will help even the most disinhibited of overeaters – often quickly. They will stop bingeing and they will be able to eat their forbidden foods without danger of relapse.

Personally speaking, I have found it helpful to say to my clients “I refuse to call you an addict – you simply have some things to learn which will help you to manage your life differently.”


I would only start thinking about addiction if my overeater also has existing substance abuse problems or a history of them. For sure, there are aspects of 12 step programmes which are useful for anyone with a mental health problem to help with things like self worth and forgiveness, getting help from others and taking an inventory of all ones difficulties. But first and foremost I would turn to cognitive –emotional behaviour therapy for my overeaters(5).

Do we not owe it to our clients to “label” them as potentially normal as the rest of us?


HERE ARE SOME REFERENCES FOR STUDENTS

1 Fitzgibbon and Kirschenbaum (1999). Heterogeneity of clinical presentation among obese individuals seeking treatment. Addictive Behaviours 15, 291-295


2 Wilson T. (1993). Binge Eating And Addictive Disorders, in Binge Eating, Nature Assessment and Treatment. Eds Fairburn, C. and Wilson, T. Guildford Press.

3 Gladis, Wadden et al. (1998). Behavioural treatment of obese binge eaters, do they need different care? Journal of Psychosomatic Research 44 375-384.


4 Yanovski, Nelson, Dubbert & Spitzer (1993). Association of Binge Eating Disorder and psychiatric comorbidity in obese subjects. Am J Psychiatry December (12):1910


5 Smith, Marcus & Kaye (1992). Cognitive behavioural treatment of obese binge eaters. International Journal of Eating Disorders 12, 257-262

Ghrelin Or Gremlin - To Coin A Phrase

Title with acknowledgement to Richard Robinson
Did anyone see last nights Horizon Programme about Obesity .... the ultimate facts?

The programme pointed to some distinct differences between people in terms of their suceptibility to overweight, with focus on two hunger and satiety hormones, ghrelin and Pyy3-36. The programme suggested that bariatric surgery would correct the appetitive brain and make fatty sugary foods unattractive.

Having watched the programme, I feel that it was unduly reductionist. For example the distinct differences between the hunger and satiety hormones ghrelin and Pyy may have been caused by overeating and may not be endogenous. There are many other less well understood appetitive hormones which play a role in eating.behaviour.


The brain changes in bariatric patients affecting reward systems and the drive to eat high fat/sugar foods might well be influenced by gut function. Bariatric patients do tell me that they feel transformed by their operations. However the programme did not inform us about the cons of surgery.

I have sought the opinion of someone who is overweight and not an obesity professional, who didn't find this programme very useful. He said, I don't want surgery, is this the only thing that I can do?

It might be useful to have people believe that obesity is "not their fault". There are differences between individuals in terms of genes, life experiences, cognitive function, maternal eating habits in pregnancy, emotional resilience, environment and physiologcal makeup. So obesity treatment will remain complex and personal. One day there may well be a brave new world where each child showing risks for obesity can be fitted with a gut implant to control their appetitive brain. Until then, the battle against our fat cells continues.

Get A Grip: Love, Cherish And Protect Fat Children

Two articles in The Times Saturday 11 February 2012; the first worrying about children who consider themselves fat when they aren’t. The second, a cry for help from Lucy Cavendish, mother of a fat child who doesn't understand her son’s fatness and doesn't know what to do about it.

Lets take the former first which deserves a blog to itself. God (or whatever) save our children from parents who make comments about weight, their own willpower or lack of it and who flaunt their own obsessive attachment to the gym, pilates or running marathons.

The second article resonated with me more, having it on good authority that being the Parent Of A Child Fatter Than Other Children (PFOC) has its challenges.

I understand that Lucy, like many other PFOCS, will first try to figure out why her child is fat. Is it the genes, is it something she has done, or something about the character of the child. She seems to be blaming all of the above. She once cooked like Nigella and now one of her children is paying the price. Or perhaps he just is lazy or is having a love affair with food. There was a fat ancestor somewhere in the past.

Even if it isn’t her fault, it is her responsibility to do something about it. Everyone tells her so. Some people are telling her to put her son on a diet. HORRORS! Please find her and warn her that dieted children are more likely to gain weight even faster than before the diet. It doesn't work to put children on diets.

When you have a fat child, people think you are a bad mother or at least an irresponsible mother. People will say how can you let your child get like that. Lucy feels guilty when she buys fattening foods and is bending over backwards to put everyone at home on a healthy eating programme. That sounds fine and will convince her that she is being a good mum.  But, Lucy, if you are reading this, that doesn't work either.  For every PCFOC buying normal foods in a supermarket there are a dozen parents buying ordinary food with normal skinny children. Many children just don't gain weight.

The Government has decided to wage war on the fat child with warnings about health risks and risks to emotional well-being. In some ways they are right and Lisa is correctly afraid that a fat child is probably going to be a fat adult. But many adults are fat who were never fat as children.  I think it is these adults who find it hardest to manage their eating habits, since they were never called into question when they were young.

The days of bad interventions are gone. Doctors no longer give slimming pills to children as they did but rest assured, they don't know what else to do. Obesity is the physician’s Achilles heel.  Instead we have do-gooding, Jamie Oliver, bless him, and earnest strategies trying to foster healthy eating for our kids. We have the dreaded “fat letter” and a fat lot of good that is going to do. We even have a MEND child obesity programme which appears to have failed Lisa and her son. Although MEND received a gazillion pound grant, I would love to meet just one cured-fat success story, a fat child made thin. I haven’t yet.

There is no doubt that there are some lazy, irresponsible and unknowledgeable parents who stuff their children full of junk. There are parents who simply do not know that their child is fat, because they do not know how to interpret what they see. Despite what we are led to think, I believe that these are in the minority.

The rest of us have to do daily battle, with our need to defend ourselves from criticism, and with the unending responsibility to conduct a battle, which we cannot win. There is a limit to the control we can exert and limit to the miles we can force these little ones to run. We risk doing damage in the process; a child deprived of treats will only want them more. We stop just appreciating our fat children and envelop them in the pall of our own anxiety, always wondering what to do that will work this time.

To the mother of a fat child I would say this.  Really there is nothing you can do. This is a child who above all needs to be loved and celebrated, learn to view their difference as a gift to help you to rise above yourself. Let them eat all they want; do not try to convince them that they cannot be hungry; do not scrutinize their portion sizes; they really do need more than thin children.

Above all, deprive the child of nothing that you would not let them eat if they were thin. By all means take them out for a walk for fun, but do not heed the advice to deprive them of their TV and to force them onto the football pitch.

The child who is fully accepted and loved at home will be better able to overcome the difficulties they will face outside. To any young and vulnerable person, teasing and bullying is the worst thing that can happen. Above all it mustn’t happen at home with guarded comments such as “You would look better in that if you were a bit thinner.”  A zero tolerance policy of teasing among siblings should also be in place.

Instead of trying to fix the child’s weight, fix their ability to manage these torments and to overcome them. You may need to call on professional help to keep their self esteem intact.  Above all, you must find a way to let them know that it is not their fault. Nor, when they are children is it their responsibility to do something about it. Nor, strangely enough is it yours for now.

Having worked unceasingly with fat people for decades, I am now convinced that fatness is a disease that can only be managed, never cured. The best chance a fat child has of losing weight is to do it for themselves, when they are older, in time and in the best way for them.  They have a far better chance of managing their weight in the future if you are able to give them a solid sense of self worth and self respect in early life.

So, if you are going to stop trying to manage their weight, what can you do? If I did have a checklist, it would contain some of the following;

Adore and be proud of your fat child, give them loads of hugs and listen to their problems.

Engage the school, make sure you let them know that your strategy for your child is long term and alert them to let you know if there are problems.

Make sure he knows that weight is not his fault. You might need help to put this in the right words. If he thinks it isn’t fair, he is right.

 Ignore comments or assumed comments from others. Make sure that everyone in the family reads this blog.

Tell well-meaning others that diets make fat children fatter. Tell the child that missing meals is fattening.

 Do not diet yourself, or make weight comments about yourself or others, do not praise beautiful children, do not use the child to compete with you in a weight loss programme.

 Help your child to love a large range of foods.

Teach your fat child how to cook (all foods including treats).

Do not ban any food, under any circumstances including visits to Macdonalds, do not make comments, but use substitutions, like sorbet rather than ice cream for the family.

 Get help if necessary to teach her how to combat teasing including Facebook bullying.

 Make sure she is doing things she enjoys, from ice skating to dancing or tweeting.

 If your child wants to diet, do NOT quickly agree and I advise some expert help, such as from me!

If she is bingeing or secretly eating, she is deeply alone and unhappy. Spend time with her and find out what she is feeling.

If you have any questions or concerns, email me at admin@ncfed.com and meanwhile, celebrate your fat and hungry child.

To Detox Or Not To Detox, That Is The Question

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.

Binge Eating and Food Addiction

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/

Binge Eating Treatment

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.