Positive Health Online

The headlines, backed by government statistics, say it all - Britain is in the grip of an obesity crisis. There has been a marked increase in obesity rates over the past eight years:

• In 1993 13% of men and 16% of women were obese;
• In 2011 this rose to 24% for men and 26% for women.

Of children attending reception class (aged 4-5 years) during 2011-12, 9.5% were obese.[1]

There are a number of obvious, and well-documented reasons behind this alarming epidemic.  The 50 and 60 year olds of today were brought up in the austere conditions of post war Britain with a simple, if sometimes frugal diet, chilly houses and an active lifestyle - how many children were driven to school in the 1950s?  Life as a child was all about playing outside: kicking a ball, hopscotch, skipping, spending the holidays building a soap box or out all day on your bike. We don’t need to enumerate the stark differences of a child’s life in the noughties.

Parents who are in a rush to get to work, who skip breakfast themselves, may give their child money for breakfast or lunch instead of preparing a balanced meal or snack. This money may then be spent on crisps, chocolate and a coke. The ready-meal culture, laden with fat, sugar, salt and additives doesn't help either. Often shoppers are unaware of the nutritional value of food and how they compare with freshly made meals. The pounds, then the stones, pile on.

Worryingly, society's perception of what is a normal size and what is fat or obese appears to be changing too, with alarming statistics being published in the press on an almost daily basis. In a report published in February 2013 by The Health and Social Care Information Centre, it was revealed that the proportion of adults with a normal BMI (Body Mass Index) had decreased between 1993 and 2011 - from 41% to 34% among men and from 50% to 39% among women. The proportion that were overweight (including obese) increased from 58% to 65% in men and from 49% to 58% in women during this period.

There are many and complex reasons why people over-eat; it would be simplistic to attribute it solely to ignorance or idleness. Modelling unhealthy eating patterns of parents or holding on to entrenched beliefs about wasting food or clearing one's plate is common. Associations between food and comfort are often firmly embedded too - a sweet given to soothe a distressed child or a weekly burger bar visit with an absent parent can set up a connection that will endure in the subconscious.

Clients presenting with issues relating to food - most specifically overeating - form a large part of my practice.  These are people who know they have a difficult relationship with food, but find they are unable to change their habits. Some have sought help from their GP, who often will simply give them a diet sheet, tell them to exercise and leave them to get on with it.  A practice nurse with whom I spoke recently, asked if hypnotherapy for weight loss worked, complaining that most of her obese patients didn't stick to their diet.

There appears to be a real lack of understanding of what drives people to overeat. It is rare for any evaluation of the psychological state of the patient to be conducted by GPs. Little effort appears to be made to find out what is going on underneath the surface, for instance what is the void that food is filling? Is there a fear associated with being ‘normal’ sized or more attractive, and if so where does that fear stem from? This sort of exploration may not be within the remit or clinical expertise of general practitioners, but if time is available to have an in-depth consultation with such patients, referrals to talking therapists or a community Psychiatric Nurse (CPN) could be made.

People overeat for many reasons other than hunger. Overeating and especially binge eating tends to increase when people are stressed, upset, lonely or bored; there is research that has shown a link between depression and obesity. Many people will self-medicate with food, seeking comfort or 'anaesthetic' through eating.  Analysis of data from 16 research studies confirmed that depressed, compared to non-depressed people were at significantly higher risk for developing obesity. There was also evidence to show that the risk among depressed people for later obesity was particularly high for adolescent females.

Expecting clients who are experiencing depression to commit to a diet or exercise programme, is naive in the extreme. If an individual is depressed, the motivation to exercise is likely to be low. Obese clients will often resist exercise because of the physical difficulty of such movement, as well as the embarrassment factor if they go to a gym or pool. To dismiss this concern would display a lack of empathy - very large people do get looked at when surrounded by slimmer, fitter people. I therefore recommend increased activity, rather than a prescribed exercise programme.

The majority of clients seeking my help will have tried many different diets and attended slimming clubs too. Some will tell me that a certain diet has 'worked' for them previously, unaware of the irony in their statement - if a diet worked, they'd only do it once! The problem with diets is that they require people to think about food all the time, and thinking about food is what most people with eating issues do too much of anyway. Serial dieters consider certain foods as ‘good’ and others as ‘bad’ and judge themselves accordingly. It is their relationship with food and what, to them, it represents that needs to change, rather than the actual item they put in their mouth.

Clients may also be in denial about the reasons behind their weight issues claiming a ‘slow metabolism’ (which is very unlikely) or that everyone in their family is big. Some have an irrational fear of being hungry, so they eat before they need to. I will ask them what they believe will happen if they don’t eat at the time they expect to, which is something they have rarely considered. When they realize that there is no consequence to being hungry on occasion, we are part of the way to adjusting their mindset.

Many people eat 'unconsciously' whilst working, watching TV or doing something else; eating like this is often hurried too. This means that that they often fail to register that they've had a meal, which can lead to further eating. Other people simply have no idea of how unbalanced or unhealthy their diet is or how large their portions are until they keep a food diary or share a photo with me of their loaded plates.

Through hypnotherapy, underlying issues which have led to overeating and weight gain can be explored and worked through using cognitive as well as hypnotherapeutic approaches. Clients with complex issues may benefit from regression therapy to identify an incident or incidents in their past which have led to the destructive eating behaviours. In hypnosis, clients can release past hurts and change negative beliefs about themselves. It is not unusual for clients to have experienced criticism, bullying or other problems when younger or as an adult that lead to low self-esteem. If they have been subjected to unwanted attention at an earlier age, they may subconsciously consider themselves safer overweight.  

A difficult challenge is where a client is unsupported in their quest to lose weight or make changes. One example would be where a spouse or partner is also overweight and doesn't want to confront their own eating patterns. Another would be where an insecure partner feels more comfortable with their other half big. This is a situation I have experienced with a client. She had split with her husband some years earlier after meeting someone else. When her husband saw her next, she had lost several stones in weight and was looking very attractive. In time she and her husband got back together. Shortly afterwards he started buying her little ‘treats’: a box of chocolates; a rich pastry; taking her out to a coffee shop for a latte and a cake. The weight piled on and she went out less. The client's realization of her husband’s role in her overeating allowed her to take back control and to reject his unhealthy offerings.

Hypnotherapy can offer a different approach to dealing with emotional eating problems as well as habitual behaviour. By working through underlying issues, they are better placed to commit to practical changes as well as cease 'self-soothing' through eating. Not everyone can afford or has access to a psychotherapist or hypnotherapist, so diets and slimming clubs are likely to remain the options available for people who can't fund or source their own therapy. The NHS has little to offer except dieticians and further down the line, bariatric surgery. Cognitive Behavioural Therapy - the NHS's preferred therapy - is in limited supply and is a very brief therapy, which isn't appropriate for all.

If obesity is not going to become an even bigger issue in our society, more psychological support is needed for those with problem eating. I believe that there should be greater investment by the NHS in talking therapies, and that meaningful help should be offered sooner. The cost of providing appropriate talking therapy to an individual before they develop serious health conditions will save the NHS and society in the long term. To support an individual with weight-related health conditions is very expensive, not only in treatment cost, but also in lost working days, welfare payments and the impact on the patient and their family.

Bariatric surgery is currently offered on the NHS as a treatment of last resort, but is available privately for those who are overweight and can pay.  Bariatric surgery is useful as a life-saving treatment, but does nothing to tackle the psychological issues that always exist where a person is morbidly obese, so other solutions need to be found. In the last few years gastric-band hypnotherapy has become very popular. With this type of treatment a client is hypnotized to believe that they have actually had a gastric-band fitted. Strange as it may seem, this can be achieved, but again this does not address the causes of overeating. The appeal of a quick fix and rapid weight loss is very seductive to many obese clients, but ultimately, just as a real gastric-band can be 'overridden', so too can a hypno gastric-band.

References

1. HSCIC February 2013.