2. Obesity and ACT - Acceptance Commitment Therapy New Perspective
Washington 2012
Ayelet Kalter RD. MSc.
Expert in Treating Food & Eating Related Disorders (FERD)
Founder & Director of the Eating Dialog Study & Therapy Center
PhD Student Tel Aviv University
Good 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…

3. The current perception
The Weight Problem
The current perception

4. Facts We Have To Know
We don’t have to be thin (BMI<25) in order to be healthy
Being overweight is not a disease
BMI only weakly predicts longevity
Orpana 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):1861-7
Weight Science: evaluating the evidence for a paradigm shift. Nutr J. 2011; 10: 9
Body Mass Index and Mortality: a meta analysis based on person level data from 26 observational studies. Ann. Epidemiol 2005 Feb; 15(2):87-97
Obesity , larger waist size associated with better outcome in heart failure patients. American Journal of Cardiology 2012 July

5. Food & eating related disorders (FERD)
Facts We Have To Know
Food & eating related disorders (FERD)
Disease -
eating disorders 2%
Food & eating related disorders (FERD)
88%
morbid obesity
10%

6. Facts We Have To Know
10% - 25% of the obesity population are metabolically healthy
We do have to treat the sick obese (BMI>30) people
Bluher 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:

7. Facts We Have To Know
We all want to be thin but we don’t know how to help people to loose weight and keep it off
The diets and weight obsession are failures that make us fatter and create the diet language
Medicare’s Search for Effective Obesity Treatments Diets Are Not the Answer April 2007 American Psychologist Vol. 62, No. 3, 220–233
Does dieting make you fat? A twin study. International Journal of Obesity (2012) 36, 456–464
Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal 2011, 10:9

8. The outcome - The creation of the diet language
The medical perception – the pathogenesis model
The failure of the diet
The diet industry
The beauty ideal
The beautiful mind
The diet language

9. The outcome - The diet language
embodies rigidity, guilt, restrictions, avoidance, dichotomy and punishments
takes away the freedom to
eat what, when, where and
how much you need and
want
is based on control
takes away the joy of eating

10. lack of physical activity decreased self-esteem and body image
The Outcomes
unhealthy eating
lack of physical activity
decreased self-esteem and body image
fat discrimination
eating disorder
fat enhancement
Danielsdottir 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:

11. The Outcomes psychological inflexibility Cognitive Fusion
Experiential Avoidance
Attached to the conceptual self
Conceptualized past and future
Lack of values
Inaction, avoidant persistence

12. Maybe what we create as the solution for obesity
The question
Maybe what we create as the solution for obesity
has 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.jada
Health at Every Size Approach to Health Management The Evidence Is Weighed Top Clin Nutr Vol. 22, No. 3, pp. 272–285

13. AAAAA 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?

14. Different 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 life
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance
and Commitment Therapy: Model, processes, and outcomes. Behavior Research
and Therapy 44, 1-25.
ACT for Anxiety disorders Eifert and Forsyth Raincoast Book Canada
Hayes, S. C. & Smith, S. (2005). Get out of your mind and into your life: The new
Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

15. We 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 problems
There is an empowerment of the obesity problem ruled by political and economic interests
There is a natural diversity in weight and shape among the population – real people come in all sizes
We don’t have to be thin to be healthy
We all have
our own
set-point
Health-At-Every-Size and Eating Behaviors:
1-Year Follow-Up Results of a Size Acceptance
Intervention. J Am Diet Assoc. 2009;109:
Size Acceptance and Intuitive Eating Improve
Health for Obese, Female Chronic Dieters J Am Diet Assoc. 2005;105:

16. We don’t know how to help people lose weight and keep it off
Accept that…
We don’t know
how to help
people lose
weight and
keep it off
Why Does Dieting Predict Weight Gain in Adolesnce? Finding from Project EAY-II A 5-Year Longitudinal Study. J Am Diet Assoc. 2007;107:

17. But we do know how to: Stop the obesity process
Normalize the relations with food, eating and body
Live a meaningful life in every shape and
size
But we do know how to:

18. ”Obesity is part of living rather than a cause for not living”
Basic Assumption
The 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 thin
It is acceptance and mindfulness approach to obesity from a different perspective, which says:
”Obesity is part of living rather
than a cause for not living”

19. helping 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 Health
2005;59:440–442
The salutogenic model as a theory to guide health
promotion. Health Promotion International 1996;
1:11-8.

20. The use of ACT
The 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)

21. The Process Identify values of life – well being Committed action –
learn the health center approach
and the intuitive language of eating

22. The outcome
The outcome
People 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)

24. Thank you!!!