Helping(Clients(Outsmart(Overeating:(The(Powerful(Role(of(the(Health(and(Wellness(Coach

Paige&O’Mahoney,&M.D.,&CHWC

5(Learning(Objectives

Participants&will&learn:

1. The&role&of&dysregulated&eating&in&some&clients’&“weight&problems”

2. Personality&traits&and&skills&deficits&of&the&dysregulated&eater

3. How&eating&psychology&and&coaching&psychology&principles&support&

behavioral&modification&to&improve&client&satisfaction&and&outcomes

4. When&to&collaborate&and/or&refer

5. How&to&access&additional&information,&resources&and&training

5(Points(to(Remember

1. Weight&bias&is&wellLentrenched&in&culture&and&in&medical&establishment

2. Not&every&person&with&a&large&body&overeats&or&wishes&to&be&smaller

3. Genetics&and&biology&are&important&contributors&to&body&size&and&shape

4. Weight&stigma&undermines&clients’&mental&and&physical&health

5. Focus&on&health,&rather&than&weight,&promotes&selfLefficacy

Helping(Patients(Outsmart(Overeating:(Psychological(Strategies(for(Doctors(

and(Health(Care(Providers

Written&with&internationally&respected&eating&disorders&therapist&and&7Lbook&author&Karen&R.&Koenig,&M.Ed.,&LCSW

3&Objectives:

• Explain&why&patients&overeat&&&how&to&help

• Highlight&resources&and&experts

• Change&the&conversation&between&patient&and&health&care&professional

The(“Obesity(Crisis”

• Statistics• The&medical&treatment&model&for&elevated&BMI&promotes&weight&loss&through&diet&and&exercise

• Cultural&ideal&of&thin&permeates&medical&training

• Ineffective&methods&– Dieting&alone&rarely&results&in&sustained&weight&loss&and&does&nothing&to&improve&body&image

• Weight&cycling&is&most&common&result

• Clients&without&elevated&BMI&may&not&be&healthy&or&thriving&because&they&are&caught&in&a&vicious&cycle&of&restrained&eating&and&overeating,&depleting&time&and&energy&for&the&rest&of&life

Discussion:(What(is(Already(Working(Well?

• How&do&you&as&a&coach&define&success&in&this&area?• LongLterm&weight&loss?&

• Health&improvement?&

• Increased&wellLbeing?• Improved&attunement&to&appetite&and&emotional&cues?

• What&strategies&are&most&productive&in&helping&your&clients&realize&and&maintain&success?

Discussion:(What(are(Your(Clients’(Greatest(Challenges?

Unrecognized(Roots(of(Inconsistency,(“Lack(of(Time,”(“SelfPSabotage”

• Internalized&weight&stigma&and&shame

• Body&dissatisfaction• Skills&deficits• Internal&conflicts• Weight&cycling&and&metabolic&dysfunction&=>&Despair

Awareness(is(the(first(step(toward(change…

“Lazy(and(Unmotivated”(is(a(Myth

• Clients&come&to&us&seeking&improved&fitness,&comfort,&health

• Stigma,&blame&and&shame&abounds&in&our&culture&and&in&the&medical&community

• Ineffective&treatment&methods&perpetuate&internalized&weight&stigma,&metabolic&derangement,&frustration,&despair

• Despite&this,&millions&of&people&continue&to&diet,&hoping&to&lose&weight&and/or&become&healthier

• Will&power&is&a&finite&resource&– lasting&change&requires&SKILLS

The(Secret:(“Weight(problems”(are(often(eating(problems

• If&the&root&of&the&eating&problem&is&psychological,&it&will&not&be&adequately&addressed&with&education&and&behavior&modification&alone

• Eating&psychology&is&about&“why”&and&“how,”&rather&than&the&“what”&and&“how&much.”

• For&countless&clients,&dysregulated+eating underlies&and&perpetuates&the&weight&struggle

• Undermines&client&selfLefficacy

• Once&recognized&and&addressed,&dysregulated&eating&is&TREATABLE!

Introducing(the(Dysregulated(Eater

• Eats&when&not&hungry&and&does&not&stop&at&“enough”• May&engage&in&restrained&eating&alternating&with&mindless,&compulsive,&binge&or&runLofLtheLmill&overeating

• Often&living&above&his&or&her&set&point&and&frustrated&about&it• BMI&may&be&normal&but&eating&behaviors&may&be&dysfunctional

• Uses&food&to&cope,&manage&life,&take&a&break,&deal&with&(unacknowledged)&feelings&or&conflicts/ambivalence

• Dysregulated&eating&steals&time&and&attention&from&the&rest&of&life

Personality(Traits(of(the(Dysregulated(Eater

• Perfectionism• All:or:nothing(thinking(• People(pleasing(• Deficit(mindset(• Help(avoidance• Avoidance(of(emotional(discomfortThese&traits&look&a&lot&like&the&personality&traits&of&the&high&achiever

May&promote&success&in&other&life&domains&(work,&family,&community)

Skills(Deficits(of(the(Dysregulated(Eater

• SelfLcare&skills• Life&skills&• Pleasure&deficit• These&skills&deficits&are&also&common&to&highLachievers,&including&many&health&care&providers

These&skills&are&LEARNABLE

Why(Diet(and(Exercise(Alone(is(Not(Enough

• Controversy&on&metabolic&consequences&of&dieting,&weight&cycling&and&dietary&content*

• Behavior&change&recommendations&do&not&address&the&psychological&roots&of&overeating/chronic&dieting

• Dieting&exacerbates&dysregulated&eating&and&perpetuates&the&cycle• When&stressed&or&frustrated,&the&dysregulated&eater&is&likely&to&reach&for&food&to&reLregulate

• PreLcontemplation&vs.&action&– with&each&failure,&mounting&evidence&for&“normal”&eating&and&a&comfortable&body&being&out&of&reach

How(Wellness(Coaches(Are(Uniquely(Qualified(to(Help

• Time&and&continuity

• Empathy&

• Motivational&Interviewing:&Ask+a+Great+Question,&then&“Listen&until&I&don’t&exist”&– individualized&approach

• Strengths&focus,&Appreciative&Inquiry• Evaluating&stageLofLchange• “The&Client&Has&the&Answers”&–>&internal&LOC• Process&Orientation• “My&Certainty&is&Stronger&than&your&Doubt.”&

Skills(that(Coaches(Can(Cultivate(with(Clients

• Non:Judgmental(Awareness• Self:Compassion• Curiosity• Values(Identification(and(Self:Definition((strengthsLfocus)• Emotional(Intelligence(and(Appetite(Attunement• Process:Orientation(and(Pacing((supports&consistency)• Self:Regulation (supports&persistence and&resilience)

Notice(that(several(of(these(are(the(thinking(and(feeling(skills(of(the(pre:contemplation(phase.(Clients(need(a(solid(psychological(foundation(for(successful(

behavioral(change.

Helping(Clients(“Set(Up(for(Success”

• SelfLdefinition&and&selfLdefined&agenda• Responding&vs.&reacting• Positive&selfLtalk:&having&a&constructive&response&at&the&ready• Planning&ahead:&time,&meals,&pleasure,&emotional&regulation• Portable&meal&and&snack&kit

• “What&will&you&tell&yourself&when (not&if)&obstacles&arise?”• Perfection&is&not&required:&focus&on&balance,&selfLkindness,&consistency,&sustainability

Collaboration(and(Referral

• When&to&refer:&• Client’s&eating&problems&are&associated&with&significant&health&or&mental&health&consequences&(hypertension,&diabetes,&lab&abnormalities,&anxiety,&depression,&history&of&trauma,&abuse,&neglect)• Client&meets&criteria&for&an&eating&disorder&(AN,&BN,&BED)• Client&is&“stuck”&and&not&making&progress• Client’s&best&interest

• The&Dream+Team+concept*:&physician,&dietitian,&therapist,&coach,&trainer,&other&experts&(e.g.&diabetes&educator)

• Intuitive&Eating&training&and&community

• Eating&Disorders&therapists

Where(to(Find(Additional(Resources• Helping+Patients+Outsmart+Overeating+Resources&Section• Paige’s&website:&www.deliberatelifewellness.com

• Health&Professionals’&page:&resources,&worksheets• Subscribe&for&newsletter,&Master+Recipes+eLbook• Training&and&Coaching&page:&classes&for&professionals&and&laypersons

• www.karenrkoenig.com and&other&books&by&Karen&R.&Koenig,&M.Ed.,&LCSW• The&Rules&of&“Normal”&Eating• Starting&Monday• Outsmarting&Overeating• The&Food&and&Feelings&Workbook• Nice&Girls• What&Every&Therapist&Needs&to&Know&About&Treating&Eating&and&Weight&Issues

• Tylka,&et.&al.&review&article,&“The&WeightLInclusive&versus&WeightLnormative&Approach&to&Health:&Evaluating&the&Evidence&for&Prioritizing&WellLbeing&Over&Weight&Loss.”&Journal+of+Obesity+(2014):&1L18.&

Questions?(

• What&one&thing&did&I&learn&that&I&did&not&know&before?

• Will&I&change&anything&about&the&way&I&work&with&clients&as&a&result&of&this&presentation?

About(Paige(O’Mahoney,(M.D.,(CHWC

Paige&O’Mahoney,&M.D.,&CHWC,&is&a&Wellcoaches®Lcertified&health&and&wellness&coach,&certified&Intuitive&Eating&counselor,&retired&pediatrician,&author&and&foodie.&

She&is&the&coLauthor,&with&Karen&R.&Koenig,&M.Ed.,&LCSW,&of&the&awardLwinning&book,&Helping+Patients+Outsmart+Overeating:+Psychological+Strategies+for+Doctors+and+Health+Care+Providers.

Information&about&her&coaching&practice&and&educational&offerings&for&health&care&professionals&and&patients&may&be&found&at&www.deliberatelifewellness.com or&you&may&email&Paige@deliberatelifewellness.com.

Disclaimer

This&presentation&is&intended&for&informational&and&educational&purposes&only.&It&is&not&intended&as&a&substitute&for&the&individualized&medical&or&psychological assessment,&advice&and&individualized&care&of&a&client’s/patient’s&personal&health&care&provider&or&mental&health&professional.&Patients&and&clients&should&consult&with&their&personal&health&care&professional&regarding&their&individual&situation&and&concerns.&For&health&professionals,&the&information&contained&herein&may&not&be&applicable&to&or&appropriate&for&every&patient. Paige&O’Mahoney,&M.D.,&Karen&R.&Koenig,&M.Ed.,&LCSW,&and&Deliberate&Life&Wellness&LLC&specifically&disclaim&any&and&all&liability&arising&directly&or&indirectly&from&the&use&of&any&information&or&products&contained&in&these&materials.