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!!!