Surgery or Therapy? The West’s problem with obesity isn’t just a medical issue; it’s an emotional one too.

Yesterday, researchers from Imperial College London published a report that stated that up to 2 million people in the UK could be eligible for bariatric or weight loss surgery. Bariatric surgery involves placing a cuff around the top of the stomach, effectively restricting how much the patient can eat. For a one off cost of anywhere between £3,000 and £11,505 per person, the NHS could begin to make huge savings through the resulting reduced levels of type 2 diabetes and heart problems. And this all comes with an 80% success rate. But I have to say that as tempting a solution as this sounds; this report worries me. There are many reasons for the current obesity epidemic; both social and psychological. Psychologically speaking, people over eat because they're bored, sad, angry, have low self-esteem or just simply have never known anything different so offering bariatric surgery feels like an over-simplistic solution to a very complicated issue.

So much has been written about our emotional relationship with food and people will have their own very personal reasons for misusing or abusing it; whether through over eating or through food restriction. Many people are unaware of what they are doing or why they are doing it. The way they use food has become normalised; it's just what they do to feel safe or to feel like they are in control. In her book Eating Your Heart Out, Julia Buckroyd states that the misuse of food is 'instead of something; it is instead of feeling, or knowing, or understanding something that feels too difficult or frightening or unacceptable' (Buckroyd, 1994: 13).   In other words, it is an avoidance tactic.

At times, comfort eating has been a real problem for me. Interesting term that; comfort eating. Eating for comfort. This implies a sense of discomfort that food can somehow magically take away. It also sounds quite harmless yet I doubt that many people would be happy to admit to comfort eating on a regular basis. Personally speaking, there was something shameful about it so I would keep it hidden. For many years I did this without considering why I did it. It was not until I began training as a counsellor that I began to take a long hard look at how I cope with difficult emotions and accepted that I used food to avoid them. Now I notice my cravings and I use them rather than act on them. Don't get me wrong; none of this happened over night. First of all I needed to understand the difference between craving food for comfort and when I was genuinely hungry (I can highly recommend 'On Eating' by Susie Orbach as a good place to start with this process). Once I'd grasped that, I was more able to reflect on and work through the difficult emotions I was avoiding through therapy. It's still difficult sometimes, but now I know that eating will not take my pain or discomfort away. That happens through sharing my experience and asking others for their support.

I understand why bariatric surgery is part of the solution to the West's problems with obesity but it needs to be just that; a part. Advocating this very medical response to obesity as some kind of a magic bullet feels like a further denial of our emotional selves; like our out of control bodies need to be tamed, cuffed and subdued by the rational mind. It saddens me that no case was made in the media for counselling or psychotherapy to be offered alongside or even instead of bariatric surgery. But then I would say that, wouldn't I.

References

• Buckroyd, J. (1989) Eating Your Heart Out.  The Emotional Meaning of Eating Disorders, London: Macdonald Optima
• Orbach, S. (2002) On Eating, London: Penguin

• Triggle, N (2014): Weight loss surgery: Up to two million could benefit on the BBC News website http://www.bbc.co.uk/news/health-25766253 - accessed 17/01/2014

Perpetrators of domestic abuse; damned if you don't.

Some of you may have heard the report on yesterday's PM Programme on Radio 4* about the Stop the Hurt project in Peterborough which works with the perpetrators of domestic abuse. It wasn't the easiest report to listen to. The men were asked to describe their behaviour towards their partners which included one man kicking his pregnant partner in the stomach, resulting in the loss of the baby. As the reporter said, many people listening to this report would think "this man should have been ... in front of a court, not in front of some counsellors" but this man deeply regretted his actions and wanted to change which is why he was there (his partner dropped the charges against him and the project doesn't take men who have been sent by the courts).  In my eyes, that's enough for me to feel some hope for him and his partner. The project has a reoffending rate of only 2.1% so these men are committed to the difficult process they're undertaking and good for them. Good for them for realising that their violent and abusive behaviour cannot continue, accepting that they need to change and then doing something about it.

Immediately after on the Six O'clock News, it was reported that Charles Saatchi has claimed that his ex-wife Nigella Lawson has a cocaine habit. As you might remember, Charles Saatchi was photographed with his hands around Nigella Lawson's throat earlier this year; an incident that led to their divorce. Saatchi had dismissed the event as "a playful tiff"; accepting a caution from the police but apparently unable to admit that his behaviour was unacceptable. And now, as is often the case when an abuser refuses to atone for their actions; the ritual humiliation of the victim has begun with many of today's red tops pronouncing the claims of Nigella Lawson’s alleged cocaine habit as if they were fact. Now I have no idea whether the claims of drug use are true or not but like many women who have left an abusive partner, it's not over for Nigella Lawson yet and  now she's faced with having to defend herself and her reputation; her word against his.

These two examples, broadcast so close together just goes to show how confused and complicated our views about the perpetrators and victims of domestic abuse can be. The men at Stop the Hurt risk being reviled for admitting to the abuse they had committed but have done it because they know that what they have done is wrong. That kind of admission takes immense courage yet I know that there will have been many people shouting at their radios or even switching it off; unable to forgive them and the way they had treated their partners.  In that report, the role the women were appropriately allocated was that of victim. So what of Nigella Lawson? Earlier this year I would have said that she was offered the role of victim by the press too. But oh, how quickly they have forgotten; so quick to attack her now. The predominantly patriarchal press hates a successful and strong woman and has fallen into line with the man of the piece. They would cast Charles Saatchi as the victim when he is anything but. If I had to choose, I would take the men of the Stop the Hurt project over him any day. Respect comes out of humility not force. I wish humility on Charles Saatchi; for his own sake and for that of Nigella Lawson.

* This report was broadcast on 26/11/2013 and is available on iPlayer until 03/12/2013.  The report can be found at 37 minutes and 28 seconds into the episode.

Change can be pretty sneaky sometimes

This morning, I walked along a street that I haven’t walked along for a little while.  I used to walk that way to and from my psychotherapist’s house and for those three years, there had been a set of foundations ready to be built on in a vacant lot.  When I walked past today, there was a house!  Completely finished and ready for someone to move in.  I was so used to seeing this unattractive stretch of concrete that I was genuinely surprised that a house had miraculously appeared in my absence.  It felt odd and unexpected but I had to admit that the house was a lot more attractive and useful than the overgrown lot that was there before.  It set me to thinking about my own experience of change through psychotherapy and that of my clients too.  

Change quite often sneaks up on us.  It’s easy enough to identify the things we’d like to change but how that change actually comes about can sometimes feel like a bit of a mystery.  Like the house; it all happens when we aren’t looking.  This sense of change sneaking up on us is often described as an embodied change or shift.  It’s that point where we’ve stopped having to think about it and just do it instead.  It’s worth remembering that change can only come about through a process of learning.  New neural pathways need to be laid down and that takes time and practice; just in the same way that learning any other new skill does.  To begin with, it takes real effort to put new ways of being or relating into practice and that quite often means taking risks with how we are in relationship with other people.  The good news is that these risks can be mitigated within a therapeutic relationship.  Counsellors and psychotherapists are here for you to practice on.  Seriously, we don’t mind and any good counsellor or therapist will actively encourage it.  It’s the whole point of us being there with you.  

I would say that embodied change through counselling or psychotherapy happens something like this: 

Together, you and your counsellor explore your experience; you begin to take the risk that your counsellor will accept you for who you are; then you begin the process of change by challenging your unhelpful ways of being through your relationship with your counsellor; eventually you begin to take these risks with other people; one day, you realise that this new way of being or relating doesn’t feel risky anymore and so that change has become embodied.

So, not so mysterious after all then.