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Thank you for visiting my thoughts and ideas site. If you want to speak directly or have my thoughts on something that is important to you email me at admin@ncfed.com

Thursday, 28 June 2012

Eating Disorder Recovery - What Helps

This is how it is from the view of sufferers

Its not just about being a good therapist. Or having the right tools.  We must realise how scary change can be. We must know what isnt helpful - that's the subject of my next blog!

The client is the expert, not us, as Emma Woolf showed us in her memoire of recovery, “An Apple A Day”. But, the client still needs us by their side as what… A therapist? A mentor? A guru? They need our wisdom alongside their own. They need our sense of humour and basic optimism. They dont necessarily need our University Degrees. They certainly dont need "what worked for us".

This is what they tell us aids their recovery; in no order of importance

Reconnection: – but not, I think the pro anorexia, community. People way that doing things like YOGA JOURNALING and SPIRITUALITY helps them to reconnect to themselves. Therapists take note!

Close relationships: Knowing that your family and friends really care about you and you are in reach.

Statements of support: "I know you're trying"  “I’m there for you” – what other statements are useful and what are not.? If someone says “You are looking better these days” it can send your client into a spiral of worry.

Empathetic Friends: Its useful if your friends know what they can and can't do and say.

Compassion: Eating disorders are such hard work.Compassion must flow from us to them and they need to learn to be compassionate for themselves whatever they are doing.

Therapy: it’s good to know that therapy helps as well, but looking forward is more important than looking back. Beware of therapists who don't know anything about nutrition, or the link between food and mood. But beware of therapists who focus on food instead of your general wellbeing.

Learning HOW to eat healthfully: Now there's a big chunk. There are so many food rules inside eating disorders, like being scared of carbs and counting all your calories. Wisdom, education, experimenting and reconnecting to natural cycles of hunger and satiety must be given by an expert not just someone who wants you to start eating more (or less).

This was in The Journal of Treatment And Prevention:  May-June 2012

The NCFED website tries to provide this help to people with eating problems. If there is anything that we can do or write to help people on their recovery journey, let us know. A quick email to admin@ncfed.com will always guarantee a personal reply from the Founder, Deanne

Tuesday, 26 June 2012

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.

Thursday, 21 June 2012

Bulimia Suicide: Is Fashion To Blame?

A 14 year old doctor’s daughter has hanged herself. She has been suffering from bulimia resulting apparently from fat teasing at school. The coroner blames the fashion industry. He suggests that 30 years ago young women were not exposed to as many thin images as they will find now everywhere they look – not just in magazines. He is right.

The death of a young woman on the threshold of her adult life is horrible. Equally horrible is living with the stress of bulimia. Equally awful is the pain of having so many emotions that are so unbearable and overwhelming that the only way out is to self destruct in this final way.

We don’t know the full story; her parents had taken her laptop away and this is information which we don’t yet understand.

We do live in a different world right now which crept up on us silently like cats paws. So many things - not just fashion magazines - make it hard to float above the waves. 40 years ago I could walk for 5 minutes down the High Street without seeing one fast food joint, not one single restaurant and not even a coffee shop. People only ate at home.

I could go shopping without having to choose between 30 different types of crisps or 40 varieties of yoghurt and we bought our chocolate in bars so small that they were gone in just two bites.

I didn’t have to worry about being left behind in case I missed an episode of East Enders, or stay awake at night in case my friends were talking about me on Facebook. There was very little fat teasing since very few people then were fat.

I didn’t have to worry in case I couldn’t get into skinny jeans and cropped tops because they simply weren’t cool back then. We didn’t have to be exposed or die.

We were able to have fun in our own way without being in the glare of social media for people to comment on and pass judgment on. We were able to have fun without the need for drugs or drink.

Life went by more slowly, so even unhappy people had time to digest their emotions and try to make sense of them without the help of this army of counsellors and psychotherapies and peddlars of happiness that we have today.

So the coroner wasn’t quite right to pour blame on the fashion industry. There have been too many changes making it hard for anyone to survive their teens intact.

But why didn’t this young girl get proper help from an eating disorder specialist? Perhaps I could have saved her life. This haunts me. If you know a 14 year old with bulimia call me NOW! 0845 838 2040.

Monday, 18 June 2012

Anorexia And “Force Feeding”- Self Determination Or Self Annihilation

Today I was listening to LBC radio regarding decision in favour of the so-called force feeding of patient E. On Saturday Norman Lamont suggested that the decision to force feed could be an intrusion on her right to self determination . What complicates this case is that the parents of this young medical student,- anorexic since eleven years of age-wants their daughter to be left to die with dignity.

There is nothing dignified about anorexia or any other mental health condition for that matter. Also, I just wish that people would STOP using the term “force feeding”, which reminds us of the traumas inflicted on hunger striking suffragettes wanting to obtain the vote for British women. I just wish that people would use the proper term, which is ENTERAL FEEDING.

Many clinicians have been writing in favour of the judge’s decision on Linked In. We talk to each other about things we know, which is that low weight impairs the ability to think clearly. That at low weights the anorexic voice drowns out logic, reason and happiness.

But nothing said it better than Kate, who came nervously to the radio to express her point of view. Kate has been anorexic since age 9 and in hospital many times during her young years. She said “I have no idea why I just didn’t want to eat, but I didn’t, and there were times when I would have been very happy to just fade away.

“But they didn’t let me, and there were times when I was on a section and they threatened me with the tube…. No it wasn’t a threat, it was just something they said would happen but it felt like a threat at the time. Having no control over what they put in it was the worst thing imaginable for me.

But I somehow got to the age of 20 and I said to myself, I’m sick and tired of this anorexia. It took 11 years for me to admit I had a problem. So I made myself start to eat. I’m 24 now and life is so much better. Life isn’t a bed of roses but anorexia is very hard work; and I had enough.

I spoke to my father about it and he admitted that he had something like me when he was in his teens, but being a man nothing was said or done about it.”

The interviewer asked, “Everyone is saying that it’s all the pressure on young girls to be slim, in magazines and so on?

“Oh no”, she said, “When I was nine I hadn’t even seen a magazine. It’s nothing to do with magazines and models, it’s just the way the brain is wired”.

So there you have it from the people who really count. Clinicians know very little. Listen to the people who have looked into the pit and been dragged into the light, kicking and screaming. At all costs we have to arbitrate in favour of the wish to live.

Wednesday, 13 June 2012

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.