What are the NHS doing?

A client told me today that her doctor would not refer her for counselling for depression and overeating, the doctor refused saying that it was OK to overeat to deal with depression as long as she sticks to low fat yoghurts and fruit. She even had the gall to add that they taste just as nice and would fill her up just the same. I am horrified. And it gets worse. The doctor advised her to join Slimming World or Weight Watchers, saying that they aren’t really diets. This, despite my client telling her that these clubs don’t help her as they don’t address the psychological reasons behind her overeating. And that in any case they had never worked for her and that she has in fact gained weight over the years while going to these slimming clubs. The doctor just didn’t listen. Moreover, this doctor is clearly lacking in information and effective strategies to help her. If the best she can come up with is low fat yoghurts and WW, we are indeed in big trouble. This doctor seriously thinks that telling someone to overeat fruit is a good thing. I want to cry.

I can’t tell you how many stories like this one I have heard over the years. Admittedly this is the first one where a doctor openly advises her patient to overeat fruit, but why am I so shocked and surprised? Legitimising overeating is something that diets have done for ever. In my Weight Watchers days I clearly remember being sold the number one benefit of FREE soups, namely that I could eat as much as I wanted. The message being, it’s OK, if you want to eat and you’re not hungry, eat FREE foods. I was constantly urged to abate my cravings for chocolate or crisps with as many carrot and celery sticks as I could. How does a presumably intelligent and highly educated doctor not see that promoting overeating of any food is unhelpful and downright dangerous. How can they fail to realise that they are compounding the problem, not solving or even managing it.

We always tell women not to stop overeating when they first start a course or a workshop. We invite them to overeat with awareness, to find out as much about the behaviour as they can. To take it very slowly. And this is always with a view to stopping or drastically reducing how much they overeat. We know that in order to do that, in order to stop overeating, we need to address all the psychological, behavioral and physical reasons we overeat in the first place. How can it be that Audrey and I, two ordinary women, can see that and a doctor cannot? It didn’t take me eight years of psychotherapy training to work out that if I continued to overeat free foods when I was on a diet, I’d be overeating chocolate and crisps as soon as I was off it. I didn’t need a degree in medicine to realise that the more we go on diets and sign up to slimming clubs, the fatter we become in the long run. It is blindingly obvious not just to me and to all the Chocolate Fairies; there are many, many scientists and researchers have known this since the 1940s when Ancel Keys conducted the Minnesota Starvation Experiment.

WW and SW produce wonderful glossy brochures targeted at the government and the NHS documenting just how many pounds they have helped us Brits lose over the years. Their materials fail to mention how many pounds we re-gain and how many of those pounds lost belong to same person who has lost and gained them over and over again, usually ending up a good few pounds heavier than when she started and feeling like a hopeless failure to boot. Blaming herself rather that the diets for her failure. This has got to stop. Now.

It is time the NHS woke up and admitted they are losing the so called battle against obesity. If they had the courage and the budget, they might just acknowledge that what people need is compassion, understanding and real, effective tools. This doctor would realise that my client knows best, she knows what she needs and some support in the form of counselling would be a start right now.

I’m working on a proposal for my doctors' surgery to offer them an ongoing weekly group for what they consider to be their hopeless cases, at no cost to the women or the NHS. I hope they will take up the offer.

The Obesity Crisis?

The obesity crisis. The crisis is not about obesity - it's about people's relationship with food and the food industry. All the focus is on people losing weight. Doctors put patients on diets and send them to slimming clubs, the main aim being for them to come back a few months later slimmer, lighter. That’s how they measure success. I heard on the radio today that the government is “promoting body building as way of improving the health of the nation”. What?! How do they equate the two? Body building has never and will never equal good health! Being strong and having pumped up muscles is NOT the same as being healthy. There is no evidence, not a shred that I can find, to support the idea that body builders have fewer health problems or live longer, healthier lives than people who do a moderate amount of exercise…

By focusing on obesity the doctors and the government are missing the point. By measuring results in pounds/kilos lost and BMI they are, as ever, dealing with the symptom and not the problem. The problem, as I know you know, is not the weight - it’s the way we eat. And the problem is not fixed simply by the losing the weight. Through conventional diets 98% of people who lose weight (and many of them don’t even manage it!) put all the weight back on within 2 years! People’s health is not improved by dieting. People’s health is improved by eating well and being active. Yes, if people eat too much they will be overweight and that may impact their health. By developing a healthy and balanced relationship with food and their bodies, they will eat what they need, find ways to be physically active and lose weight - but you can’t just take short cuts and hope that if we just get people to lose the weight, without understanding what drives them to overeat, what the real problems are, without changing long term habits and choices, they will be healthier too! Yo-yo-ing up and down in weight has been proven to be more unhealthy than being consistently (but stably) overweight. By putting pressure on women to lose weight without giving them the necessary tools and support to address the reasons why they overeat or make food choices that cause weight gain, we are increasing their stress levels - as they feel guilty and ashamed about their supposed lack of self control and discipline. Not only does stress play a big part in ill-health, but the constant failure to lose weight often sees women giving up and... eating more! My point is that continuing to address the symptom is a dangerous waste of time and money which compounds the problem and creates more weight gain. What we have to offer at Beyond Chocolate is an approach which empowers women to take control of their eating, to make lasting, sustainable choices and to feel good about themselves. We address the real crisis - the way we eat, the reasons we overeat, the way we use food and the reasons underpinning our habits and behaviors. And over and over again we have had clients whose health has improved as a result of following the Beyond Chocolate principles, regardless of whether or not they have lost weight! Even their doctors have agreed! The thing is it takes time and that's not sexy. There's no dramatic transformation. It's a slow process and often things get worse before they get better.

Our new book, Beyond Temptation, takes the Beyond Chocolate principles to the next level, guiding women to really understand their overeating, recognising their triggers and patterns, so that they are in a position to stop turning to food as a salve, a comfort, a treat... so that they can make food choices which are both healthy and satisfying... so that they can say no to junk food, not because it’s ‘bad’ or forbidden, but because they care enough about themselves to use food as a way of nourishing their bodies rather than as a way of punishing, numbing, treating or soothing themselves. When we address the real issues, we find real solutions and there are real, lasting benefits.

This September we are planning to undertake a study of the Beyond Chocolate approach. We’ll be taking a group of overeaters who have been told they need to lose weight to be healthier and we will support and guide them for six months. Alongside them the will be a control group who will be doing the usual diets. And we’ll see what the results are, after six months, after a year, after two years...

The crisis is not about obesity. That’s like saying that the best way to reduce crime and stop burglars from robbing houses is to teach them the difference between honesty and dishonesty. To teach them how to make a living the honest way. Like they don’t know? Really? As if there are not complex social and personal reasons why criminals behave the way they do. Just like teaching people about ‘healthy eating’ - hands up who doesn’t know what’s healthy?? We don’t need more information and teaching. We need support, guidance, understanding and compassion. We need to know that we’ll get to the root of the problem rather than staying on the surface and making it all look good. Rather than focusing on people looking good. Criminals are much less likely to re-offend when they are met by someone who sees the crime as a symptom and offers support, guidance and opportunities (rather than simply punishment) to make changes to their lives. Locking them away may solve the immediate problem but it doesn't address the issues, it sweeps them under the carpet, it costs a fortune and it leaves us with many unhappy unfulfilled human beings. Putting people on diets, focusing on weight loss, is just the same. It’s time the powers that be addressed the real issues underpinning the ‘Obesity Crisis’ and stopped looking for quick fixes that make their data and records (and people) look good! And besides, the quick fixes aren't even working. Apparently the epidemic is growing. It’s time they acknowledged that they are losing the war because they are fighting the wrong battles with the wrong weapons. If they could just stop fighting, stop waging a war against FAT, they would see that there are real people, with real issues who need real help. They would acknowledge that the sugar lobbies, the corn syrup manufacturers and the food industry in general have far too much power and are selling us food that isn't even food and that there's no way people can lose weight sustainably on a diet of pretend nourishment (next week's blog post I think!). As I write I know how naive that is. And I won’t stop clamouring for it anyway :-)

What would you say to this government if it asked for your opinion on what to do about the so-called Obesity Crisis?

Have we hit rock bottom?

According to a recent article in The Telegraph, doctor's will soon be paid for telling their patients that they are fat. Family doctors, the article states will: "be able to boost their income if they record giving “weight management advice” to obese patients, or offer them a free place on a diet club, which the NHS would pay for."

Quite apart from the worrying monetisation of health that is going on in our country and the fact that we know DIETS DON'T WORK for long term weight loss (but I'm not going there as we talk about this elsewhere), I'm so flabbergasted by this news that I'm not sure where to start my rant...

So let's start with the obvious: do they really believe that people don't know they are overweight (also, who defines the criteria of what is considered as 'overweight' and what is this criteria based on)? That they need a doctor to tell them?? More worryingly, we know from working with thousands of women over the years that many of them are already reluctant to go to the doctor's as so many of them have had awful experiences of being told they were fat and needed to go on diets - even when they go in for completely unrelated issues. If this approach is institionalised and people know that their weight will come under scrutiny every time they go to a surgery, how many will opt to ignore possibly serious symptoms in order to avoid the shame and embarrassment of being told that they are fat? Ridiculous!

And since when has shaming ever been an effective approach to achieve long term weight loss? We know, again from speaking to many Beyond Chocolaters, that this is often what pushed them to overeating in the first place. I know from my own experience. My mum put me on the scales aged 11 and told me I was too fat to go to the beach 'looking like that' and I struggled with being 'too fat' for the next 20 years. My self esteem, my self worth and my view of my body were crushed and distorted by this experience and the repeated variations of it by well meaning doctors, relatives, friends and teachers over the years. I remember feeling mortified, rebellious and hopeless all at the same time every time someone expressed concern over my weight. I took these messages on and made them my own so that I was also constantly telling myself that I was too fat. And how did I make myself feel better? Yep, with food. Lots of it.

It was only when I stopped beating myself up, when I stopped believing that there was something wrong with me because I couldn't control my eating and couldn't stick to a diet and keep weight off for any amount of time that things started to shift. It's not rocket science. It seems obvious to me that it's just not viable to shame people into losing weight.

Breath. Rant over.

I'm going to be writing to my local MP to tell them exactly what I think of this ridiculous scheme. Please, join me and let the government know how you feel about this too. We can make a difference if we speak up...loudly.