Once upon a time.…That's how a story always begins, isn't ?

So, once upon a time, when I had just finished studying, it was twenty years

ago, I was sure I was going to succeed to help people lose weight, help

them to be thin. I was full of ambitions and passion and step by step my

clinic became the largest one in Israel. True, my patients lost weight, but

they also regained it.

My patients were confused and I felt helpless. I couldn't understand what I had

done wrong. Slowly I realized that something was not as I thought it might

be and maybe I didn't really know how to make people thinner. I also

understood that probably weight is not an outcome of willpower.

At that point – 12 years ago - I attended a workshop in Philadelphia,

which was part of a convention of eating disorder. At the middle of

the workshop we were asked to get up and dance. To my great

surprise, everybody, including a group of extremely obese people,

did it. I was the only one who remained sitting, although I was the

thinnest person there. That was a turning point in my professional

perspective. I realized that you can't weigh your self-esteem.

Step by step, without even noticing, I started leading my patients to

get off the diet roller coaster. By then I felt that I could not continue

selling the “thinness dream”. So I retired from my position as

president of the dietitians association in Israel in order to act

according to my beliefs .

It was not easy because, although people knew that diets were a

failure, they continued looking for the magic that would allow

them to achieve the fantasy. They were ready to pay a fortune in

order to get it. I, as a dietitian who did not sell those dreams

anymore, started to lose patients and money and to receive much

negative criticism. It wasn't easy but the way back was already

closed. I couldn't save my patients from their bodies. At that time I

understood that the diet game was ruled by the political and

economic side of what was called "the obesity epidemic". I

discovered that the facts about the consequences of obesity were

just a small part of the whole picture and maybe we don't have to

be thin to be healthy.

So, as I said before, once upon a time…

I was a "real" dietitian who helped her patients to become thin, I was part of

the diet industry - but not anymore.

Now I am looking to help people get off the diet race, stop gambling on the

next diet, stop being occupied and ruled by the diet language of eating.

I try helping them to realize that real people come in all sizes and that real

happiness in life does not rely on weight, counting calories and thinness.

That's why I opened the eating dialog – school for fat studies. One of the

school's main purposes is helping the professionals who work with obesity

and eating behavior to think, see and behave differently with their patients

and make the shift from the weight-centered approaches to the health-

centered approaches, meaning making a shift from the diet language of

eating to the intuitive language of eating.

This process is based on the ACT dimensions with its main

component – the acceptance.

Accepting the sad fact that I don’t know how to help people to lose

weight and keep it off, and I can't help people be thin as they want.

But the worst thing that I have to accept is that, being part of the

diet roller coaster makes us heavier than before and less healthy,

both physically and emotionally. And from that point I have to look

for the real value of life and move toward it.

So in this workshop I will try to make you understand and be part

of this process.

"Eating Dialog”

An academic program for physicians and dietitians using ACT

to make the shift from the diet paradigm which

focuses on weight to the HAES paradigm which focuses on well being .

Ayelet Kalter RD. MSc.The founder & director of the Eating Dialog Study & Therapy Center.

The founder & coordinator of the "Eating Dialog – School for Fat studies ”

in Ariel University Center. The HAES leader in Israel.

www.eatingdialog.com

“Eating Dialog”

Words for thought I would be happy and healthy if I just lost 5 pounds…

I could feel great if I didn’t eat the pizza…

I could be thin if I had a strong willpower…

I would not go to the party unless I managed to get

into the black dress…

I don’t have….if I had….I would be happy...

If I succeed to get rid of…. I would surely be happy…

Obesity One of four Americans is suffering from obesity. Obesity kills 400,000 people every year. Obesity causes coronary heart disease, cancer, diabetes, blood

pressure… Obesity costs around 100 billion dollar a year. Global epidemic. In 1980, 30% of America’s population were defined as overweight.

Today 60% are defined as overweight Our children are going to be the first generation in the modern

world whose life will be shorter than their parents.

Eric Oliver –” the fat politics”2005

What do we feel?What do we feel?

FearFear

Fear of eatingFear of food

Fear of being fatFear of binge eating

Fear of loss of control

Fear of eatingFear of food

Fear of being fatFear of binge eating

Fear of loss of control

"In Amsterdam some Buddhist guru taught me that in

order to get rid of pains, you have to stop nourishing

and feeding them .

The diet he gave me consisted of two kinds of water,

green and mineral.

He also warned me against hospitalization, even if I

felt weak. This is the strongest indication that fear

wants to gain control”, explained the guru, "and the

best way is to ignore its alarm sirens.

Look at it in a philosophical way. Do we water

weeds? And that is the whole theory."(Yael Israel, "The taste of life", Carmel Publishing House.)

What happens when we are ruled by fear?

What happens when we are ruled by fear?

FightFight

War against obesity - diet industry.War against fat people - fat discrimination.

The thinness race.

War against obesity - diet industry.War against fat people - fat discrimination.

The thinness race.

The diet trap shir story

The situation today

120 million Americans are:

Enslaved by the diet roller coaster )yo-yo cycle(.

Enslaved by the diet paradigm.

Enslaved by the diet language of eating.

The main objectives underlying the diet paradigm The main objectives underlying the diet paradigm )life style change, losing weight without dieting…()life style change, losing weight without dieting…(::

Obesity is an illness. Obesity is an illness.

You have to lose weight and get to the right weight according to You have to lose weight and get to the right weight according to

the BMI in order to be healthy.the BMI in order to be healthy.

Everyone can lose weight, keep it off and achieve the ideal weight. Everyone can lose weight, keep it off and achieve the ideal weight.

Weight reduction is an outcome of willpower.Weight reduction is an outcome of willpower.

By modifying our behavior - eating healthy food and exercising - By modifying our behavior - eating healthy food and exercising -

we can reach our healthy weight.we can reach our healthy weight.

Bronwell KD. The LEARN program for weight control. 7th edn. American Health: Dallas, TX 1997.J Hum Nutr Diet. 2004; 17(6):503-12

Avenell, A Journal of Human Nutrition and Dietetics, 17, 317- 335 2004

Weight centered approaches

Eating Thinking patterns – dictate and create the language in which

we think and according to which we behave.

Thinking patterns – tell us what, how much, when and how to

eat as well as what we will feel before and after eating.

Hence, the complex dialog with the food resides in the need for

physical and emotional nourishment, which starts when we

come into the world and ends when we leave it. This dialog is a

language – the language of eating.

The diet language is an outcome of the diet paradigm.

The diet language embodies rigidity, strictness,

dichotomy, guilt, restrictions, avoidance and

punishments. The diet language is based on control. The diet language takes away our freedom to eat what,

when, where and how much we need and want. The diet language takes away the joy of eating.

The diet language

Good - bad

I am fat so I can’t get out and meet people

How many calories do I have to eat?

How many calories I burned in one hour

running? What do I have to eat?

I have no willpower

I am not allowed to eat the cake.

Today I will feast

tomorrow I will diet.

Just today…

All - nothing

I won't go to the restaurant because I wouldn’t resist eating.

Although we all use the diet language as the solution for the

obesity problem or maybe because we all use the diet

language:

95% of the people who lost weight regained it in 5 years.

Our eating behavior is defective – binge eating, loss of control,

ignoring hunger and satiety, being afraid of enjoyment, eating

unhealthy food – we are afraid to eat.

Fat discrimination.

Social processes that are the result of the medicalization and

the mystification of obesity and eating – harm our well-being.

Increase of disorder eating and eating disorder.

Abuse on the background of body hatred and low self-esteem.

America is heavier than it used to be.

Mann, T., et al., Medicare's Search for Effective Obesity Treatments: Diets Are Not the Answer, Am Psychol, 2007. 62)3(: p. 220-33.

Although we continue being enslaved by the diet paradigm as individuals, as professionals and

as therapists-

We suffer from being overweight, eating in an unhealthy way and

hating our bodies .

Words for thought:

Everything can cause suffering.

Everything can be a sufficient reason for

suffering but none of them is a necessary

reason.

Suffering by itself is not the issue but rather

clinging to it.

Natural pain

More suffering

More suffering

More controlMore avoidanceMore clinging

The happiness trap

More controlMore avoidanceMore clinging

Dr. Russ Harris

Many reasons for the human suffering and

psychopathology exist in our language, in the

translation we give it and in the difficulties to make

changes and become more flexible.

We cling to special tools and continue using them

although they are inefficient and useless to us.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. )2006(. Acceptance and Commitment Therapy: Model, processes, and

outcomes. Behaviour Research and Therapy 44, 1-25

What do we cling to?

The stories we have been told about the obesity epidemic.

The wish to be thin and the fear of being fat.The diet paradigm in all its forms - the thinness race. )Lir story(

A monk asked: "What is the essence of all the

essences?"

Joshu answered: "How long have you been

preoccupied with this issue of essence"?

The monk said: "I have been engaged with the issue of

essence for a very long time."

Joshu said: "Fortunately he has met me. This fool is

almost entirely 'threadbare."'(The Joshu Zen Book.)

Maybe what we create as the solution )controlling eating, controlling weight, avoiding

eating…( has actually become the problem?

Can it be different?

The treatment is not about getting rid of the obesity, nor

is it about teaching clients new elegant ways to control

their weight, help them be thin .

It is acceptance and mindfulness approach to obesity,

operates from a different perspective, which says:

”Obesity is part of living rather

than a cause of not living.”

ACT for Anxiety disorders Eifert and Forsyth 2005 Raincoast Book Canada

This will allow the clients to avoid

controlling their body and their eating ,

and help them eat normally and live a

full life in every shape and size.

Acceptance and Commitment Therapy

ACTThe third wave of the CBT

Therapeutic tool for creating

psychological flexibility,

helping the clients and the students make the

shift from one approach to the other.

What is Acceptance & Commitment Therapy?  

Acceptance and Commitment Therapy )ACT(

gets its name from one of its core messages: to accept

what is out of your personal control, while committing to

an action that will improve your 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 CanadaHayes, S. C. & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

Values

Cognitivedefusion

Acceptance

Being present

The observing

self

Committed Action

ACT MODEL

Mindfulness skills

PsychologicalPsychologicalFlexibilityFlexibility

PsychologicalPsychologicalFlexibilityFlexibility

Mindful skills - 4 categories

The mind = The thinking self + The observer self

Thinking self – the part that is always thinking; the part that is

responsible for all your thoughts, beliefs, memories, judgments,

fantasies etc…

Observing self – the part of your mind that is able to be aware of

whatever you are thinking or feeling or doing at any moment.

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.Luoma, J., Kohlenberg, B. S., Bunting, K., & Hayes, S. C. (2005). ACT and self-stigma in substance abuse: A pilot study. Paper presented at the Annual Meeting of the Association of Behavior Analysis, Chicago.

Acceptance: making room for painful feelings, urges and

sensations, and allowing them to come and go without a

struggle.

Contact with the present moment: engaging fully with

your here-and-now experience, with an attitude of openness

and curiosity.

Defusion: distancing from, and letting go of, unhelpful

thoughts, beliefs and memories.

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.Luoma, J., Kohlenberg, B. S., Bunting, K., & Hayes, S. C. (2005). ACT and self-stigma in substance abuse: A pilot study. Paper presented at the Annual Meeting of the Association of Behavior Analysis, Chicago.

MindfulPaying attention in a particular way: on purpose,

on the present moment, and non-judgmentally.

Bringing one’s complete attention to the present

experience on a moment-to-moment basis.

Paying attention with openness, curiosity, and

flexibility.

Mindfulness

Is not an obesity control strategy that tries to control our eating.

It is not for evaluating or judging our eating.It is for seeing it, describing it, looking at it.

The observation worksheetNotice yourself noticing

Push the ‘observer self’ plug

Worksheet no.1

Autobiography in five chapters - Portia nelson

I walk down the street.There is a deep hole in the sidewalk.

I fall in.I am lost… I am helpless.

It is not my fault.It takes forever to find a way out.

I walk down the same street. There is a deep hole in the sidewalk.

I pretended I don't see it.I fall in again.

I can't believe I am in the same placeBut it is not my fault

It still takes a long time to get out

I walk down the same street.There is a deep hole in the sidewalk.

I see it is there.I still fall in…it's a habit.

My eyes are open.I know where I am.

It is my fault.I get out immediately.

I walk down the same street.There is a deep hole in the sidewalk.

I walk around.

I walk down another street.

Evaluating the workability and cost of various strategies you

have used in order to cope with weight issues and to

reduce suffering.

Worksheet no.2

Acceptance is Knowing what you can’t change. Having the courage to change what

you can. Developing the wisdom to know the

difference. Allowing change.

The diet obsession increases the obesity prevalence and causes

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 to be thin to be healthy.

We all have our own set-point.

Losing 5-10% its enough for attaining our well-being.

We don’t know how to help people lose weight and keep it off.

Accept that…

But we do know how to:Stop the obesity process.

Lose 5-10% and keep it off.

And most importantly

Eat healthy, be active and live a meaningful life in every shape and size.

Acceptance is not giving up.

BUT

It is letting go of ineffective and unworkable

change agenda to open the door for fundamental change

to occur.

What do you have to accept personally?

Worksheet no.3

Weight is not an outcome of willpower.

Avoidance of certain foods empowers loss of control and binge eating.

Being part of the diet cycle…)yo-yo( – cause us harm.

Winning the thinness race is like winning the lottery.

Diet – every diet - makes us fatter.

Using the scale is harmful.

We can’t weigh our happiness.

Life is here and now. Not in the future not when you are thin.

Normal eating is following internal codes according to your own hunger and satiety.

.

.

.

אכילה אמיתית הינה אכילה מתוך קודים פנימיים לרעב ושובע ולא מתוך חוקים

חיצוניים.

.עונג והנאה מהאכילה הינם חלק בלתי נפרד ממנה

.אנשים אמיתיים באים בכל מיני גדלים

" שפת הדיאטה פוגעת באכילה שלי, בself שלי וב "well being שלי

ושל ילדי המחקים אותי.

What do I have to accept?

Getting hooked

“Hooked by thoughts” – means getting caught up in

our thoughts which exert a strong influence over our

actions.

In what situations does your mind manage to hook you?

What sort of things does it say in order to hook you?

How do you manage to unhook yourself?

)based on Russ Hurries worksheet(

Worksheet no.4

DefuseLooking at thoughts

rather than

from thoughts

Russ Hurris

Cognitive Defusion learning to step back and detach

from unhelpful thoughts, feelings, behaviors…

Identify value of life Well-being

Committed action

“Eating Dialog”

From control strategy tofreedom of choice

From weight-centered approach with its diet

language of eating to the health-centered

approach with its intuitive language of eating .

Mindful eating Intuitive eating arie stoty

Mindfulness

Hunger and satiety

Emotional hunger

ObservationAcceptanceBeing presentCognitive defusion

Mindful

skills

Physical hunger

Letting go of: Experiential avoidance techniquesthat belong to the diet language

Identify the hunger

Identify its level

Identify the food that will satisfy you

MindfulSkills

ObservationAcceptanceBeing presentCognitive defusion

Physical hunger

Feel hunger

Identify the emotional hunger

Identify the emotion

Expansion

Acceptance

Cognitive defusion

Emotional hunger

Mindfulskills

Experiential avoidanceCognitive

fusion

Mindless eatingBinge eatingLow self esteemIncrease obesity

Value of life – well being

Being with the

feeling Eat the feeling

Emotional eating

Mindfulskills

Mindful eatingNo guiltNo damage to the self

No loss of controlNo binge eating

Committed action - Choice

Feeling

Normal eating

Emotional hunger

Epilog

"Eating Dialog - School for “fat studies” From the weight-centered approaches

to the health-centered approaches.

Ayelet Kalter RD. MSc.The founder & director of the Eating Dialog Study & Therapy Center in Tel Aviv .

The founder & coordinator of the "Eating Dialog - School for fat studies”

in Ariel University Center. The HAES leader in Israel.

www.eatingdialog.com

“Eating Dialog”

To promote new social and professional discourse designed to abandon

the boundaries of the diet paradigm. The discourse enhances the critical,

political, social, and economic point of view. Thus, it facilitates the shift

from the bio-medical model to the bio-psycho-social model.

“Eating Dialog”

The objectives of the program

To promote society in general and individuals in particular toward

their well-being in every shape and size.

To lead the professionals to think, see and behave differently regarding

issues that deal with weight, shape, body and eating so they can make

the shift from the weight-centered approaches to the health-centered

approaches.

Health-centered approaches

HAES))

The intuitive eating language

ACT*

ACCEPTANCE COMMITMENT THERAPY*

“Eating Dialog”

The school model

Weight-centered approaches

The diet eatinglanguage

The outcome of the processThe process is individual and experiential and takes

place first and foremost within oneself.

The students are going through a process of training

and change so that they can actualize, teach, treat

and behave through the health-centered approaches.

The students become leaders and a role model, both

socially and professionally.

“Eating Dialog”

“Eating Dialog” In the future

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)

“Eating Dialog”

Thank you!