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17/Nov/2017

Obesity, dieting and weight loss – what do we know? 

In Part 1 of this series, we looked at the effectiveness of weight loss programs and diets by people who feel fat and want to lose weight.  We concluded that losing weight is not the solution.  Even after losing weight, guilt, deprivation and “feeling fat” can persist.  The solution is to acquire the skills to control when you start eating and when you stop eating.

In Part II of this series, we looked at what it is that starts and stops us from eating – the determinants of eating behaviour – and why it is that we have to eat in the first place.  We will discover that “the real problem” has nothing to do with willpower.

In Part III of this series, we will look at the extremely complex internal mechanism that regulates our eating behaviour.

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PART III:  The Internal Automatic Regulatory Mechanism (ARM)

We now recognize that the balance needed for the existence of life is extremely ‘delicate’ and that the control of this balance is simply too important to be left to conscious control.  To think that humans regulate their weight and their food intake by consciously thinking about it and making calculated decisions, is simply absurd.  It is important to keep these things in perspective.

Obviously, there must exist some type of mechanism – a regulator – which controls the balance of energy.  The analogy which is often made is to a thermostat in your house.  The thermostat in your house controls the temperature of your house or the quantity of heat in your house.  It does this by measuring the temperature – a measure of heat energy.  Something in the thermostat – a type of metal or mercury or some other substance – changes with temperature (it expands or contracts) and this can turn on a switch which turns on the furnace which generates more heat.  When heat is generated and the temperature rises, it changes the thermostat which in turn shuts off the switch.

This is known as a “negative feedback system”.  That is, the more the furnace works, the more it shuts itself off.

A similar system must be operating in your body.  When you need energy, something measures the need and turns on ‘hunger’- the drive to eat.  This is also a negative feedback loop in that the more food you consume, the less eating you should want to do – eating should shut itself off.  When there is enough energy, eating is shut off – i.e. ‘satiety’

But how does this system work?  Let us look at this in more detail.

What Is Being Controlled

In your house we know that what is being controlled (the controlled quantity is heat as measured by the temperature of your house).  But what is it that is being controlled in your body?  Think about it.  What is it in your body that is being measured and controlled?  Is it your body weight?  Is there something inside which can measure your body weight and when you begin to lose weight you start to eat and as you gain weight you are compelled to stop eating?  Or is it your body temperature?  Or is it energy in general, as measured by calories?  What is it?

Before we begin to try to answer this question, let us look at some of the research studies that have been done so that we can get a better idea of just how well the system works and what affects it.  The studies that will be discussed here are just a very brief summary of the many studies that have been done with a variety of different types of animals as well as with humans.

The first step is just to gather more information so that we can get a better idea about what is going on.

  • Random Diet

What do you think would happen if you take animals (e.g. laboratory rats) and give them a ‘cafeteria’ diet?  That is, if you give them many different types of foods that they can partake of freely in a fairly comfortable and relaxed environment.  You could give them chocolate chip cookies, bananas, specially prepared well-balanced laboratory diets, and all sorts of other foods that humans eat.

What do you think happens when animals are put into such environments and allowed to eat as much as they wish at any time?  Do you think that they gain weight?  Lose weight?  Binge on only specific types of foods?  Maintain a well-balanced diet?  Maintain their weight?  What do you think?

Well, unless the circumstances are very abnormal or extraordinary, you would find that the animals tend to eat a well-balanced diet, maintain their caloric intake and maintain their weight.  The regulator works very accurately under these circumstances.

  • Artificial Weight Gain

Animals can be made to gain weight artificially through a number of means including such things as force feeding (as is done with geese and other animals which are bred to produce certain types of foods) or through injecting insulin which increases the uptake if sugar and causes animals to eat more and gain more weight.  What do you think happens when animals who have had their weight artificially raised are allowed to eat food freely without continued insulin injections or force feeding?  Do you think that they continue to gain more weight?  Maintain their elevated weight?  Lose weight?

Animals in this situation will decrease their food intake below what they normally eat until their weight decreases and levels off back within a normal range.  They will then maintain their food intake and caloric intake at an appropriate level to maintain their weight.

The regulator continues to work!  Even when animals are made artificially fat, their weight returns to normal and their eating is maintained at an appropriate level.

  • Artificial Weight Loss

Animals can be made to lose weight by decreasing the amount of food they are given – i.e. depriving them.  What do you think happens when rats are artificially made to lose weight by being deprived of food and then given their food back freely?  Do you think they continue to maintain a lower weight?  Do you think they gain weight?

When allowed to eat freely again, the animals actually increase their food intake beyond their regular levels until their weight comes back into the normal range.  They then level off their caloric intake to maintain their weight within the normal range.

Again, the regulator works very accurately even if you try to trick the system by artificially decreasing body weight.

  • Caloric Dilution

It is possible to dilute the number of calories in an animal’s food by adding non-nutritive bulk such as cellulose to dry food or water to a liquid food like Metrecal.  What do you think happens to the rats if you dilute their food in half by adding non-nutritive bulk?  Obviously, in order to eat the same number of calories they would have to eat twice the quantity of food.  Do you think the animals eat more?  Eat less?  Eat the same?  Do you think they gain weight?  Lose weight?  Stay the same?

Studies clearly demonstrate that animals increase the amount that they eat in relation to how much you dilute to food.  If you dilute the food in half, they eat twice as much.  They maintain their caloric intake at a constant level; they maintain their weight; and the regulator continues to work even though they have to eat twice as much.

  • Concentrate Calorie

It is possible to increase the number of calories in an animal’s food (the calorie density) by mixing very high caloric substances in with the regular food.  For example, one can include glucose in with the regular food.  In fact, animals prefer this mixture if given a choice between their regular food and food mixed with the sugar solution.  But now, the same quantity of food has significantly more calories.  What do you think animals do in this situation?  Do you think that they eat more food and gain weight, or do you think they eat less food and maintain their weight?

Again, the regulator works!  Animals in this situation, even when presented with food that they find appealing and prefer, will actually decrease the total amount that they eat in order to maintain a constant caloric intake and maintain their weight.

  • Aversive Flavour

Obviously, one factor which affects eating is the taste of the food.  Just as sugar makes the food more appealing or preferred, the same food can be made less appealing and even aversive by adding some substances.  Quinine, for example, is an extremely bitter substance which animals and humans find very distasteful if added even in small amounts.  If you add a very small amount to the regular food of a rat and give the rat a choice between a quinine adulterated food and another food, the rat will never eat the quinine flavoured food.  However, what do you think the animal does if you don’t give it a choice and it only has the quinine flavoured food to eat?  Do you think it eats less?  Do you think it eats the same?  Do you think it loses weight?

Well, as you may have guessed, the animals will continue to eat the same caloric quantity even though they appear to hate the food – to the point where the food literally becomes poisonous and makes them ill.  The regulator works again!  Animals will continue to eat the number of calories required to maintain their weight even when the food is very aversive and bad tasting.

In summary, therefore, we can see that the regulator works very well indeed.  Even when extraordinary attempts are made to ‘trick’ the system, the system still works very accurately.  While there are always exceptions, this is generally the rule for all animals under normal situations and, if you think about it, it is true for most people as well.

How does it work?

It is quite clear that caloric intake is being regulated very carefully.  So is weight.  The question is now, how does it work?  If you were going to build a system inside the body to monitor and regulate the caloric intake, how would you do it?

Going back to our example of a thermostat in the house, we know that mercury expands with increased quantity of heat (temperature).  The mercury will vary exactly with the amount of heat – the quantity we wish to control – and we can connect a switch to the mercury level and consequently it is easy to measure and control the amount of heat in our house.

But how would we measure the amount of energy being taken in or used up by our body?  What would be equivalent to that column of mercury in our body?  What system or systems in our body do you think could be used to tell us when we need or do not need energy?

This very question has been the centre of much interest for more than 100 years of scientific investigation.  There are volumes written about this.  Let’s just look at some of these briefly.

  • Gastric Motility – Stomach

The stomach and its activities is an obvious possibility.  Stomach ‘growling’ and sensations are frequently associated with ‘hunger pangs’.  Not surprisingly, this was one of the earliest areas of research.  Many years ago some researchers felt that hunger was in fact simply the sensations of stomach contractions.

While there is absolutely no doubt that the stomach plays a very important role in controlling and monitoring our eating, there is already some evidence that indicates that the stomach, by itself, cannot be the controlling factor.

Remember what we observed with our rat?  When food is diluted of calories, the animals eat much more.  Stomach distention by itself, therefore, cannot be the ruling factor.  In addition, there is clear evidence that humans with partial removals of their stomachs as well as those with denervation of their stomachs regulate their weight very well, although meal patterns change somewhat.

Therefore, the stomach, although it may be important, is by itself not even necessary for accurate regulation.

  • Oral pharyngeal Factors

The mouth and throat, chewing and swallowing, taste and smell, all play significant roles in affecting our eating.  There have been numerous studies which indicate a significant involvement of all of these factors.

For example, the simple acts of eating and swallowing alone, even without the food entering the stomach, will have the effect of stopping the eating of an animal (for a short term).  Similarly, our taste buds are affected by many aspects of the physiological condition of our body, including our specific needs for various nutrients or what we have just eaten.  This in turn influences how different things taste to us – sweet, salty, good or bad – and consequently affects our ‘appetite’ for different types of food.  It has also been demonstrated, for example, that when certain substances such as sugar are taken into the mouth, these substances may permeate the lining of the mouth and actually enter into the blood and brain well before the food becomes digested in our stomachs.  This allows our brain to monitor what we are eating very rapidly.

However, other studies indicate that actually eating the food is not even necessary for maintaining caloric regulation and weight.  Studies on animals with tubes inserted directly into their stomachs indicate that animals will learn to press levers to have food injected directly into their stomach without even tasting or swallowing the food.  These animals will maintain appropriate caloric intake and maintain their weight.  Even if you dilute their food, they will increase their intake appropriately.

Therefore, although oral pharyngeal factors are clearly important and significant, they also cannot fully explain how the system maintains caloric intake and weight regulation.

  • Body Temperature

The various temperatures of different parts of our bodies have a major effect on our eating behaviour.  When our ‘core’ (deep internal body) temperature rises, eating behaviour becomes inhibited.  For example, when people have fevers, there is a definite suppression of appetite.  The relationship between core temperature, brain temperature, and body surface temperature is quite complex and its effect on eating is also very complex and unclear.

However, there is also evidence which indicates that temperature and eating can be separated.  For example, many drugs which are used to supress appetite actually decrease temperature.  So it can be seen that body temperature and eating behaviour can be separated and temperature by itself cannot be the controlling factor.

  • Lipostatic – Fat Metabolism Rates

There have been suggestions that the metabolism of fat in our body is a critical factor in affecting our eating behaviour and the regulation of calories.  We already know that when we have excessive calories, physiological changes can take place to convert excess sugar into fat.  When we require energy and have a deficit of readily available calories, our physiology shifts in the other direction to convert fat to sugar.  There have been some suggestions that this mechanism itself is the critical factor indicating hunger (fat to sugar) and satiety (sugar to fat).  The most obvious limitation with this particular theory is that the process is so slow it would not begin to stop eating during a meal until far too many calories had been consumed.  Therefore, while this metabolic cycle may in fact be important, it by itself cannot account for the precise and delicate control of eating behaviour and caloric regulation.

  • Blood Borne Factor

It has been well known for many years that factors in the blood affect eating behaviour.  There have been numerous studies which have shown that such things as infusing the blood of a hungry animal into the body of a satiated animal will cause that animal to begin eating.

While there are numerous possibilities as to what these various blood-borne factors might be, one obvious factor is the blood glucose (sugar) level.  The ‘glucostatic’ theory suggests that the amount of sugar in the blood controls whether a person is hungry or satiated.  Increasing the amount of sugar in the blood of an animal which is eating will cause eating to stop.  However, there is no relationship between the amount of sugar in the blood and the beginning and cessation of eating.

The glucose utilization (A/V ratio) suggests that the critical factor is not the absolute concentration or amount of sugar in the blood, but rather the amount of sugar in the arteries (the blood vessels that take the blood to the cells of the body to nourish them) and the amount in the veins (the blood vessels which take the used blood away from the cells).  Obviously, if your body does not need energy and is not using sugar, the amount of sugar in the arteries will be the same as the amount of sugar in the veins.  However, if your body does need energy and is using sugar to provide that energy, then the amount of sugar in the arteries will be greater than the amount of sugar in the veins.  There is a good relationship between this ratio and onset and cessation of eating behaviour.

However, there are problems with these theories as well.  Diabetics who have notoriously high blood sugar levels are also well known for having voracious appetites.  The fact is, that eating behaviour and blood sugar levels can be separated and although this is clearly an important factor, it too by itself cannot be the only factor which controls and regulates our caloric intake, our eating behaviour and consequently, our weight.

  • Brain – Hypothalamus

It is obvious that our brain is intimately involved in the control of eating behaviour.  In particular, a small area of the brain known as the hypothalamus is critical in controlling and integrating not only our eating behaviour, but other behaviours such as drinking, temperature regulation, and other behaviours critical for survival.

So what is the conclusion?  It is obvious that the regulator – the internal automatic regulatory mechanism (ARM) – is expectedly complex.  Although a great deal is known about this, it is still poorly understood.

The regulation of eating behaviour is even more complicated than simply regulating calories.  For example, the body must also carefully control the balance of salts and water, and what we eat affects this.  If, for example, the concentration of salts in our bodies is too high, and we do not have enough water, we become thirsty.  However, if there is no water available for us to drink, it would be detrimental for us to eat foods.  That would increase the salt concentrations in our body.  Consequently, when we are in need of water, there is an active suppression of appetite.  There is decreased eating.  Similarly, temperature regulation also plays an important role.  Since it is critical that our temperature levels are carefully guarded and that our concentrations are maintained in addition to our energy balance, all of these factors interact in an extremely complex way.

The fact is that the system is simply too complicated to be left to our willpower or conscious control.  To think that humans regulate their weight and their food intake by consciously thinking about it and making calculated decisions, is simply absurd.  The internal automatic regulatory mechanism cannot be corrected and there is no magic solution.

its complicated, 3D rendering, traffic sign

In Part IV of this series, we will discover the solution to the problem.  At the present time, the solution may not appear to be obvious to you and you may not have the skills.  But, be patient, the solution will become obvious and the skills are easily acquired.

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SOURCES

Chaput JP, Tremblay A. (2008, November 11). The glucostatic theory of appetite control and the risk of obesity and diabetes. International Journal of Obesity. Doi:10.1038/ijo.2008.221

Garcia, J., Hankins, W., Rusiniak, K. (1974, September 6). Behavioral regulation of the milieu interne in man and rat. Science. Vol. 185, Issue 4154, pp. 824-831.  DOI: 10.1126/science.185.4154.824

Jordan, H. A. (1969). Voluntary intragastric feeding: Oral and gastric contributions to food intake and hunger in man. Journal of Comparative and Physiological Psychology, 68(4), 498-506.  http://dx.doi.org/10.1037/h0027664

Stunkard, A., Fox, Sonja. (1971, March). The relationship of gastric motility and hunger: A summary of the evidence.  Psychosomatic Medicine

White, C, Purpera, M, Ballard, K, Morrison, C. (2010, June 6). Decreased food intake following overfeeding involves leptin-dependent and leptin-independent mechanisms. Physiology and Behavior, Volume 100, Issue 4, Pages 408-416

 


9/Aug/2017

Statistics Canada says close to a third of Canadian kids under 17 are overweight or obese.  The rising prevalence of overweight and obesity in several countries has been described as a global pandemic.  In 2010, overweight and obesity were estimated to cause 3.4 million deaths, 4% of years of life lost, and 4% of disability-adjusted life-years (DALYs) worldwide.  Data from studies in the USA have suggested that, unabated, the rise in obesity could lead to future falls in life expectancy.  Concern about the health risks associated with rising obesity has become nearly universal; member states of WHO introduced a voluntary target to stop the rise in obesity by 2025, and widespread calls have been made for regular monitoring of changes in the prevalence of overweight and obesity in all populations[1].body-image

It is more apparent than ever that losing weight is not an achievable goal for the majority of people.  As incredible as it sounds, that’s what the evidence is showing.  For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear.  “It couldn’t be easier to see”, she says; “long-term weight loss happens to only the smallest minority of people”.  Traci Mann’s research on long term weight loss shows that on average, dieters only maintain a 1 kilogram weight loss over two years.

One solution would be to prevent weight gain in the first place.  “An appropriate rebalancing of the primal needs of humans with food availability is essential”, University of Oxford epidemiologist Klim McPherson wrote in The Lancet[2].  But to do that, he suggested, “would entail curtailing many aspects of production and marketing for food industries”.  As necessary as this may be, it is certainly not a “quick fix” solution.

Have you ever dieted?  Did you lose weight?  Did you gain it back?  Why are we obsessed about doing something that has been proven over and over again to not work?  There is an alternate approach, and believe it or not, it has been around for at least 35 years.

The SHAPE (Strategies for Healthful and Pleasurable Eating) Eating Control Program was developed by Dr. Arthur Cott and his colleagues at the Behavioural Medicine Unit (BMU), St. Joseph’s Hospital, Hamilton, Ontario, in the early 1980’s.  Dr. Cott’s approach utilized the scientific evidence in the learning theory literature to design a comprehensive educational program for individuals who felt fat, wanted to lose weight and were fed up with the numerous diets, both mainstream and fad, that they had unsuccessfully endured.  I was privileged to be one of those who worked with Dr. Cott and would like to share his wisdom with you.

The SHAPE Program was a 24 week course that combined both lectures and small group tutorials.  The students in the course ranged in age from 16 years to 70 years.  Both males and females paid a hefty registration fee to attend this course which was taught at locations in Hamilton, Toronto, Kitchener and St. Catharines over a 10 year period.  The lectures were delivered by Psychologists from the BMU, including Dr. Arthur Cott, Dr. Harvey Anchel and Dr. Richard Marlin.  The tutorials were led by Behavioural Therapists who had been trained and

specialized in the application of cognitive behavioural therapy for chronic somatic and mental health conditions as well as behavioural issues, such as eating control.  Again, I was fortunate to have been a tutorial leader and eventually, the Manager of the SHAPE Program.

weight-loss-weight-gain-signRecently, I decided to investigate the current scientific literature regarding behavioural approaches to eating control and weight regulation.  I discovered the work of Dr. Brian Wansink, (Ph.D. Stanford 1990) who is the John Dyson Endowed Chair in the Applied Economics and Management Department at Cornell University, where he directs the Cornell Food and Brand Lab.  He is the lead author of over 100 academic articles and books on eating behaviour.  Kelly D. Brownell, Yale University, has hailed Dr. Wansink as “the Sherlock Holmes of food”.

Clearly, Dr. Brownell had never met Dr. Cott.  I very quickly discovered that Dr. Cott’s approach from 35 years ago is just as relevant today as it was back then.  I had always believed that this approach was remarkable in its interpretation and implementation of science.  Now I know that it has survived the test of time.  Dr. Cott’s approach was truly ahead of its time.

At one point, the SHAPE program was featured in one of our Canadian magazines which resulted in an overwhelming response from readers across Canada who wanted to participate in the program.  To meet this need, those of us at the BMU at the time, made a decision to develop a “correspondence course” version of the program.  Being the pack rat that I am, I am extremely fortunate to have a copy of the course content developed by the BMU and I would like to start sharing it with you now.  This is the first of a 4 part series (check out our blog each week to find the rest!).

PART I:  WHAT IS THE REAL PROBLEM?

Believe it or not, even though many people think they have a weight problem, weight is not really the problem.  Look at the following examples.  All of these people thought they had a weight problem.  Does any of this sound familiar to you?

Maryanne is a 41-year old, full-time health care professional, married with 2 school-age children.  She’s been fat and she’s been skinny.  She has waged a constant battle over the last 10 years in her attempts to control her body weight.  She has tried low-fat diets, low-carb diets and counting calories.  Maryanne has struggled with frustration from Scarsdale to Pritikin to Beverly Hills Diets.  Some of them worked… for a while.  “I lost 44 lbs in 6 weeks and I’ve put it all back on” comments Maryanne.

Bill is 48 years old, married with 3 grown children, all of whom are living away from home.  The nature of his occupation, a senior manager in the steel industry, requires him to make several business trips a year and to attend numerous business functions, usually all associated with eating.  The impetus for Bill to do something about his weight had come from his family physician who had been treating him for the past year for elevated cholesterol and triglyceride levels.  Bill had been monitored for 12 months as he attempted to stay on a prescribed diet, which included very few of his favourite foods.  Bill was discouraged and fed up with the ‘diet’, but still concerned about potentially serious health problems.

Elizabeth had dieted for at least 25 of her 30 years, attending every kind of group dedicated to losing weight.  She knows she’s fat while others claim she’s skinny.  She claims to have lost “at least 1000 lbs” and spent hundreds of dollars on diets.  For the past 2 years she has successfully maintained her weight at 120 lbs.  At 5’3” tall, Elizabeth appears to be a ‘normal weight’ person.  Elizabeth describes herself as ‘fat’.  She believes that her primary goal is to lose weight and listed her ideal weight as 110 lbs.

Each of these three people has one or more of the following problems:

  • “I feel fat!”
  • “I just look at banana splits and donuts and gain weight”
  • “I am always hungry”
  • “eating desserts makes me feel guilty, but when I don’t, I feel deprived”
  • “nothing seems to fit”
  • “I must be addicted to food. Once I start eating peanuts, I can’t stop”
  • “I’m always on a diet”
  • “whenever I’m on a diet, my family loses weight”
  • “going to the beach means wearing sweat pants and t-shirts, never a bathing suit or shorts”

The question is, what do any of these problems have to do with weight?  The answer is NOTHING!  Weight is not the problem.  Weight is simply the result or outcome of the problem.  The problem is lack of control of eating.  Your eating is controlling you – you are not in control of your eating.

Many of us complain of feeling guilty after eating certain kinds of foods.  Questions such as “should you be eating that?” or “is that in your diet?” are frequently heard as family members comment on what we are about to eat.  Some individuals report that the guilty feelings are so strong that they avoid eating in public as much as possible.  Instead, they consume large quantities of their favourite foods when they can be certain of no interruptions.

A second characteristic frequently demonstrated by people with eating problems, especially the constant dieter, is that of deprivation.  While everyone else is enjoying steak with béarnaise sauce, baked potato with sour cream and apple pie a la mode, the dieter is suffering with a tossed salad and no dressing, broiled fish and water.  Feelings of “why me?” and “it’s not fair” often result in secretive snacking.  Many of us have a long list of “forbidden fruits” or list of foods which we believe we should not eat.

It is not unusual for individuals to provide the following reasons for their inability to control their eating:

  • “I have no willpower”
  • “I’m weak willed”
  • “my mother made me clean my plate when I was a child”

We often feel miserable as a result.

None of these problems are related to weight alone.  Losing weight is not the solution.  Even after losing weight, guilt, deprivation and misery can persist.  The solution is to acquire the skills to control when you start eating and when you stop eating.

Control of eating is not always the entire solution to an eating problem.  Quite frequently, there is a second component which must be addressed and that is the problem of “feeling fat” or body image.  Body image problems result when an individual’s perception of their size is discrepant with their actual size.  In other words, the individual feels fat even though they are not fat.  For example, friends and family frequently tell them that they “don’t need to worry about their weight”, however, they continue to feel fat.

Individuals with ‘fat body image’ problems demonstrate behaviours such as:

  • Asking their spouse “does this look fat on me?”
  • Checking every mirror or plate glass window to make sure that their ‘fat spot’ is tucked in or covered up
  • Standing in the back row to get their photo taken
  • Wearing sweat pants and shirt to the beach
  • Avoiding gyms, reunions, and exercise

Weight loss alone is not the solution to a body image problem.  In fact, it can make the problem worse as the discrepancy between the size a person perceives themselves to be and their actual size becomes larger.  Once a body image problem has been identified, it is necessary for the individual to start behaving “thin”, thus leading them to “think thin” and eventually to “feel thin”.

Most people who say they have ‘weight problems’ usually have some concerns about their willpower or lack of it.  They are often accused by other people of lacking willpower.  They are often scolded by others for not using it.  What we know is that the control of eating is far too important to be left to willpower and conscious control and far too complex.

In Part II of this series, we will start by looking at what it is that starts and stops us from eating – the determinants of eating behaviour – and why it is that we have to eat in the first place.  We will discover that “the real problem” has nothing to do with willpower.

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[1] Ng, Marie et al.  (2014, May 28).  Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013.  The Lancet, 384 (9945), 766 – 781.  DOI: http://dx.doi.org/10.1016/S0140-6736(14)60460-8

[2] McPherson, Klim.  (2014, May 28).  Reducing the global prevalence of overweight and obesity.  The Lancet, 384 (9945), 728 – 730.  DOI: http://dx.doi.org/10.1016/S0140-6736(14)60767-4

 


2/Aug/2017

eating-chocolate

Binge eating.  If you are or every have been a binge eater, I’m sure that simply reading the phrase elicits different feelings inside of you.  And if you’ve struggled with binge eating, I’m sure you’ve also tried many different diet and self-talk strategies to try and curb your eating; “My diet is going to start tomorrow”, “I need to get my money’s worth from this buffet!”, “Five more cookies and I’m done!” Sound familiar?  I could probably write a 15 page essay on all of the things I’ve ever said and done to curb my eating habits!

The problem with binge eating is that it doesn’t just end with food.  Researchers Hannah Woolhouse, Ann Knowles and Naomi Crafti (2012) explain that women who binge eat have an increased likelihood that they will suffer from low self-esteem, poor body image, interpersonal problems, depression and anxiety.  What their research and many others reveal, is that if we have a complicated relationship with our eating habits, we often have a complicated relationship with ourselves as well.

buffet-black-and-white

Woolhouse, Knowles and Crafti were interested in determining if mindfulness (the practice of being present or aware of what’s happening, free from judgement) could help women in controlling their binge eating habits.  They conducted a study where 30 women (ages 18-52) who regularly binge eat participated in a Mindful Eating Group (MEG) for 3 hours a day, for 10 weeks (Woolhouse, Knowles & Crafti, 2012, p. 324).  The women participated in mindfulness practice (such as formal and informal meditation and mindful or attentional eating), as well as CBT elements (including meal planning and food monitoring) (Woolhouse, Knowles & Crafti, 2012, p. 324).

A 3 month follow-up at the conclusion of the program found that participants who reported binge eating twice a week or more dropped from 80% to 14% (Woolhouse, Knowles & Crafti, 2012, p. 328).  Of all of the mindfulness practices introduced, mindful eating was reported to have the biggest impact on their habits, including slowing down chewing, paying attention to flavours and stomach fullness, and likes and dislikes of “binge foods” (Woolhouse, Knowles & Crafti, 2012, p. 329, 331).  There were also significant improvements in over-eating and dieting behaviours, and body image dissatisfaction (Woolhouse, Knowles & Crafti, 2012, p. 324).

The takeaway is that mindfulness has the potential to transform our relationship with food as well as with ourselves.  Improving our relationship with both food and ourselves can improve our eating habits and our overall mental health.  While more research is needed in regards to mindfulness-based intervention, early research shows that this growing practice is worth giving it a shot.

If you’re looking for some simple ways to become more mindful while eating, check out our “Tip Tuesdays” on Twitter @JMAssociatesInc, or on Instagram @jmarlinandassociates.  If you’re interested in learning more about identifying unhelpful eating patterns, body image and more comprehensive mindfulness strategies, enroll in our evidence-based mindful eating program (ACT for Mindful Eating) by sending us an email at info@jmarlinandassociates.com.

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Reference: Woolhouse, H., Knowles, A. & Crafti, N.  (2012).  Adding Mindfulness to CBT Programs for Binge Eating: A Mixed-Methods Evaluation, Eating Disorders, 20:4, 321-339, DOI: 10.1080/10640266.2012.691791


25/May/2017

Do you feel as though your clothes just don’t fit the way you would like them to?  Do you feel anxious about the upcoming summer months and losing the layers of winter clothing?  Do you feel like the battle to lose weight and feel great is an endless one?  Well, you’re not alone.

‘Do you feel fat?’ is an abrupt question and may be intimidating  for many to answer, but the reality is that it is, in fact, how many of us are already feeling, and the majority of us would respond ‘yes’.  I felt a bit apprehensive in using this very question as the title of my blog and the tagline of our advertising campaign for the month, but throughout my research for this blog, I came to learn that the fact of the matter is that asking people this question is really just getting to the point and not ‘avoiding the elephant in the room’, so to speak.  This trend is not surprising given the media’s influence on people’s perception of what is considered to be ‘fat’.  Responding affirmatively to this question does not necessarily mean that our weight or body mass index (BMI) falls within a category that is considered to be overweight or obese, nor would it confirm without a doubt that our body shape or size is posing any risk to our health.  I am not saying that feeling fat never equals being fat, but I am saying that the former can, and most definitely does in many cases, exist without the latter.

I was interested in collecting some numbers so that I could really see if what I thought was happening was really happening – if many people felt fat and were dissatisfied with their body.  I anonymously surveyed 100 people of varying characteristics, ages, genders, and cultures.  I asked them a series of questions, which were as follows:

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The results were what I had expected, yet for some reason I was still surprised by what I saw.

I know that a lot of people feel fat, and I know that many are dissatisfied with their body, but seeing the numbers really drove the point home – people’s undesirable body image, whether justified or not, is a real problem.

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Click here to see a bigger image:  do-you-feel-fat-surevy-results

As you can see in the graph above, the majority of people we surveyed feel fat, are not satisfied with their body, have tried dieting, would like to lose weight, compare their bodies to others, and are unhappy with the number on the scale.  Surprisingly, many even said that others would not agree with their perception of their shape and size, suggesting that this may be a group of individuals who feel fat, but perhaps would not necessarily meet the true criteria for being fat or may not be seen as fat by othersLet’s face it – we are typically our own worst enemy and toughest critic!

There are a number of assumptions we can make when analyzing these results.  Here are a few assumptions that I have made based on these results, but there are definitely still other angles that can be taken.

  • Many people are in fact overweight: It is known that overweight and obesity is a real problem in the current world, and perhaps the reason that many confirmed that they feel fat, are unhappy with the number on the scale, and are dissatisfied with their body, is because they are, in fact, overweight or obese.  Again, this is just an assumption we can make since we did not ask any information in our survey about weight classification or BMI.  Statistics Canada reported that in 2014, 61.8% of Canadian men and 46.2% of Canadian women were said to be overweight or obese based on their BMI classification (The Huffington Post, 2015).  If being overweight or obese is where the problem lies, then behavioural intervention (i.e. eating behaviour, exercise, education, etc.) is required to prevent weight gain to a level that puts people into these categories.
  • The majority of people have a negative body image: Whether or not individuals fall into the overweight or obese categories, it is evident that body image is a real issue that needs to be addressed.  The Canadian Women’s Health Network supports this point as it reports that 80% to 90% of women and girls in Canada are unhappy with the way they look (CWHN, 2012).  Women are not the only ones dealing with body image issues as many people may think.  The Guardian reported that more than 81% of men talk in ways that promote anxiety about their body image by referring to perceived flaws and imperfections, compared with 75% of women (The Guardian, 2012).  The study also found that 38% of men would sacrifice at least a year of their life in exchange for a perfect body.  If body image is where the problem lies, then psychological intervention is needed to help individuals maintain a positive perception of their size and shape – a positive body image.
  • The media and cultural trends have influenced unrealistic and likely unhealthy perceptions of what is considered to be an attractive body shape and size: If we look back over the years, the ‘perfect’ body shape and size has changed drastically, and what may have been considered ‘attractive’ or ‘desirable’ decades ago, would now be considered ‘fat’, ‘unattractive’, or ‘undesirable’.  This video shared by BuzzFeedVideos in 2015 shows the ideal body types over time: https://www.youtube.com/watch?v=Xrp0zJZu0a4.  The media’s view of ‘the perfect body’ is not static and so why should we keep trying to chase it, rather than learning to love the body we have, as long as we are doing what is needed to keep it healthy.  If you feel fat, consider how much the media is playing into that feeling.  If the media and its strong influence over our perceptions is where the problem lies, then educational intervention is needed to help individuals understand that different body shapes, types, and sizes exist, and that striving to be something we are not can cause more harm than good.

There are indeed other interpretations or conclusions we can make based on the results of our mini study’s results, however, there seems to be one overarching issue that needs to be addressed, regardless of the root of the problem – people feel fat, are unhappy with their bodies, and are looking for solutions.  If people continue to feel fat, a chain reaction of other problems can begin.

Some studies, including one done in 2012 by The Norwegian University of Science and Technology, found that thinking you are fat or feeling fat can actually lead to you becoming fat.  They identified a number of reasons supporting why this may happen, such as the psychosocial stress of trying to achieve the ‘ideal body type’, skipping meals, and ‘yo-yoing’ on and off unsustainable diets.  Other studies, including a body image study done by researchers at Bradley Hospital, Butler Hospital, and Brown Medical School, have looked at the effect of having a negative body image on psychological health.  This study and others like it have concluded that adolescents with negative body image concerns are more likely to be depressed, anxious, and suicidal than those without intense dissatisfaction over their appearance, even when compared to adolescents with other psychiatric illnesses.  They also found that in addition to higher levels of depression, anxiety and suicidality, patients with shape/weight preoccupations expressed higher levels of dissociation (a coping style characterized by blocking out emotions), sexual preoccupation/distress, and post-traumatic stress disorder (PTSD), and that the majority of the adolescents in the study were not actually overweight.  This suggests that weight may not be the problem, but rather the perceptions that individuals have of themselves, whether or not they are in fact overweight.

At J Marlin and Associates Inc. we understand this issue, and have developed an effective psychological, educational, and behavioural solution.  Our approach to this issue may be different than others and may be new to many people, but it is supported by the scientific evidence, and we encourage it with confidence.  It allows us to tackle all of the issues that have been researched around ‘’feeling fat’’, including the true need to lose weight, the need for proper education around eating behaviours and perceptions of ‘the perfect body’ and psychological strategies around acceptance, engagement in life regardless of how you feel, and coping with challenges or barriers along the way.

Our solution is ACT for Mindful Eating.  This 10-session course begins in September of 2017.  Students will learn to approach all of their behaviours more mindfully, from grocery shopping to food preparation to eating in restaurants and at work, and to maintaining a risk free eating environment in the home.  Mindful Eating helps us to better understand, appreciate and, when needed, change our relationship with food.  Mindfulness helps us to foster a non-judgemental acceptance of things as they are in the present moment (i.e. our current body shape and size), notice what can and cannot be changed, move towards what is meaningful to us, and to continue along that very path regardless of the ‘stuff’ that interferes or may try to stop us on our way.

We can quite reasonably assume that many of you reading this will have felt fat at some point, may feel fat right now, or may know someone that feels fat, and we can help.  Please feel free to get in touch with us if you are interested in hearing more about what we can do for you.

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26/Apr/2017

small-shortsIt has been a LONG winter and now the sun is shining and you want to enjoy the outdoors.  You pull out your favourite pair of shorts and pull them on.  What the heck!!!!!!  WHO SHRUNK MY SHORTS?  Don’t worry, you are not alone!  You may ask yourself whether your partner washed them in hot water or you may wonder if these shorts belong to your skinny sister.  But deep down inside, you know that it is not the shorts that shrunk, but you who has grown bigger.

Now, if the answer to how you gained the weight isn’t immediately apparent, it could be due to something called the “mindless margin”.  There are many cues in our environment that lead us to overeat and for most of us they impact our eating without us even knowing about it.  And it doesn’t take much extra eating to pile on the pounds.  Did you know that eating just 3 jelly beans a day for a year is enough extra calories to result in a 1 pound weight gain?  That “mindless margin” is only 10 extra calories a day.  If you eat way too much, you know it, and if you eat too little, you can tell.  However, eating even 100 extra calories more or less in a day is not noticeable and is significant when it comes to your weight.  But 100 calories a day equals 10 pounds in a year!!!!

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 So every time that you eat every last bite of your dinner, even though you were already full half way through; eating half of that cookie still sitting on the pan as you walk by the kitchen; eating the few bites that your child leaves on their plate – This is the “mindless margin”.  In all of the above instances, it’s not that you were consuming the extra calories because you needed them – you weren’t even hungry!  And if you had resisted them, you would never have missed them.  In each case, you may have just ‘slightly overeaten’, but the price you end up paying for this is high.

So what is the solution?  Being more mindful about our eating is one answer, and you can check out our previously posted blog (Who Stole My Chips?) for tips about how to do this.  But a safer response may be to change your everyday eating environment to protect you from the “mindless margin”.  Use a smaller plate or glass, sit further away from the buffet table, move the candy dish off your desk at work.  All of these have been proven – scientifically – to result in less eating.

You can learn how to do this and a whole lot more by registering for our eating control course titled ACT for ME starting in September 2017.

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Source – Brian Wansink.  (2006).  Mindless Eating.


10/Mar/2017

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Does this scenario sound familiar to you?  You sit down to watch TV.  During the commercial break you hear the bag of chips calling to you from the kitchen cupboard.  You decide to have a handful and return to watching TV.  Next commercial break you do the same thing, but this time you take the bag back to the couch.  By the next commercial, the bag is empty and you wonder how that could be.

This is one of many examples of mindless eating and you are probably not aware that it is happening.  Mindless eating happens when you are distracted by something else so that all of your attention is not on what you are eating or how you are eating.  When distracted, we are far more likely to shift into autopilot and overeat and this is one very common reason for weight gain.
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Still not convinced?  Clinical studies have examined the effectiveness of awareness and eating. For example, Timmerman and Brown (2012) conducted a study on middle-aged women who frequently ate out at restaurants.  The intervention involved teaching the women how to be more “aware” of their choices, hunger, fullness and mindless eating behaviour.  The result?  The women ate 300 calories less each day.

So, how many times a day are you eating mindlessly?  Take a look at this list and check the ones that you regularly engage in.

  • Driving
  • Making dinner
  • Desktop dining
  • Reading a magazine
  • Cleaning up after a meal
  • Watching a movie at the cinema
  • Talking on the phone
  • Eating when you are bored, stressed or anxious
  • Emptying your plate even though you are full
  • Attending a party or social event

Almost everyone eats mindlessly at one time or another.  But if you are struggling with your weight, then it is crucial to know how often you are eating mindlessly and then to do something about it.

Here are 7 tips for eating more mindfully:

  • Eat for the first 5 minutes of every meal in silence
  • Designate a place in your home where the only thing that you do is eat
  • Eat with chopsticks
  • Don’t eat from a carton – take a serving size and put it on a plate/bowl
  • Make food hard to get – most of us won’t work too hard to eat
  • Pretend you are a food critic and you will have to describe how the food looks, smells, feels, sounds, and tastes
  • Try taking the first 4 sips of hot tea or coffee with full attention

There are many opportunities in a day to practice these tips and we know that mindful eating gets easier and more effective with practice.  You will eventually feel more satisfied when you eat.

Enjoy your meal!!!!

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Timmerman, G.M. & Brown, A.  (2012).  The effect of a mindful restaurant eating intervention on weight management in women.  Journal of Nutrition Education and Behavior, 2012 Jan-Feb;44(1):22-8. doi: 10.1016/j.jneb.2011.03.143.



If you read last week’s blog on How to Sabotage Your Next Diet, and if you have ever dieted before, there is a good chance you could relate.  The truth of the matter is, when we diet, we tend to experience feelings such a guilt, shame, and failure, which are not much fun at all.  Food and eating is meant to bring us joy and pleasure, not to shame us for enjoying it.

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Mindfulness, the concept of moment-by-moment awareness of our thoughts, feelings, sensations, and environment, is becoming a well-documented tool for mental health, but did you know the principles could also be applied to diet?

eating-in-front-of-tvIn fact, most of us likely practice the opposite of mindful eating, we are more likely engaging in mindless eating.  We lack awareness of how we fill our plate, or our portion size.  We eat in front of the TV or computer, and we do not notice cues in our body signaling us that we are full.  With mindless eating, most of us can consume an unnoticed 200-300 calories each day, which overtime can lead to unwanted weight gain.  Consider this: have you ever been eating chips and went to put your hand in the bag, only to find it empty? Or have you ever eaten the last piece of crusty, dried out chocolate cake even though it tasted like cardboard?

Without thought, a lot of the cues in our environment and body go unnoticed.

Below are a series of questions to ask yourself about your eating and eating habits.

Take a few moments to complete the Mindful Eating Self-Assessment Questionnaire[1].

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Once you complete the questionnaire, take some time to review it.

The point of this exercise is to start the process of becoming more aware of situations surrounding food.  Why you may eat in certain situations, what your feelings usually are when you are eating, if you are aware of the surroundings that make you more likely to participate in unhealthy behaviours?

We first must begin to notice our behaviours before we being to change them.

Visit our web page for details about our upcoming course and FREE Information Session on JMA’s Balancing ACT for Weight Control

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[1]Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the Mindful Eating Questionnaire. J Am Diet Assoc 2009;109:1439-1444.


30/Dec/2016

Happy New Year from J Marlin and Associates Inc.

2017

Here we are at the start of a brand new year and many of us are deciding on our 2017 Resolutions.  If you are like hundreds of thousands of other people, living a healthier lifestyle, including losing weight, will be at the top of your list.  And, like many of thousands of others, you will fail.

Diets, for most people, teach you to do the wrong things.  Check to see how many of the following are familiar to you and what you can do differently in 2017.

How to Sabotage your Next Diet

1. Generate a list of forbidden foods:dont-eat-me

  • They become an immediate temptation
  • They call to you from the fridge in the kitchen
  • Leads to sneaky behaviour
  • Leads to binge eating
  • Leads to guilt

Learn how to eat whatever you want!

2. Weigh yourself frequently:

  • If you have gained, you beat yourself up
  • If you have lost, it’s never enough
  • You end up playing games with the scale

Learn how to put the number on the scale into perspective!

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3. Avoid social events:

  • Feel deprived
  • Who and What is most important to you is ignored

Learn how to control your eating in all situations!

4. Give in to external pressure to lose weight:split-in-road

  • Losing weight for a special event (wedding, reunion)
  • Need to fit into an outfit you already own
  • Partner wants you to lose weight
  • The media trend of the day
  • Trying to look like what you see in magazines and on TV

Learn how to move in the direction of what matters most to you!

5. Believe everything you read about dieting:

  • You can lose 10 pounds in 2 weeks
  • If you exercise, you can eat as much as you want
  • It’s always a good idea to go with the salad
  • It’s better to eat lots of mini meals rather than eating fewer, larger meals
  • Cut back on carbs to lose weight
  • Skipping breakfast makes you gain weight
  • Eating at night will make you fat
  • Slow weight loss is the only way to lose weight and keep it off
  • You have to set modest goals if you want to lose weight
  • A slow metabolism prevents weight loss
  • Low-fat foods help you lose weight

Learn to control your eating behaviour and never diet again!diet-cartoon

Balancing ACT for Weight Control

Visit the Education page for details about our upcoming course and FREE Information Session

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15/Nov/2016

Thanksgiving turkey and Halloween candy are over for this year… but another holiday season is looming.

femaleAre you already feeling doomed when it comes to controlling your eating and your weight?  Do you feel guilty about what you eat?  Are you ashamed because you failed again this year?  Is “dieting” at the top of your New Year’s Resolution list……again?

The weight loss industry WANTS YOU.  If you are thinking of going on a diet again – DON’T!!!!!

There are many reasons why going on yet another diet doesn’t make sense.  The most powerful reason of all is because it hasn’t worked, doesn’t work and will statistically never work.  In reality, 97% of dieters regain everything they lost and then some within three years.

 

But there is an alternative.  There is an easy, effortless and low risk of failure solution to the problem.  If you understand what controls your behaviour and you understand the basic rules of learning, then it will become simple for you to control your eating behaviour.  Fortunately, the skills you need are easily acquired.male

By using a combination of Acceptance and Commitment Therapy (ACT) and behavioural and environmental engineering you can move closer to a weight and life that is most meaningful for you.  As a student in our program you will learn that:

  1. You are not that “fat” person, but the person who has that thought
  2. There is no such thing as “willpower”
  3. Hunger is not the issue
  4. Your habits get you “hooked”
  5. It’s not what you eat, it’s how you eat it
  6. Mindful eating leads to control
  7. Lack of confidence is holding you back

This is not a “diet breakthrough”.  This is a new way of looking at weight problems in the context of living a life that is truly fulfilling.

Balance the scale once and for all with Balancing ACT for Weight Control.

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J Marlin and Associates Inc. offers Cognitive Behavioural Therapy services to help individuals increase their sense of vitality, well-being, and fulfillment.

Head Office1100 Burloak Drive, Suite 602 Burlington, ON L7L 6B2

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