Harnessing the power of the mind to overcome obesity

The eating disorder service is a highly specialised branch of mental health traditionally focused on treating patients suffering severe weight loss through conditions such as anorexia and bulimia. These patients often define themselves through their weight and body shape, and we are now looking at employing these skills to help tackle obesity.

Latest figures show the number of overweight people in the UK will rise by 11 million during the next two decades if the current trend goes unchecked.

This scenario has serious implications with an accompanying rise in obesity related illnesses, ncluding diabetes, heart disease and cancer.

At present, weight loss surgery is the only effective treatment for morbid obesity that brings sustained weight loss over longer periods of time. But this is very much a last resort after other methods such as diet, exercise, drug therapy and weight reduction classes have failed.

Operations to reduce weight through gastric bands and gastric by-passes respectively cost £8,000 and £11,000 and, if the 1m plus people in the UK with Grade Three Obesity all had surgery, it would cost £10 billion which is around 10% of the health service’s entire budget.

However, there are a number of potential problems.

Research shows around 25% of people regain a significant amount of weight after surgery. One in ten people with a gastric band need a further operation due to slippage, leakage or infection and many return to familiar eating disorder patterns, such as binge eating.

The common misconception is that obese people are simply greedy and have no self control about the amount they eat.

To date, behavioural change programmes have tended to focus on diet and exercise without addressing the fact that some patients have deep-seated  emotional issues leading to entrenched beliefs. These, in turn, prevent change.

We call this process Emotional Processing for Obesity Change (EPOCH), which is designed to address these issues with treatment that combines diet with psychological processing.

The project is in its infancy and is kick-started by a two week residential programme followed by a one year treatment programme aimed at achieving a 5-10% weight loss. This may seem modest, but a 5% drop in body mass reduces the risk of chronic diseases like diabetes and heart disease. In addition, gradual sustained improvement has the benefit of building a patient’s belief that they can change.

Some patients express the desire to regain control of their lives without resorting to surgery while others want to tackle underlying issues which they recognise influence their current behavioural patterns.

EPOCH postulates that emotional associations in someone’s past can repeatedly foil attempts to successfully manage their own weight.

This can be driven by fear of failure or lack of confidence that may stem from an earlier experience, such as bullying when someone was made to feel embarrassed, inadequate or worthless because of their condition.

These negative associations can strongly influence someone’s decision-making years later where they avoid or give up addressing personal issues around weight management. The aim is to help patients unearth and identify these emotional blocks in therapy and then challenge and replace them with more resourceful responses. These new empowering responses could include an angry challenge rather than submissive response to past bullying and stigmatisation someone may have.

It also develops greater personal acceptance of who they are as an individual as well as nurturing a supportive internal voice that they can succeed and achieve sustained weight loss.

Various techniques are used to ensure patients can tap into and use these resources in their everyday lives and move towards a healthier and more sustainable change of lifestyle.

Although still in its infancy, we are quietly confident EPOCH could prove a valuable tool in tackling one of the great health challenges facing the National Health Service.

Eric Johnson-Sabine, Nicholas Hawkes and Claire Gallagher work at Barnet, Enfield and Haringey Mental Health NHS Trust, north London.

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• http://twitter.com/francessmith frances smith

  well its good news to hear such a programme exists, even if its very new. after all people don’t talk about comfort food for nothing.

• mannu2718

  Fantastic article. Very insightful and almost disturbingly thought provoking. I can certainly relate to the emotional issues you mention. Since I have lost a little weight my confidence has improved almost to the point of being obnoxious at times. However, when I have a bad moment/day and become depressed, I resort to my old habits. 

  It is a difficult battle and I have to keep reminding myself to face it head on. Keep myself busy and develop a strong character. These traits are alien to me but I am very motivated to succeed. 

  Family and loved ones need to show tough love in these situations. They need to be brutally honest and do their bit to keep the affected person busy. It certainly makes losing weight easier if your friends provide a helping hand. 

• http://twitter.com/MTNORDIC TUG and BIBI

  How to lose weight for life, Pete Cohen and Nordic Walking

• SB_UK

  Frances Smith >> ‘comfort food’

  Comfort food to combat stress.

  I wonder what we’d find lies at the root of stress in people in the developed world where obesity is such a problem.

  The love/desire of money.

  Human beings trapped between a primitive love of material wealth (Hell) and the higher inkling that the love of material wealth is wrong.

  The guy looking down at his primitive self is right.

  The left hand takes the share incentives or bonuses from assisting some environmentally unsound corporation, whilst our right hand protests at the inequality which money brings.

  We, ourselves, are the problem.
  We *know* that we, ourselves are the problem.

  We’re conflicted.

  And that logical conflict (cf. cognitive dissonance) drives stress.

  A logical resolution to the conflict requires a new global economic system, one which will not involve money – one in which sharing is the supported paradigm
  - one in which inequality (in material world ownership) cannot occur.

• http://twitter.com/francessmith frances smith

  good luck with that mannu, but please don’t blame yourself for a lack of confidence, there is almost certainly something outside of you that created it.

• sheherezade

  It is no news that emotional disturbance is a root cause of eating disorders. The critical issue is why it is that EATING is felt to be the way to counter this disturbance. Others may counter it through other ways (eg violence, kleptomania, depressive inactivity) or overcome the disturbance through more socially acceptable processes (eg running, yoga, engaging in politics). Assuming that people will always experience emotional disturbances, the key question for EPOCH (or any other proposed therapy) is how and which socially acceptable processes are presented. Are certain processes more likely to be accepted as a alternative to eating in particular and which are they?

• DaiWales

  I’m sympathetic although I’m barely overweight and I don’t know anyone who is obese. But why does the UK have such a proportionately higher number of people with emotional problems leading to obesity.  
  I do know that economically struggling areas of the country have a higher percentage of these cases, but deprived areas of northern France don’t have the same problems. Cultural traditions ?

• MrsBrownatHome

  As one who does have a difficulty with weight which has been a lifelong situation I can say, with complete confidence, that this post is a load of complete rubbish. 

• Mike Newman

  A woman who lacks the self respect to look after herself is hardly likely to care for others to whom she has a Duty of Care. Maybe that goes a long way to explaining the fractured society in which we are cursed to live.