October 17th, 2012
I am a member of the Listserv for the Academy of Eating Disorders. I noticed today that a lovely letter was posted from a therapist, Kathy Kater, in St. Paul, MN about treating clients with BED. She treats this group of people with such sensitivity and understanding of the disorder. I wanted to post a copy of Kathy’s letter for all of you. I’m also going to buy a copy of her book. This is the place to start — treating the kids!
I’m coming in late to this discussion but this topic is near and dear to me and wanted to add my thoughts. Sorry if this gets a little long winded.
At least half of my clients in the past 35 years have been struggling with BED, and in the past 25 years I have only used a non-diet approach, having found this to be the only road to success. Most of these women and men would be considered obese. Some had medical issues, others feared these would occur if they didn’t lose weight (most had been prompted to believe this by their physicians, but also they believed general media messages equating fatness with health problems). Virtually 100% believed dieting was their only hope, and so asking them to let it go is like to asking someone to jump off a cliff without a parachute. Wow. This just takes so much courage, and I think it is so important never to forget this and to let our patient’s know we understand this too.
That said, I think the first hurdle in helping our patients to relinquish weight loss as a goal lies with all members of the therapeutic team really believing in the non-dieting approach. So this is just something to check on first. If we are asking our patients to take such a big risk, any ambivalence or uncertainly on our part will surely make their ability to do this impossible.
This is not to say that people cannot have a preference for a lighter body or that they should not welcome weight loss if it occurs as a by product of learning to live in and truly care for and listen to their bodies. I can wish the windows and doors on my old house were less stiff and creaky, as long as I still lovingly take care of it, and maybe with enough love and polish and DW40 they will loosen up, but maybe they won’t, and my job is still to keep lovingly paying attention to and taking care of my home. But if they re-invest in weight loss as a goal at any time, it will inevitably again be self-sabotaging. If at any time I start taking a hammer to my doors and windows, I may force them to open or close for a while, but over time, with harsh treatment, they will only be worse off than before.
Geneen Roth wrote, “Either you believe in kindness or you don’t.” I say that to patients a lot. Caring for our bodies is not something we can fake, so it doesn’t really work for our patients to “do” a non-dieting approach. Our job is to help them ultimately give themselves over to developing a positive relationship with their bodies, not different in any way from working on a long-standing, conflicted relationship with another person. You can’t “pretend” to listen, you have to really be willing to listen and respond in ways that are trustworthy and nurturing and helpful. Of course people want a guarantee that if they do this, they will lose weight, but of course the only answer is, we cannot know. What we do believe is that a loving, caring relationship with oneself and one’s body is going to lead to the best outcome possible. Fortunately, the research is starting to document this, so that too is exciting and something we can talk to our patients about. It seems so obvious, but now we have DATA showing that the more people feel aversive about their bodies, the less likely they are to take care of them, and vise versa of course.
Some people just cannot dare to give up being hopeful that dieting will work, and will return to believing in it again and again. I think it’s important to note that patients do not have to take our word for it (that clinging to weight loss as a goal is self-sabataging). A thorough history of their experience with weight loss and gain will show this to be true. How many patients have we heard people at high weights say, “If only I could have accepted my body in high school.” This is a tragic but important realization that of course has to be grieved. I spend a fair amount of time getting this history, because its powerful and necessary for people to see that all the years of trying to be thinner have only made them fatter and more out of control with food. In ACT (which is an approach I use) this is called helping patient to reach a point of “creative hopelessness.” If anyone is interested in an example, I wrote a chapter about this appearing in Treatment of EDs; Bridging the Gap Between Practice and Research (2010, by Margo Maine, Doug Brunnell, and Beth Hartman McGilley).
There are good books written about helping patients accept the non-dieting approach (Karin Kratina is a pro, and many HAES experts), but for me it boils down to this: helping people to see that whenever the goal is eating for weight loss, right there we have an aversive, harsh, authoritarian relationship with the body. This in itself will always interfere with their ability to establish a positive, sustainable relationship with their body. Helping our patients give up dieting requires helping them to become willing to see, listen to, and care about themselves again. They cannot have it both ways: harsh, rejecting and distant from their bodies/listening, loving and responding to their bodies. There are so many good metaphors that people relate to that can help them remember this.
These are just my two cents. This and that it seems so much better to help kids avoid the road to body rejection and dissatisfaction in the first place! This totally provides the juice for me in doing work toward primary prevention. Which leads me to mention my newly updated Healthy Bodies; Teaching Kids What They Need to Know curriculum is now available (released at the NEDA conference this week!). If you want to check it out, you can do so at www.bodyimagehealth.org. I apologize that part of the site is still under construction, but part of it is functioning and it will be fully complete in the next few days..
Kathy Kater, LICSW, Psychotherapist
- Healthy Bodies; Teaching Kids What They Need to Know (2012)
- Real Kids Come in All Sizes: Ten Essential Lessons to Build Your
Child’s Body Esteem (2004)
2497 7th Avenue East, Suite 109
North St. Paul, MN 55109
Office: 651 770 2693
Web site: www.bodyimagehealth.org