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:

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

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.

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

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.


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


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


How You Can Treat Arthritis – By Not Treating Arthritis

For every pound of excess weight, four pounds of extra pressure are put on the knees. Needless to say, overweight and obese people are at much higher risk of developing arthritis. In fact, an obese person has a 60 percent greater risk of getting arthritis than people who maintain a healthy body weight.

One in five Americans has been diagnosed with arthritis, but according to the Centers for Disease Control and Prevention (CDC), that number jumps to more than one in three among obese people — and two out of three Americans are either overweight or obese.

“Weight plays an important role in joint stress, so when people are very overweight, it puts stress on their joints, especially their weight-bearing joints, like the knees and the hips,” says Eric Matteson, MD, chair of the rheumatology division at the Mayo Clinic in Rochester, MN.

While many may disregard arthritis as unimportant and non-life threatening, it is in fact a chronic condition with serious impact on people’s lives. Arthritis is the leading cause of disability in the United States, and can lead to many debilitating problems for overweight people, from daily pain and discomfort, decreased mobility, and may even necessitate surgery.

One study examined the factors contributing to total knee and hip replacements in people between the ages of 18 and 50. A remarkable 72 percent of those who underwent joint replacement surgery were obese.

Weight loss has been shown to be effective in decreasing the effects, prevalence, and onset of many comorbid conditions, particularly arthritis. A study of overweight women showed that a weight loss of merely 11 pounds reduced their risk of developing knee Osteoarthritis by half.

Healthcare costs attributed to arthritis and other rheumatic conditions (AORC) in the United States in 2003 was approximately $128 billion, and is continuing to increase as obesity continues to rise.  For providers who have patients that suffer from arthritis, or who are at risk for arthritis, weight loss using a medically supervised program can mean an enhanced quality of life for their patients, as well as provide a cost effective solution to arthritis, and many other comorbid conditions.

In a quickly changing healthcare climate, providers must be quick to adopt smarter and cost-effective strategies to reduce expenditures while maximizing quality of care. Treating comorbid conditions singularly without looking at the bigger picture of what is causing these ailments will increasingly become a costly mistake for both physicians and their patients. Talk to Robard today about how to streamline your patient care efforts by starting a medical weight management program today.

Sources: CDC, John Hopkins Arthritis Center, Everyday Health, Arthritis Foundation

Blog written by Vanessa Ramalho/Robard Corporation


Stress and Weight Gain

We all experience stress in our lives. But, did you know that stress could be a contributor to weight gain and preventing you from losing weight? Stress causes our bodies to produce increased amounts of stress hormones. These hormones cause a rush of adrenaline that is sometimes referred to as the “Fight or Flight Response.” When the brain receives a signal that the body is under stress, it releases the stress hormones to help the body endure whatever is upon it. It makes one ready for action and endurance. The human body is made to survive.

However, after the adrenaline rush is over, the body continues to make cortisol. This is the hormone that triggers hunger or the “replenish mode.” For our ancestors, this was necessary. They may have gone long periods of time without eating and endured a harsh physical environment without knowing when they would eat again. Our ancestors needed the cortisol due to high levels of physical stress and activity. Often, they burned double the calories they consumed just looking for their food.

We can hardly say that now. However, despite the decline in physical activity, we are under as much stress today as our ancestors. Much of our stress comes in the form of mental and emotional. Even physical stress, such as chronic illness, brings with it an emotional toll.

Cortisol and the “replenish mode” are designed to allow for survival. Cortisol slows our metabolism to conserve energy and resources. This means we hang on to fat stores. This may not have been a problem for our great-great-great grandparents who hunted and gathered their food supply, however, driving to the nearest drive-through or ordering take-out is not such strenuous work. Add a slow metabolism from cortisol and you get added weight gain.

So, how can you start now to decrease your stress and prevent weight gain? Here are some tips:

1. Take your vitamins. Your B-vitamins and magnesium to be exact. The B-vitamins provide energy and nervous system function and magnesium is known to reduce anxiety. Most of us are not getting enough of these vitamins in our diets.
2. Get protein for breakfast. Breakfast is the most important meal of the day only if it is protein packed. Experts recommend 35 grams or more to get your metabolism cranked, increase your energy level, and keep you satiated longer.
3. Exercise more. Not only are you burning calories and increasing your metabolism, you are reducing your stress level. When you are on the elliptical, bike, treadmill, or in a yoga pose, you can sweat away the day’s concerns and burn off that adrenaline.
4. Get a good night’s sleep. At least 7-9 hours per night to combat cravings. Lack of sleep makes you hungry.
5. No crash diets or starving. When you drastically restrict a food group or reduce your calorie intake, you slow your metabolism further. This will not help when under stress. Instead, find a well-balanced, high protein, low carb diet plan and drink plenty of water. There are plenty of food options for quick, on-the-go nutrition and protein.
6. Eat mindfully. By eating slowly, you give your body time to realize you are full. Mindful eating makes us more aware of emotional eating and combats the cortisol levels our bodies are producing from stress.
7. Seek help. Often stress in life is more than we can handle alone. Seek out a therapist, a health care professional, a support group, or health coach. Do not be ashamed to ask assistance during a difficult time.


You May Not Be Getting the Nutrients You Think You Are

Smart dieters often look at a product’s
nutrition facts panel to understand how much nutritional value it
contains. A label may tell you that a certain brand of cheese has eight
grams of protein or, if you rely on tech, your MyFitnessPal may tell you
that a cup of strawberries has 220mg of potassium.

By doing
this, you’re probably under the assumption you are being a responsible
dieter — and in many ways, you are. However, is what you’re seeing on
the label what you actually consume when it comes to nutrients? Do they
have the expected effect? Some researchers would say no, and have
published their findings in The American Journal of Clinical Nutrition.

to a May 23, 2017, article published by the Department of Nutrition,
Exercise and Sports at the University of Copenhagen, “The nutritional
value of a food should be evaluated on the basis of the foodstuff as a
whole, and not as an effect of the individual nutrients.” The
conclusion, based on the opinion of an international expert panel of
epidemiologists, physicians, food and nutrition scientists, “reshapes
our understanding of the importance of nutrients and their interaction.”

we eat, we do not consume individual nutrients. We eat the whole food.
Either alone or together with other foods in a meal. It therefore seems
obvious that we should assess food products in context,” says Tanja
Kongerslev Thorning, PhD. What does this mean? Well, although the
nutrients on the label are valuable, it may more important to understand
how they combine with other food we eat as well as how our bodies
digest them to really decide how beneficial or detrimental certain foods
are to us.

Researchers used cheese as an example. At face
value, cheese has a relatively high content of saturated fat. However,
researchers believe that cheese has a lesser effect on blood cholesterol
than what you would expect with a food containing that much saturated
fat. Another example researchers used were almonds. Almonds contain a
high amount of fat, but release less fat than expected while digesting.

and research like this shed light on the possibility that the foods we
are eating could be healthier — or worse, less healthy than we
originally thought — which could potentially shake up how we look at
nutrition as a whole. What’s more, studies like this could lead to more
personalized dietary recommendations from health care providers for
overweight patients.

“More studies are needed, but ultimately it
seems that some areas of nutrition science need to be rethought,” says
Professor of Food Chain Nutrition Ian Givens at the University of
Reading. “We cannot focus on a nutrient without looking at how it is
consumed and what else is eaten at the same time.”

Source: University of Copenhagen, Department of Nutrition, Exercise and Sports

Blog written by Marcus Miller/Robard Corporation

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