RobardUser Robard Corporation | June 2017

3 Types of Eating Dysregulation Underlying Patients’ Higher Weights




A major reason for the failure of current medical treatment for “overweight” is that “weight” problems often are actually eating problems. Higher weight may be due to genetic loading, metabolic or hormonal conditions, neurotransmitter imbalances, chronic dieting and weight cycling, or other causes, but it often occurs because people are eating in ways that are out of sync with appetite cues for hunger, pleasure and satiation. To resolve this problem, eating disorders’ therapists have been successfully using psychology of eating approaches for more than three decades and it’s time for other health care professionals to follow their lead.

Dysregulated eating comes in several varieties, including emotional eating, mindless eating, and binge-eating. Usually patients have more than one form of eating dysfunction and often engage in all three types. Underlying them all is anticipated or actual distress (generally felt as anxiety or bodily tension) lessened by the act of eating, which prevents or reduces it. Discomfort might come from obsessing all evening about the leftover lasagna in the refrigerator and keeping busy to refrain from eating it, then finally scarfing it down in one fell swoop before falling exhausted into bed. Or, distress might arise in a flash, driving someone to mindlessly polish off three cookies in a four-pack, in spite of having reached satiation after having consumed only one. In broader clinical terms, this dysregulated dynamic could be called obsession (intrusive thoughts about eating or distress about refraining from eating) followed by compulsion (the act of eating), which reduces the anxiety caused by the intense food craving. Thus, is habit formed, for who wants to experience ongoing internal angst when it could be made to disappear in a delicious twinkling. This dysfunctional dynamic overrides “normal” eating appetite cues: to eat when hungry, choose foods that are enjoyable, eat with awareness and an eye toward pleasure, and stop eating when full (quantity) or satisfied (quality).

Here is how dysregulated eating plays out in emotional, mindless or binge-eating:

1. Emotional eating is done to avoid, prevent or reduce emotional distress which may be caused by internal or external stress, memories, or simply experiencing mildly unpleasant or uncomfortable feelings. Emotional eating is meant to cheer you up or calm you down. Eating a pint of Ben and Jerry’s ice cream might act as a pick-me-up and be the highlight of a boring Saturday night alone or, alternately, help soothe rattled nerves after your boss chews you out in front of your entire department or you finally mail in your taxes minutes before the federal tax deadline. Such eating has a distinct, specific purpose: to re-regulate emotional dysregulation by tuning it up or toning it down. It also can serve as a prophylactic to unwanted feelings such loneliness, anger or disappointment. Why feel bad when you can, instead, eat something that tastes good? 

2. Mindless eating is just that—snacking or grazing through what’s in your food cabinets or refrigerator on auto-pilot. Or it could play out as overeating because you’re not paying attention to fullness or satisfaction cues. Mindless eating is done as if you’re in a trance and is usually not driven by any one specific discomfiting emotion, unless it’s boredom or the desire to avoid tasks. It’s done because there is food somewhere to be had. You think of it or see it and you eat it. It’s that simple, no thinking required. Unconscious eating is also born of habit: before you flop down on the sofa to watch TV, you automatically gran a bag of chips or you keep eating simply because the food is in front of you. Overeating is another form of mindless eating. When it’s all gone, you’re done, and not before.

3. Binge-eating is classified as a Feeding and Eating Disorder in the Diagnostic and Statistical Manual of Mental Disorders. It involves eating an excessively large amount of food in a short period of time—often rapidly, with little awareness, to well beyond full—“on average, at least once a week for 3 months” without the ability to control intake, followed by feelings of guilt, shame, or disgust (1). Bingeing is a self-driven activity that takes on a life of its own, an act accompanied by feelings of frenzy, madness and desperation. In its aftermath, the stomach feels distended and aches and you are wracked with guilt, shame and remorse.

To understand patients’ specific eating problems, health care professionals need to ask questions about their state of mind before, during and after eating. Moreover, patients need to hear that they are not bad, permanently defective or societal outcasts because of their dysfunctional eating patterns, and that they can resolve them by obtaining emotional and psychological support via therapy and intuitive-eating or health coaching, as well as through groups, workshops, books, blogs, podcasts and videos tailored to healing dysregulated eating.

Endnote
(1) American Psychiatric Association, ed. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric Association, 2013), 350.


Disclaimer: Please note that this article is intended for informational and educational purposes only. It is not intended as a substitute for the medical or psychological assessment, advice and individualized care from your personal health care provider or mental health professional. Please consult with your personal health care professional regarding your individual situation and concerns. For health care providers, the information contained herein may not be applicable or appropriate for every patient. Paige O’Mahoney, M.D. 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. Mention of products, techniques, methods, resources, approaches, or other entities in our materials is for informational purposes only and does not indicate endorsement.






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One-Third of the World is Overweight and We Are Part of the Problem



According to a recent article by CNN, 2 billion adults and children worldwide – the equivalent of one-third of the world’s population -- is overweight, and the U.S. is among the countries most severely affected.

The article reflected the results of a study published in the New England Journal of Medicine that included 195 countries and territories. The study also notes that an increasing number of people globally are dying from comorbid conditions related to obesity, such as cardiovascular disease.

“People who shrug off weight gain do so at their own risk -- risk of cardiovascular disease, diabetes, cancer, and other life-threatening conditions,” said Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, who worked on the study. “Those half-serious New Year’s resolutions to lose weight should become year-round commitments to lose weight and prevent future weight gain,” he said in a statement.

The conclusions of the study do important work in highlighting obesity as a growing concern in global public health as a chronic condition in and of itself; however, researchers also hope to educate the public at large about the link between obesity and other diseases in the hopes that preventative measures and treatment can help people avert early mortality. Almost 70 percent of deaths related to an elevated BMI in the analysis were due to cardiovascular disease, killing 2.7 million people in 2015, with diabetes being the second leading cause of death.

The study notes that obesity rates rose in all countries studied, irrespective of the country’s income level. “Changes in the food environment and food systems are probably major drivers,” they write. “Increased availability, accessibility, and affordability of energy dense foods, along with intense marketing of such foods, could explain excess energy intake and weight gain among different populations.”

While obesity rates continue to rise in the U.S., with approximately one-third of our own adult population being overweight or obese, we are luckier than other countries to have access to medical resources that can help curb this epidemic. Now more than ever, the need to begin treating obesity is becoming a public health imperative and medical providers are being called on to lead the charge. (Interested in learning how obesity treatment affects population health? Register for this free webcast!)

Treating obesity is easier than you may think, especially when you work with an experienced partner. Robard takes all the guess work out of treating obesity, and provides all the tools and resources to get you started within 60 days. Join in the conversation that’s happening, not just around the country, but around the world, and learn more about medical weight management today.




Source: CNN

Blog written by Vanessa Ramalho/Robard Corporation



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Medical Providers Aren’t Learning About Obesity



When discussing weight, there’s a disconnection between the dieter and healthcare provider. Many providers find it difficult to even broach the subject, despite the escalating rise in the disease its related chronic conditions. It would seem that the importance of obesity education is more important than ever. However, the lack of obesity education in medical training is alarming.

According to a recent study conducted by Northwestern Medicine, licensing exams for medical students have a “surprisingly low” amount of questions in regards to obesity prevention and treatment. Why is this problematic?

“It’s a trickle-down effect,” said lead study author Dr. Robert Kushner. “If it’s not being tested, it won’t be taught as robustly as it should be.” Putting a finer point on it, “The inadequate testing means medical schools have less incentive to provide obesity education in their curriculum, and students have less incentive to learn about it.”

So what’s being done to remedy the situation? For starters, the National Board of Medical Examiners (NMBE) requested that a panel — the same panel of six obesity medicine specialists that reviewed test items from several United States Medical Licensing Examinations to perform the study — identified which topics weren’t adequately covered on the exams in relation to obesity. The panel also suggested that development committees consisting of obesity experts be established in order to begin adding obesity-related elements these exams.

However, something does need to be done in the intermediate. Updates to these exams will benefit future healthcare providers and their patients, but obesity is an intensifying epidemic that needs more immediate, contemporary solutions. As a provider, if treating obesity isn’t or wasn’t one of your primary objectives, maybe it’s time to change that.

Source: Northwestern University


Blog written by Marcus Miller/Robard Corporation

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