For people with this problem we need to come up with ‘non-caloric’ ways to treat ourselves when this script kicks in. A patient of mine and I recently came up with this list –  a great starting point for anyone who has this problem. The trick is to print it off and keep it in your purse/wallet and refer to it as needed – the human mind has a strange habit of getting us to forget these strategies at the critical points when they are most needed. Here are some thoughts – as you can see they vary from what can be done at home in a few minutes (the time it takes to prepare and eat a bowl of ice cream) to larger rewards:

• Buy your favourite trashy magazine and then read a few pages
• Buy some luscious teas from the tea speciality shop and enjoy a cup
• Buy yourself a bunch of flowers from supermarket
• Paint nails or toenails (guys are generally less keen on this one)
• Go to movies
• Call a friend (very powerful if loneliness is the emotional driver)
• Shop for costume jewellery and other inexpensive stuff
• Watch favourite recorded TV show
• Internet surfing for fun (great way to allow cravings to pass)

Everyone needs their own, personalised list, so if this is an issue for you (or the people you work with) get writing!

I don’t know how many people I have worked with on their weight management over the years – it’s been a lot – and then I have trained and supervised hundreds of other therapists with their more challenging patients. What I have come to see is that the vast majority of people who struggle with their weight are unhappy at some level. They are not necessarily clinically depressed, but they are unhappy.

Food is the self-medication. It promises that ‘being-cuddled-in-your-mother’s-arms-as-you’re-being-fed’ primal, soothing experience. It is the same for my patients who drink too much or use recreational drugs. Others are looking for more love (which often reads as ‘sex’). People make the understandable mistake of thinking that having pleasure, in any of these forms, will make them happier, will sooth their troubled soul. The paradox is that trying to make ourselves happier through pleasure will, in the long run, actually add to our unhappiness. Pleasure is fine along they way, but it does not work as a strategy to be happier. Eating to self-sooth causes most of my patients to feel guilty, angry at themselves and more unhappy.

Paradise Lost, Inadequacy found
Modern life can be tough – technology and greater opportunity creates frustration, confusion and a greater sense of not being good enough, a greater sense of missing out. I remember visiting an idyllic tribal village in Fiji ten years ago where they had just gotten TV. The schoolteacher on this gorgeous island was lamenting how these kids, who previously thought they lived in paradise and had all they wanted, now thought otherwise. Television showed them everything else that they could have, that they did not, and their paradise suddenly fell way short. They started to find that their life as they knew it, was no longer enough, it was inadequate, they were inadequate.

I don’t think turning back the clock is the answer. I’m not convinced life was better a hundred and fifty years ago, or even fifty years ago. Back then, life was simpler, there may have been a greater sense of community and your extended family may have lived nearby. If a parent, or grandparent, was abusing you, however, the legal system was largely unable to stop this and it went unchecked – and the abuser knew this. Thankfully it is not so today where abusers can be punished twenty years, or more, later. And for half the population back then – women – opportunities to be who you could be, who you wanted to be, were very limited.

In working with people  who have been deeply traumatised, as well as the obese, I have only found two things that really sooth unhappy souls – truly loving relationships and having a sense of meaning in life. Amongst the demands, the incessant consumerism and rush of the modern world, life will be meaningless unless we make it meaningful. Meaning, in turn, informs our purpose in life. Lots of things will make us unhappy, how quickly we bounce back will depend on the meaning and sense of purpose that we have in our life. Nothing else, not even loving relationships, has the power to heal major trauma experiences.

For those of you less inclined to read a 300+ page book, in upcoming posts I will walk you thru some of the key principles that have come out of my research, clinical work and writings on how to find meaning and purpose in our lives. This is what I have found to be the most powerful treatment for having too much food, alcohol, drugs or sex in our lives.

PS I would love to hear comments from you about this and other recent posts – to comment, just click on the title of this post and this will open the ‘Reply’ box under the article.

Beware the seduction of the new, exciting and fascinating

There are several reasons why we don’t finish things we start. As I wrote about in Food Lovers, sometimes it’s failure fear, sometimes it’s success stress. For me it was seduction. Let me explain. Last year while on holidays I started writing a book about how to choose a healthy partner. I was several chapters into it when I realised I was at risk of making another contribution to Unfinished-Idea Heaven. You see, four years ago I started writing another book, a sequel of sorts to Food Lovers, although very different in many ways. I had finished writing it and was in the laborious rewriting and editing phase. This is the most tedious part of book writing, unable to compete with the alluring seduction of researching, writing and falling in love with a fresh, exciting and fascinating new book. In relationship therapy I often see people make the mistake of comparing a fresh, exciting new partner with the too well known, no-longer-exciting one that they have spent the last few years with. You can guess who usually wins. A few years on the exciting new partner is looking a lot like the last one … sometimes worse!

The danger is that we can give up on equally valid, or even more valid, ideas and projects as the shiny new ones grab our attention. To combat this temptress I made a deal with myself that I would not write anything else – blog articles included – until I sent the book off for publication. This happened just last week. So over the coming weeks you can expect to see me bothering your Inbox as I catch up on a pile of articles that came to me while finishing off this last book. Oh … by the way – wishing you all a belated healthy, happy and prosperous 2012.

A recognised problem with the Body Mass Index, is that it simply measures our weight relative to our height. It does not allow for muscle. The site goes on to cite a research letter published in JAMA (the journal of the respected American Medical Association) that reported that 97% of players in the National Football League are technically overweight and more than 50% are obese. Celebrities who suddenly found themselves overweight included Will Smith and Pierce Brosnan, while Arnold Schwarzenegger, Sylvester Stallone and Mel Gibson immediately became obese. Tom ‘the sexiest man alive’ Cruise woke up to find himself  obese as a result of his height deficiency against his broad-shouldered, muscled body.

The site reports that the 1998 redefinition prompted a group of researchers to criticize the new threshold in The American Journal of Public Health. They wrote:

“Current interpretations of the revised guidelines stigmatize too many people as overweight, fail to account for sex, race/ethnicity, age, and other differences; and ignore the serious health risks associated with low weight and efforts to maintain an unrealistically lean body mass … This seeming rush to lower the standard for overweight to such a level that 55% of American adults find themselves being declared overweight or obese raises serious concerns.”

This seems to me to be eminently relevant. The last thing people need is another reason to feel bad about themselves – the media already does a great job of this! My biggest concern is that it creates a focus on the need to lose weight when the research shows that we are better off being overweight and fit rather than slim and unfit. The site also looks at the research behind well propagated ‘research findings’ that being overweight dramatically shortens our life span. It finds that the research behind these statements is not as solid as people think. While I do not accept all the points on this site, it does prompt us all to raise our level of critical discernment when confronted with the ‘science’ around obesity.

It is an interesting approach that is designed to mimic the effects of gastric bypass surgery without the risks of surgery. It looks like a clear plastic sock, open at both ends (see image). It is inserted into the top part of the small intestine just after the stomach. The barrier is placed endoscopically, via the mouth, with imaging assistance so that the doctor can position it precisely. The device works by simply stopping food from making contact with the lining of the small intestine where so much absorption takes place: the duodenum and jejunum. As the food exits the device, absorption begins so some food is digested through the rest of the small intestine.

As is often the case, with less risk, there is slightly less power when compared with surgery, in bringing about weight loss. The Endobarrier brings about 19% average excess weight loss (compared to around 50% for banding and other forms of surgery) and is more geared towards improving diabetes.  Most of the diabetic patients in the clinical trials have shown improvement in the disease.

My primary concern with gastric banding is that it ‘trains people up’ to eat a poorer diet as the foods that most readily pass through the band are processed foods e.g. ice cream, chocolate, milkshakes, mashed potato and baked goods like biscuits. Moreover, vegetables and lean protein can be a problem with a band. Bypass surgery allows people to continue to eat healthy foods without this ‘training up’, but surgical risks are greater.

The Endobarrier has received approval in Europe and is commercially available in Chile, Germany, the United Kingdom and the Netherlands. Further trials are beginning to gain approval in the USA. Trials to date have included 500 people and I will be watching with interest our local experience here in Australia. For more information go to the manufacturer’s website: www.gidynamics.com

Our drive to respond quickly in making important decisions is not a problem if we’re choosing a movie, big problem if we’re choosing a car, a house, a career … or a partner. From a weight management perspective you would be surprised how much less you eat if you slow down your decision making when it comes to choosing what to put in your mouth next. You see all of these choices are initially driven by emotions around these needs for closure, comfort, or not to feel a fool, or to keep up with the Joneses. Over time, the emotions will be replaced by rationality as our higher self  is given the space to do what it does.

In certain situations, one has to make lightning fast decisions. The following comes from a pre-flight briefing from a Canadian Starfighter F104 instructor (thanks to Noel Whittaker the financial guru who sourced this lovely quote). These jet fighters were the first combat aircraft capable of sustained Mach 2 flight – yes, that is twice the speed of sound – and at full noise, it could go quite a bit faster again! NASA later used them for spaceflight training. So things happen very quickly in these machines and they did not have a great safety rating. Indeed, the Canadians’ nickname for it was the ‘Widowmaker’. Accordingly, the briefing by the trainer to trainee co-pilots went like this:

‘If you hear me yell, “Eject! Eject! Eject!” the last two will be echoes.

If you stop to ask “Why?” you’ll be talking to yourself, because by then you’ll be the pilot.’

Fortunately, we can generally make decisions more slowly in life. I would suggest that as a rather obvious guideline, the more important the decision, the more time should be put aside to make it. So a movie, several minutes; a car several weeks and a partner several months – and then a couple of years more before embarking on the complete lock-in – having children!

When I have to make an important decision, my first response is a question: When is the deadline? I then put some thought/research into the question early on and let my unconscious mind turn it over and then I revisit it leading up to the point at which I must decide – sometimes, if it’s important, I will ask for an extension. In this way we allow our higher self to dominate over our ‘intuition’ and ‘gut feelings’ that can often be driven by these powerful emotional forces that have nothing to do with making a good decision. This is the art of the ‘slowfull decision’.

I have been on the Tony Ferguson meal replacement diet, and it has worked well. It has a Progress phase where you add in normal meals and snacks with some MR. This has been great in learning about food, carbohydrates in particular. It also encourages mindfulness, and after shakes for a while, every mouthful of normal food is a taste sensation and I certainly enjoy it.

What Cindy did not know is that I did some consulting to Tony Ferguson (TF) and actually developed their Progress program. I was very impressed by their preparedness to embrace the principles of the psychological research that I cover in my book. To clarify a couple of points, right from the start the TF program encourages having at least one healthy meal a day made up of lean protein and salad or vegetables. In the Progress phase, this is increased to two meals on some days as we gradually rebuild our relationship with food. This is the phase where we also add back in the more fattening foods that people love like chocolate and cheese. The trick is to learn to eat these foods on your terms, where you control them rather than them controlling you! The reason why diets fail is because people a) feel deprived of these foods and b) when they sneak back into the person’s diet, they go back to their old ways of overeating – having  not learnt to eat them mindfully as Cindy reminds us.

Which brings me to an interesting question I was asked recently. The question was essentially: If you want people to develop a healthy eating lifestyle, would not having a chocolate meal replacement (shake or munch bar) for lunch go against this principle? Would it not make people less inclined to eat a healthy, balanced lunch? Don’t you train them up to eat poorly? In the decade plus that I have been working in this space with hundreds of people this has never been a problem. But that is only a part answer to the question. The real question is: Why is it that people don’t find it more difficult to eat healthy meals after a period on meal replacements (MRs)? This is for two reasons.

First, we can cope with deprivation of calories and an eating experience, if we are not also having deprivation of taste/emotional satisfaction. This is why the flavours of MRs are chocolate and coffee and not broccoli and rolled oats. This is why MRs have a role and are the next best weight loss strategy (see my recent post on MRs) after trying to eat a healthy diet to lose weight has failed. This is also why shakes are not enough for some people and they need an energy controlled munch bar to give them a chewing experience. In essence, we can’t feel too deprived – whether it be of chewing or flavour – or else it all becomes too hard and the weight loss program is abandoned.

As Cindy has highlighted “after shakes for a while, every mouthful of normal food is a taste sensation and I certainly enjoy it.” Once we can increase the eating experience, we can afford to decrease the taste experience. Whether it is a shake or a munch bar, they do not come close to replicating the range of flavours, tastes and chewing experiences of real, healthy food. Moreover, through the process of psychological ‘habituation’ these MRs, no matter how intense the flavour, become boring if eaten repeatedly. The human mind becomes hungry for new taste experiences.

Second, even when people have lost weight, I encourage them to continue using MRs in two situations – when they are going to skip a meal anyway or when they need the convenience of ‘fast food’. Nothing is quicker, or more convenient (or cheaper) than grabbing a munch bar or adding water to a shake. And when people are at risk of grabbing a burger with fries, or some fried chicken,  or a or candy/chocolate bar, a balanced MR, while not as good as a healthy meal, is a better choice. I find that people who struggle with their weight, even after they have lost it, need to keep using MRs (as indeed I do) to keep their weight off. So for these reasons, while it sounds like a concern, in clinical reality, it’s not a problem at all.

As I said in my post on the treatment pyramid, when people have tried to lose weight by just eating a healthy diet, MRs are the next best thing – further up the treatment pyramid, things get much more problematic.

A couple of key points to note. The most effective form of weight loss and the inevitable one if all those below it fail, is premature death! As you can also see from the pyramid, working on an understanding of the psychological issues that lead to sabotage sits over every intervention.

In the first instance, of course, as any good dietitian will tell you, we should try to manage our weight by eating in a healthy way.  But the question is what to do when this fails? This is when we start to move up the hierarchy – hence my interest in the next level up of MRs because after this level things get more problematic.Everything we can do sits in this pyramid – there ain’t no more! (You will notice that, despite the hopes of many people when they walk into my consulting rooms, magic wand waiving did not make it onto this list.)

For many years now the medical profession has been using MRs when the morbidly obese need to lose weight more quickly, for example, when they are under the more immediate threat of obesity related complications like hypertension and heart failure. In recent years, I have noticed more and more research studies are using MRs as a way to bring about weight loss initially.

The reason for this is that to achieve weight loss we must compete with the convenience of fast food and the even greater ‘convenience’ of skipping meals altogether. This is why, as I need to watch my weight, I still have a MR for lunch when I’m in my rooms. It’s even quicker and more convenient than sending out for a toasted sandwich, not to mention cheaper! And then I know I’m having something that has fewer calories and is not badly nutritionally balanced. I can bang it down in under a minute! As you might guess my lunch break is a misnomer – it’s not about lunch, it’s 50 minutes in the day that I don’t have back to back patients and is about returning emails, phone calls and dealing with other problems my secretaries have carefully and diligently accumulated throughout the morning .

The art is now in the transitioning of people from MRs onto to a healthy eating lifestyle and a new relationship with food. How best to do this has been a key area of interest to me for some time now.  As an aside, you will note the line referring to ‘devices’. In a later blog I will let you know of  an intriguing development of a new device that does not require surgery that has been shown to be effective in weight loss.

It is worth being reminded of the 10 Rules even though you will probably have seen them. The only one I could not leave alone was Rule Nine. Whenever this principle is spoken about I am compelled to qualify it as sometimes an inner voice can get us into trouble or hold us back.

Here they are:

Rules for Being Human

Rule One – You will receive a body. Whether you love it or hate it, it’s yours for life, so accept it. What counts is what’s inside.

Rule Two – You will be presented with lessons. Life is a constant learning experience, which every day provides opportunities for you to learn more. These lessons are specific to you, and learning them ‘is the key to discovering and fulfilling the meaning and relevance of your own life’.

Rule Three – There are no mistakes, only lessons. Your development towards wisdom is a process of experimentation, trial and error, so it’s inevitable things will not always go to plan or turn out how you’d want. Compassion is the remedy for harsh judgement – of ourselves and others. Forgiveness is not only divine – it’s also ‘the act of erasing an emotional debt’. Behaving ethically, with integrity, and with humour – especially the ability to laugh at yourself and your own mishaps – are central to the perspective that ‘mistakes’ are simply lessons we must learn.

Rule Four – The lesson is repeated until learned. Lessons repeat until learned. What manifest as problems and challenges, irritations and frustrations are more lessons – they will repeat until you see them as such and learn from them. Your own awareness and your ability to change are requisites of executing this rule. Also fundamental is the acceptance that you are not a victim of fate or circumstance – ‘causality’ must be acknowledged; that is to say: things happen to you because of how you are and what you do. To blame anyone or anything else for your misfortunes is an escape and a denial; you yourself are responsible for you, and what happens to you. Patience is required – change doesn’t happen overnight, so give change time to happen.

Rule Five – Learning does not end. While you are alive there are always lessons to be learned. Surrender to the ‘rhythm of life’, don’t struggle against it. Commit to the process of constant learning and change – be humble enough to always acknowledge your own weaknesses, and be flexible enough to adapt from what you may be accustomed to, because rigidity will deny you the freedom of new possibilities.

Rule Six – “There” is no better than “here”. The other side of the hill may be greener than your own, but being there is not the key to endless happiness. Be grateful for and enjoy what you have, and where you are on your journey. Appreciate the abundance of what’s good in your life, rather than measure and amass things that do not actually lead to happiness. Living in the present helps you attain peace.

Rule Seven – Others are only mirrors of you. You love or hate something about another person according to what you love or hate about yourself. Be tolerant; accept others as they are, and strive for clarity of self-awareness; strive to truly understand and have an objective perception of your own self, your thoughts and feelings. Negative experiences are opportunities to heal the wounds that you carry. Support others, and by doing so you support yourself. Where you are unable to support others, it is a sign that you are not adequately attending to your own needs.

Rule Eight – What you make of your life is up to you. You have all the tools and resources you need. What you do with them is up to you. Take responsibility for yourself. Learn to let go when you cannot change things. Don’t get angry about things – bitter memories clutter your mind. Courage resides in all of us – use it when you need to do what’s right for you. We all possess a strong natural power and adventurous spirit, which you should draw on to embrace what lies ahead.

Rule Nine - Your answers lie inside of you. Trust your instincts and your innermost feelings, whether you hear them as a little voice or a flash of inspiration. Listen to feelings as well as sounds. Look, listen, and trust. Draw on your natural inspiration. (Over time you can tell the difference between this higher self and your inner frightened critic – your inner critic, is nearly always a child part of you that is frightened of usually both failure and success –GBW)

Rule Ten - You will forget all this at birth. We are all born with all of these capabilities – our early experiences lead us into a physical world, away from our spiritual selves, so that we become doubtful, cynical and lacking belief and confidence. The ten Rules are not commandments, they are universal truths that apply to us all. When you lose your way, call upon them. Have faith in the strength of your spirit. Aspire to be wise – increasing wisdom is the ultimate path of your life, and it knows no limits other than those you impose on yourself.

Now to be honest, I’m sure there’s a difference between the two sports but be blowed if I have a clue what it is. My nephew chimed in with ‘Rugby is not life and death, it is more important than that.’ So, feeling out of my depth, I went to safer ground and asked if they had seen the movie Invictus. For those of you who haven’t seen it, it is about Nelson Mandela’s first days in office as the President of South Africa and how he brilliantly uses the Springboks rugby team to reconcile the races and their tinderbox tensions. Matt Damon plays the captain of the team while Morgan Freeman does a magnificent job as Mandela. I was more than happy to watch the movie again, because it is not about rugby, it is about inspirational leadership and Mandela’s amazing capacity for forgiveness. Having read his autobiography, I, like the rest of the world, have a deep admiration for this unusual human. So the next day, as we had ten of us at our place watching the film for the second time, I noticed things that were not so evident to me the first time round.

A couple of times Mandela referred to the poem that saw him through his 27 years in prison. Afterwards, I found myself returning to the last lines of the poem, ‘… I am the master of my fate, the captain of my soul.’ A message I am repeatedly trying to deliver in psychotherapy. I wondered what the poem might have been called so I could hunt it down. Strangely enough, my guess that it was called ‘Invictus’ turned out to be correct! Yes, sometimes I’m a bit slow (as my 17 year-old son is never too slow to point out – so Jack, I thought I would get in first!)

Invictus, Latin for ‘unconquered’, was written by William Ernest Henley when he was just 26 years old. At the age of 12, Henley fell victim to tuberculosis of the bone. A few years later, the disease progressed to his foot. To save his life it was amputated directly below the knee when he was 17. The year was 1865. Dr John Snow, the inventor of anaesthetics, had used the new procedure with Queen Victoria for the birth of the last two of her nine children only a few years earlier. It is unlikely Henley would have been given one for a relatively simple procedure like an amputation. Mind you, a lack of anaesthetic would have been the least of his problems as he tried to make his way in life back then with the legacy of a childhood of severe illness and only one foot. The words of this poem drip with conviction and a faith in the self that could only be hammered on the anvil of adversity. I’m guessing that by the time he wrote this poem, he had experienced further ‘dark nights of the soul.’ Here is the poem in full.

Invictus

Out of the night that covers me,
Black as the Pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find, me unafraid.