Weight Loss for Food Lovers

Are Good Manners Hurting Your Health?

In terms of addiction, food is right up there with marijuana - but our emotional attachment to it makes unhealthy eating a far tougher habit to control, says psychiatrist, obesity expert and author of Weight Loss for Food Lovers Dr George Blair West.

from Diabetic Living Magazine

For most people eating at the homes of friends and family is the most difficult challenge of all the places we can eat, when it comes to maintaining a healthy eating lifestyle.

Once a regular pot-smoker, John had no trouble turning down a marijuana joint while relaxing with old friends:
"I've kicked the habit because I don't want my seven year old son to have a pot-head father," he explained. Yet when they offered him a sugary soft drink and packet of potato chips, he couldn't bring himself to refuse - despite an ongoing battle with his weight and type 2 diabetes. The reason?
"I didn't feel I could reject their hospitality by saying 'no'."

A patient I was seeing because of his expert self-sabotage in managing his diabetes, John's dilemma is a common one that illustrates only too well the complications of our relationship with food and drink, especially in social situations. After years of marijuana abuse, he had given it up for the sake of his son and had no great difficulty in sticking to that commitment. Yet when it came to losing weight to protect his health, John placed his own needs way below the importance of pleasing his friends in the list of priorities - an indication of the power of that subconscious code of behaviour we all start developing in relation to food from the moment we are born.

Like many of us, John's problem in managing his weight is not the sum total of calories in versus calories out. This only works if we are mindless robots without complex thought processes and emotional reactions to social situations. Instead, managing our weight is the sum total of the positive force of motivation versus the negative experience of giving up foods we love. Social pressure is considered by researchers to be particularly powerful because it impacts on both sides of this equation in the wrong directions. It weakens our motivation and increases our sense of deprivation around denying ourselves food that others are indulging in.

Undermining Motivation
Motivation is strongly influenced by other people who are with us when we eat. In recent research it was found that people who were restrictively dieting were very sensitive to not only the spoken, but the unspoken pressure exerted by others. The researchers found that by planting a 'confederate' to eat with research subjects, they could manipulate how much the subjects ate. The more the confederate ate the more the subjects ate and vice versa. Amazingly when they replaced the confederate with a statue, the effect was the same - if they turned the statue so it was facing away, people ate less than when they felt it was watching them!

Add to this the impact on us of people who are not a stranger but someone we care about like a mother, aunt, mother-in-law or good friend. Unfortunately, in many cultures care and love for another is expressed through the giving of a 'nurturing' (read 'fattening') meal. How often have you been made to feel that if you don't eat all the food in front of you that in some way you are rejecting not the food, but their caring for you! These are big stakes. Saying 'no' becomes not about rejecting the food but rejecting the person. No wonder so many people grapple with this problem.

Then add to this pressure the 'guilt arguments' of
• 'I cooked it specially for you!' or
• 'Think of the starving millions!' and
• 'Everyone needs to break out and live a little!'

Usually, these comments are not designed as manipulations but are will intentioned statements designed historically to 'fatten you up'. We only have to go back one generation (the generation of the person offering us the food!) when fattening people up was not only a good but a necessary thing to do. Only a couple of decades later with food in abundance and obesity raging, it is a very different world.

Lessons from Alcohol
The best strategy for most adults is to look at how you negotiated alcohol in your life. Most people (by no means all) have developed a range of strategies to help them not to drink to excess. Most importantly we all are aware of the need to deal with peer group and social pressures in limiting our alcohol intake. I'm continually surprised at how few people that come to me for help have developed similar strategies for managing social pressures around indulging in food as they have for managing alcohol.

Most people develop a habitual way of drinking when out. For example, they might start a meal with a mixed drink, have two glasses of wine with the meal, interspersed with iced water and finish with a coffee. If people encourage them to drink more they say, 'No, I have to drive' or 'No, I can't eat that on my medical (diabetic) diet' and, more simply, 'No, I'm watching what I drink.' We need to remember the Law of Interpersonal Respect means that no one can require us to explain why we do what we do if it does not effect anyone else. This means:

• Don't fall into the trap of justifying why you do what do.
• People who want you to do this are disrespecting your individuality.
• Pre-handle people who reliably try to 'fatten you up' by taking them aside beforehand and asking them to help you by not offering unhealthy foods.
• Ask them to consider providing a range of foods that suit a low glycaemic index diet.
• Better still give them some recipes of your favourite foods.

The Take Home Message
People who care about us through food need two things. First, they need to hear that we have appreciated and savoured their carefully prepared food. To do this you only need one or two mouthfuls. So when the dessert or baked potato dish comes out say something like, 'That looks spectacular. I'm so full … but I must try some. Don't give me a serve I'm going to steal some of my partners.' Then after eating a fully savoured mouthful, describe its attributes to your host to demonstrate you have tasted and enjoyed it. 'That is sooo good. You must have used really good quality chocolate …'

Second, do not accept a serve of their special dish and leave most of it on your plate - otherwise your actions will be perceived to speak louder than words! And once it's on your plate you're in grave danger of eating it. Sharing with another is much more socially acceptable these days. If not, see if you can serve yourself a thin serve. If worse comes to worse then jump in early and clear the table yourself!

In this second article in the series on self-sabotaging our eating, Dr Blair-West will follow his discussion of our attachment to food by looking at some of the complexities around how we sabotage our weight loss or diabetic diets. In particular, he looks at how food can present similar problems for us as addictive substances like marijuana and how saying 'No' to food can be even harder than saying no to drugs. The problem begins the moment we start to restrict our intake of unhealthy foods …

Counsellors for alcohol, nicotine and other drugs are everywhere - try and find one for food addiction. Dr George Blair-West, our resident food addiction psychotherapist looks at the issues.

'He offered me the joint and I was able to say 'No' without any trouble. A little while later he offered me a can of full strength soft drink and a packet of potato chips. Before I knew it I was eating them. I didn't want to reject his hospitality by saying no.'

'How was it that you could say no to marijuana, when you used to have a real problem with it and yet you can't say no to a carbohydrate hit?' I asked John, a patient I had been seeing for his expertise in self-sabotage especially when it came to managing his Type 2 Diabetes.

'I don't know,' John replied confused, 'I agree it's a bit weird'.

'Why is it that you gave up smoking drugs after developing it into a refined art over many years?' I asked.

'I don't want to be a pot-head father to my 7 year old son.'

'And who are you trying to lose weight for?'

'I'm just doing that for me.'

'John, how much do you respect yourself?'

'I'm not sure … To be honest I'm not sure I like myself very much.'

'Think about what you have told me. Despite having had a roaring drug habit you have no difficulty saying no to your mate when it comes to drugs - which you're doing for your son - but when it comes to doing something for you there's no fight in you at all! I think we have an underlying motivation problem here. At the very least we have a problem saying 'No thanks' to people.'

John's story is very common and illustrates the complexities of trying to stick to a particular diet. What is unusual about his story is that not only does it remind us of the problem people often have saying 'No thanks' when offered certain foods but it reminds us that food is harder to resist than drugs. We tend to accept food automatically, because our bodies are evolved to make the most of these opportunities. We are more likely to notice being offered drugs and in some ways this makes managing them easier than managing the temptation of food! The astute reader will also have started to wonder about the underlying personal values that we carry that sit behind our food choices. We will return to this big issue in a later article in this series.

When does the problem saying 'No thanks' to food begin? Where does the addiction/self-sabotage process start. The research is very clear on this. It doesn't start when a friend offers us some delectable food, or when we find ourselves in front of a buffet, it begins the moment we try to adopt a blanket ban on certain foods. It begins the moment we agree with a Doctor or Dietitian to take certain foods out of our diet. Doctors and Dietitians who are up with the latest research will not ask you to make any food forbidden. Nor will they let you go hungry. In Australia the National Health & Medical Research Council's recommendation to GPs is that everyone on a diet should eat 'ad libitum' i.e. until you feel full. Feeling hungry has to be a thing of the past.

The moment we tell ourselves we can't have a particular food is the moment we begin the self-sabotage process. Self-discipline is absolutely of no help. All self-discipline does is delay the time until we ultimately eat the food we love and kick off the self-sabotage process.

The What the Hell Effect & Last Supper Effect
There has now been buckets of research that show that denying ourselves our favourite foods ultimately has the opposite effect. The most famous research has been that in the 'What the Hell Effect'. First done now 30 years ago it is surprising how few professionals working in weight loss know of this research and understand its implications for weight loss. A group of university students made up of those who are dieting and those who are not, are told that the researchers are testing the appeal of different flavors of ice cream. In fact, this is only one untruth!

The first untruth they are told is that there will be a delay in the testing program as the researchers sort out some backroom problems. The students are told that as there is plenty of ice cream they might as well have a milkshake or two, or three… while they are waiting. The researchers carefully observe how many milkshakes each student drinks. They are then offered the ice cream. Again the researchers carefully count how many serves of ice cream each student eats.

What they found was that for those students who were not dieting, as was expected, the more milkshakes they drank beforehand, the less ice cream they subsequently ate. In contrast, the students who were dieting had the opposite result. The more milkshakes they drank beforehand, the more ice cream they ate subsequently!

The researchers dubbed this the What the Hell Effect. Basically, once dieters started to break their diet they decided 'what the hell' and started rebound overeating.

The closely related 'Last Supper Effect' is when students are told that they are about to go on a diet and they are found to start eating more, as dieters do, on the Sunday before the Monday they are to start the diet. My favourite is what I call the 'double, double last supper effect' which is when we plan to go on a diet on Monday to justify overeating on Sunday and then, come Monday, we don't go on the diet. If you think about this it is a fascinating example of the mental gymnastics that we are up against in trying to lose weight. No wonder traditional diets that don't look at how we sabotage don't work!
Standard diets - trigger.

Diabetic diagnosis and recommended diet Provoke disordered eating in the same way.

Low self esteem drives eating - the gain brings on type 2 which feeds back into low self-esteem - undermines motivation.

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