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Tuesday, 27 January 2015

Anorexia And Auschwitz: A Cry From A Specialist

I cannot let the 70th Anniversary of the Liberation of Auschwitz pass without mentioning it in my eating disorder post.

To honour the suffering of those who endured torture, starvation and murder in the concentration camps, I bring myself to watch the film records and listen to the individual stories of heinous crimes, sometimes the small individual torments impacted on me more than the gross depictions of the crimes of Nazi Germany.

When people describe hunger that was so unimaginably painful, I think of my anorexic patients whose starvation is arguably - "self imposed", and I quail.

Self Imposed I hear you say!  Well, I've read many, many accounts of anorexia and I have ministered with compassion to many of anorexia's prisoners, and a lot of you are going to say OF COURSE it's not self imposed, it is a mental illness. But it is self imposed, because the self has been imprisoned by the anorexic Voice, in the same way as the selfhood of the concentration camp victims was imprisoned by their captors. The Voice captured me for a short while many moons ago, until I made my great escape.

So when I see the hollow eyes of the inmates of Auschwitz, Belsen and all the other Hells, I think of my anorexic people. But the weeping of a starving man in Auschwitz, caught for just a moment on camera has rent my soul.

What has become of us in this free and wealthy age where people willingly, proudly and insistently starve themselves into skeletons. People with anorexia do lie, do cheat, pretend that they are allergic, evade and often uncaringly torment their loved ones who just wish to see them live. It's what the illness is about.

So how can I, an eating disorder specialist, come to terms with the willing, compulsive starvation of my unhappy clients while my heart and soul is full of the starvation and suffering of a generation of innocent men, women and children. I sigh, I sigh and sigh; I bring myself back to my work, haul in my compassion and carry on.

Wednesday, 21 January 2015

Emma Woolf Letting Go Like Elsa In Frozen?

Letting Go: How to Heal Your Hurt, Love Your Body and Transform Your Life.

A new memoir of recovery from the girl who wrote An Apple A Day a century ago. Emma does what we therapists find hard to put into words, finding recovery not just in weight gain but in healing the mind, body, heart and soul of someone who has been caught in the claws of an eating disorder. As one of my patients put it, Letting Go, is like restoration of a stately home.

Can it help someone who is still sick and listening to the unforgiving anorexic Voice?  Perhaps it can. I hope it can. You can see a short review on our website http://eating-disorders.org.uk/emma-woolf-lets-go-and-heals/

but better still, read this book, a gift for therapists and patients alike.

Friday, 16 January 2015

Katie Hopkins Says It As It Is About Obesity

I'm not one for looking at reality TV shows of any kind but one late night found me meandering over Katie Hopkins and her strange quest to gain and lose weight to prove that if you have the will it can be done.

In part of the programme she ran the gauntlet of 4 large ladies for committing a hate crime by insisting that at their size they couldn't possibly be healthy, or at least not for long.

Then she made mincemeat of a psychologist claiming to specialise in eating disorders. I think that this expert was trying to change Katie's views about people's failure to lose weight. The best that this psychologist was able to do was declare Katie as lacking in compassion.

 "Would I employ you if you were obese? No I would not. You would give the wrong impression to the clients of my business. I need people to look energetic, professional and efficient. If you are obese you look lazy."

 "To call yourself ‘plus size’ is just a euphemism for being fat. Life is much easier when you’re thinner. Big is not beautiful, of course a job comes down to how you look."

This set me to thinking and I did a straw poll here at our offices. We would employ people who are overweight but the larger the person,  the more the hesitation. They say that when we make decisions about staff, the decision is made in the first 15 seconds. We have about 15 seconds to make an impression on an employer. There is a tipping point between yes, perhaps, and no. The larger a person is, the more something else has to be there, like a fabulous smile, radiant hair, and a sparkle in their eyes.

Is this right? Maybe yes and maybe no, it is how it is, the world was never fair.

I deal with this controversial issue at our trainings. Can we have an obese eating disorder therapist or an obese therapist helping someone to lose weight.  Everyone wants to say yes of course, good therapy is not about what someone weighs. But they are probably thinking NO.  This applies to therapists who are underweight just as much as it applies to therapists who are overweight. Would you want your anorexic daughter to be treated by a skinny minny who lives on mung beans and salad?

I found myself leaning toward Katie for her ability to say what she thinks. It's controversial but it should lead to honest debate. I work with people who can't lose weight and I often find that many people do what is easiest because discomfort of any kind is hard to bear.  To walk instead of sitting in front of the TV, to give up drinking alcohol which is laden with calories, to refuse to pander to children who demand their daily dose of crisps ......is just too hard so we give in to a need for comfort that is VERY, VERY deep.

The current focus of science is to try and find reasons for obesity which are not anyone's fault like genes or hormones. This demonstrates that some people have a harder job to maintain their weight than others so they look at people who are slimmer and say they're lucky. But that isn't true, many people who are normal weight work at it all the time like, learning how to cook, and it has become their habit. At the heart of it all, some people cannot tolerate discomfort.

Katie hasn't said that obesity is anyone's fault ... I think....but I think she is saying that you can run but you cannot hide.  The Health At Every Weight philosophy is one way of hiding, because if you are too thin or too fat you probably aren't very healthy. The it's in my genes approach is another way of hiding. Some parts of us must be accountable;  and if you cannot be accountable you are........ unaccountable with whatever that implies. Or you prefer to live your life with less discomfort.

Oh heavens, Katie got inside my head. Take her out someone before I lose my friends!

Thursday, 15 January 2015

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"

Wednesday, 14 January 2015

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".