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What is obesity?

Obesity is usually defined by using the body mass index (BMI). BMI is a simple and effective calculation. A person’s weight is divided by the square of their height. A person is overweight if their BMI falls in the region between 25kg/m² to 29.9kg/m² and a person is obese if their BMI exceeds 30kg/m².

Now comes the scary stuff…

According to the latest figures from the British Health and Social Care Information Centre, 67.1% of men and 57.2% of women are overweight (including obese). In 2013, just over a quarter of all men (26%) and a quarter of all women (25%) were obese. In 2013, 19.1% of children aged 10 to 11 were obese. In the United States, obesity affects one third of the adult population (Flegal et al 2010)

 

Health risks of obesity

 

The main health risks of obesity, according to an American Department of Health and Human Services website, are as follows:

Heart disease

High blood pressure

Stroke

Type 2 diabetes

Abnormal blood fats

Metabolic syndrome

Cancer

Osteoarthritis

Gallstones

  • – and more.

 

In addition to these physical problems, obesity can both cause or exacerbate psychological problems such as low self esteem, low self-confidence, negative body image, and depression.

 

Causes of obesity

Bleich et al (2012) carried out a survey of primary care physicians in the USA to obtain perspectives on the causes of obesity. This interesting survey identifies three different types of cause:

  • Individual Behavioural Factors
  • Individual Biological Factors
  • Physical / Social Environment Factors

Among the physicians surveyed there was widespread agreement concerning individual behavioural factors. They were almost unanimous in attributing over-consumption of food and insufficient physical exercise as causes of obesity. 90% or above of those surveyed thought that restaurant / fast food eating and consumption of sugar sweetened beverages were causes of obesity. 88% identified lack of will-power as a cause. There was slightly less agreement concerning individual biological factors. 75% identified genetics or family history as a cause, 44% attributed obesity to metabolic effect and 25% to endocrine disorder. Three physical / social environmental factors were identified. 83% of physicians surveyed thought that “cultural factors” were a cause of obesity, 69% thought that lack of information on good eating habits is a cause of obesity and 52% attributed obesity to lack of access to healthy food.

These results reveal a number of striking features. The causes identified in this survey are almost entirely physical causes, and this is hardly surprising as the participants in the survey are practicing GPs. Sugary drinks are mentioned but alcohol isn’t, which is rather surprising. And I would suggest that this survey reveals two main causes to which the other causes are subsidiary: Overeating and lack of exercise.

Whatever the physiological condition of your body, whatever genetic or historical factors may contribute to obesity, the fact remains that obesity is still caused by ingesting more food than the body can burn off. Lack of information about healthy eating and lack of access to healthy food still amounts to the same thing – too much intake of weight-inducing food.

Cultural factors are not clearly defined in this survey and yet, however they may be defined, they still boil down to overeating and lack of exercise. In Britain, great social change has occurred over the last 50 years or so. People work longer and more irregular hours. Cost of housing has soared to unprecedented levels which means that both cohabiting partners need to work and they may simply lack the time to cook and prepare healthy food for themselves or their children. Simple lack of time can cause an over-reliance of fast or processed food.

Increasing levels of road traffic and concerns for safety mean that children rarely play unsupervised outside of the house. For children today, “play” is more likely to involve staring at the screen of a computer, laptop or tablet than anything physically active. Thus, bad habits are formed early and, consequently, childhood obesity continues to rise.

The only psychological factor mentioned in the Bleich survey is lack of will-power. I would suggest that the main psychological cause of obesity is comfort-eating. This is hardly a straightforward issue as people may comfort eat for a whole variety of reasons, such as stress at work, anxiety in general, low self-esteem, bereavement, lack of confidence, and a whole host of other such personality issues.

All of which means that obesity is very difficult to treat effectively. An obese person may know what they should be doing about their condition but they may feel prevented from doing so by any combination of personal and practical factors. Yet the search for short-term solutions continues. Diets and weight-loss plans abound and public appetite for them is huge. The problem with diets is that they may be fairly effective in the short term but are often too unbalanced or restrictive to be of any use in the longer term. Weight is lost and then gained as soon as the diet is abandoned. People are resorting to diet inhibiting medications, but use of these without proper medical guidance can literally be fatal.

Demand for a simple, safe and effective treatment for obesity has led to increasing use of surgical treatments. Of these, the most popular, safe and effective seems to be in implanting of an adjustable gastric band (AGB). We have also seen the rise of “virtual” gastric band treatments using hypnosis. I will discuss each of these in turn.

Treatments for obesity: adjustable gastric band surgery (AGB)

In 1974, L H Wilkinson experimented with a number of approaches aimed at reducing the size of the stomach. Among these was a treatment which involved wrapping the stomach in a mesh. Four years later, Wilkinson and Peloso refined the treatment by wrapping a polypropylene mesh around the upper part of the stomach. Non-adjustable gastric banding was first tried on animals by G Szinicz and his team (Szinicz et al 1989) in the mid-1980s and by 1986 L Kuzmak was implanting adjustable silicone gastric bands into humans. The development of laparoscopy in the 1980 has meant that silicone adjustable gastric bands can now be inserted with minimal invasive surgery and a rapid recovery period.

From the results given in Snyder’s paper, AGB is certainly effective in reducing “excess weight”. The average excess weight loss in the first 6 months following surgery is 35% and this rises steadily over the following years to reach a peak after four years of surgery, when the average excess weight loss reaches 64.3%. After that, there appears to be a steady decline. The average excess weight loss after ten years following surgery falls to 38.5%. Again, according to statistics in Snyder et al (2010), there appears to be a significant increase in “quality of life” for the first six months following surgery followed by a steady decrease over the next 18 months.

So – AGB treatment is an effective method of weight loss, with patients losing, on average, around half of their excess body weight. But, during the first six months after surgery, monthly follow-up operations are required for band adjustment. Thereafter, band adjustments may take place every three to six months. In addition to these inconveniences, dietary and lifestyle changes are also required.

(N)utritional education and dietary compliance are likely to be the most important elements for achieving successful weight loss and maintenance.

 Banding requires that a patient make dietary and behavioral adjustments to cope with their changed gastric ability.33 High-risk eating habits such as grazing, and emotional or mindless eating should be avoided because these behavior traits will hinder weight loss.34 The patient must be an active participant in helping to create a proper stoma size by monitoring the volume of food they consume…

Snyder et al (2010) p 59.

Volume restriction can put AGB patients at risk of vitamin deficiency. Use of vitamin supplements is recommended. Dietary advice recommends avoidance of “soft foods” such as yoghurt, chips, ice cream and cream soups. Cream and butter sauces should be avoided along with fatty or greasy foods. Grazing, snacking and comfort eating should also be avoided.

So – the findings of Snyder et al may be summarized as follows:

  • The success rate is high, but around 15% of patients fail to achieve 25% of excess weight loss.
  • Longer periods tend to reveal significant weight re-gain.
  • Dietary and / or lifestyle changes remain fundamental to success.

Do note that last point. AGB surgery does not take away the need to make dietary and lifestyle changes. Without them, while there still may be some weight loss owing to restricted stomach volume, the weight loss will probably not be sufficient to lift the patient out of obesity.

Treatments for obesity: virtual gastric band hypnotherapy.

 Virtual gastric band hypnotherapy involves the induction of hypnosis and the offering of suggestions to convince the “unconscious mind” of the client that a gastric band has been surgically fitted. I have made no secret of my views about this procedure (see my previous article on this subject) but I have decided to revisit the subject to see whether there was any scientific evidence that the procedure is successful. I consulted the following academic journals:

  • International Journal for Clinical and Experimental Hypnosis
  • American Journal of Clinical Hypnosis
  • Cotemporary Hypnosis

None of these publications had any scholarly articles about any aspect of virtual gastric band hypnosis. So far, then, there is no hard scientific evidence to suggest that virtual gastric band treatments are successful.

When I wrote my earlier article in 2012 I was shocked at the amount of money some “therapists” were charging for VGB hypnotherapy. Research I conducted at the time suggested that the average cost of VGB was around £850 for anything between one and four sessions. One of my own clients told me that she paid £1300 for two sessions of VGB, and the treatment had no effect upon her weight whatsoever.

Cost-wise, the situation seems to have improved a little. It seems that the cost of VGB (up to 4 sessions) these days comes to around £550. A lot depends upon the area. Treatments in London are likely to be far more expensive than in other parts of the country. I think that there are two reasons for the fall in price. The first is that there are a number of very cheap VGB products available for purchase, such as CDs, DVD, podcasts and the like. The second reason is that the credit crunch and subsequent recession has had an impact upon the practice of hypnotherapy. People are less prepared to spend money, and if they do spend money they want some reassurance that their therapist is effective, properly qualified and registered. The recession has purged hypnotherapy of some of the “get rich quick” chancers who are only in it to make as much money as easily as possible and in the quickest possible time.

Losing weight requires significant lifestyle changes. We have seen that effective AGB surgery requires the patient to make permanent and significant changes to diet and exercise routine. While the patient may still lose some weight owing to less stomach size, if the patient sticks to a diet of high sugar and fat then they are unlikely to lose sufficient weight to escape obesity.

The same must therefore be true of VGB clients. For VGB to be effective, the client must make changes to diet and exercise routine. VGB cannot have any lasting beneficial effect unless the client makes the necessary changes. If a client is responsive enough to hypnotic suggestion to accept VGB suggestions then they will also be responsive to suggestions to alter their diet and lifestyle.

But if clients are able to respond to orthodox weight loss suggestions, why bother with VGB in the first place? I have never said that VGB can never work. My point is that the people for whom it works are people who would respond to orthodox hypnotherapy for weight loss. The whole pretence of surgery is reduced to the status of a gimmick, a selling point to convince would-be purchasers of the possibility of a magic-wand type of quick fix.

My advice to people who are overweight or obese is as follows. Firstly, see your doctor. If you are seriously obese then AGB might be recommended. If so, I would suggest you consider this recommendation. AGB is a safe and reversible procedure. Along with dietary and lifestyle changes it can lead you out of the trough of obesity. If you have trouble making those changes, or if you wish to avoid surgery, then consider hypnotherapy for weight loss. But do so on the understanding that hypnotherapy does not offer a magic wand solution. If you’re overweight then lasting changes have to be made. If they are not made then you will stay where you are. Hypnotherapy can help you to make those changes. It cannot make the changes for you. And if you do decide to try hypnotherapy click here to ensure that the therapist you choose is properly trained and registered, and is interested in lowering the weight of your body, not your wallet.

 

REFERENCES

 

Bleich S. N.; Bennett W. L.; Gudzune K. A.; Cooper L. A., National survey of US primary care physicians’ perspectives about causes of obesity and solutions to improve care, BMJ Open. 2012; 2(6): e001871

 

Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2008.JAMA 2010;303:235–41

 

Garrow, J. S., Treating Obesity: The first law of thermodynamics still holds, British Medical Journal, vol 302, 6 April 1991.

 

Kuzmak LI. A review of seven years’ experience with silicone gastric banding. Obes Surg. 1991;1:403–408.

 

Lifestyles Statistics Team, Health and Social Care Information Centre, March 2015.

http://www.hscic.gov.uk/catalogue/PUB16988/obes-phys-acti-diet-eng-2015.pdf

Website accessed 01/05/2015

 

National Heart, Lung and Blood Institute, 2012

http://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks

Website accessed 01/05/2015

 

Snyder, B. et al, Past, present, and future: Critical analysis of use of gastric bands in obese patients, Journal of Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Dove Press, 2010.

 

Szinicz G, Mueller L, Erhard W, et al. Reversible gastric banding in surgical treatment of morbid obesity – results of animal experiments. Res Exp Med (Berl). 1989;189:55–60.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As someone who has been in practice as a registered hypnotherapist for many years I am sometimes called upon to give advice and lend support to newly qualified or trainee therapists. From this experience I gather that the technique of ideomotor response, or IMR for short, is no longer taught as part of a hypnotherapist’s basic training.

When I began training as a hypnotherapist some twenty years ago, IMR was one of the first techniques we were taught. The National College of Hypnosis and Psychotherapy offered a basic hypnotic induction technique which included IMR as part of the process. While IMR is not suitable in all cases for all people, to abandon it altogether is throwing the baby out with the bathwater.

Ideomotor responses are elicited and employed when a person has already been hypnotized. Using the method that we were taught, a suggestion is offered to the hypnotized person that their unconscious mind will completely take over the control of one the fingers of the person’s hand – whichever hand is nearest to the person doing the hypnotizing. The unconscious mind will show that it has taken over the finger by allowing that finger to feel, and become, increasingly lighter and lighter until it actually rises up from where it is resting. When such an IMR response has been established it can then be used as a way of communicating with the unconscious mind directly. Simple “yes or no” questions are asked and the unconscious mind can “choose” the answer by allowing the finger in question to float upwards from where it is resting.

As trainees, we were encouraged to use this technique with most clients and for most presenting issues. For example, someone who smokes may do so for a variety of reasons. They may smoke simply because it is an unfortunate and dangerous habit they have picked up, they may smoke because they identify with the “image” it creates, or they may smoke to comfort some underlying problem or anxiety, and so on.

It is, perhaps, more useful with eating problems. Suppose a person knows what dietary changes they need to make and is responsive to hypnotic induction and suggestion. But the changes still don’t happen. Then maybe there is some deeper issue that the client hasn’t disclosed, simply because they’re not aware of its possible significance with regard to the present issue. IMR can sometimes lead the arrow straight to the target.

I think that IMR is a very useful technique for trainees to learn. Having said that, I don’t use it myself very much these days. The reason is that when you have been involved with therapy for quite a while you tend to develop an intuition about whether the problem of the person sitting in front of you is being driven by “deeper” motivations. A properly conducted initial non-hypnotic consultation will often tell you as much as you will get from the use of IMR. Another problem is that not everyone responds to IMR suggestions in the same way. Some inner defensiveness may inhibit ideomotor response, the finger may fail to rise, and then the client might feel that they themselves have failed in some way. Also, you can never be sure as to whether the “yes” and “no” answers you elicit through IMR are absolutely truthful. The unconscious mind doesn’t lie consciously – that is a contradiction in terms. But it may be operating in a way which is not immediately apparent to the therapist.

Sometimes I use IMR as a handy shortcut. I might ask a hynpotized subject to wander through an imaginary room and look at miscellaneous objects, and if the unconscious mind regards one of those objects as significant to let me know by an IMR. The applications are many and manifold, especially in past-life work. It is a useful tool. Not for everyday use, perhaps. But it should certainly be taught to hypnotherapy trainees.

The Father of Hypnotherapy?

March 18th, 2015

James Braid - a pioneer of hypnosis

James Braid – a pioneer of hypnosis

This latest concern with stage hypnotism (see previous three posts) reminded me that our modern ideas of hypnotism, and our use of it in hypnotherapy, actually emerged from something rather similar.

Modern interest in hypnosis can be traced back to the illustrious Franz Mesmer and his famous theories of “animal magnetism”. Mesmer (from whose name we derive the word “mesmerism”) had some medical training but became more interested in what we today might call “alternative” methods of treatment. He became convinced that within the bodies of mammals, both human and animal, there was some sort of special magnetic force which could be harnessed to produce strange and wonderful phenomena. In the early stages of his experimental research Mesmer got his subjects to ingest magnetized iron and attributed his results directly to internal magnetism. He soon came to realize that actually swallowing magnets was not necessary in order to get the required reactions. Read the rest of this entry »

No – I didn’t see You’re Back in the Room. Personally, I find stage hypnosis at best boring and at worst deeply irritating. Maybe I’m an old stick-in-the-mud but I take very little pleasure when people are made to look foolish for the entertainment of others. To me, it seems to represent one of the lowest traits of human nature. Stage hypnosis is rather like my other bête noire, the prank phone call. I detest these with a passion, especially if the prank caller is some smug radio DJ. But it is just harmless fun, isn’t it? Tell that to the family of Jacintha Saldanha. Read the rest of this entry »

Music can put you in hypnosis, at least in my experience. When I listen to certain pieces I experience all the phenomena of light hypnotic trance, such as inner absorption, lower awareness of my surroundings and unawareness of the passage of time.

Of course, this only happens when I listen properly. If I happen to hear one of the pieces in question when I’m busy doing other things then I don’t suddenly go into hypnosis, anymore than I would if I happened to hear someone reading a hypnotic induction script out loud. One must be in the mood!

Does this have any therapeutic value? Can one use music as a session of hypnotherapy? Yes and no. Yes, because if music (or some pieces of music) induces hypnosis then all you need to do is to administer (or self-administer) positive therapeutic suggestions and you have a session of hypnotherapy. No, because music tends to carry its own associations with it. This can be due to the “meaning” of the piece of music itself or due to personal associations. The piece might bring back memories or remind you of things which have nothing to do with therapeutic suggestions. And if you start listening to a piece of music and drift off into hypnosis and then start giving yourself suggestions the chances are that the spell of the music will quickly be broken and you will quickly return to full waking consciousness.

I’m sure that it must be possible to harness the hypnotic power of music to good therapeutic ends. But I haven’t figured out the best way to do it yet! In the meantime, here is a piece which never fails to put me in hypnosis. It is by George Gershwin, of all people.

Although I have loved all sorts of music throughout my life, the popular music of the early 20th century was always a bit of a blind spot. However, when I was at university I fell in love with Gershwin’s music. It happened by accident. I listened to the second movement of the Piano Concerto, and that was that – I was hooked! When I was a student, Gershwin wasn’t very hip and trendy but I didn’t care. Gershwin was held in high regard by people such as Ravel and Stravinsky. If he’s good enough for them, he’s good enough for me!

The hypnotic piece by Gershwin is his Lullaby, written in 1919. Unbelievably, this work (in its original form) was written as an academic exercise. It doesn’t sound like it! Try it and see for yourself…

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