The Vegan

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Alsana treatment service have done a study with dieticians who work with eating disorder clients. They have something to say about veganism and eating disorders. What follows does not apply to people who are vegetarian for religious reasons. Asana writes:

“In a survey we conducted with hundreds of dietitians who specialize in eating disorders, we found that 98% of eating disorder dietitians saw clients who followed a vegan eating style. Of these, 75% of vegan clients realized that their eating disorder was enmeshed with veganism, while 25% of clients realized the eating disorder was separate and veganism was a true value in their belief system”.

We ask, how does a client KNOW whether their veganism is a symptom of eating disorder behaviour. Most insist that they have genuine concerns for the planet, for animal welfare and for sustainability.

The clients whose vegan diet is mostly a symptom of the eating disorder, do not have a therapeutic space to  disentangle their veganism from eating disorder thinking. At the start of therapy most insist that veganism is essential to their identity.

At the NCFED we have many thoughts about veganism, while accepting how important it is at first. We want to know whether there are other hidden issues that make veganism a compelling dietary choice. Veganism has been linked to autism, to irrational contamination fears and to early attachment issues between a mother and her child during the developmental stage we sometimes refer to as Kleinian Rage! Freud may have linked eating choices to fears of oral impregnation. We have found that veganism and also vegetarianism can be associated with OCD especially if there is no flexibility in the person. In other words, would even thinking about eating a bit of fish cause a meltdown – or would it be OK if nothing else was available.

The vegan diet can lead to serious nutritional deficiencies such as choline, iodine, B vitamins and imbalances in essential fats that cannot always be rectified by vegan sources (especially Omega 3 fats). The effects on the neurochemicals of mood, metabolism and appetite can maintain eating disorder symptoms.

If veganism is a symptom rather than a true spiritual value for the 75% of patients identified in this study, the route to recovery must include broadening the choice of food. Supplements alone are not a good way to address the potential depletions of a vegan diet, because supplements lack the synergy of nutrients that exist in real food. Some people see supplements as an alternative to eating a balanced diet, and this is also part of eating disorder thinking.

No one has yet come up with a treatment that will confront the thinking that has led to their choices as well as to rebalance their physiology.  Recovery is not just about dealing with childhood adversity.

If your client is vegan or vegetarian, recovery may entail getting more variety into their diet. and oh my goodness, how this will be resisted! Can they become a flexitarian, and use some form of animal based foods as a medicine? Will they secretly consider themselves superior to you because they make more ethical choices? This will interfere with your therapy.

If you the healer are vegetarian or vegan, can you congruently help a person to expand their food choices? Will you see yourself as superior to your meat-eating client? This will interfere with your therapy.

Eating disorders are not just about feelings, they are also about food. A restrictive diet is not great for anyone with an eating disorder. The vegan / vegetarian client may need a great deal of informed and compassionate support to disentangle their values from their eating disorder symptoms and be more open with their choices.

Self X & Eating Distress

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ARE YOU SUFFERING FROM X?

I’ve been watching  a series called Phil Stutz on Netflix  and was so excited because this is how I work. I am always sharing pictures with my clients to explain to them what is going on and keeping them stuck in their body image hell and horrible relationship with food.

Stutz tells us that we all have an interferer self he calls “X” that gets in the way of us being happy. Shakespeare said much the same thing when he wrote about each person’s unique fatal flaw. Macbeth had his fatal ambition and  Hamlet’s fatal flaw was his procrastination he just couldn’t make decisions until it was all too late.

Eating disorders shows us our particular and unique X-SELF. We don’t get an eating disorder simply because someone was mean to us or because we had a difficult childhood; the X-SELF that drives us toward our eating disorder could be that our basic nature is sensitive, or an anxious, or that we have a perfectionistic nature. Oh;  of course, our life experiences have some bearing on our disorder of choice but even people without traumas develop anorexia, bulimia and problems with binge eating.

The question we must ask ourselves is NOT what caused our eating disorder, we have to face up to WHO is this X-SELF that has decided to  obsess about food, calories, the bodies of pop stars and influencers to such an extent that we want to mould ourselves like putty into an ideal shape and size. What is the real X-SELF that is blinding our light.

This X-SELF is part of us, it isn’t something that will go away, it takes constant and continual self- awareness, pain and hard work to stop critic-X from interfering with our better life.  You won’t get rid of X-SELF by starving yourself or working out for hours in the gym. You just put off the pain.

There are so many ways of having an eating disorder. One sad young woman starves herself, eats in 8-hour windows and spends hours in the gym. She has a meltdown if the scales show that she has gained half a pound (of what).

One sad married woman is addicted to cola and McDonalds; the idea of missing her fix makes her shake with fear. She is 30 stones and desperately unhappy. She lives only to eat and her life has shrunk to the corners of her living room. She thinks that a gastric band would solve all her problems with food. It will not.

One sad man can only allow himself to eat so long as he purges afterwards. He is going to live his life  with his head down a toilet. If he is watching the sun rise over a glorious mountain he will be thinking about when he can next eat and purge.

I share many ideas with Phil Stutz and I work in ways like him.  He says (among other things) that the meaningful life starts with caring for the body, not using it like a lump of putty to showcase the six pack or the 13-inch waist. Not overeating in an act of defiance against a fat-phobic culture.   Oh yes, we can use the tricks of therapy to get someone partly well, like CBT and DBT and MANTRA. But every person with an eating disorder needs to meet SELF-X and learn how to use every tool in the book to stop it from pulling your strings. Hard, occasionally uncomfortable and ongoing work.

Only with guidance from a therapist who can show you the mirror into your soul, can you ever get well. Watch Phil Stutz, and reach out for help, we are waiting. 0845 838 2040

Obesity in the elderly-does it matter?

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I have just returned from a cruise. Cruises are exciting holidays that are often favoured by  older people, especially those who are widowed, because they are safe and there are many opportunities for connection that you will not find in an hotel. Being of a curious mind, and  a watcher of the behaviour of other people, I noticed many things about my fellow guests.

The food available on a cruise ship (and in holiday hotels) is vast. Many people use eating as a form of recreation. It has nothing to do with staying alive. Holiday food is like being in a sweet shop, with no one there to stop us from putting our hands in the cookie jar. If you add the cocktails and if you are on a package where all you can drink is included, it is even better.

Many people on holiday eat and drink as if there is no tomorrow. Our enjoyment of a holiday is often conditional on letting go of all the rules and constraints of everyday life. Our Palaeolithic brain drives us to gorge on anything that is placed in front of our nose and the tastier it is, the more we want it. But; Palaeolithic man spent much of his life in starvation mode as well, and we have not learned how to adjust.

Many older people are infirm, they are using walking sticks and the elevator rather than the stairs. They have problems with their hips and their knees and they have trouble getting up or sitting down. Some are riddled with arthritis, that is an inflammatory condition. They sit with their morning coffee, watching the exercisers on the walking deck that every cruise ship boasts. The average deck extends for between quarter and a third of a mile around the ship. The older walkers are not particularly thin but – none are at the other end of the scale.

Health in the elderly is Not At Every Size. Obesity in older people is significantly associated with a range of infirmities that affect health and quality of life. Thinness is not a good idea either. I am told that longevity is best in people with a BMI in the “just overweight” category.

Obesity rates have increased enormously recently, even in more elderly age groups,” said Eva Kiesswetter, PhD, from the Institute for Geriatric Biomedicine at the University of Nuremberg, Germany, at the DGE conference.

In addition to the other well-known consequences, excess weight in the elderly can affect falling risk, pain, cognitive performance, and above all, one’s independence. The infirm elderly can live for a long time, but often in a state of pain, dependency and depression. Some of my companions – most if not all in larger bodies went on a trip, but could not get out of the tour bus and walk around– that is not much fun for them.

The need for vigilance in ageing

Research tells us that increases in BMI are normal through the lifespan partly due to changes in muscle mass and metabolism. To avoid weight gain in ageing is effortful and would require vigilance regarding diet and activity. Vigilance is not the same as dieting. Also, there are concerns about weight loss, even in the elderly. This is because weight loss leads to a decrease in muscle mass or bone density that can be particularly risky for elderly people. Dieting alone is thus unhelpful for older people.

Kiesswetter and her colleagues in Germany investigated which weight-loss interventions had a positive effect on elderly people’s physical functionality. The team incorporated 49 studies into their evaluations. They found that a combination of nutritional and activity interventions produced the best results. This combination can improve functional status and moderately reduce body weight without causing a loss in muscle mass, according to the findings.

Gerontologists also tell us that eating extra (complete) protein is helpful for the average older person, helping to sustain muscle mass particularly if someone also spends a little time moving on their feet. Sugar is unhelpful to older people. This isn’t dieting, it is self-care.

Elderly people with a normal BMI can also become ill but are less likely to be “inflamed”. Difficulty moving makes old age FEEL much older than it is; apart from what we know to be the associated health risks.

QOL in the elderly is being able to stand up gracefully, move about flexibly, sit down softly, get dressed easily and to go for long rambles with family and grandchildren. Age has its challenges but our body is a companion to the mind and both need care.

Is obesity a disease?

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A number of academics and researchers have come together to advise that obesity should be recognised as complex, progressive, chronic, multifactorial disease. It is a disease for which there is no effective treatment other than strategies that could make it worse,  such as changes to diet and lifestyle. All the names one gives obesity – “disease”, “weakness”, “moral failure” etc, cause stigma, and stigma makes the problem worse. Because of this, it is proposed by some people that the word “obesity” should be banned and fatness should be celebrated.

At the moment, whatever you feel about it, the word “obesity” simply refers to an arbitrary and often inaccurate measure of the amount of fat on a human body. There is a certain level of fatness that is associated with better health, but not in everyone. I get that. Thin may also mean sick. Unexercised also means sick and smoking also means sick. But not in all.

There are levels of fatness which – with or without stigma – are associated with poor health.  And it for this reason that I am conflicted. Because, removing the effects of stigma will not remove the effects of obesity.

There is an inconvenient truth that the fatter a person is, the more they are at risk of diabetes, some endocrinal cancers, inflammation, cognitive impairment, liver disease. There is a lie at the heart of ‘Health At Every Size’. Yes, I do know that stigma increases the health effects of a fatter body. And the more I list the effects of obesity, the more defensive I feel.

It was proposed by my erstwhile colleagues that we can reduce stigma by calling obesity a metabolic disease rather than a moral issue. But how are these academics planning to create this change in the short-term, when most people in the community really don’t share this definition of obesity and would prefer not to live in a larger body?  I think that it is important to throw off the shackles of stigma and celebrate any human shape, but, despite the body-positive movement, we aren’t there yet. Children asked to say what they most worry about STILL put weight gain near the top of their list. We are also still getting fat stigma in micro-doses everywhere.

Last month for example,  I went to see Back To The Future. I couldn’t help but notice that the villain was fat, the hero was slim and the love interest was not plus size. Even if “disease labelling” makes health professionals take treatment more seriously, I am uncertain whether feeling diseased will help anyone feel happier or more at peace with themselves.

As an obesity trainer, I have pondered how to help health professionals manage the overweight client without bringing stigma into the room and without agreeing or disagreeing about whether a person “needs” to lose weight. I think that we need to respect the client, while also doing a proper assessment to understand their motives and outcomes and to make sure that nothing else is wrong. If they are overweight because they have a seriously disturbed relationship with food, this needs to be dealt with first and there is no quick-fix for a longstanding eating disorder.

It has been argued that eating disorder professionals shouldn’t touch the client wishing to lose weight, because weight-loss efforts are associated with compulsive eating. This frankly is simply an opinion I disagree with.  The eating disorder specialist is schooled in neuroscience, nutrition, physiology, and psychology. With this knowledge we know enough to do a holistic assessment of the person wanting weight loss.  A relationship with food is by nature complex; and it evolves in the crucible of the client’s life events and relationships. By getting the client’s story, their health, the history of their weight loss efforts, their lifestyle and aspirations, we are better able to guide him or her on what to do next.

The latest thinking on weight-loss therapy does not involve dieting, deprivation or going to the gym. But here I end my blog because, that is another story for another time.

Boxing, weight loss & eating disorders

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Boxing, Cricket, and dying to be thin.

I always knew that boxing was one of those sports that led to eating disorders in men, and most probably in women too.

A talented 17-year-old boxer called Ed Bilbey died in the ring after drastically cutting his weight so that he could keep competing in his weight category.

It was a chance visit to a boxing gym when he was 13 that set the course of Ed’s short life.

As he watched the men pummel the heavy bags, Ed fell in love with the game, and he eventually became a gifted 17-year-old wanting to pursue a long term career in boxing.  He was training hard to win the E. Midlands welterweight title; he had remained in this category since he was much younger despite having grown to 6 ft tall. To keep his weight down, his mother would catch him taking hot baths and sleeping in layers of clothes and duvets as he tried to lose weight through dehydration. He had been running in black bin bags; he said to his mum “I’ve got to sweat this weight off”.

On the day of the weigh in, he ate some eggs for breakfast then nothing else for the rest of the day, then he went into the ring for his match. Shortly after the fight ended, Ed collapsed and died. The Coroner said that his intense training, and rapid weight loss through dehydration had killed him.

Cricket also has its men with eating disorders. Freddie Flintoff was bulimic and now engages in compulsive exercise to keep thin. No one YET has made the connection between Shane Warne’s rapid weight loss behaviours, periods of starving,  and his struggles to keep his weight down. One may ask, what other things did Shane do to try and deal with his weight?

Another highly ranked boxer called Conor Benn has recently tested positive for a female fertility drug that causes males to lose fat and build more muscle. He was due to fight Chris Eubank’s son, aged 33, who at that time weighed as little as he had done at age 18. His father said that his son cutting so much weight was “suicidal”.

If only people knew what we know. Sweating weight off is a losing game. Sweat takes minerals out of your body that help your body to burn energy.  Those minerals also keep your heart beating.  In the end, even if you don’t actually die, you gain weight more easily and your body becomes a fat-making machine.

I wish that all sports coaches, especially in boxing, knew the cost of eating disorders and the sheer dangers of forcing a person’s weight down so that they can be match-fit for the category in which they are competing. Ed’s Mum and England Boxing have raised concerns that people in sport put hopes of future investment ahead of boxers’ welfare. England Boxing claim that they are starting a review; let’s not build our hopes too high.

Are sweeteners good for people with eating disorders (& obesity)?

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Written with acknowledgement to Science Magazine

Artificial sweeteners, which can be hundreds to thousands of times sweeter than cane sugar, are generally not processed by the human body, which is why they provide no or few calories.

We have all been there, feeling virtuous because we have a diet drink. All that lovely sweet taste and filling fizz without the guilt or calories associated with sugar. But a new study suggests that these artificial sweeteners may not be as harmless as once thought; they may even increase the risk of diabetes or weight gain.

Scientists have long suspected a link between artificial sweeteners and obesity in humans, but until now that connection had only been shown in lab mice. Now, scientists in Israel have tested these chemicals in humans. Their results show that artificial sweeteners not only disturb the microbes living in human guts – which are critical for supplying essential nutrients, synthesising vitamin K, and digesting dietary fibres among other things—but some may impact how quickly the body removes sugar from the blood after a meal. The longer glucose stays in the blood, the greater the risk of diabetes, cardiovascular disease, kidney disease and weight gain.

Eran Elinav an immunologist at Weizmann Institute of Science in Israel, tells us that non-nutritive sweeteners are not inert in humans.

Every human hosts a unique bouquet of microbes—bacteria, viruses, and fungi—that live naturally in and on our bodies; in the intestine, nose, mouth and on the skin and eye. The number of cells that make up this vast microbial community is about as many as all the rest of cells we have in the body. This community we c all the microbiome, is seeded at birth, and not only helps digestion but also protects against pathogens and supports the immune system.

Non sugar sweeteners disrupt the microbiome because even though they have no calories for humans, they serve as nutrients for some microbes, which then proliferate. This causes an imbalance in microbial populations that can cause chronic intestinal inflammation or colon cancer. The Israeli study confirms that non-nutrition sweeteners can disrupt the gut microbiome within two weeks of exposure and suggest their effects on sugar metabolism can vary from person to person.

Michael Goran, a professor of paediatrics and program director for Nutrition and Obesity at Children’s Hospital Los Angeles says, that what isn’t food for us can still be food for our gut bacteria. Different sweeteners have different chemical properties but can have similar effects in our gut.

David Katz, a nutrition specialist, and the founder of Yale University’s Yale-Griffin Prevention Research Center, agrees. “This is an elegant, elaborate, and powerful study which establishes decisively that non-nutritional sweeteners impair glucose metabolism by causing specific damage to the microbiome.”

The Bitter History of Sweeteners

Humans have a natural preference for sweet foods that over the millenia prove that the food is safe and it is also  an evolutionary adaptation that drove us to high-energy foods at a time when nutritious foods were scarce. Natural sugars, such as glucose, fructose, cane, or milk sugars, are digested to produce energy—measured in calories—that helps our organs function. 

Sweeteners, which can be hundreds to thousands of times sweeter than cane sugar, have been created to provide no or few calories.

Saccharin, the first commercialised non-nutritive sweetener, was discovered in 1879 in coal-tar derivatives at Johns Hopkins University. Thanks to President Roosevelt who thought that sweeteners are a guilt-free way to lose weight, saccharin dodged a ban by the U.S. Food and Drug Administration (FDA). In 1977, when the FDA tried again to ban saccharine because of the suspected risk of causing cancer in rats, Americans fought back. They sent millions of letters to Congress, the FDA and President Carter in protest.

Ultimately, only a cancer earning label was required on saccharin products. But this was dropped too in 2000 when scientists found that humans metabolise saccharin differently from rats, and it didn’t pose a cancer risk for humans.

Low or zero calorie sugar substitutes are in thousands of beverages and foods worldwide and generated £18 billion in 2021. This number is expected to rise as demand for these sweeteners—particularly in low- and middle-income countries—continues to expand. 

In the USA a survey in 2017 showed that 80 percent of children and more than half of adults consumed low-calorie sweeteners once daily. Obese adults used low-calorie sweeteners more frequently. Eating disorder and obesity experts have noted for decades  that sugar substitutes are linked to increased hungers and increased desires for fat-rich foods but we have never known why, until now.

Most eating disorder and obesity treatment programmes now require patients or clients to stop having drinks laden with sweeteners. It is not a good way to prevent weight gain and it is not a good way to cheat your hunger. We are not suggesting that it is better to have high sugar drinks and foods either. Sugar is still a very well proven health risk for obesity, diabetes and other health problems but the impacts from sweeteners also means a healthy caution should be observed.      There is no getting away from the truth – that drinking water, eating natural foods, and having a little bit of what you fancy is the safest way to live.

The Actual Study (If you want more of the science)

Elinav has been interested in uncovering the links between nutrition, gut microbes, and the risk of developing common diseases, such as obesity and diabetes, with the hope of devising microbiome-based personalised medicine.

In 2014, Elinav and colleagues that saccharin, sucralose, and aspartame each raised blood glucose of mice to levels that were significantly higher than those of mice that were fed sugar. When gut microbes collected from mice fed with artificial sweeteners were added to mice that had no gut bacteria of their own and had never been given artificial sweeteners, their blood-glucose levels shot-up as if they were consuming artificial sweeteners themselves.

“In mice, some of these non-nutritive sweeteners are sensed, and they impact the gut microbes, which have an amazing capacity to metabolise many of these compounds,” Elinav says. He decided to test whether the same held true in humans: Could altered gut microbes disturb the glucose metabolism?

Elinav’s team first screened 1,375 volunteers for any consumption of zero-calorie sweeteners in their daily lives. They identified 120 adults not previously exposed and gave them one of the four commonly used sweeteners—saccharin, sucralose, aspartame, and stevia for two weeks. The volunteers were then monitored for a third week. Scientists compared their blood-glucose responses against those who were not given artificial sweeteners.

Within 14 days after beginning any of the four tested artificial sweeteners, scientists observed significant differences in the populations of gut bacteria among volunteers. “We identified very distinct changes in the composition and function of gut microbes, and the molecules they secret in blood,” Elinav says. This suggests that gut microbes rapidly respond to artificial sweeteners.

To test how artificial sweeteners affect the body’s ability to control the surges in blood sugar after consuming sugar as part of meals, volunteers were monitored for blood glucose levels after a test glucose drink. Normally, blood glucose levels should peak in 15 to 30 minutes and then return to normal within two to three hours. If the glucose levels remain elevated, it signals that the body isn’t processing and storing excess glucose properly, a phenomenon known as glucose intolerance.

In the Israeli study, sucralose and saccharin pushed the body towards glucose intolerance, which if sustained may cause weight gain and diabetes. Aspartame and stevia did not affect the glucose tolerance at the tested ingested levels.

“The glycaemic responses that are induced by saccharin and sucralose, possibly by the gut microbiome, may be more pronounced,” Elinav says.

To confirm that disturbance in microbial populations disrupted blood glucose levels, scientists administered faecal microbes from stool of human participants to germ-free mice. The study found that microbes from the volunteers with elevated blood sugar levels also suppressed glucose control in the mice.

“The gut microbes, and the molecules they secrete into our bloodstream, are very altered in all four non-nutritive sweetener consumers,” Elinav says. “Each of the groups responded in a unique way.”

Although, the study didn’t follow the volunteers long term, this is the first study to show that the human microbiome responds to sweeteners in a highly individual manner. This can disrupt sugar metabolism in some, if not all consumers, depending on their microbes and the sweeteners they consume. It is currently unclear whether personal differences are due to genetic, epigenetic or lifestyle factors.

Children’s food, sugar tax & Government control

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The children’s food campaign Sustain is urging the Government not to drop the sugar tax and any other strategy being used to try and control the increase in childhood obesity.

The say –   “Children’s Health Under Threat! Reports have emerged that the new Government is considering ripping up a number of its flagship childhood obesity strategy measures. Even the successful Soft Drinks Industry Levy is under threat, as well as plans to protect children from junk food marketing. We’ve joined the Obesity Health Alliance and 70 organisations in a joint letter to PM Liz Truss. asking her to consider the cost of reversing these measures for children’s health and the NHS”.   

Many of our readers don’t like the sugar tax, they say that this makes food more expensive for poor people who are the ones eating more sugar. We know that many poor families eat junk food because their children do not want to “eat broccolli”. So healthy food is more likely to be thrown away.

Why is an eating disorder organisation like ours interested in childhood obesity? Will the push for healthy eating drive people toward dieting and eating disorders?

Or will childhood obesity lead to eating disorders because overweight adolescents will try to lose weight in ways that could be dangerous?

I have heard it said that some supermarkets are not selling real cola and are pushing the diet colas that are also implicated in weight gain. This is because the “bad” bacterial in the gut feed off the chemicals in diet drinks.

NCFED takes a lot of calls from parents who are worried about their children’s eating habits, and also worried to interfere in case their child starts being funny with food.

Feeding children a lot of sugar over a period of years is like feeding them slow poison. The NHS IS on its knees managing weight related issues. Where do YOU stand on this very difficult issue?

Cognitive Remediation for Eating Disorders

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What is it?

Monday Musings: Cognitive Remediation for Rigidity and Fixations in Eating Disorders.

Many of you readers are not sure what we do to treat eating disorders and overweight. So, these musings are to give you a peep into the secrets of treatment.

Eating disorders are problems with behaviour. Therapists seek to know what lies beneath problem behaviour like purging, starving and binge eating. Some therapists say it is all about early experiences. Other therapists think it is all caused by trauma or not having better ways to self-soothe.

People get into eating disorders by one road only. For whatever reason, they want to change their weight to feel better about themselves. So, they stop eating what they want and begin eating what they think they should.   The unintended consequence for some people is getting into serious food restriction. For other people,   dieting or cutting out food groups leads to binge eating and a small number of people  end up purging to try and manage their binges.

A tangle of different “maintaining factors”.

Tangles of EDs

Very few people know what keeps people stuck inside the tangle of an eating disorder.  There are many different things and so we must UNPICK the eating disorder, one tangle at a time. One of these tangles is very stuck habits. Everything inside an eating disorder is a habit, what food you binge, how you binge or purge, how and when you exercise, how often and when you might weigh yourself.

Some people with eating disorders,  especially people with anorexia or ARFID are very rigid by nature and they are easily fixated by the small details of the food they eat and what they think it does to them.  Many show signs of Obsessive Compulsive Disorder. This is partly to do with how their brain works. If we ask a person with anorexia to describe a picture, they tend to focus on a great deal of detail.  A person who eats normally tends to tell us about the overview of a scene, such as “This is a picture of the countryside in autumn”.

To recover from eating distress,  a person needs to become more flexible – to allow them to make more helpful food choices, and to worry less about their eating.

Cognitive Remediation (CRT) is a therapy  that works directly with the brain. The therapist is trained to do tasks with their client like picture work, or use of symbols, so that the brain learns how do several useful things. Firstly, to stop focusing on small details like “the food I just ate for lunch” and secondly to stop obsessing about ideas and thoughts so that the sufferer develop better coping strategies.

Cognitive Remediation Therapy is not the only thing we use to help restore a client to health. This is simply addressing one of the tangles in which they are trapped. Most good eating disorder specialists, like ours,  will have done some training in CRT.  If you need help with an eating disorder, have a look at our counsellor list at https://booking.eating-disorders.org.uk/counsellors/search

Young people at risk – test an App

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stem4 Self Worth/Eating Disorders app Research Study – request for help in recruiting participants.

stem4 is a London-based teenage mental health charity that aims to develop positive mental health in teenagers through education and early intervention. stem4’s digital portfolio of award-winning evidence-based apps (Calm Harm, Clear Fear, Move Mood and Combined Minds) have been created by Consultant Clinical Psychologist Dr Nihara Krause in collaboration with young people, and are available free of charge on the App Store and Google Play.

This study is a preliminary evaluation of a new app called Worth Warrior for young people who experience early stage eating disorders. Like the other stem4 apps, this app, which will also be available free to users, has been developed by a Clinical Psychologist and stem4 Chief Executive Officer and Clinical Lead, Dr Nihara Krause and has been funded by the National Institute of Health Research (NiHR). The app uses techniques from a talking therapy called, Cognitive Behavioural Therapy for eating disorders to help tackle the symptoms of early eating disorders and low self-worth.

stem4 would like to know if the Worth Warrior app works well and if it can help young people manage their early symptoms of eating disorders by contributing to improving their self-worth. They will use a ‘before and after’ design to see if the Worth Warrior app is user friendly and can help to reduce symptoms in young people aged between 17-25 years.

The research will take place over a 7-week period and aims to include up to 30 young people. stem4 would like to collect information using online questionnaires at three time points, followed by a brief interview online. Young people will be recruited via stem4’s networks, social media, and their website. The project is divided into three stages:

Time 1: Introduction and familiarisation with the app.
Time 2: Post-app familiarisation (1 week).
Time 3: Follow-up after 6-weeks to see if the app was helpful.
Data will be collected via questionnaires at each time point. In order to collect more detailed feedback of using the app and its benefits (or qualitative data) participants will also be invited to take part in a brief online interview at Time 3. This qualitative part of the study will be jointly produced with young people.

As a thank you to the young people participating, stem4 will be offering a £30 Amazon voucher.

Participants can find out more and see if they are eligible for the study here:

https://stem4.org.uk/body-image-eating-disorders-app-research-study/

Chewing & Spitting Adam Kay

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Adam Kay the famous writer and broadcaster admits to a “serious eating disorder” where he chews large amounts of food (usually junk food) and spits it out.

He became painfully aware of his size after a sexual encounter where his partner said that he had done well despite being “a big guy”.

He took the comment to heart and he decided to lose weight the quick way, by starving. Unsurprisingly he developed extreme hunger and began to crave food. Having failed to throw up, he decided to spit food out as a way to lose weight. He began to spit out more and more, to the extent that he kept a bin bag full of spat out food in his room until one day he was “found out”.

For a while, this strategy to lose weight worked. He lost a lot of weight and people began to be concerned about his appearance.

We have an article about chewing and spitting on our information pages. Some people have written in; they are annoyed about the things I have written. They are annoyed about me writing that we can take in a lot of calories when we spit out food, because a lot of energy is inadvertently swallowed.

The psychology of spitting


Spitting can become a major addictive behaviour because of the dopamine hits it gives. But the psychology of spitting is complicated.

For a short time, chewing food and spitting it out will calm the hunger drives. But this doesn’t work well in the long term. When the mouth receives food that the stomach doesn’t get, the brain is not fooled. Chewing palatable tasty and forbidden food will give us a dopamine “hit” that feels gratifying, but there are other physiological processes going on that could make it more likely that we will gain weight in the long term – one month, one year down the line. That is personal. The quick fix of spitting has a cost.

One reader wrote to me that the psychology of spitting food out is simple. He says it is simply about getting the taste without the calories. I do NOT agree.

Why people might chew and spit

What is the person REALLY spitting out? Who is the person REALLY spitting out?

I have found out that most people who chew and spit are very anxious, and this is a way of calming themselves down.

What is the underlying deep sense low self-worth that causes someone to believe that they do not deserve to eat real food. It is not just fear of getting fat.

What is the source of the pain that is being expressed by a behaviour that would be generally seen as shameful?

Does this person really believe that this is the only method of weight control available to them?

What is the cost of doing this, and what is stopping them from getting help?

How to get help

I wish that I had worked with Dr Kay, to find out what led him to take the comment about his size so much to heart, and to be the victim of someone else’s unguarded opinions about him. Maybe it is this fragility that lay behind so many of his other problems with life, work and relationships.

If you need help with chewing and spitting, we understand. Contact 0845 838 2040 and explore your options


https://www.thetimes.co.uk/article/my-secret-eating-disorder-by-adam-kay-2qrghx65m