Statistics Canada says close to a third of Canadian kids under 17 are overweight or obese.  The rising prevalence of overweight and obesity in several countries has been described as a global pandemic.  In 2010, overweight and obesity were estimated to cause 3.4 million deaths, 4% of years of life lost, and 4% of disability-adjusted life-years (DALYs) worldwide.  Data from studies in the USA have suggested that, unabated, the rise in obesity could lead to future falls in life expectancy.  Concern about the health risks associated with rising obesity has become nearly universal; member states of WHO introduced a voluntary target to stop the rise in obesity by 2025, and widespread calls have been made for regular monitoring of changes in the prevalence of overweight and obesity in all populations[1].

It is more apparent than ever that losing weight is not an achievable goal for the majority of people.  As incredible as it sounds, that’s what the evidence is showing.  For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear.  “It couldn’t be easier to see”, she says; “long-term weight loss happens to only the smallest minority of people”.  Traci Mann’s research on long term weight loss shows that on average, dieters only maintain a 1 kilogram weight loss over two years.

One solution would be to prevent weight gain in the first place.  “An appropriate rebalancing of the primal needs of humans with food availability is essential”, University of Oxford epidemiologist Klim McPherson wrote in The Lancet[2].  But to do that, he suggested, “would entail curtailing many aspects of production and marketing for food industries”.  As necessary as this may be, it is certainly not a “quick fix” solution.

Have you ever dieted?  Did you lose weight?  Did you gain it back?  Why are we obsessed about doing something that has been proven over and over again to not work?  There is an alternate approach, and believe it or not, it has been around for at least 35 years.

The SHAPE (Strategies for Healthful and Pleasurable Eating) Eating Control Program was developed by Dr. Arthur Cott and his colleagues at the Behavioural Medicine Unit (BMU), St. Joseph’s Hospital, Hamilton, Ontario, in the early 1980’s.  Dr. Cott’s approach utilized the scientific evidence in the learning theory literature to design a comprehensive educational program for individuals who felt fat, wanted to lose weight and were fed up with the numerous diets, both mainstream and fad, that they had unsuccessfully endured.  I was privileged to be one of those who worked with Dr. Cott and would like to share his wisdom with you.

The SHAPE Program was a 24 week course that combined both lectures and small group tutorials.  The students in the course ranged in age from 16 years to 70 years.  Both males and females paid a hefty registration fee to attend this course which was taught at locations in Hamilton, Toronto, Kitchener and St. Catharines over a 10 year period.  The lectures were delivered by Psychologists from the BMU, including Dr. Arthur Cott, Dr. Harvey Anchel and Dr. Richard Marlin.  The tutorials were led by Behavioural Therapists who had been trained and

specialized in the application of cognitive behavioural therapy for chronic somatic and mental health conditions as well as behavioural issues, such as eating control.  Again, I was fortunate to have been a tutorial leader and eventually, the Manager of the SHAPE Program.

Recently, I decided to investigate the current scientific literature regarding behavioural approaches to eating control and weight regulation.  I discovered the work of Dr. Brian Wansink, (Ph.D. Stanford 1990) who is the John Dyson Endowed Chair in the Applied Economics and Management Department at Cornell University, where he directs the Cornell Food and Brand Lab.  He is the lead author of over 100 academic articles and books on eating behaviour.  Kelly D. Brownell, Yale University, has hailed Dr. Wansink as “the Sherlock Holmes of food”.

Clearly, Dr. Brownell had never met Dr. Cott.  I very quickly discovered that Dr. Cott’s approach from 35 years ago is just as relevant today as it was back then.  I had always believed that this approach was remarkable in its interpretation and implementation of science.  Now I know that it has survived the test of time.  Dr. Cott’s approach was truly ahead of its time.

At one point, the SHAPE program was featured in one of our Canadian magazines which resulted in an overwhelming response from readers across Canada who wanted to participate in the program.  To meet this need, those of us at the BMU at the time, made a decision to develop a “correspondence course” version of the program.  Being the pack rat that I am, I am extremely fortunate to have a copy of the course content developed by the BMU and I would like to start sharing it with you now.  This is the first of a 4 part series (check out our blog each week to find the rest!).

PART I:  WHAT IS THE REAL PROBLEM?

Believe it or not, even though many people think they have a weight problem, weight is not really the problem.  Look at the following examples.  All of these people thought they had a weight problem.  Does any of this sound familiar to you?

Maryanne is a 41-year old, full-time health care professional, married with 2 school-age children.  She’s been fat and she’s been skinny.  She has waged a constant battle over the last 10 years in her attempts to control her body weight.  She has tried low-fat diets, low-carb diets and counting calories.  Maryanne has struggled with frustration from Scarsdale to Pritikin to Beverly Hills Diets.  Some of them worked… for a while.  “I lost 44 lbs in 6 weeks and I’ve put it all back on” comments Maryanne.

Bill is 48 years old, married with 3 grown children, all of whom are living away from home.  The nature of his occupation, a senior manager in the steel industry, requires him to make several business trips a year and to attend numerous business functions, usually all associated with eating.  The impetus for Bill to do something about his weight had come from his family physician who had been treating him for the past year for elevated cholesterol and triglyceride levels.  Bill had been monitored for 12 months as he attempted to stay on a prescribed diet, which included very few of his favourite foods.  Bill was discouraged and fed up with the ‘diet’, but still concerned about potentially serious health problems.

Elizabeth had dieted for at least 25 of her 30 years, attending every kind of group dedicated to losing weight.  She knows she’s fat while others claim she’s skinny.  She claims to have lost “at least 1000 lbs” and spent hundreds of dollars on diets.  For the past 2 years she has successfully maintained her weight at 120 lbs.  At 5’3” tall, Elizabeth appears to be a ‘normal weight’ person.  Elizabeth describes herself as ‘fat’.  She believes that her primary goal is to lose weight and listed her ideal weight as 110 lbs.

Each of these three people has one or more of the following problems:

• “I feel fat!”
• “I just look at banana splits and donuts and gain weight”
• “I am always hungry”
• “eating desserts makes me feel guilty, but when I don’t, I feel deprived”
• “nothing seems to fit”
• “I must be addicted to food. Once I start eating peanuts, I can’t stop”
• “I’m always on a diet”
• “whenever I’m on a diet, my family loses weight”
• “going to the beach means wearing sweat pants and t-shirts, never a bathing suit or shorts”

The question is, what do any of these problems have to do with weight?  The answer is NOTHING!  Weight is not the problem.  Weight is simply the result or outcome of the problem.  The problem is lack of control of eating.  Your eating is controlling you – you are not in control of your eating.

Many of us complain of feeling guilty after eating certain kinds of foods.  Questions such as “should you be eating that?” or “is that in your diet?” are frequently heard as family members comment on what we are about to eat.  Some individuals report that the guilty feelings are so strong that they avoid eating in public as much as possible.  Instead, they consume large quantities of their favourite foods when they can be certain of no interruptions.

A second characteristic frequently demonstrated by people with eating problems, especially the constant dieter, is that of deprivation.  While everyone else is enjoying steak with béarnaise sauce, baked potato with sour cream and apple pie a la mode, the dieter is suffering with a tossed salad and no dressing, broiled fish and water.  Feelings of “why me?” and “it’s not fair” often result in secretive snacking.  Many of us have a long list of “forbidden fruits” or list of foods which we believe we should not eat.

It is not unusual for individuals to provide the following reasons for their inability to control their eating:

• “I have no willpower”
• “I’m weak willed”
• “my mother made me clean my plate when I was a child”

We often feel miserable as a result.

None of these problems are related to weight alone.  Losing weight is not the solution.  Even after losing weight, guilt, deprivation and misery can persist.  The solution is to acquire the skills to control when you start eating and when you stop eating.

Control of eating is not always the entire solution to an eating problem.  Quite frequently, there is a second component which must be addressed and that is the problem of “feeling fat” or body image.  Body image problems result when an individual’s perception of their size is discrepant with their actual size.  In other words, the individual feels fat even though they are not fat.  For example, friends and family frequently tell them that they “don’t need to worry about their weight”, however, they continue to feel fat.

Individuals with ‘fat body image’ problems demonstrate behaviours such as:

• Asking their spouse “does this look fat on me?”
• Checking every mirror or plate glass window to make sure that their ‘fat spot’ is tucked in or covered up
• Standing in the back row to get their photo taken
• Wearing sweat pants and shirt to the beach
• Avoiding gyms, reunions, and exercise

Weight loss alone is not the solution to a body image problem.  In fact, it can make the problem worse as the discrepancy between the size a person perceives themselves to be and their actual size becomes larger.  Once a body image problem has been identified, it is necessary for the individual to start behaving “thin”, thus leading them to “think thin” and eventually to “feel thin”.

Most people who say they have ‘weight problems’ usually have some concerns about their willpower or lack of it.  They are often accused by other people of lacking willpower.  They are often scolded by others for not using it.  What we know is that the control of eating is far too important to be left to willpower and conscious control and far too complex.

In Part II of this series, we will start by looking at what it is that starts and stops us from eating – the determinants of eating behaviour – and why it is that we have to eat in the first place.  We will discover that “the real problem” has nothing to do with willpower.

[1] Ng, Marie et al.  (2014, May 28).  Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013.  The Lancet, 384 (9945), 766 – 781.  DOI: http://dx.doi.org/10.1016/S0140-6736(14)60460-8

[2] McPherson, Klim.  (2014, May 28).  Reducing the global prevalence of overweight and obesity.  The Lancet, 384 (9945), 728 – 730.  DOI: http://dx.doi.org/10.1016/S0140-6736(14)60767-4

Do you feel as though your clothes just don’t fit the way you would like them to?  Do you feel anxious about the upcoming summer months and losing the layers of winter clothing?  Do you feel like the battle to lose weight and feel great is an endless one?  Well, you’re not alone.

‘Do you feel fat?’ is an abrupt question and may be intimidating  for many to answer, but the reality is that it is, in fact, how many of us are already feeling, and the majority of us would respond ‘yes’.  I felt a bit apprehensive in using this very question as the title of my blog and the tagline of our advertising campaign for the month, but throughout my research for this blog, I came to learn that the fact of the matter is that asking people this question is really just getting to the point and not ‘avoiding the elephant in the room’, so to speak.  This trend is not surprising given the media’s influence on people’s perception of what is considered to be ‘fat’.  Responding affirmatively to this question does not necessarily mean that our weight or body mass index (BMI) falls within a category that is considered to be overweight or obese, nor would it confirm without a doubt that our body shape or size is posing any risk to our health.  I am not saying that feeling fat never equals being fat, but I am saying that the former can, and most definitely does in many cases, exist without the latter.

I was interested in collecting some numbers so that I could really see if what I thought was happening was really happening – if many people felt fat and were dissatisfied with their body.  I anonymously surveyed 100 people of varying characteristics, ages, genders, and cultures.  I asked them a series of questions, which were as follows:

The results were what I had expected, yet for some reason I was still surprised by what I saw.

I know that a lot of people feel fat, and I know that many are dissatisfied with their body, but seeing the numbers really drove the point home – people’s undesirable body image, whether justified or not, is a real problem.

Click here to see a bigger image:  do-you-feel-fat-surevy-results

As you can see in the graph above, the majority of people we surveyed feel fat, are not satisfied with their body, have tried dieting, would like to lose weight, compare their bodies to others, and are unhappy with the number on the scale.  Surprisingly, many even said that others would not agree with their perception of their shape and size, suggesting that this may be a group of individuals who feel fat, but perhaps would not necessarily meet the true criteria for being fat or may not be seen as fat by others.  Let’s face it – we are typically our own worst enemy and toughest critic!

There are a number of assumptions we can make when analyzing these results.  Here are a few assumptions that I have made based on these results, but there are definitely still other angles that can be taken.

• Many people are in fact overweight: It is known that overweight and obesity is a real problem in the current world, and perhaps the reason that many confirmed that they feel fat, are unhappy with the number on the scale, and are dissatisfied with their body, is because they are, in fact, overweight or obese.  Again, this is just an assumption we can make since we did not ask any information in our survey about weight classification or BMI.  Statistics Canada reported that in 2014, 61.8% of Canadian men and 46.2% of Canadian women were said to be overweight or obese based on their BMI classification (The Huffington Post, 2015).  If being overweight or obese is where the problem lies, then behavioural intervention (i.e. eating behaviour, exercise, education, etc.) is required to prevent weight gain to a level that puts people into these categories.

• The majority of people have a negative body image: Whether or not individuals fall into the overweight or obese categories, it is evident that body image is a real issue that needs to be addressed.  The Canadian Women’s Health Network supports this point as it reports that 80% to 90% of women and girls in Canada are unhappy with the way they look (CWHN, 2012).  Women are not the only ones dealing with body image issues as many people may think.  The Guardian reported that more than 81% of men talk in ways that promote anxiety about their body image by referring to perceived flaws and imperfections, compared with 75% of women (The Guardian, 2012).  The study also found that 38% of men would sacrifice at least a year of their life in exchange for a perfect body.  If body image is where the problem lies, then psychological intervention is needed to help individuals maintain a positive perception of their size and shape – a positive body image.

• The media and cultural trends have influenced unrealistic and likely unhealthy perceptions of what is considered to be an attractive body shape and size: If we look back over the years, the ‘perfect’ body shape and size has changed drastically, and what may have been considered ‘attractive’ or ‘desirable’ decades ago, would now be considered ‘fat’, ‘unattractive’, or ‘undesirable’.  This video shared by BuzzFeedVideos in 2015 shows the ideal body types over time: https://www.youtube.com/watch?v=Xrp0zJZu0a4.  The media’s view of ‘the perfect body’ is not static and so why should we keep trying to chase it, rather than learning to love the body we have, as long as we are doing what is needed to keep it healthy.  If you feel fat, consider how much the media is playing into that feeling.  If the media and its strong influence over our perceptions is where the problem lies, then educational intervention is needed to help individuals understand that different body shapes, types, and sizes exist, and that striving to be something we are not can cause more harm than good.

There are indeed other interpretations or conclusions we can make based on the results of our mini study’s results, however, there seems to be one overarching issue that needs to be addressed, regardless of the root of the problem – people feel fat, are unhappy with their bodies, and are looking for solutions.  If people continue to feel fat, a chain reaction of other problems can begin.

Some studies, including one done in 2012 by The Norwegian University of Science and Technology, found that thinking you are fat or feeling fat can actually lead to you becoming fat.  They identified a number of reasons supporting why this may happen, such as the psychosocial stress of trying to achieve the ‘ideal body type’, skipping meals, and ‘yo-yoing’ on and off unsustainable diets.  Other studies, including a body image study done by researchers at Bradley Hospital, Butler Hospital, and Brown Medical School, have looked at the effect of having a negative body image on psychological health.  This study and others like it have concluded that adolescents with negative body image concerns are more likely to be depressed, anxious, and suicidal than those without intense dissatisfaction over their appearance, even when compared to adolescents with other psychiatric illnesses.  They also found that in addition to higher levels of depression, anxiety and suicidality, patients with shape/weight preoccupations expressed higher levels of dissociation (a coping style characterized by blocking out emotions), sexual preoccupation/distress, and post-traumatic stress disorder (PTSD), and that the majority of the adolescents in the study were not actually overweight.  This suggests that weight may not be the problem, but rather the perceptions that individuals have of themselves, whether or not they are in fact overweight.

At Odyssey Health Services Inc. we understand this issue, and have developed an effective psychological, educational, and behavioural solution.  Our approach to this issue may be different than others and may be new to many people, but it is supported by the scientific evidence, and we encourage it with confidence.  It allows us to tackle all of the issues that have been researched around ‘’feeling fat’’, including the true need to lose weight, the need for proper education around eating behaviours and perceptions of ‘the perfect body’ and psychological strategies around acceptance, engagement in life regardless of how you feel, and coping with challenges or barriers along the way.

Our solution is ACT for Mindful Eating.  This 10-session course begins in September of 2017.  Students will learn to approach all of their behaviours more mindfully, from grocery shopping to food preparation to eating in restaurants and at work, and to maintaining a risk free eating environment in the home.  Mindful Eating helps us to better understand, appreciate and, when needed, change our relationship with food.  Mindfulness helps us to foster a non-judgemental acceptance of things as they are in the present moment (i.e. our current body shape and size), notice what can and cannot be changed, move towards what is meaningful to us, and to continue along that very path regardless of the ‘stuff’ that interferes or may try to stop us on our way.

We can quite reasonably assume that many of you reading this will have felt fat at some point, may feel fat right now, or may know someone that feels fat, and we can help.  Please feel free to get in touch with us if you are interested in hearing more about what we can do for you.

It has been a LONG winter and now the sun is shining and you want to enjoy the outdoors.  You pull out your favourite pair of shorts and pull them on.  What the heck!!!!!!  WHO SHRUNK MY SHORTS?  Don’t worry, you are not alone!  You may ask yourself whether your partner washed them in hot water or you may wonder if these shorts belong to your skinny sister.  But deep down inside, you know that it is not the shorts that shrunk, but you who has grown bigger.

Now, if the answer to how you gained the weight isn’t immediately apparent, it could be due to something called the “mindless margin”.  There are many cues in our environment that lead us to overeat and for most of us they impact our eating without us even knowing about it.  And it doesn’t take much extra eating to pile on the pounds.  Did you know that eating just 3 jelly beans a day for a year is enough extra calories to result in a 1 pound weight gain?  That “mindless margin” is only 10 extra calories a day.  If you eat way too much, you know it, and if you eat too little, you can tell.  However, eating even 100 extra calories more or less in a day is not noticeable and is significant when it comes to your weight.  But 100 calories a day equals 10 pounds in a year!!!!

 So every time that you eat every last bite of your dinner, even though you were already full half way through; eating half of that cookie still sitting on the pan as you walk by the kitchen; eating the few bites that your child leaves on their plate – This is the “mindless margin”.  In all of the above instances, it’s not that you were consuming the extra calories because you needed them – you weren’t even hungry!  And if you had resisted them, you would never have missed them.  In each case, you may have just ‘slightly overeaten’, but the price you end up paying for this is high.

So what is the solution?  Being more mindful about our eating is one answer, and you can check out our previously posted blog (Who Stole My Chips?) for tips about how to do this.  But a safer response may be to change your everyday eating environment to protect you from the “mindless margin”.  Use a smaller plate or glass, sit further away from the buffet table, move the candy dish off your desk at work.  All of these have been proven – scientifically – to result in less eating.

You can learn how to do this and a whole lot more by registering for our eating control course titled ACT for ME starting in September 2017.

Source – Brian Wansink.  (2006).  Mindless Eating.