Eating disorder and EDNOS

“ACT on LIFE, NOT on Weight”Diététique & philosophie

Nicolas Sahuc Nîmes/Montpellier [email protected]

www.nicolassahuc.fr

Fondateur et vice-Président de l’association “L’ACT, redonnons du sens au comportement alimentaire”www.sudtca.fr

mailto:[email protected]

mailto:[email protected]

http://www.nicolassahuc.fr

http://www.nicolassahuc.fr

http://www.suct

http://www.suct

PlanA. Food identity

B. Primun non nocere

C. Foodchoice and confusion: Hungry / Emotions

D. In practice

E. Conclusion: “the wind and the sun”

A“ACT on LIFE, NOT on Weight”

Food identity

Food identity 1/2

Food identity 2/2

B Primun non nocere

“ACT on LIFE, NOT on Weight”

“First do no harm”

Connect the 9 points with only 4 straight line. You could not up the stylo of the paper.

Game

TRY

Need to take care with people who wants to loose weight

Elis

a C

osso

nnet

They try to control hungry but every time they loose and sometimes binge eating.

“Find the answer into the plate to losse weight: dieting, calories count...People focus on their body and weight scale”. (N. Sahuc)

Elisa Cossonnet www.elisacossonnet.com

“Plate focusing”BMI Vs body perception

http://www.elisacossonnet.com

http://www.elisacossonnet.com

Over-evaluation of shape and weight and their control

Strict dieting;non-compensatory

weight-control behavior

Binge eating Significantly low weight

Compensatory vomiting/laxative

misuse

Events and associated

mood change

The “transdiagnostic” cognitive behavioral theory EDNOS

Christopher G. FairburnProfessor of psychiatry at the university of Oxford

Impact sur les choix alimentaires

Lunch

10h

17h

breakfast

After

Dinner

End of the day ?

Lunch

10h

17h

breakfast

After

Dinner I crack and give in to my cravings

Guiilty

Binge eating

End of the day ?

Lunch

10h

17h

breakfast

After


Guiilty

Binge eating

“Tomorrow I restrictive day”

End of the day ?

Lunch

10h

17h

breakfast Breakfast control

After


Guiilty

Binge eating


End of the day

“Are you hungry in the morning?” “No”

?

Lunch

10h

17h


I eat a low-calorie meal

After

“I want to eat but eat=gaining weight”

I crack and give in to my craving


Hungry

Guiilty

or

Binge eating

Strategies to fight hunger and thoughts about food


End of the day


?

Lunch

10h

17h



After


Frustrated



Hungry

Guiilty

or

GuiltyHungry

Eaten too much

Binge eating



I must not crack

ECHECE.S.➘

End of the day


?

Lunch

10h

17h



After


I need suggarFrustrated



Hungry

Guiilty

or

GuiltyHungry

Eaten too much

Binge eating



I must not crack

I fight to not eat

ECHECE.S.➘

ECHECE.S.➘

End of the day


?

Lunch

10h

17h



Control my hungry

After


I need suggarFrustrated

Frustrated

Hungry



Hungry

Guiilty

or

GuiltyHungry

Eaten too much

Hungry I want to eatBinge eating



I must not crack

I fight to not eat

ECHECE.S.➘

ECHECE.S.➘

I fight to not eatECHEC

E.S.➘

End of the day


?

C Foodchoice confusion: Hungry / emotions


Dichotomia behavior

Craving Craving

Hungry/mood

Food Restrictive behavior

Tmie

Frustrated

GuiltyCraving

Food Restrictive behaviorFood Restrictive behavior

The Minnesota semi-starvation experiment (Keys et al., 1950)

significant increases in mood (depression) and important personality changes

most of the subjects experienced perdiodsof severe emotional distress and depression

extreme reactions: self mutilation and binge eating during the rahbilitation phase

Participants exhibited a dramatic increase in food preoccupation while the both phase

sexual interest was drastically reduced

The volunteers showed signs of social withdrawal and isolation

the participants reported a decline in concentration, comprehension and jugement capabilities

Severe and prolonged dieatry restriction can lead t o serious physical and pshycological complications. Many of the symptoms once thought to ne primary features of

anorexia are actually symptoms of starvation

Strict dietingBreakfast

25% of Energy

1 32 4 5 6

Lunch 40% of energy

7 8 9 10 11 12

Snack 10% of energy

Dîner 35% de l’AET

Food crisis zone1 ounce bread

fat-free yagourth tea

without sugar

Omelette with a green salad and one fruit

150kcal 300kcal ? ?

600kcal 960kcal 240kcal 840kcal

I’m not hungry /

hungry / or strategy

I’m not hungry /


Fight against hungry

8h 12h30 17h 20h

Strict dietingBreakfast

25% of Energy

1 32 4 5 6

Lunch 40% of energy

7 8 9 10 11 12

Snack 10% of energy

Dîner 35% de l’AET

Food crisis zone1 ounce bread

fat-free yagourth tea

without sugar

Omelette with a green salad and one fruit

150kcal 300kcal ? ?

600kcal 960kcal 240kcal 840kcal

I’m not hungry /


I’m not hungry /


Fight against hungry

8h 12h30 17h 20hI can hold

Vs well being

DietingSensory

Specific Satiety

Sensory Specific Satiety

too much pleasure

Frustrated Guilty

Food quantity

-1-2-3-4 +1 +2 +3 +4

Feeling well in my body➚ self-esteem

Real Sensory Specific

Satiety

Feelingmyself

The triggers(“Vaincre l’anorexie” Ed. Dr. Vanderliden)

4 cases:

Emotions: qualify as negative (ex: feeling alone)

Not eating

Negative thinking

Seeing food

A are nutrition-related

Seeing food

Not eating

Barlow et Allen (2007)

Unacceptable mood

Strategy to erase the mood

Aboard strategy

Acceptanceno strategy

to erase

well being

feeling bad mood

D In practice


Focus on emotions = loose psuchological flexibility“the more I try to control my weight, more I loose energy, more I cannot

use it for the essential of my life”

Work on body perception

Dietetic:

Focus on when I hungry

Feel sensory specific satiety

correction du flux alimentaire

Mindfulness

Wok on dieting behavior and cognitions

CBT-E

Prevent Eating Disorder (?)

“Plates focusing” vs Dietetic

Psychoeducation on HungryNot the same

Always different as an other day

Not weird to feel hungry

Depend from the last meal

Could appear many times per day

“I prefer people craving when they are hungry more than people dieting when they are hungry”

Could be different if:

I’m tired

Feeling bad...

Professionnal strategyEmpathie

Expert

Links between client and professional

Motivational approaches

Reflective listening

Philosophia

Hypnotic communication

DO

Collaborate with patient

Ask “open” question

Be patient

Explore the views of the patient

Ask for what the patient is worried

Show interest and understanding

Use Socratic style of interviewing

If the patient shows ambivalence, show understanding

DO NOT

Argument too much

Put patient on the weight scale

Criticize the patient

Judge morally

Start a debate

Threat or warn the patient

Make the patient ridiculous

Order the patient

Ignore the patient point of view

Propose solution

E Conclusion:“the wind and the sun”


The North Wind and the Sun were disputing which was the stronger, when a traveler came along wrapped in a warm cloak.They agreed that the one who first succeeded in making the traveler take his cloak off should be considered stronger than the other.Then the North Wind blew as hard as he could, but the more he blew the more closely did the traveler fold his cloak around him;and at last the North Wind gave up the attempt. Then the Sun shined out warmly, and immediately the traveler took off his cloak.And so the North Wind was obliged to confess that the Sun was the stronger of the two.

The North Wind and the Sun were disputing which was the stronger, when a traveler came along wrapped in a warm cloak.They agreed that the one who first succeeded in making the traveler take his cloak off should be considered stronger than the other.Then the North Wind blew as hard as he could, but the more he blew the more closely did the traveler fold his cloak around him;and at last the North Wind gave up the attempt. Then the Sun shined out warmly, and immediately the traveler took off his cloak.And so the North Wind was obliged to confess that the Sun was the stronger of the two.

“KINDNESS EFFECTS MORE THAN SEVERITY.”

Questions time ! “Let us think of interesting

questions, rather than criticise”

Next Eating Disorder ConventionNîmes 1 et 2 avril 2011 www.sudtca.fr

http://www.sudtca.fr


Thanks for your reading

Questions time ! “Let us think of interesting

questions, rather than criticise”

Next Eating Disorder ConventionNîmes 1 et 2 avril 2011 www.sudtca.fr



Eating disorder and EDNOS

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