2Obesity and ACT - Acceptance Commitment Therapy New Perspective Washington 2012Ayelet Kalter RD. MSc.Expert in Treating Food & Eating Related Disorders (FERD)Founder & Director of the Eating Dialog Study & Therapy CenterPhD Student Tel Aviv UniversityGood morning, I would like to thank the Renfrew foundation for being here and thank you for joining my workshop.I am exited and hope we will have an interesting time together.I am from Israel. I used to be a clinical dietician and the chairwoman of the dieticians association. After many years of working in the field, I realized that my original profession is one of the reasons people developed food and eating-related disorders. That’s why in the last 10 years I made a big shift : I published two books The first one was published 6 years ago and is called: “how much happiness weighs – on food, body and soul” and the second was published this year and is called: "we are all real people – diets are the most successful failure in the modern generation.”These days I am leading the HAES approach in Israel. I am also trying to create a new profession that will work from different perspective in the field of obesity and disorder eating and will be called therapy in food and eating-related disorders and this workshop one piece of the program . hope this workshop will be a mind-opening experience for you. And one last remark before continuing…I had two possibilities , first was to read the lecture, that way for sure won’t be mistakes but you get bore the second option is to be spontaneous and hope you forget me for my English and just join me. I choose the second one. So let’s start…
3The current perception The Weight ProblemThe current perception
4Facts We Have To KnowWe don’t have to be thin (BMI<25) in order to be healthyBeing overweight is not a diseaseBMI only weakly predicts longevityOrpana HM, Berthelot JM, Kaplan MS, Feeny DH, McFarland B, Ross NA. BMI and Mortality: results from a national longitudinal study of Canadian adults. Obesity 2010;18(1):214-8.Excess Deaths Associated With Underweight, Overweight, and Obesity. JAMA.2005 Apr 20;293(15):1861-7Weight Science: evaluating the evidence for a paradigm shift. Nutr J. 2011; 10: 9Body Mass Index and Mortality: a meta analysis based on person level data from 26 observational studies. Ann. Epidemiol 2005 Feb; 15(2):87-97Obesity , larger waist size associated with better outcome in heart failure patients. American Journal of Cardiology 2012 July
5Food & eating related disorders (FERD) Facts We Have To KnowFood & eating related disorders (FERD)Disease -eating disorders2%Food & eating related disorders (FERD)88%morbid obesity10%
6Facts We Have To Know10% - 25% of the obesity population are metabolically healthyWe do have to treat the sick obese (BMI>30) peopleBluher M: The distinction of metabolically ‘healthy’ from ‘unhealthy’ obese individuals. Curr Opin Lipidol 2010, 21:38-43.Soverini V, Moscatiello S, Villanova N, Ragni E, Di Domizio S, Marchesini G: Metabolic Syndrome and Insulin Resistance in Subjects with Morbid Obesity. Obes Surg 2010, 20:Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie- Rosett J, Sowers MR: The obese without cardiometabolic risk factorclustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES ). Arch Intern Med 2008, 168:Karelis AD, Faraj M, Bastard JP, St-Pierre DH, Brochu M, Prud’homme D, Rabasa- Lhoret R: The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab 2005, 90:
7Facts We Have To KnowWe all want to be thin but we don’t know how to help people to loose weight and keep it offThe diets and weight obsession are failures that make us fatter and create the diet languageMedicare’s Search for Effective Obesity Treatments Diets Are Not the Answer April 2007 American Psychologist Vol. 62, No. 3, 220–233Does dieting make you fat? A twin study. International Journal of Obesity (2012) 36, 456–464Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal 2011, 10:9
8The outcome - The creation of the diet language The medical perception – the pathogenesis modelThe failure of the dietThe diet industryThe beauty idealThe beautiful mindThe diet language
9The outcome - The diet language embodies rigidity, guilt, restrictions, avoidance, dichotomy and punishmentstakes away the freedom toeat what, when, where andhow much you need andwantis based on controltakes away the joy of eating
10lack of physical activity decreased self-esteem and body image The Outcomesunhealthy eatinglack of physical activitydecreased self-esteem and body imagefat discriminationeating disorderfat enhancementDanielsdottir S, O'Brien KS, Ciao A. Anti-fat prejudice reduction: a review of published studies. Obes Facts 2010; 3:47-58.Neumark-Sztainer D, Paxton SJ, Hannan PJ, Haines J, Story M. Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 2006; 39:
11The Outcomes psychological inflexibility Cognitive Fusion Experiential AvoidanceAttached to the conceptual selfConceptualized past and futureLack of valuesInaction, avoidant persistence
12Maybe what we create as the solution for obesity The questionMaybe what we create as the solution for obesityhas actually become the problem?Pearson A.N., Heffner M. & Follette V.M. (2010) Acceptance Commitment Therapy for Body Image Dissatisfaction. New Harbinger Publication, Inc.Health-At-Every-Size and Eating Behaviors: 1-Year Follow-Up Results of a Size Acceptance Intervention 2009 by the American Dietetic Association. doi: /j.jadaHealth at Every Size Approach to Health Management The Evidence Is Weighed Top Clin Nutr Vol. 22, No. 3, pp. 272–285
13AAAAA Suffering by itself Is not the issue but rather clinging to it The diet?The bariatric surgery?The thinness race?The use of medication?Fighting the obesity?
14Different perspective - (Acceptance and Commitment Therapy) The use of ACT(Acceptance and Commitment Therapy)In order to accept what is out of our personal control, while committing to an action that will improve our quality of lifeHayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptanceand Commitment Therapy: Model, processes, and outcomes. Behavior Researchand Therapy 44, 1-25.ACT for Anxiety disorders Eifert and Forsyth Raincoast Book CanadaHayes, S. C. & Smith, S. (2005). Get out of your mind and into your life: The newAcceptance and Commitment Therapy. Oakland, CA: New Harbinger.
15We don’t have to be thin to be healthy Accept that…The diet obsession increases the obesity prevalence, causes eating disorders and emotional and health problemsThere is an empowerment of the obesity problem ruled by political and economic interestsThere is a natural diversity in weight and shape among the population – real people come in all sizesWe don’t have to be thin to be healthyWe all haveour ownset-pointHealth-At-Every-Size and Eating Behaviors:1-Year Follow-Up Results of a Size AcceptanceIntervention. J Am Diet Assoc. 2009;109:Size Acceptance and Intuitive Eating ImproveHealth for Obese, Female Chronic Dieters J Am Diet Assoc. 2005;105:
16We don’t know how to help people lose weight and keep it off Accept that…We don’t knowhow to helppeople loseweight andkeep it offWhy Does Dieting Predict Weight Gain in Adolesnce? Finding from Project EAY-II A 5-Year Longitudinal Study. J Am Diet Assoc. 2007;107:
17But we do know how to: Stop the obesity process Normalize the relations with food, eating and bodyLive a meaningful life in every shape andsizeBut we do know how to:
18”Obesity is part of living rather than a cause for not living” Basic AssumptionThe treatment is not about getting rid of obesity or about teaching clients new elegant ways to control their eating and weight in order to be thinIt is acceptance and mindfulness approach to obesity from a different perspective, which says:”Obesity is part of living ratherthan a cause for not living”
19helping them eat normally and live a full life in every shape and size This will allow clients to avoid controlling their body and their eating,helping them eat normally and live a full life in every shape and size(based on the salutogenic model by Antonovsky)Salutogenesis. J Epidemiol Community Health2005;59:440–442The salutogenic model as a theory to guide healthpromotion. Health Promotion International 1996;1:11-8.
20The use of ACTThe use of mindful skills as a way to see the diet language and the way it causes suffering.Alberts H.J.E.M, Thewissen R, Raes L, Dealing with problematic eating behaviour. The effects of a mindfulness-base intervention on eating behaviour, food cravings, dichotomous thinking and body image concern. Appetite , Volume 58 (3)
21The Process Identify values of life – well being Committed action – learn the health center approachand the intuitive language of eating
22The outcomeThe outcomePeople probably won’t become thin but they will eat normally, have good relation with their body and live healthy and full lives in every shape and size
23(Carlos Castaneda = The Teachings of Don Juan) Before you embark on any path ask the question: Does this path have a heart? If the answer is “no”, you will know it, and then you must choose another path.”(Carlos Castaneda = The Teachings of Don Juan)