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.Tagged in: gastric band, health, obesity, weight, weight loss
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