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:
High blood pressure
Type 2 diabetes
Abnormal blood fats
- – 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.
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.
Website accessed 01/05/2015
National Heart, Lung and Blood Institute, 2012
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.
January 30th, 2013
In Praise of January!
I love January. I know that I’m in a minority but it really is one of my favourite months. What’s so great about January? Well…
It isn’t December! OK – we shouldn’t moan about Christmas unless we want to be branded as Scrooges. But there is something horribly predictable about December. The same decorations, the same wretched music, the same full-on advertising, the same stress, the same overindulgence. It never really changes from one year to the next. Somehow, January is always different.
Nothing happens in January. Apologies to those with birthdays in January – but the month is blessedly free of over-hyped events. No Valentine’s Day, no Easter, no Mothers Day / Fathers Day, no vile Halloween – no excuse for the big retailers to bombard you with demands for your money. Yes – you see Hot Cross Buns in the shops and boards outside of pubs telling you to Book Now for Valentines Day!! Don’t miss it!!! – but one can ignore such things. There is Burns Night of course but, mercifully, the supermarkets haven’t got round to hyping it up yet. Long may that continue.
January never disappoints. We have no expectations of January therefore, whatever the weather may do, it never lets us down – unlike July and August, which always seem to disappoint.
January is a seriously beautiful month. Not a majority view I know! But the light in January seems to be somehow special and unique to the month. Nothing is darker than an early morning in the first weeks of January – as cool, austere and beautiful as a Dowland pavan, and all the more cherishable because that special stygian quality will soon give way to the lighter mornings of spring. The dense gray clouds of January quietly illuminate the Sussex countryside revealing every possible shade of dark brown, dark green and gray. And sometimes it snows. And when every bad thing has been said about snow, and in spite of the fact that I have the deepest sympathy for those who have to travel in it and those for whom it brings hardship, it remains miraculously beautiful.
January is – a virtuous month! It is the month for resolutions and change, but he strange thing is that January always gives you the feeling that you’re making changes for the better even if you’re just resuming your normal diet / alcohol intake / exercise routine after the excesses of Christmas. You feel like you’re being good, you feel like you’re turning over a new leaf, even if you’re just reverting to normal.
New Year’s Resolutions in Britain and America.
January is a good month for making changes because, after the Christmas mayhem, it already feels like you’re moving away from the past towards something better. But what sort of changes do people want to be making in January? According to a Journal of Clinical Psychology, published by the University of Scranton, Pennsylvania, the Top Ten New Years Resolutions for 2012 are:
1. Lose Weight
2. Getting Organized
3. Spend Less, Save More
4. Enjoy Life to the Fullest
5. Staying Fit and Healthy
6. Learn Something Exciting
7. Quit Smoking
8. Help Others in Their Dreams
9. Fall in Love
10. Spend More Time with Family
Compare the above American list with the following British one, taken from the Daily Mail Online:
1. Lose weight
2. Get fit
3. Eat more healthily
4. Save money/spend less
5. Get a new job
6. Spend more time with people who matter
7. Try new experiences
8. Get out of a rut
9. Visit a country you’ve never been to
10. Read more
Interesting to compare these two lists. Four of the resolutions are more or less the same (Lose weight / get or stay fit / spend less and save more / spend time with family or those who matter).
On the American list there is one for quitting smoking. The other five resolutions are very striking for two reasons – they are very positive and extremely vague. What exactly does it mean to “get organized”? It is important to be clear about this because otherwise sensible time management can spill over into obsessively tidying one’s desk etc. Again, what does “enjoy life to the fullest” actually mean? Does it simply mean enjoying everything around you to the utmost – in which case, is it OK to spend hours and hours watching every TV program you fancy or every YouTube clip that grabs your attention? Does it mean to get what you fancy right now, at all costs, and to hell with the future – to borrow money to get the things you think you want or to have an “enjoyable” affair and put a stable relationship at grave risk?
“Learn something exciting” – like what? Anything you learn can be exciting if you approach it in the right frame of mind. Many people take up studies in some area or another and expect the subject to excite them and get bored if it doesn’t. But anything worth learning requires work and effort. The excitement has to come from within. If you can get excited about learning then the sky’s the limit.
“Help others in their dreams” – which others? What dreams? Or what if their dreams are potentially harmful, unrealistic and doomed to disappointment? “Fall in love” – easy enough to do, too easy perhaps, but a positive outcome is likely to depend upon your present situation and who you choose to fall in love with.
The British list is a little more practical and a little less starry-eyed. Healthy eating ties in with both weight loss and fitness resolutions and is an eminently sensible resolution. Most of us have a rough idea as to what is healthy and what isn’t. Again, “Get a new job” is unlikely to be a vague resolution for those who make it. Work is the major modern preoccupation. Most people know what sort of new job they would be going for.
However, “Try a new experience” and “Get out of a rut” suffer from the same problem as several of the American resolutions. What sort of new experience and what do you want it to achieve for you? Get out of which particular “rut”? Even the most zany and spontaneous life has its routines, habits and ruts. Is a rut always a bad thing?
“Visit a country you’ve never been to”: Foreign travel has, over recent decades, become the major modern leisure activity. Nowadays, everybody has been everywhere. But this trend has gone hand-in-hand with another. Nowadays people are often shockingly ignorant and unaware of where they actually live. We are so desperate to leave our country that we’ve forgotten what it contains. People know about the roads and traffic routes in the areas they live in but are often totally ignorant of the actual neighbourhoods or surrounding countryside.
“Read more”. Read more what? More Shakespeare? More Aeschylus? More red-top tabloids or fashion mags? This resolution is meaningless unless you have some idea as to what you want to read and why you want to read it.
How Are Your New Years Resolutions Going?
From looking at those two lists of Top Ten resolutions we can see that the vital, and often missing, ingredient is clarity. Which changes do you want to make and why do you want to make them? Get that right and you’re half way there. But if you don’t know where you’re going you’ll never get there.
As January 2013 draws to a close, the January Joggers continue to disappear. They’ll be back again next year. They were out in force between Christmas and New Year and into the first weeks of January. The wet weather and the fall of snow probably dampened their spirits. But why does this happen every year? Lots of people jogging in brand spanking new lycra outfits with bottles of water and iPod headphones and every other accessory you can name. Then they disappear. Why? Because what these people want is to enjoy the benefits, the results, of exercise. They don’t enjoy the exercise itself. And until they do, all the New Year Resolutions in the world won’t help a bit. The new lycra will languish in a cupboard. The gym membership fee will be wasted. But if you learn how to enjoy the exercise itself the positive results will happen as a matter of course – and may come as a big and welcome surprise.
Here’s where hypnotherapy may lend a helping hand. Be clear about where you want to go and what you want to achieve. It is better to set the bar low and achieve something than to set targets that are nothing more than castles in the air. When you know where you’re going and how you’re going to get there, then hypnotherapy can help you to start enjoying the journey. All journeys have their tough moments, their obstacles, their setbacks, their challenges. But if you can start to enjoy the new experiences which even the smallest changes can bring in their wake then your goals, or some of them at least, can at last be realized.
You don’t have to wait until next January to make new resolutions…
February 1st, 2012
In a previous article I explained the reasons why I don’t offer virtual gastric band treatments for weight loss. It was not my intention to suggest that treatments which include the “fitting” of a virtual gastric band are never successful. However it seems highly likely that the success in such cases is in fact due to other factors.
I referred to a Daily Mail article in which a person had, it seems, been successfully treated for weight loss using a virtual gastric band. But the article makes it clear that the person concerned had around ten sessions of hypnotherapy and was put on an extremely radical diet. It was this, I would suggest, which caused the weight loss, not the virtual gastric band. The VGB could easily have been omitted and the treatment would still have been a success, at least in the short term. This treatment package, successful though it was (in the short term) is a far cry from the one-session “magic wand” type of treatment which clients hope for when they sign up for VGB treatments. Read the rest of this entry »
January 9th, 2012
Someone drew my attention to an article published in the Daily Mail last year. It was all about an overweight woman who lost 8 stone by having a “virtual gastric band” fitted under hypnosis. If you’re interested you can read the article on the Daily Mail website. Just click here:
What a success story for hypnotherapy! Or is it?
People are becoming increasingly aware of the “virtual gastric band”. Clients increasingly enquire about virtual gastric band treatment rather than hypnotherapy for weight loss. They do this in the belief that their problem can be solved by one session of hypnotherapy and that no subsequent effort on their part is required. They believe, or hope, that the virtual gastric band is a magic wand which will simply make their weight problem disappear. If only it were that simple! Read the rest of this entry »
Hypnotherapists soon get used to the fact that clients have certain preconceptions about the whole business of hypnotherapy. Even when they don’t say it, you suspect they might be thinking something like: “will he make me cluck like a chicken?” or “will he get me to sing like Barbra Streisand?”. Sometimes people ask me those questions outright. I usually say that I charge extra for such services! But then I take some pains to explain that hypnotherapy isn’t really some species of conjuring trick, that hypnosis is a serious therapeutic tool and that therapy is a serious business – a partnership between client and therapist which aims at getting the client where he or she wishes to be. Read the rest of this entry »