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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