Marie from NZ wrote to me saying: I have just read your book and putting the tools into practise and for once feel a HUGE relief around the whole issue and am very excited about the future of my weight journey.  BUT I have so many questions but topical right now is how to deal with the ‘binge’ feelings and actions that still occur esp mid-afternoon onwards – it is my danger time.  This has become MORE dangerous as I have my high sacrifice foods in the house (am a stay at home mum) for morning tea time.  I have already eaten through (in one sitting) my whole supply of cheezels for next week!!! In some ways am feeling more out of control.  Help

Thanks Marie for raising this critical issue. This is very common in the early stages as your mind is still operating on the lifelong hangover belief that you still really aren’t allowed to eat cheezels (or whatever). So when you make them available your mind thinks ‘I’ve got to make the most of this opportunity.’ This will improve over time as your mind come to see that you really can eat whatever you want. But in this transition phase of ‘food relationship recovery’ you are at risk of overeating the foods you love. The solution? Pause Points. What has no pause points? A big packet of cheezels. Surprisingly the solution is provided by the food manufacturers (you won’t hear me say that very often!)

The pack on the right is for the smail ‘variety’ packs – each with only 100 Calories (not that I want you to count calories). This is what a great pause point looks like. To start a second packet you have to go back to your cupboard, take it out and open the second packet. It’s not the work involved to do this – it’s the fact that it creates a space in which you decide if you really want more. Effective pause points include making your favourite muffins (not too big) and freezing them so you only defrost one at a time (to binge you have to really love rock hard ice-cold muffins and have good teeth!) There are all sorts of ways to make pause points – get creative. The ultimate pause point is a shop. Just buy one portion e.g. a small chocolate snack bar and take it home – make sure it gets the full savouring treatment. Ultimately, no one can stop you from overeating if you’re committed to it, but creative pause points are the way to manage the risk.

I was out to dinner with my wife recently and we had just eaten a light meal. We decided to indulge ourselves with dessert. Being food lovers, we are always interested in new delicious food experiences, so we chose a cake from the dessert cabinet  we had never seen before – A Chocolate Diana cake. Designed to be the mother of all desserts, this cake had a chocolate sponge base, a layer of chocolate mousse, a layer of cheesecake, a layer of vanilla sponge, and was topped with chocolate icing, a chocolate stick, and a blob of vanilla icing, served with cream and ice cream with a strip of chocolate sauce and caramel sauce beside it. WOW!  The cake was an uncut virgin so we knew our serve would be fresh.

With great anticipation, I mindfully tuned into my first mouthful. The texture was certainly moist and fresh, but the flavours were so bland that I could not distinguish between the cheese cake layer and the mousse layer. It just tasted like a soft, moist mouthful of choclatey stuff. But it looked so good! Surely I was mistaken? So my next mouthful included some of the caramel and chocolate sauce …. now it tasted like choclatey stuff with commercial supersweet, bottled ice-cream topping! Even the chocolate stick on top had no flavour and was obviously made from cheap compound chocolate. I had had enough. If you are going to enjoy yourself, it has to be worth the calories. My wife agreed that this cake was definitely not worth it, so we were comfortable with abandoning the mission at this point – leaving half the serve behind.

My wife observed that what she was most pleased about as we left the restaurant, was that her mind was happily commenting tha she had “saved calories”. In the past, her mind would have been berating her for “wasting food”. By repeatedly leaving a little food on her plate over the last few years (especially when noticing she was no longer hungry, or the food was not tasty) she had finally retrained her brain to undo those childhood scripts of eating everything on her plate. So now the customary guilt was being replaced by self-congratulation – way cool!

For a long time I have been uncomfortable with goals and all the rah rah around trying to achieve them. To be specific the problem is the timeframe. This means that when people don’t achieve goals in their often arbitrarily allotted timframe they become demoralised and give up.  I heard one righteous presenter argue the dogma that ‘a goal is a dream with deadline’. What a great way to kill a dream!! So often, in both my life and others, I have seen dreams arrive long after they were hoped for, and it was the very lack of a deadline that kept them alive long enough to allow their delivery.

And then my daughter and wife have clarified for us all an entirely different problem with goals. I don’t think I can explain it any better than my daughter has on her blog. We teach best what we are grappling with ourselves! Have a read by clicking here

Many people put on weight as a defense against intimacy arising from past hurts. Their fat becomes a buffer, a shield to keep the opposite sex at a distance. But the truth is that it doesn’t work quite how we might think. In reality there are lots of men out there who are attracted to big women (and vice versa). Unfortunately for those using this strategy, people are often attracted to what’s below the surface – beauty is not skin deep … dammit!! So if getting fat does not keep people away, how do we get it to work?

One of my patients today spoke with great self-honesty about her response to our work in trying to help her with relationships. I’ve been suggesting that she put herself out there to meet men for some time (we needed some material to work with in therapy!) Finally, she announced, that after considering a range of options, she was going to join RSVP. But … she had realised that since making this decision (but not yet signing up) she was eating more and had gained 5kgs i.e. about a dress size.

“Now I can’t fit into any of my fashionable clothes. So I guess I’m not going anywhere until I lose this weight.”

By putting on weight so we are too big to leave the house to socialise – for whatever rationalisation – we achieve the end result of avoiding the risk of potential intimacy. I never cease to be fascinated by the endlessly creative spirit of the human state!

PS In the end she agreed that she had to get out there irrespective of her weight … we’ll see.

An issue that often gets overlooked when trying to lose weight is portion control. If you are eating well and not losing weight the next thing to look at is portion size. All too often we mindlessly eat more than we need to feel satisfied. By mindfully savouring our food we will find that smaller portions are as satisfying as larger ones – this is the key to  successful and sustainable weight loss.  But what is the correct portion size? Fortunately, in Australia we have an absolute expert in this field. I have known and worked with Amanda Clark, a superb dietitian, for some years now and am thoroughly impressed by her very practical approach to this problem.

Her brilliant book, Portion Perfection, shows you exactly the right amount to eat if you want to lose or maintain weight. The book includes everyday and occasional foods (including the high sacrifice foods you don’t want to live without) and spells out just how much to eat for everyone over the age of 5 years. It has hundreds of pictures showing popular Australian packaged foods, including almost every brand of yoghurt, cereal and muesli bar available in Australia, as well as common take-away foods. There’s also a Portion Perfection plate and bowl to make sure you serve up the right amount. All the Portion Perfection products are available at www.greatideas.net.au along with all the healthy cookbooks and resources recommended by Australian Dietitians.

At a recent workshop I was talking about ‘other-sabotage’. This is when a partner does things like starting to buy chocolates and taking their ‘loved one’ out to their favourite restaurant as their weight starts to fall. This lead me to talk about my working definition of love. As a relationship therapist one needs a clear way of understanding love, or else relationships (and life) get very confusing. When people finish a sentence about an abusive parent or partner with ‘… but I know he/she loved me in their own way’ they end up very confused as they hang onto a dream that maybe one day…   True love is not hard to recognise when you apply this definition that I modified from Scott Peck:

True love is a commitment to nurturing personal growth – in both you and the other.

Love is not a feeling – it is a commitment. When we are putting our irritable (and irritating) tired, grumpy child to bed without responding to their annoying behaviour, the dominant feeling is not a loving feeling – but the action is loving. If we see love as a feeling, all long-term relationships must become loveless eventually, for longer periods, as the ‘novelty’ wears off – but not so when you see it as a commitment to nurturing personal growth.  And then, to nurture another’s personal growth requires deep empathy for where they are at and what they need at that point in their life to grow into better people.

If  you only nuture the growth of others and not your own, you clearly don’t love yourself. This will limit how much you can love others by limiting how much they can love you. You will sabotage the relationship once someone loves you more than you do. Equally, our children need to see us take time to meet our own needs, otherwise they will grow up thinking they are only ‘good’ if they are looking after others.

If someone is sabotaging your weight loss, or stopping you from educating yourself, or getting therapy, or maintaining your friendships – it’s not love you’re looking at, it’s the opposite …

It was Laura Lovett who described The Popeye Principle in her detailed paper published in 2005 on the First Nutrition Crisis.* In the 1920′s, following the Great War it was not obesity that was a problem in the USA, it was malnutrition. Created by Elzie Segar, Popeye debuted on 17 January 1929 in the comic strip Thimble Theatre. In 1933, Max and Dave Fleischer adapted the characters of Popeye, his sweetheart Olive Oyl, their foundling adoptive child Sweet Pea and his arch enemy Bruto,  into a series of Popeye the Sailor cartoons for Paramount Pictures. The cartoons were such a success that they ran until 1957 while the comic strip is still rerun today, 80 years later.

Other than being the star of an iconic cartoon series, a movie (played by Robin Williams), video games and hundreds of advertisements, why is Popeye of such interest? Popeye single-handedly (admittedly he does have ferocious forearm muscles!) made spinach the third most popular food in the USA after turkey and ice cream!! And it was not spinach lightly sautéed in butter and garlic and served with a juicy eye fillet, that he made so popular – it was canned spinach!!! All this with the 1930′s technology of an animated cartoon. Imagine what a clever advertising company could do now (and of course  they do do now) with the post-George-Lucas-era wizardry of 21st century technology!

*Published in the Journal of Health Politics, Policy and Law, Vol 30 No. 5.

Thanks to Dr David Rimmer who broke us all up at my Brisbane workshop with this wonderful example of how creative the unconscious mind can be as it rules our conscious mind and our life. I was talking about how powerful the unconscious can be in getting us to avoid things that threaten it in some way … how we never forget to pick up lotto winnings, but we do forget root canal appointments; how we can ‘forget’ that we have Type 2 Diabetes when our favourite dessert is in front of us etc.

Procrasticleaning is when we suddenly find ourselves cleaning the house, the desk, the car, instead of doing something we would rather avoid!

Eye Movement Desensitisation & Reprocessing (EMDR) has come a long way since I was first trained in it in 1993. Many who did not understand it thought it was just hypnosis or a passing fad. Those of us who practised it thought it was amazing. A few years later, I decided to specialise in trauma therapy because it was so good to have a treatment that actually cured many people! Such a rare outcome in psychiatry! Not to mention that it would often work in just a few treatment sessions (after detailed assessment sessions). People who had had nightmares and intrusive memories for years would come back saying things like, ‘What did you do to me?! I can’t recall it now even if I try.’

These days I’m often using EMDR to treat overweight people who unconsciously  use their weight as a way of protecting themselves from potential abusers. Grilo et al* found that 69% of people awaiting bariatric surgery (e.g. gastric banding) had a history of childhood abuse.

I tend to forget that most of my colleagues see PTSD as a largelly untreatable condition and just prescribe medications and offer their sympathies. Worse still, they may get people to talk about the trauma, which, the research shows, will aggravate their condition. This is a tragedy for sufferers who find themselves in front of an uninformed professional.

Because it was the new kid on the block, EMDR worked hard to justify itself scientifically. Now it is recognised around the world as one of only two (maybe three) effective treatments for PTSD. Here in Australia in 2007, the  Federal Goverment joined the rest of the world in only recognising EMDR and CBT as effective treatments for PTSD. Click here to download information booklet from the Australian Centre for Posttraumatic Mental Health -  ACPMH Guide for People with PTSD. On pages 14 and 17 you will see that it only recommends CBT and EMDR as other treatments have either not been adequately tested or are less effective.

I first started treating PTSD in 1984 and until EMDR came along I used CBT and imaginal flooding. It does work – but the big difference is that EMDR works more quickly with less drop-out because the uncomfortable phase ends sooner. This work can be quite gruelling for patients. The following document looks at some of the research showing that, of the two, EMDR is generally found to work more quickly, which is a big issue for (paying) sufferers: EMDR Efficacy

*Grilo et al – click here to go my research page that includes this paper (bottom of page)

Not so long ago I shared a podium with the legendary AFL player, captain and coach Leigh Matthews. He told the amusing story of how they had a sports psychologist profile each of his team’s players into categories like ‘Thinker’, ‘Feeler’ (I wouldn’t have thought there would be much room for these guys on a football field!), ‘Enforcer’ (sounds more like it) and ‘Mozzie’ (these guys buzz around with their ADHD, bothering the hell out of the other team).

The psychologist was explaining to Leigh how, for example, you give the Thinkers the game plan the night before to ponder it, whereas the Mozzies you don’t tell until just before they go on because they have the memory span of a … well, you get the idea. Then Leigh, getting a bit irritable with all the psychobabble, asks the psychologist, ‘Just tell me which types respond best to me criticising and yelling at them?!’

The psychologist was a little tentative in front of the great man. ‘Aah … sorry sir. No personality type responds well to being criticised or yelled at. In fact, to bring the best out in people they need to feel good about themselves. Yelling at someone never achieves that.’

Leigh was more than a little disappointed. But, he went on to say that it has become clear to him that it is a total myth that people stay on their toes if you are critical, if you don’t reassure them, don’t let them know when they do something well. Specific recognition (rather than general positive comments) improves performance and brings out the best in people.

Partners, who would never consider yelling at a work colleague, somehow think it’s ok to yell at each other. Then they complain about their relationship/partner not meeting their needs. People who don’t like their overweight body often spend a lot of time putting themselves down, yelling at themselves in their mind, hating their body. We all need to remember to focus on parts of partners (and parts of our bodies) that we can appreciate – from this place real change for the better can occur.

The only problem was that I did not authorise it and have no agreement with them!  Amazon appear to be on the case though. The silver lining, was the great review it had received. A New Yorker loses 32 lbs (14.5kg) just from reading my book! Here’s the full review:

Most Helpful Customer Reviews

The relationship between dietary restraint and failure to lose weight pivots around the issue of ‘rigid’ as opposed to ‘flexible’ control of eating. If you want to understand why around 90% of people can’t stick to diets the answer lies in people restricting what they eat too much – the so-called ‘restrained eater’. Not all restraint is problematic, no restraint at all is how we gained weight in the first place! No, there is a particular kind of restraint that expalins why most weight loss plans fail. Don’t believe me, here the words from the world experts on the subject:

“… there is no relationship between dietary restraint per se and disinhibited or disordered eating patterns. Rather, this relationship depends on the predominant type of restrained eating. If eating behavior is primarily rigidly controlled, this pattern of restraint is associated with more disturbed eating patterns, for example, binge eating. In the long run, this type of restraint is not helpful in weight reduction or weight maintenance. If the restrained eating behavior is more flexibly controlled, then this type of restraint is associated with less disturbed eating behavior, lower body weight, and more successful weight reduction and maintenance.”*

Rigid control is all about attempting to totally avoid sweets or other favourite foods while trying to lose weight. It’s about having inflexible rules and prohibitions. It’s about creating a state of deprivation and craving for loved foods that slowly, but very surely, begins the process of self-sabotage that will bring the diet undone. This is how our mind responds to dietary deprivation. You can be as sure of this as you are about the sun rising tomorrow. So what is ‘flexible restraint’? Well, there’s a great book on exactly that issue …

*I have added the italics. From: Joachim Westenhoefer & Albert J. Stunkard et al, Validation of the Flexible and Rigid Control Dimensions of Dietary Restraint International, Journal of Eating Disorders, 1999 Vol 26 (p 53-64).

In resarching the kids book on healthy eating habits that my wife and I are writing, I have come across some fascinating research. For example, Dr Brian Wansink’s research found a typical veggie lover either:

• was a good cook
• lived with a good cook
• or had a parent who was a good cook

I can tell you, from a psychotherapists point of view, that to fall in the first or second categories, you usually needed to have come from the third. His team went on to research 317 ‘good cooks’ (at least one other person had to agree with the person!) to find out what they were doing so right. They identified five different kinds of cooks:

• Giving cooks
• Competitive cooks
• Healthy cooks
• Methodical cooks
• Innovative cooks

All cooks but one, promoted the health of their family. Which one? The Giving cooks – unfortunately the most common type – these are the makers of comfort food! Unconsciously, they know that by giving rich, fattening foods, at one level, they are giving pleasure – if only it didn’t send us to an early grave. Unwittingly, these culinary experts used their skill for evil instead of good (ok, that’s overstating it George!) to make energy-dense, high carb foods such as baked cakes, brownies and other sweet foods for desserts. And what did the other four types do that promoted the health of their families? They used their cooking to increase the variety of foods that those around them ate. Like any great chef, they were much more interested in fresh, wholesome foods as central to this variety.

Wansink gives us five strategies for increasing the variety in kids meals:

1. Buying a greater range of foods for the family home
2. Trying new recipes (including ethnic ones)
3. Substituting different, healthier ingredients (veggies and spices) into favourite recipes
4. Taking kids to the grocery store and letting them choose a new, healthy food (something my brilliant Psychologist wife worked out 15 years ago when this research was not yet a light bulb in the researcher’s thought bubble!)
5. Visiting a range of authentic ethnic restaurants (kids are more likely to try new foods on a ‘special’ night out with a bit of healthy peer group pressure!)

Food for thought (sorry!) for any parent!

I have just read a fascinating article by Rothman* looking at how we have a very different kind of motivation for starting to lose weight compared to keeping it off. When we start out, it’s all about our expectation of looking and feeling better (as per Expectancy Theory) and how well we believe we can deal with the challenges we will face (Self-Efficacy Theory).  However, once we have lost weight it is then all about how satisfied we feel with our new weight and how it compares to what we might slip back to.

Learning from the Smokers!
Compared with people wanting to lose weight, smokers are less likely to attempt to give up because they can’t get excited about giving up the smokes like an overweight person can get excited about being slim and gorgeous. As a non-smoker they expect to be less sexy, less Humphrey Bogart! But six months out, the now non-smokers fight back and start to do better than the weight losers who are starting to regain! The daily challenge for the smokers is now much less as they are over the hump and non-smoking has become a habit! Their enjoying not coughing their lungs up each morning and being able to walk to the kitchen without needing oxygen masks to drop down from the ceiling!

Meanwhile, if the weight losers are dieting and feeling deprived they’re now struggling bigtime – life how it was, eating as much cake or pizza as they wanted, looks better, not worse than the daily struggle of trying to keep the weight off.  Then if there are no habits around how to eat the fattening foods they love in a healthy way – weight regain is inevitable.

Rothman points out that “The greater likelihood of long-term success among smokers may reflect, in part, their more modest expectations about what it would be like to be nonsmokers.

So, this means we need to be very careful about how much we expect our life to be better once we lose weight. One of my patients recalled very clearly how he did not turn out to be ‘rich, oversexed and happy’ when he lost 25kg – and then put it all back on! Secondly, by even three months out, we need to be in habits that allow us to eat the foods we love (there’s a really good book on this subject …) and automatically avoid the fattening foods we don’t love.

*Rothman AJ “Toward  a theory-based analysis of behavioral maintenance” Health Psychology 2000

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People who attend my workshops have heard me rant that educating people about how to be healthier through exercise and what to eat is, largely, a waste of time. It’s not just my idea Professor Philip James, as the Chair of the International Obesity Task Force said:

“It’s been shown in a whole series of systematic analyses that telling people they should exercise more and eat less and this type of health education … the evidence – systematically refuted by independent scientists – shows it’s a pretty useless way of approaching the problem.”

But we have been brought up in a world that values education so much that it is hard to let go of this idea. Why? In simple terms it’s because education – telling people what they should know/think/do is easy (and makes us feel oh so clever and … educated!) – life gets a whole lot more complex the moment we have to look at why people don’t do what they know they should. Few people are trained in the psychology of this complexity.

So it was with interest that I read this paper by Kumanyika et al called “Maintenance of dietary behavior change” (Health Psychology 2000). On reviewing this area in detail they conclude that:

“Overall, these data give the impression that qualitative dietary changes, once learned, are more likely to be maintained than the reduced calorie intake that might be needed to maintain a lower weight. However, the level of difficulty involved [e.g. working out which processed foods are high in salt] in making such changes, may deter individuals who are not highly motivated.”

So, education will change what people eat, but this does not translate to decreasing caloric intake! And then when it gets hard, it will depend on motivation as to what changes. In short caloric intake is about motivation, not education.

For those professionals who will be attending my workshop here is your pre-reading material. These are seminal papers in the psychology of weight loss field.

1) Westenhoefer, Behavioural Correlates of weight loss maintenance – This comes from the Lean Habits Study which is one of the rare, long term studies that looks at what counts when it comes to losing weight and keeping it off. The  key finding for me was that ‘flexible control’ – as opposed to ‘rigid control’ – correlated with weight loss maintenance at three years, whereas ‘rigid control’ did not. Rigid control ‘includes attempts to totally avoid sweets or other favourite foods’ while trying to lose weight. In many ways, my work is all about clinically operationalising ‘flexible control’.

2) Eat, drink and be merry for tomorrow we Diet – This classic paper is all about Restraint Theory and how it applies to the ‘Last Supper Effect’.

OPTIONAL READING

3) Kumanyika, Maintenance of dietary change – this paper concludes that education will change what people eat, but this does not translate to decreasing caloric intake! And then when it gets hard to work out (e.g. how much salt or fat there is in processed foods) it will depend on motivation as to what changes. In short managing our weigth is about motivation, not education.

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