Obesity and ACT -
Acceptance Commitment Therapy
New PerspectiveWashington 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
The Weight ProblemThe current perception
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
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
Disease -
eating disorders
2%
Food & eating related
disorders (FERD)
88%
Disease -
morbid obesity
10%
Food & eating related disorders (FERD) Facts We Have To Know
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, 20:295-301.
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 1999-2004). Arch Intern Med 2008,
168:1617-1624
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, 90:4145-
4150
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
The outcome - The creation of the diet language
The medical perception – the pathoge
nesis model
The failure of the diet
The diet
industry
The beaut
y ideal
The beaut
iful mind
The diet
language
embodies rigidity, guilt, restrictions, avoidance, dichotomy and punishments
takes
away
the
freedom
t
o eat
what,
when,
where
and
how
much
you
need
and
want
is
based
on
control
takes
away
the
joy
of
eati
ng
The Diet Language
The outcome - The diet language
unhealthy eating
lack of physical activity
decreased self-esteem
and body image
fat discrimination
eating disorder
fat enhance
ment
The Outcomes
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; 39:244-51.
The Outcomes
psychological
inflexibility
Cognitive Fusion
Experiential Avoidance
Attached to the conceptual self
Conceptualized past and future
Lack of values
Inaction, avoidant
persistence
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: 10.1016/j.jada.2009.08.017
Health at Every Size Approach to Health Management The Evidence Is Weighed Top Clin Nutr Vol. 22, No. 3, pp. 272–285
The question
•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?
Different perspective -
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 2005 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.
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 t
o
be t
hi
n t
o
be
healt
hy
We
all
have our
own set-
poi
nt
Accept that…
Health-At-Every-Size and Eating Behaviors:1-Year Follow-Up Results of a Size AcceptanceIntervention. J Am Diet Assoc. 2009;109:1854-1861
Size Acceptance and Intuitive Eating ImproveHealth for Obese, Female Chronic Dieters J Am Diet Assoc. 2005;105:929-936.
We don’t know
how to help
people lose
weight and
keep it off
Accept that…
Why Does Dieting Predict Weight Gain in Adolesnce? Finding from Project EAY-II A 5-Year Longitudinal Study. J Am Diet Assoc. 2007;107: 448-455
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:
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”
Basic Assumption
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.
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, 2012. 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)
The Process
Identify values of life–
well being
Committed action – learn the health center approach and the intuitive language of eating
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
The outcome
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(
Thank you!!!