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The Impact of Your Thoughts
Wellness in a Wider Perspective

Dominique Crispim

Even though obesity and its associated diseases are of worldwide concern, there is still uncertainty about the specific causes. Our attitude towards food and eating may play an important role in contributing to obesity. One recognised way of measuring eating behaviour is with The Eating Inventory (EI) of Stunkard and Messick. This questionnaire allows a score to be given to three human eating behavioural categories: Cognitive restraint of eating, disinhibition and hunger. Cognitive restraint refers to the conscious restriction of the food or types of food we eat to control weight. Disinhibition is the lack of control over eating in response to social, environmental and emotional influences. Finally, the hunger score deals with the physiological phenomena experienced when the body has a need for food. Many reports have used the EI to study the relation between eating behaviour and weight gain. The essence of these studies is given below.

One study looked at the association between the EI score and weight gain and body mass index (BMI) in 638 women aged 55 to 65 years(1). Disinhibition was shown to be the only significant independent predictor of weight change. The higher the disinhibition, the greater the weight gain. However, when coupled with a high cognitive restraint of eating, a high disinhibition will yield the smallest weight gain. Therefore, for those of us who grab the Ben & Jerry's when we're feeling down - resist, or padlock the freezer!

The high disinhibition and restraint of eating may benefit our weight control, but what influence does it have on our children? In fact, it has been shown to have the opposite effect on children, causing them to be over weight(2). Childhood obesity is a growing problem in western societies and both genetic predictors and environmental influences play a role. It has e.g been shown that maternal disinhibition not only increases the mother's own, but also her daughter's weight(3).

Most of us use the above mentioned restraint when we diet, and try to avoid disinhibition. As many of us have found, the weight never seems to stay off and we are often left with feelings of guilt and failure. A vicious circle that sounds familiar? Besides eating behaviour, other attitudes and choices have also been shown to influence our weight. Certain attitudes towards diet and health, such as "we are born fat" and "calories are more important than taste when buying food," have been shown to play a part in weight control(4). Females who believe their weight is predetermined are typically heavier than those who believe they can successfully manage their weight. This was not the case among males, who were far less willing to compromise taste. Focusing excessively on weight may lead to additional stress, potentially resulting in disinhibition; thus, creating a vicious circle.

Neuro-linguistic programming (NLP) may help us understand and deal with our weight issues(5). NLP is linking our thoughts and speech (even conversations with ourselves) to the actions we subsequently take. Understanding ourselves is the first step to understanding our actions. There is no point thinking about the cream cake you ate, without asking why you ate it. Were you hungry? Did you really enjoy the taste? Did your mother restrict the types and quantities of food you were allowed to eat as a child? Asking questions is an important feature of NLP, and the answers help us understand our actions. When we make mistakes or have bad experiences, we should be looking back at them and be learning from them, not labelling them as disasters for the rest of our lives. The same applies to our positive experiences - we should model what went right. Goals are part of moving forward, and in NLP it is suggested that goals be turned into outcomes. Simply put, it is about making your goals have depth and using all your senses. When you do reach your goal or outcome, how will you feel and what do you see? What will people say to you? Imagine yourself being a character in a movie.

Our state (way of being at a specific time) can influence our health and well being. When your boyfriend walks out on you, do you feel thin and beautiful and full of energy? NO, quite the contrary, our minds are linked to our bodies, and, therefore, influence each other. Next time you walk down the street, walk tall and smile, and see if you feel different. Not only will you look thinner and more attractive, you will also feel that way. It is that easy to change your state, and it is in your control. Also within our control are our beliefs. NLP claims that beliefs that are limiting us from changing, need to be re-evaluated. Do you still have the same beliefs as when you were a child?

The next two studies demonstrate some aspects of NLP relating to weight control. The first compared the effects of a 'weight loss centred diet' (energy restriction) to a 'health-centred non-diet wellness program' (6). The non-diet approach emphasises eating to physiological cues, e.g. hunger, and encourages body acceptance. 78 chronically dieting women aged 30 to 45 years, with BMI = 30, were randomly divided into the two groups. Both groups had weekly sessions for six months followed by six months after-care group support. The non-diet approach received particular interest due to commonly seen down falls of a diet approach, such as short term results, and effects of failure on self image and cognitive restraint, which potentially may intensify the diet/overeating cycle.

Generally, weight loss is recommended to all obese patients to decrease the risk of associated illness, such as heart disease, diabetes and hypertension. The emphasis is on the need for metabolic fitness, and not necessarily being thin. In this study, comparing the weight loss centred diet to the non-diet wellness program, both groups improved in metabolic fitness, as well as in psychological and eating behaviour variables. In contrast to the diet group, the non-diet group did not lose weight, but they did maintain their weight and had reduced cognitive restraint. Both groups exhibited improvements in the hunger and disinhibition variables. Another problem with the diet approach is the drop out rate. This study showed the non-diet approach to decrease this drop out rate. The non-diet group were also found to have higher total energy expenditure after a year, which may be due to increasing self esteem, and encouragement to increase lifestyle activity (opposed to structured activity). At the end of the study, when asked if they agree with the statement, 'The program has helped me feel better about myself', 93% of the non-diet group agreed while only 51% of the diet group agreed. By changing some beliefs in these obese subjects, improvements were noted mentally and physically.

The next study used cognitive-behavioural therapy (CBT) to evaluate health related quality of life (HRQL) in obese subjects, with or without binge eating disorder (BED) (7). CBT is based on the interaction and influence of thoughts on emotions and behaviour. Persistent negative and irrational thoughts can result in maladaptive behaviour. Therapy involves identifying these thoughts, and replacing them with positive ones. In the study, half of the subjects received treatment, and half were untreated controls. The BED subgroup first received sessions on binge eating. Subsequently, the entire treatment group attended 12 weekly structured sessions on the LEARN program for weight control. Initially, the sessions taught them about regular weight control, BMI and instructed them on calorie counting and monitoring daily food intake. They were then taught behavioural strategies for achieving stimulus control and a pattern of regular eating. No diet plans were given, but rather the subjects were encouraged to build their personal diet day by day. HRQL (physical and mental) was assessed by a questionnaire. The CBT's final target was to modify eating styles, physical activity and related habits. Motivation and self-esteem was reinforced and expected to change both mental and physical health perception. An average weight loss of 9.4 kg was accompanied by improvements in the HRQL in the treatment group. BED subjects had a lower average weight loss, but higher improvements in the HRQL scales. CBT was reported to improve depression and maladaptive attitudes about body shape and eating. The results suggest that improvements in self-esteem and awareness of the potential upcoming success of controlling weight are major determinants of perceived health status, largely exceeding actual loss of body weight.

This last study illustrates how our general attitude and body perception can affect our health and well being. Even though some studies show disinhibition and restraint as positive factors in weight control, more studies show these results as short term if we don't change our beliefs. It is important to note, that even though the focus here has been weight control, many of the principles of neuro-linguistic programming, cognitive-behavioural therapy and the wellness program are versatile, and are ubiquitous to many aspects of life. However, we are all individuals with different beliefs, needs and wants, for which reason we need to look inwardly to explore ourselves before we can find the ideal strategy to suit our personal needs.


References:

1. Hays NP, Bathalon GP, McCrory MA, Roubenoff R, Lipman R, Roberts SB. Eating behaviour correlates of adult weight gain and obesity in healthy women aged 55-65y. Am J Clin Nutr 2002; 75, 475-83.
2. Hood MY, Moore LL, Sundrajan-Ramamurti A, et al. Parental eating attitudes and the development of obesity in children. The Framingham Children's study. Int J Obes Relat Metab Disord 2000; 24(10), 1319-1325.
3. Cutting TM, Fisher O, Grimm-Thomas K, Birch LL. Like mother, like daughter: Familial patterns of overweight are mediated by mothers, dietary disinhibition. Am J Clin Nutr 1999; 69, 608-613
4. Kuchler F, Lin BH. The influence of individual choices and attitudes on adiposity. Int J Obes 2002; 26, 1017-1022.
5. O'Connor J, McDermott I. Way of NLP. Thorsons 2001.
6. Bacon L, Keim NL, Van Loan MD, Derricote M, Gale B, Kazaks A, Stern JS. Evaluating a 'non-diet' wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviours. Int J Obes 2002; 26, 854-865.
7. Marchesini G, Natale S, Chierici S, Manini R, Besteghi L, Di Domizio S, Saritini A, Pasqui F, Baraldi L, Forlani G, Melchionda N. Effects of cognitive-behavioural therapy on health-related quality of life in obese subjects with and without binge eating disorder. Int J Obes 2002; 26, 1261-1267.

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