I have often thought that we get so caught up in our own daily needs and worries that it’s easy to misinterpret the actions of others. How many times have I felt like the guy in this video? This next 4.5 minutes is eye opening.
Briefly, one obstacle to treatment is that the current version of the Diagnostic and Statistical Manual of Mental Disorders or the DSM IV does not classify binge eating as its own disorder but rather falls under a general category. Therefore getting full insurance coverage is often impossible making adequate treatment extremely costly. When the next version of the DSM is released in May 2013, BED will be classified as a specific eating disorder, giving it parity with other medical conditions. This means that insurance companies will view BED as medically based. Whether you have an HMO or a PPO your treatment will be fully covered.
At the end of the article Dr. Greenblatt states that medications and Cognitive Behavioral Therapy (CBT) have been found to work well. My clinical experience shows that medications for BED are not very effective and that CBT can be helpful if there is no underlying trauma.
What has been shown to be effective is The Tapas Acupressure Technique (TAT). The National Institute of Health funded a study by Kaiser Permenante showing TAT is significantly more effective than CBT or Chi Quong for weight loss maintaince. TAT addresses the underlying stresses and traumas that both cause the shame related to bingeing and trigger bingeing. In the 12-session group process I developed and lead with my colleague, Patricia Thatcher, LICSW, it’s possible to transform your relationship to food for good. The pre and post-assessment questionnaires conducted on four groups, showed that “eating to self-soothe” was reduced by 50%.
Thousands of new chemicals are created every day and hundreds of them find their way into our food to “enhance” taste and texture, prolong shelf life, be addictive and cheap. But can you tell the difference between cat chow and chicken fried rice?
If the number of ingredients on the food label is longer than your grocery list and you see words you can’t pronounce, consider a healthier alternative. Take this test to see if you can tell the difference between cat chow and fried rice. I got 7 out of 11 right.
While preparing a talk called, Weight Loss That Lasts, I gave myself one minute to name as many diets as possible but stopped when I got to thirty in 30 seconds. If you’re confused about what food plan to follow, get in line. For any diet guru who declares theirs is the sure fire way to lose weight – and “proves” it with scientific references and twenty testimonials, there are just as many others that contradict it.
So what do you do? Certainly not diet because “diets don’t work”. You may have heard this flip little statement before and doubted it was true even though your experience of yo-yo dieting proved its validity. Here’s what you already know about dieting but have not allowed yourself to believe;
Overeating is not really about food. It’s a solution to a problem; a clever habit that you unconsciously developed, often at an early age, hoping food would soothe you or protect you from being hurt, only to find that the vicious cycle of yo-yo dieting hurts you as much if not more than the reasons you overeat.
What dieting teaches you is to ignore the very signals that help you know whether you’re really hungry or not. It fosters the belief that you don’t know what you want other than to lose weight. It doesn’t teach you to recognize and listen to your natural hunger so you know to stop eating when you’re full. Instead, dieting teaches you to mistrust your very own body, which makes you think that your body has betrayed you when in fact you have betrayed your body.
If you listen to your body’s natural and normal desires to eat you won’t be confused by the confusing and contradictory myriad of dieting choices. Instead, you will slowly learn to listen to your body’s natural and normal need for sustenance so that you lose weight and keep it off without depriving yourself or punishing yourself with food. Wouldn’t it be radical to replace the guilt of overeating and the preoccupation with the next best diet with the desire and delight to feed your body just the right amount of nourishing and delicious food? Imagine!
Do you know that the average woman wants to lose 10 – 15 pounds more than any other goal? This ambition can be more important than having a successful career or relationship because she thinks that the weight loss is her key to getting everything else she wants. Nothing could be further from the truth.
If we compare the average woman’s relationship with food to the criteria in the DSM 4 (the diagnostic manual used by professionals to diagnose mental health issues) most women would qualify as having an eating disorder.
There are times when we all eat to self-soothe and so fast that we don’t taste the food. We’re human and it’s normal. After all, when we were infants and we cried, wasn’t the first comfort offered the breast or the bottle? And didn’t we gulp it down only to fall into a blissful sleep again? How could wanting food to feel better be any more normal or primal? Of course we find solace in food!
And what would we do if our mothers (or other caregivers) tried to feed us more when we were full? … Turn our heads away. We were born knowing when we were satisfied.
What’s not normal is when we overeat or binge and the behavior becomes an habitual but unreliable way of handling stress. This is when the shame and guilt set in; when stuffing feelings and the vicious cycle of yo-yo dieting makes us more consumed with losing weight than with having the work and relationships that truly nourish us best.
So are you the average woman or not? I hope not. But if you are, know that it is possible to heal from emotional eating. Though this thought may seem unthinkable now, when you learn to eat to trust your own internal cues, the way you did as a baby, you will be able to nourish rather than punish yourself with food. Why would you want it any other way?
You’re staring at the bag of chips or the container of ice cream or tub of hummus contemplating your next move.
One voice warns you, “Don’t eat it!’
Another voice commands, “You want it! It eat now!”
And then in a flash, after you’ve spent the next two minutes in a feeding frenzy — another voice laments, “I can’t believe I ate the WHOLE thing.”
Then you know the next tactic in this mind game is that shame and guilt join the battle. Like the man in the Alka-Seltzer commercial, you feel awful; you’re bloated or your pants are too tight or you’re so full you can’t lay down to sleep.
What’s worse is that you ate so fast you didn’t even get the pleasure of tasting the food you craved. So you had to eat more and more just to prove to the voice in your head telling you to, “eat it now” that you actually ate it.
What if you …
You might actually not eat the WHOLE thing. It’s called, Mindful Eating and it really works; not immediately but over time, it will. Try eating with your eyes closed for a few minutes during a few meals and see what happens. You might find that your cravings are satisfied so you don’t, “eat the whole thing!”
If you try this exercise, let me know what happens. I’d love to hear your story.
This blog is devoted to tools, commentary and even a little humor to help you Transform Overeating.
I welcome your feedback, comments and stories.
Published in the NASW Focus Newsletter, February 2011
Obesity is a modern epidemic that cuts across class, culture, race and gender.1 The “weight battle” is so prevalent that many therapists have clients struggling with weight issues and body image but feel ill-equipped to help. International statistics reveal that the most advanced technological societies have the largest obesity problems.2 In addition, it has been reported that up to 95% of all people who lose weight gain it back within two years.3 In 2005, Kaiser Permanente conducted a study comparing three approaches for weight loss maintenance.4 Compared to groups employing Chi Gong and Cognitive Support methods, the group utilizing the Tapas Acupressure Technique® (TAT®) was the most successful. As a result NIH awarded Kaiser Permanente $2.1 million to further study the efficacy of TAT with weight loss maintenance. Results of this study are expected to be reported in February 2011.
Tapas Acupressure Technique is a self-administered mind/body approach that reduces and clears stress. It is a combination of using specific fingers to lightly touch a few acupressure points around the eyes and the back of the head while placing one’s attention on different aspects of a problem. This problem could be physical in nature like “I crave sweets right now” and/or psychological like “I feel really upset about craving sweets right now”. The result of completing the TAT process is an experience of non-attachment to the problem, including a sense of freedom and inner peace.
Based on our combined 45 years of experience in utilizing mind/body modalities with weight loss issues, trauma and stress management, our certification as TAT Professionals, and the results of the Kaiser Pilot study we developed a twelve-session group program called Weight Loss that Lasts. Our intention is to help clients replace failure with long-term success by:
At the heart of this program is the Tapas Acupressure Technique, which addresses all aspects of stress and weight related challenges participants bring to the group including: anxiety, depression, yo-yo dieting, binge eating and previous trauma. We also process emotions such as shame and grief connected to limiting beliefs, poor body image and relationship problems.
Each two-hour session is based on specific themes such as: trauma, understanding and working with parts of self, negative beliefs/patterns/behaviors, addictions and cravings, allergies and medical issues, genetic and inherited patterns, the meaning of each step in the nine-step TAT process, developing resources, and anything else that gets in the way of reaching/maintaining ideal weight. A four-hour session is held where we eat a meal together and the participants learn how to guide one another in the TAT process. Homework offers opportunities to practice TAT at least once between group sessions with a phone “buddy”, which enhances member skill development and promotes group cohesion. This is a skills based group where psychodynamic “processing”, long check-ins and discussions are discouraged, including discussions about food and diets. Each week we focus on specific problems the participants bring in related to the theme and complete a TAT group process on these problems.
Since the spring of 2008, four different groups were conducted with twenty-two of thirty-three participants completing an eighteen question pre and post-group questionnaire. After twelve weeks 17 out of 22 participants responded “not at all or a little bit” to “eating a lot of food in a short amount of time” and “eating large amounts of food when not hungry”. Sixteen participants reported that they completely stopped binge eating. In addition, “eating to soothe my feelings” was reduced by 50%.
Examples of comments taken from participants’ evaluations are:
“Sugar doesn’t talk to me anymore. I stopped binge eating through using TAT directly on the habit of binge eating and on emotions such as abandonment related to bingeing.”
– FK (lost & has kept off 34 lbs)
“This has been a terrible week with my husband’s health and our relationship but I’m completely in control about food. I’m sticking to my eating plan and losing weight.”
“I always regarded eating as a symptom rather than the problem, so my much improved eating reflects overall stress management. Everyone has noted that I look more rested and relaxed and I certainly feel it. … My blood pressure, which was medication resistant, has dropped from 155 over 110 to about 125 over 85 in two months. … I liked the sense of community although our experience and difficulties were very different.”
“I’ve lost 20 lbs and my blood sugar was in “normal range” … I feel much more confident about continuing to lose weight until I reach a healthy body mass index. I’m able to feel safe when exercising and have much better self-esteem and body image.”
“As I worked my way through various life traumas I discovered a yearning to write that was at my core. As one trauma after another cleared up I felt free to do more writing. I even dare to call myself a writer again. Something has settled in me. It feels like I’m living my true purpose.”
– LC (lost and has kept off 25 lbs)
Every participant, desperate for long term success, entered the group with chronic weight loss challenges. Though not every group member lost weight during the twelve sessions, our findings suggest that participants began to address underlying core issues. For example, a participant, disappointed that she did not lose weight, realized that she was not addressing the stresses around her husband’s illness and as a result of the group process began to do so. By the groups’ completion most participants reported reduced cravings and binge eating, diminished shame and anger, an increased ability to identify and resist triggers, improved coping skills, reduced negative impact of past trauma history and a renewed sense of purpose and hope for the future. During a reunion group, many participants reported that they continued to lose weight. Those who practiced TAT daily experienced the best results. Those who did TAT with a “Buddy” in between sessions reported feeling more connected to the group and experienced better results. Several members who continue to meet monthly with weekly “Buddy TAT Sessions” experience a high degree of success in clearing life stress and continued weight loss and maintenance. This is consistent with a study reported by Svetkey (2008) where those who had ongoing monthly personal contact had the least weight gain after 30 months.5
As we write this article we are aware of the most recent findings that by 2020 three out of four Americans will be obese.6 Our hope is that this type of Weight Loss That Lasts Program can help a significant number of people avoid this prediction.
Bariatric surgery is a popular form of weight management that gets a lot of media attention because the weight loss is hailed as fast and permanent, particularly with Roux-en-Y gastric bypass but also with the less invasive Lap Band Surgery. Its popularity is driven by three other factors, two of which are not so obvious: It can work when other weight loss attempts fail, it’s legitimized by celebrities who’ve had the procedure and it’s a financial boon for hospitals. Let’s examine the latter first.
From an administrative point of view, if weight loss surgery wasn’t profitable, hospitals wouldn’t spend their marketing budgets aggressively advertising their programs. Not long before I first started working in a surgical weight loss clinic, that hospital was the first in town to perform bariatric surgery. Having almost no local competition, it was the most lucrative department in the hospital. Now, ten years later, a Google search on “bariatric surgery, Boston,” turns up 286,000 results with seven hospitals in and around Boston on the first page of the search, all competing for a chance to help you change your life. It’s estimated that in 2020, 1/3 of the US population will be overweight. Even if only one quarter of 1% of that population wants surgery, the number of people seeking surgical weight loss will be ample reason for hospitals to invest a lot more money competing for patients.
Another reason weight loss surgery is popular is because very public people have gone very public about their surgery, lending their names and thus their endorsements. Star power makes “ordinary” people take notice. When celebrities like Carnie Wilson, Sharon Osbourne, Al Roker, Rosanne Barr, Big Boy, Randy Jackson, Tyra Banks and Star Jones publicize their before and after pictures, the striking difference seems easy; like overnight success. The problem is that these pictures don’t show the time or struggle it took to get from before to after. The pictures bypass the recovery period, making the whole process look easy. It’s not easy. It is serious. Little is mentioned in the popular media about the possible risks and potential complications; gall stones, infection, and even malnutrition if meticulous attention is not paid to a follow up diet.
I am not cynical enough to think that hospitals provide bariatric surgery only because it’s a money maker. I couldn’t have worked in a surgical weight loss clinic assessing people’s readiness for such a life altering procedure if I didn’t believe that it’s right for the right people. Those who perform bariatric surgery and support the process through nutritional and psychological counseling are dedicated professionals who believe that they are saving lives. For many people weight loss surgery is a life saver because obesity kills.
Nor do I believe that celebrities go public just to boost their careers because it’s not a news bulletin that most people want to broadcast. It takes courage to come out as an obese person who needs help even when you’re famous. To some extent we owe a big thank you to those who are willing to tell their stories. At the same time, the celebs are the best marketing tool a hospital could ask for.
Bariatric surgery is an inviting last resort in a quick fix society but it’s not a quick fix. The answer to weight loss that lasts is not in the surgery despite the number of hospitals that offer the procedure or the numbers of celebrities who tell their success stories and make it look like a trendy option. The procedure can be successful — and you can still fail to maintain your weight loss. I’ve seen this happen too many times in my clinical practice; you don’t want this to happen to you. Eating healthy, planning meals and exercise all remain an important part of self care, even more so after bariatric surgery. So before deciding to join the chorus of people singing the praises of surgical weight loss, it’s important to do your research on a life-altering procedure. Get the facts. Then ask yourself if you’ve honestly tried everything and if you’re truly willing to change your life.
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