•This mee(ng is organised and paid for by Janssen •Slide content has been reviewed by Janssen to ensure compliance with the ABPI Code of Prac(ce for the Pharmaceu(cal Industry. •Speakers may express personal opinions that are not necessarily shared by Janssen. •Adverse events should be reported. Repor(ng forms and informa(on can be found at www.mhra.gov.uk/yellowcard Adverse events should also be reported to JanssenCilag Ltd on 01494 567447. •Prescribing Informa(on is available at this mee(ng. JanssenCilag Ltd, 50100 Holmers Farm Way, Buckinghamshire, HP12 4EG, UK ▼Invokana® (canagliflozin) This medicinal product is subject to addi4onal monitoring and it is therefore important to report any suspect adverse reac4ons related to this medicinal product.
Transcript
• This mee(ng is organised and paid for by Janssen
• Slide content has been reviewed by Janssen to ensure compliance with the ABPI Code of Prac(ce for the Pharmaceu(cal Industry.
• Speakers may express personal opinions that are not necessarily shared by Janssen.
• Adverse events should be reported. Repor(ng forms and informa(on can be found at www.mhra.gov.uk/yellowcard Adverse events should also be reported to Janssen-‐Cilag Ltd on 01494 567447.
• Prescribing Informa(on is available at this mee(ng.
Janssen-‐Cilag Ltd, 50-‐100 Holmers Farm Way, Buckinghamshire, HP12 4EG, UK
▼ Invokana® (canagliflozin) This medicinal product is subject to addi4onal monitoring and it is therefore important to report any suspect adverse reac4ons related to this medicinal product.
The Psychology of Overeating
Dr Jen Nash Clinical Psychologist
Chartered with the Bri(sh Psychology Society Director of Posi(ve Diabetes.com
and PsychBody.com
Job number: PHGB/VOK/0415/0074 Date of prepara(on: April 2015
Introductions
A confession! I have type 1 diabetes
Struggled to translate the medical care and educa(on into my life
• We too, are the ‘pa(ent’ when it comes to being able to implement lifestyle change
Yet how oien do we take our own advice?!
NHS Health Professionals?!
What is the Missing Link?
The people we work with (and us) generally
know what they need to do to care for their health
Something gets in the way when they leave us
Is it
mo(va(on?
People ARE mo(vated….
We (generally!) don’t have to ‘mo(vate’
ourselves to….
-‐ Get dressed
-‐ Clean our teeth
-‐ Kiss our child goodbye in the
morning
We value our child feeling loved as they
go to school…..
……so we organise ourselves to wave them off in the
morning
We value not breathing our garlic breath from last night’s dinner on our colleagues…….
……so we organise ourselves to brush our teeth in the morning
Our Iden(ty, our self
esteem and our values
The Problem: • Each person IS mo(vated to do EXACTLY the right thing for them, given two aspects of themselves:
• Knowledge + informa(on + emo(ons + values
Tradi(onal Medical/Health Educa(on
Models ???????
Emo(ons and Values
• Where in our health care selngs are we talking about emo(ons and values?!
Psychological models point
to……
Our: Iden((es
Self-‐esteem
Values
Emo(ons….
As the bridge between
knowledge and behaviour
THESE guide all our decisions; including
decisions about our health and what to eat
Ea/ng Context…..
Biological Factors
Social
Factors Psychological
Factors
• We’re figh(ng our evolu(onary history
BIOLOGICAL REASONS……
• ….to seek out and store food in (mes of plenty to sustain us in (mes of scarcity
Our bodies have evolved…
• …where food is readily available
Contradicts our modern day lives……
Psychological Reasons
The connec(on between emo(on and food is one that is established from
birth
Tears comforted by caregiver’s milk
Food to soothe upset as the child develops
By adulthood, an unconscious pathway exists for the impulse to reach for food to distract & comfort
Social Reasons
Shared ea(ng experiences are a way of bonding and celebra(ng within
communi(es
Family members may offer food to show their love when it is difficult to express emo(ons directly
What Does this Look Like in Prac(ce?
Meet Anna…..
45 years old, NHS
pharmacist
BMI of 40, type 2 diabetes
Referred for dietary advice
No change to her weight
Meet Anna…..
Star(ng secondary school– told by her mum not to cry
Figuring herself out – making up
‘rules’ about
herself and the world
Started to eat
chocolate bars in secret
Food was helping
Anna cope with
feelings she didn’t know how to fix
A strategy that worked for ‘Lirle Anna’
Now an adult, Anna was s(ll using this same
strategy
Meet Anna….. • Food, rather than being a solu(on; had become the problem
• The desire to eat a symptom of an underlying emo(onal distress
• A-‐ha moment for Anna – I’m not:
• “Out of control” • “Greedy” • “(Just) A chocolate lover”
Meet Anna…..
• We devised a simple strategy – when she no(ced the urge to eat for non-‐hunger reasons, she would say internally ‘Oh look, here’s li<le Anna again’ and consider what she could do to manage her difficult emo(ons directly
Anna -‐ triggers to ea(ng
Trigger Interven/on
Ea(ng before weekly mee(ngs with boss
Asser(ve communica(on, managing impact of cri(cism
Family celebra(ons, seeing young children
CBT approaches to challenging nega(ve thoughts. Finding alterna(ve outlets for mothering ins(ncts.
Evenings alone watching TV and ea(ng
Exploring social ac(vi(es, alterna(ve approaches to “me (me”.
What Do You No/ce About Anna?
What do you no(ce about Anna? • Diabetes, medica(on, food or calories aren’t men(oned
• These aren’t the ‘real’ problems
• The problems exist in the iden((es she holds in her life:
• As employee, as mother (or poten(al mother) and as someone with a social life
Psychological approaches:
We don’t make it wrong
to eat
Everyone can use food for non hunger reasons and it can be
fine to use food in these ways
The difficulty is when food
becomes the only way to deal with
emo(ons
Goal is to make a decision about whether to eat when feeling
emo(onal rather than it being an
automa(c response
Talking About Change….. ……When there’s no (me
Conversa/on Starters
I eat because I'm bored
I eat because
I'm stressed
I eat because I'm sad or down
I eat because I'm not thinking
Food = Complicated
It’s ok, we all do it! Ask for more informa/on, or visit
www.Ea/ngBlueprint.com For Your Free Plan
“It’s very common for all of us to use food to distract ourselves when we’re feeling…..
…down/stressed/ bored”
“Are you aware that you
some(mes eat in these ways?”
Conversa(on Starters 1…..
“Thank you for sharing that with
me”
“Is this something you’d like to think
about together?”
Conversa(on Starters 2…..
Ok great. There is a different approach we can use if you like, that thinks
about ‘why’ we are ea(ng, rather than ‘what’ and ‘how much’. Would you like to hear more
about it?
Conversa(on Starters 3…..
8 Steps to Change The Ea/ngBlueprint
The Ea(ngBlueprint
• The diet has ‘forgoren’ something
• The diet oien tries to build the house (create the body/weight) before laying the founda(ons (the suppor(ng emo(ons/mindset)
• We need strong founda(ons in
order to build a house
• ‘The Ea(ng Blueprint’ provides the founda(ons
Lay the Founda(ons…..
Then Build the House……
Lay The Founda(ons -‐ The Ea(ngBlueprint
Focus
Fun
Feelings
Fables
Forgiveness
Foresight
Framework
Future
1. Focus
1. Focus We all eat mindlessly for non-‐hunger
reasons – this is normal
Start to no(ce the condi(ons in which ea(ng
occurs-‐ mindless versus mindful ea(ng
Interrup(ng mindless ea(ng involves asking ourselves, ‘’Is food what I really need?’
Focus: 3 Steps -‐ WHY
Wait How to
remember to wait?
Reminder on dominant hand/
wrist
‘WHY’ wristband
Watch, charity band
Hungry?
Is food what I really need right now? How hungry
am I? Scale of 0-‐10?
What AM I hungry for? (a break, to cheer me up, as a distrac/on, to bond with someone)
What problem am I hoping food will
solve?
Yes: Say ‘Yes’ to Food Or Emo/on
If physically hungry – say ‘Yes’
and eat
If not truly hungry and s/ll eat – that’s ok too!
Can I get my hunger met by something other
than food?
1. Focus
• Change takes (me and simply the act of pausing brings an awareness to what was an unconscious process
• Helps the person figure out what they are truly ‘hungry’ for
• The areas of the blueprint that follow are designed to help increase the flexibility to choose between a range of responses to food
If you’ve only got 2 minutes…..
• Download the WHY Plan from www.Ea(ngBlueprint.com/why
• Share it with the person and invite them to ‘experiment’ with using it
• Give the WHY plan to the person to take away
2. Fun
2. Fun Ea(ng is pleasurable and entertaining
It can become a friend
Look for ways to increase non-‐food sources of pleasure and distrac(on
When you
feel the urge to eat for non-‐hunger
reasons
2. Fun
• Stroke their pet, go online, have a lie-‐down, call or text a friend, sing a song, paint their nails, read, do a Sudoku puzzle, play a game on their phone, write an email or lerer, organise a drawer or wardrobe, start making a Christmas card list…..
Build up a list of at least 10 ac(vi(es,
different ones for different loca(ons
• If the 3 ac(vi(es haven’t ‘worked’…. • Then eat! Try 3….
If you’ve only got 2 minutes…..
• Invite the person to think of 10 ac(vi(es • Encourage them to put the list somewhere they will remember – kitchen, phone, in their pocket
• Invite the person to ‘experiment’ with trying 1, 2 or 3 of their fun ac(vi(es before ea(ng
3. Feelings
3. Feelings We oien use food to ‘stuff
down’ emo(ons that we don’t feel able to express
It’s a skill to be able to express
emo(ons authen(cally to both ourselves and others
Person needs strategies to express and manage emo(ons
……Rather than avoid or dull them
with food
3. Feelings
• Invite the person to iden(fy which emo(on they are feeling as they reach for the food • May be posi(ve or nega(ve • Start by labelling it –
– Anger? Hurt? Feeling unarrac(ve? – Sadness? Boredom? Not good enough? – Excitement Loneliness? Celebra(on?
3. Feelings
• Use a template:
• I am [insert emo(on]
• At [insert situa(on/person/trigger for emo(on]
• Because [insert reason]
3. Feelings
• I am upset at my partner because he/she forgot our anniversary
• I am hurt at my friend for sharing something I had told her in confidence
• I am cross with myself because I didn’t go to the gym
3. Feelings
• Encourage the person to develop strategies to express these strong emo(ons rather than dull them with food • Some(mes it’s safe to express them to the person involved
• Some(mes it’s not – talk to someone else, have a cry, write down what you feel, punch a pillow
• Just ‘naming it’ internally is therapeu(c
4. Fables
4. Fables
• Family stories and rules about food • May be spoken or unvoiced • ‘Eat your vegetables before having dessert’ • Post war narra(ves that were valuable, ‘Don’t waste food’ and ‘Finish Your Plate’
• We need to ques(on the u(lity of these fables, and create more helpful narra(ves that serve our modern day lives
If you’ve only got 2 minutes…..
• Explain the concept of a food fable – perhaps share one of your own?
• Think about fables in each life role: Parent, family member, Spouse/partner/friend
• Invite the person to think about how helpful their fable is to them.
• Can they experiment with
a new fable?
Ea(ngBlueprint: Level 2
5. Forgiveness
6. Foresight
7. Framework
8. Future
5. Forgiveness (Normalise)
Give yourself a break for being overweight
You’re figh(ng a biological,
psychological and social world that’s set up to promote
weight gain.
You’re not ‘wrong’ or ‘bad’ for being overweight, It’s ok to struggle – most
people do
Provides relief from shame and
s(gma
6. Foresight
To con(nue to manage your weight you need to know yourself
Learning from the predictability of life -‐ what could I do differently next (me?
Managing thinking styles around food and ea(ng
‘Good / bad’ paradigm of diets is unhelpful Thought challenging using CBT techniques
7. Framework
Weight loss isn’t just a solo journey, we don’t exist in a vacuum
Family and emo(onal environment: How to spot sabotage – and showing love through food
Physical environment: playing ‘games’ with food in the built environment
Social environment: asser(veness skills to say ‘no’
8. Future
Weight loss is a skill – yet we don’t treat it in this paradigm
Similar to learning to drive a car – it is a process that requires coaching and guidance
‘Setbacks’ and slip-‐ups are an integral part of the journey and need to be welcomed to ‘update the default’
Being able to understand a Lapse/ Relapse / Collapse
The Ea/ngBlueprint – Next Steps
Pilot Programme: ‘The Ea(ngBlueprint’
• 12 week online programme • Video based training tool • Bitesize learning (10-‐30 mins each) with accompanying ‘experiments’ to work on in every day life
• Person can use on their own at home, or it can be worked on with a HCP in their sessions
• Audit data to date demonstrates average weight loss of 5kg over 3 months
• Currently working to establish a robust evidence base
The Future – Hopeful or Not?
• The ‘what’ and ‘how much’ of ea(ng IS of key importance….
Do you feel the sense of hopelessness that
surrounds the obesity
conversa(on?
• …and be crea(ve in taking a macro and micro-‐level approach to the obesity challenge
But we need to shii our focus on to the ‘why’ of our ea(ng
behaviour
Smoking Cessa(on: Lessons Learned
Governmental Regula(on • Legisla(on
Industry • Tobacco manufacturers • Role of supermarkets and food manufacturers?
Public Heath • Educa(on and ‘Stop Smoking’ support • Campaigns that focus on the ‘why’ of ea(ng?
In Summary….
• Achieving/maintaining a healthy weight requires skills: – Emo(onal regula(on – Ability to tolerate distress – Asser(veness…..
• We need to empower people with: – skills to be able to iden(fy their emo(ons – strategies to make a choice other than food
• So the person is in control, not the food • The invita(on is to start with yourself (no marer what
your weight and shape!) • Be mindful that simply naming and normalising the non-‐
hunger components to ea(ng is an excellent first step
Ques(ons & Next Steps
• Invite the people you work with to use the free resources at: www.Ea/ngBlueprint.com and www.PsychBody.com
• Join me for a 1 day workshop for HCPs: ‘The Blueprint to Weight Loss’ – equipping you with skills to implement the Ea(ngBlueprint in your rou(ne consulta(ons. Please email for further info: [email protected]
Job number: PHGB/VOK/0415/0074 Date of prepara(on: April 2015
