In our first guest blog, clinical psychologist and specialist in emotional eating, Dr Jen Nash gives us plenty of ‘food for thought’!
We are in the midst of an overweight and obesity epidemic and whilst current health education messages are doing well to raise our awareness of the need to ‘eat less and move more’, we know for every person who can implement this advice, there are many more who struggle. This leads to a sense of failure and increased hopelessness, for both the individual who is overweight, and the healthcare professionals involved in their care, who quickly reach the limits of their perceived ability to help them.
Traditional medical and diet advice seems to treat weight loss as if it is a logical, rational process – for example, there is often an assumption that education alone leads to behaviour change. But knowledge doesn’t always lead to desired change, does it? How do we know this? Partly because many NHS health care professionals themselves struggle as much as those who they help – if not with their weight, then perhaps with their choices around alcohol, exercise, nicotine and other health decisions.
If we are increasingly aware of what we ‘should’ be doing to care for our health, what gets in the way of being able to implement these recommendations? Oftentimes we will sigh, “I’m just not motivated”.
I’d like to suggest that you ARE motivated! You don’t usually have to ‘motivate’ yourself to get dressed in the morning, or clean your teeth, or kiss your child goodbye, or turn up for work. You probably don’t talk about ‘getting motivated’ to do these tasks of life. Why? Because these activities are in line with your identity, your self-esteem and your values. You value your child feeling loved as they go to school, so you organise yourself to wave her off in the morning. You value not breathing your garlic breath from last night’s dinner on your colleagues, so you organise yourself to make time to brush your teeth in the morning!
So we are all motivated to do EXACTLY the right thing for us, given not just one, but two aspects of our experience:
1. Our knowledge + information
2. Our emotions + values
Medical and health educational models are great at the first part – imparting knowledge and information - but where in our health care settings are we talking about emotions and values?
These conversations are largely absent when it comes to discussing diet and weight loss, yet it is our emotions and values that are the bridge between ‘knowing something’ and ‘doing it’. These are the guide to all our decisions in life; including our decisions about our health and what to eat. Psychological models address emotions, but access to a clinical psychologist for people with obesity, whilst recommended by national guidelines, is extremely limited in current services.
‘The EatingBlueprint’ is a novel way for non-psychologists to start addressing the psychology of weight loss, without the jargon and potential stigma of some of the traditional psychological approaches. It is based on a blend of evidence-based psychological therapies (including solution-focussed, dialectical, compassionate, mindfulness, cognitive-behavioural and attachment approaches, for those who are interested in the detail!).
The logic of the blueprint is that trying to simply follow a diet to create the body/weight you want, without looking at the emotional ‘mindset’ about eating, is like trying to build a house before laying the foundations.. Strong foundations are needed to build a house – and a blueprint is needed as a guide. The EatingBlueprint is designed to support the development of the emotional mindset foundations necessary for both weight loss success and maintenance. To continue the analogy, the blueprint for the house’s foundations contains rooms, and in the EatingBlueprint, these ‘rooms’ are:
Let me talk you through the ‘rooms’
The blueprint begins by normalising the idea that it is difficult to lose and maintain a healthy weight. We are fighting a biological, psychological and environmental/social world that is set up to promote weight gain, and the person is not “wrong” or “bad” for being overweight. This step is designed to provide relief from shame and stigma and set the scene for an approach that isn’t about success or failure, rather one that involves self-discovery.
This area aims to encourage the noticing and overcoming of “mindless” eating. While it is usual to eat mindlessly for non-hunger reasons occasionally, we can be helped by the use of strategies to interrupt frequent mindless eating. This can be encouraged using a simple question: “WHY am I eating?” or, simply, “WHY?”
WHY is an acronym that stands for:
Remembering to pause before eating is challenging – so, in the short term, the person is invited to use a reminder on their dominant hand or wrist (e.g. a charity band - members of the EatingBlueprint receive a subtle wrist band as a reminder). This is just a short-term strategy until the automatic nature of eating becomes interrupted.
This invites the person to ask themselves, “Am I really hungry? How physically hungry am I, on a scale of 0–10? If I’m not hungry, what AM I hungry for?” (e.g. for a break, as a reward, for a distraction, to cheer myself up or to bond with someone).
This relates to saying ‘yes’ to the food or ‘yes’ to whatever the person is truly hungry for. If the person is physically hungry, this involves saying “Yes” to food and eating. If the person is not truly hungry and still eats, that’s okay too. Change takes time and the act of simply pausing brings an awareness to what was an unconscious process.
The power in this area is to help the person to discover what they are truly “hungry” for and ask themselves whether they can get their hunger met by something other than food. In time, they can begin to say ‘yes’ to this identified need, instead of the food.
The areas of the blueprint that follow are designed to help increase the flexibility to choose between a range of responses to food.
Eating is pleasurable and entertaining and it can become “a friend”. The person may need help to look for ways to increase non-food sources of pleasure and entertainment when there is an urge to eat for non-hunger reasons.
It is common to use food to “stuff down” emotions that are not easy to express. It is a skill to be able to express emotions authentically to both ourselves and others and we often need strategies to express emotions rather than to dull them with food. The EatingBlueprint provides a template for identifying and expressing feelings in ways other than through food.
These are the family stories and rules about food, spoken and unspoken. Phrases like “eat your vegetables before having dessert” and post-rationing sayings such as “don’t waste food” and “finish everything on your plate” have value, but we need to question the modern day utility of these ideas and create more helpful narratives that serve us.
To continue to maintain a healthy we need to know ourelves, learn from previous life experiences and manage their thinking styles relating to food. This step encourages the person to plan ahead and learn from the “predictability of life” (e.g. Christmas and meals out) and think about how to use this self-knowledge to experiment with new behaviours. It also invites the person to challenge the “good/bad” rules of diets using cognitive behavioural therapy techniques.
Weight loss isn’t a solo journey. The impact of family influence, the physical environment and handling social events are all crucial. The person needs assertiveness skills to be able to say “no” to the “feeders” in their lives, and to spot the signs of sabotage, often by well-meaning but threatened loved ones. The blueprint aims to provide these skills.
Weight loss is a skill, yet we don’t treat it as being in this paradigm. Like learning to drive a car, it is a process that requires coaching and facilitation, and “mistakes” and “slipups” are an integral part of the journey that need to be welcomed. The blueprint teaches how to “update the default” and stay solution-focused on the weight loss journey.
The Psychology of Weight Loss in the NHS
None of the areas of the EatingBluprint are 'rocket science', so why aren’t we systematically addressing them? Arguably, because obesity is treated within a medical model, and considered a medical/educational problem, not an emotional or psychologically related one. NHS Clinical Psychologists and therapists are generally limited to offering structured cognitive behavioural therapy (CBT), in an individual or small group format, as recommended by UK national guidelines, so these ideas aren’t particularly available to staff to utilise.
Do people struggling with obesity need to work with a Clinical Psychologist? Controversially, I say perhaps yes, because there is quite a body of evidence that suggests many who routinely use food for emotional regulation have a history of psychological issues. The incidence of trauma, childhood abuse, sexual abuse, low self-esteem and depression is high among people who are obese and in those presenting for weight loss surgery. Despite this, access to psychological services for obese people has been limited to screening for psychiatric disorders in preparation for bariatric surgery.
Whilst certainly surgery is an option for some, if we view obesity as (in part) a problem with emotions, then bariatric surgery is attempting to put a plaster on a very deep emotional wound. This may go some way to explain why this type of surgery is less successful than expected. Achieving and maintaining a healthy weight requires skills of emotional regulation and the ability to tolerate distress - in other words it takes a highly developed person. We need to widen the scope of clinical psychology and other health professionals working in the field of obesity, to empower people with:
• skills to be able to identify their emotions
• strategies to make a choice other than food
So the person is in control, not the food
Interested in finding out more about the EatingBlueprint?
The EatingBluerint is a 12-week online weight loss support programme, that empowers members to master their inner relationship with eating, through bitesize videos (10-30 mins each) with accompanying ‘experiments’ to implement new weight loss skills in daily life. If you’re someone struggling to lose weight, or a health care professional interested in using the EatingBlueprint method in your routine consultations, you can get your Free E-Course – ‘Why the F*** Are We So Fat?!’ by visiting the PsychBody website
Training workshops in the EatingBluperint Method can be organised by contacting Dr Jen Nash, Clinical Psychologist directly at firstname.lastname@example.org or via email@example.com
What do you think of Dr Jen’s ideas? Share your response and insights here and let’s discuss this important issue and this unique way of looking at it