Psychological Strategies for Weight Change Conversations

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2 Psychological Strategies for Weight Change Conversations Dr. Jen Nash Chartered Clinical Psychologist Director of Positive Diabetes : Founder of the Eating Blueprint : Author of Diabetes & Wellbeing and Your Weight Isn t About Food 2

3 Welcome & Outline The Psychology of Eating The role of food and eating in 2017 Non-hunger eating what is it? 30+ reasons why we eat 3 types of hunger 5 conversational skills to help in time-limited consultations 3

4 Polling Question What aspects of care do you feel are important to support people struggling with their weight? A. Diet and exercise advice B. Medical therapy C. Psychological support D. Surgery E. A combination of the above F. Other 4

5 The Psychology of Eating Rates of obesity are ever-increasing Current health education messages are focused on eat less and move more We know for every person who can implement this advice, there are many who struggle Leads to a sense of failure and increased hopelessness for both the person who is struggling and the health professional 5

6 Why Can t We Just Eat Less and Move More Traditional medical and dietary advice treats weight loss as if it is logical, rational There is an assumption that education alone leads to behavior change But education doesn t always lead to desired change does it? How do we know this?... 6

7 Health Professionals Health messages are clear o o o o o Alcohol intake Food choices Exercise decisions Sleeping habits Smoking Yet how often do we take our own advice? o We too, are the patient when it comes to being able to implement lifestyle change 7

8 Food Designed to solve one problem the problem of hunger There are over 30+ reasons why we eat We re using food to solve problems it wasn t designed to fix In our food abundant environments, food has become the ultimate problem solver 8

9 Polling Question Think back over the last 48 hours. What were the reasons you ate? A. It was a meal time B. Someone offered/cooked/prepared you food C. To reward yourself/celebrate something D. Because others were eating E. To receive some comfort F. To deal with stress or another emotion G. For an energy boost/to deal with tiredness H. You couldn t resist! I. You were physically hungry 9

10 Non-Hunger Eating is eating for reason(s) other than physical hunger 1) Fun 2) Feelings 3) Focus 4) Fatigue 5) Fullness 6) Fear 7) Fury 8) Fables 9) Finally 10) Friends 11) Frustration 12) Finishing 13) Free 14) Furlongs & Feet 15) Flavour 16) Forgetting 17) Foraging 18) Feeders 19) Failure 20) Fed up 21) Feasting 22) Forgiveness 23) Fritter 24) Fidelity 25) Friends 26) Foresight 27) Failure 28) Flap 29) Freedom 30) Future 10

11 3 Types of Hunger Stomach Hunger Heart Hunger Eyeball Hunger 11

12 Education IS Important There is a missing piece to the weight management jigsaw We need psychological skills to be able to implement education within the complexities of our everyday lives 12

13 Weight as a Symptom of Distress There is a substantial body of evidence that suggests many who routinely use food for emotional regulation have a history of psychological issues The incidence of trauma, childhood abuse, sexual abuse, low self-esteem and depression is high among people who are obese and those presenting for bariatric surgery (Gustafson et al, 2006) Despite this, access to psychological services for obese individuals is limited 13

14 Adverse Childhood Experiences (ACE) Questionnaire Links between high scores on the ACE Questionnaire and poor health and wellbeing, including a higher incidence of obesity/type 2 diabetes /violenceprevention/acestudy Study of more than 17,000 middle class Americans documented clearly that adverse childhood experiences can contribute significantly to negative adult physical and mental health outcomes and affect more than 60% of adults (Felitti, 2006) 14

15 The Unvoiced Story of Eating Behaviour Conscious Mind Thoughts you ARE aware of in your daily life Unconscious Mind Thoughts you are NOT aware of, but direct your behaviour 15

16 Eating: The Unvoiced Conversation I m sad I eat Dietary and Exercise Advice I m bored I eat Dietary and Exercise Advice I m stressed I eat I m lonely I eat I failed the diet I eat Dietary and Exercise Advice Dietary and Exercise Advice Dietary and Exercise Advice 16

17 Polling Question Thinking about the weight change conversations you re currently having, how often are you talking to people about their non-hunger eating? A. 0-20% of the time B % of the time C % of the time D % of the time E % of the time 17

18 Diabetes Requires Medical support Educational support Selfmanagement support Psychological Skills Support 18

19 A Different Look at Motivation When we are considering how to support people towards weight loss, we may be more effective if we help the person solve the problem they are using food to deal with, rather than trying to motivate them to remove food as a way of coping Some new tools may help 19

20 Skill 1: Dealing with Conversation Stoppers Weight can be a sensitive topic Even in our health settings We may avoid the conversation Having ways of responding can help Preparing for the conversation stoppers Can increase our confidence to have the conversation 20

21 Conversation Stoppers But I hardly eat a thing. How can you understand what it s like, you re not fat like me. Everyone in my family is big. Well you can t help me you obviously don t practice what you preach. I ve tried to lose weight before and couldn t keep it off, it s pointless trying. When I start eating, I just can t stop. 21

22 Some Unvoiced Motivations But I hardly eat a thing. I zone out when I eat and don t remember / I don t want to be judged / I m fearful of what you ll think / I don t want to have this conversation with you Everyone in my family is big. I m motivated to be accepted by those I love and care about, to fit in When I start eating, I just can t stop. I m motivated to manage my mood. If food isn t available to me when I m sad, bored or lonely, life would be unbearable 22

23 Some Unvoiced Motivations Whatever I try, I can t seem to stick to it I m unconsciously motivated to be big because I ve made a link that when I m smaller in body size, I m vulnerable How can you understand what it s like, you re not fat like me. I m motivated to not be judged; I want to end this conversation Well you can t help me, you obviously don t practice what you preach. I m motivated to not feel like a failure, so I m going to make you feel as bad as I do so we can end this conversation 23

24 Example Conversation Prompts What the person says: I don t know why I m putting on weight, I hardly eat anything. Everyone in my family is big. I ve tried to lose weight before and couldn t keep it off, it s pointless trying again. When I start eating, I find it hard to stop. Example of how you could respond: Yes, it can be really confusing, can t it? Sometimes talking about why we are eating, as well as how much can be a helpful approach. Would you be interested in thinking about the reasons why you eat? Yes, I see. How does it make you feel to imagine being a smaller size than your family members? Yes, I understand, losing weight and keeping it off can be so difficult. I want to encourage you for being successful before! Sometimes talking about why we are eating, as well as how much can be a helpful approach. Would you be interested in thinking about the reasons why you eat? Yes, it can be so difficult can t it? Sometimes talking about why we are eating, as well as how much can be a helpful approach. Would you be interested in thinking about the reasons why you eat? 24

25 Example Conversation Prompts What the person says: I m sad / lonely / tired / bored. Food is the only thing that helps. How can you understand what it s like, you re not big like me. You can t help me, you obviously don t practice what you preach. Example of how you could respond: Yes, food can be really good at solving (insert word they used). I suppose the downside is that food and weight gain can add in another problem to deal with. Would you be interested in thinking about a few more ideas of how to solve (insert word they used) so food becomes just one of your options? Yes, I can appreciate that. You re right - I don t understand exactly what it s like to be you, but I know there are some new ways of thinking about food which other people I ve worked with have found helpful. I d be pleased to share them with you if you d like that. Yes, I guess if it was easy then all of us health professionals would be a healthy weight. I m on my own health journey, and whilst I haven t got it all sorted yet, there are some new ways of thinking about food which I m finding helpful, and I d be pleased to share them with you if you d like that. 25

26 Skill 2: How do I ask a person about non-hunger eating in a nonjudgemental way? It s very common for all of us, no matter what our shape/size, to eat when we re feeling down/stressed/tired/bored. Do you sometimes eat for these reasons? 26

27 Conversation Starters 2 There are only 3 possible responses to this question! Thank you for sharing that with me. Is this something you d like to think about together? 27

28 Skill 3: What to do when a person says no Ok! with eye contact and a smile, carry on with your consultation as usual. 28

29 Skill 3: Responding to a not sure : the skill is to be encouraging There are some new ways of thinking about managing your weight that I can share with you if you re interested. It s very common to eat to deal with life s ups and downs - food CAN fix these problems in the short-term but in the longterm can mean extra weight. If we can look at the reasons why you re eating, this could help you with your weight and how you feel about life. 29

30 Responding to a Not Sure : The skill is to be encouraging There is a new tool we can use to help us, which takes a different approach to weight, by thinking about our eating styles would you like to hear about it? If you re interested, we can think about the reasons behind your eating, rather than what and how much. 30

31 Skill 4: When a person is interested in talking about non-hunger eating 1) Fun 2) Feelings 3) Focus 4) Fatigue 5) Fullness 6) Fear 7) Fury 8) Fables 9) Finally 10) Friends 11) Frustration 12) Finishing 13) Free 14) Furlongs & Feet 15) Flavour 16) Forgetting 17) Foraging 18) Feeders 19) Failure 20) Fed up 21) Feasting 22) Forgiveness 23) Fritter 24) Fidelity 25) Friends 26) Foresight 27) Failure 28) Flap 29) Freedom 30) Future 31

32 The Reasons Why I Eat Tool There are over 30+ reasons why we eat, and hunger is just one of them! What are the reasons why you eat? Tick as many that apply to you in an average month: Reason Reason I m tired I was celebrating I m stressed I can t resist I m bored / want distraction Everyone in my family is big / eats a lot I m lonely I m too busy to eat differently I don t like to say no to food I m worried, scared or anxious I m sad I don t like to leave food on my plate / not finish a packet of food I like to feel full The food was free, I didn t have to pay for it Once I ve started its difficult to stop I find it difficult to say no when certain people offer me food I want a reward I easily forget my weight loss goals I don t like to throw food away I was eating in secret or hiding what I was eating from others Food is everywhere, it s hard not to eat more than I need I felt angry The clock told me it was a meal time (e.g. dinner time) I ate something I shouldn t and thought I should give up trying It s a special occasion I always feel hungry I prefer to be bigger in body, because it makes me feel safer somehow I m aware I eat to soothe against memories or upsetting incidents from the past Others comment when I m smaller in body size Eating was a way of dealing with other feelings/emotions not listed I just love food too much! Other reason(s) not listed here Each of these can be very good reasons for eating! You may also want to see these reasons as problems that CAN be overcome if you d like to. Food and eating CAN help you deal with life s problems in the short term, as you know, it can cause you more problems in the long term. Visit for further support. 32

33 Example Conversation Prompts Non-Hunger Eating Problem Using food to fix a problem when another (more direct) solution exists Using food to deal with feelings Need skills to be able to tolerate distress Following internal or cultural rules about food / eating, without thinking What we ll hear: I m tired, lonely, bored, stressed, don t have time. I m sad, angry, worried, anxious, scared. I was eating in secret. I was hiding what I was eating from others. I like to feel full, I can t resist, once I ve started to eat it s difficult to stop. I don t like to leave food on my plate/in the packet. I always feel hungry. I just love food too much! The clock told me it was a meal time. It s a special occasion. I ate something I thought I shouldn t and felt I should give up trying. It s rude not to finish. The food was free - I didn t have to pay for it. Others comment when I don t eat as much as them or when I m smaller in body size. 33

34 What to Do if Weight Change Conversations are Not So Straightforward: Deeper reasons for eating/weight I prefer to be bigger in body because I feel less vulnerable. I m aware I eat to soothe memories or distract from upsetting things of the past. Being bigger in body keeps me sexually safe. Eating too much is a way I self harm. 34

35 Example Conversation Prompts What the person says: I ve been this size ever since (xyz). Example of how you could respond: Thank you for sharing this with me, it s natural that (reflect what they ve shared) is affecting your weight. Would you like to get support for dealing with (xyz)? I could let you know about some organisations that might help. I know why I m fat and I m not going there. I need to deal with (xyz) before I can stop using food to cope. That sounds really important. I can understand you may not want to talk about this with me if you DID want to talk to someone, I can let you know about some organisations in the community that may be able to support you / that other people I ve worked with have found helpful. Yes I understand, that sounds very important. Would you like to get support for dealing with (xyz)? I could let you know about some organisations that might help. 35

36 Suggested Resources Overeaters Anonymous: MIND: Samaritans: B-EAT:

37 Summary Food and eating are complex! Being equipped with conversational tools can support both yourself and those you are working with to have helpful, sensitive conversations We ALL have a relationship with food/eating develop a curiosity about your own interactions with food (e.g. in the workplace, family) This enables us to be more effective advocates for those we are working with 37

38 How many Psychologists does it take to change a lightbulb? One, but the lightbulb has to want to change. Thanks and Acknowledgements Thank you to all those individuals who have collaborated with me at Positive Diabetes and the Eating Blueprint. Thank you to my colleague Rosie Walker, Director of Successful Diabetes. 38

39 Next Steps Please invite the people you work with to register for a free Starter Pack by at: Your Weight Isn t About Food Book (Amazon) The Eating Blueprint Online Programme is available for health provider commissioning. Please get in touch to find out more, hello@eatingblueprint.com 39

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