Spring 2012

Be honest. It’s important to acknowledge real events without exposing them to all the details. Use language and concepts your children can understand. Tell them in neutral terms about what has happened.

Let the child know that it is not their fault.

Listen attentively. Let them know that whatever they think and feel is okay. Encourage them to express all their feelings – both negative and positive – about what is happening in their family. Asking your child about friends of theirs whose parents are divorced is a way of exposing your child’s assumptions and fears about divorce and its impact. This creates an opportunity for you to clear up misconceptions and provide reassurance. Recognize that it is normal for most children in the early stages to want their parents to get back together. Keep your kids’ feelings separate from your own. Don’t make your child your confidante. You need family, friends or a counsellor for that role. While it’s okay for kids to see their parents upset, getting too emotional can make kids feel responsible for your feelings. Children are sensitive to their parent’s mood and feelings and will only discuss with you what they think you can handle. If you feel devastated, angry or frustrated about your divorce, your children may steer clear of the topic. If you are openly angry with the other parent, your children will feel like they can only share negative reports about the other parent because this is what they think you want to hear. If you feel that you may get too upset yourself, think about asking someone else (relative, friend, counsellor) to talk with them.

Being overweight is one condition where the jury is still out on the nature (influence of genetics) vs nurture (environment and lifestyle). Debate and evidence is certainly pointing to body size and shape as a combination of what genes were passed and the contribution of psychosocial factors in your life. That said, weight treatment addresses lifestyle behavioural changes and concentrates on decreasing food acquisition and increasing activity levels. The purpose of this article is raise awareness of the limitations of current treatments and to offer guidelines on how to seek help for your weight management goals when what you are doing on your own does not seem to work. Being overweight or obese can have both emotional and functional symptoms. Chances are it will be one of these symptoms or their consequences that will lead someone to seek help. You should approach this problem in a common sense manner as you would do for any health problem to be solved – Identify the symptoms causing the most distress, consider what caused it, ask yourself how long it will last, what will be the consequences if you don’t do anything at all, and can it be cured or at least controlled? And then choose your source of help accordingly.

Weight Management Strategies

Weight management strategies are categorized according to the level of outside help involved and range from just managing on your own (self help), to seeking advice and support from others trying to lose weight (peer support), to individualized advice from allied health and medical practitioners (professional led programs), and finally for those who are at least 100 or more pounds overweight to the extreme of bariatric surgery to either prevent food intake or prevent food absorption or both. Weight loss involves going on a diet. There is a saying that ‘diets don’t work’; and in practice this certainly seems to be true. Since there is no clear definition of ‘dieting’, it means something different to each of us. But in general it means eating less than you are used to, and less than you need to maintain current weight. Most dieters do not stick to the plan long enough to achieve their goals, and even if they are successful in losing weight, they return to their former dietary and activity habits which results in weight rebound. Therein lies the problem. But, if this formula of calories in less than calories out is followed for an appropriate amount of time, and if you manage to lose significant poundage that it is not just water, — and if you do not then return to your pre-diet eating and activity patterns, then yes, diets can work.

Fad Diets

Diets offering the quickest results invariably require the complete elimination of one or more food groups leading to feelings of deprivation and sometimes they demand such a stringent depletion of nutrients that they put the body into starvation mode. This is particularly true of diets

What is known about self-help methods from a large and long running USA database is that those who monitor their weight and their food intake and their activity every day have the best chance of losing and keeping it off. Even health professionals can underestimate their dietary intake by 30% or more. Research shows that most weight is lost within the first six months before reaching a plateau. It is easy to give up at this stage, but keep in mind that the longer you have been overweight, the longer it will take to lose it and keep it off. Setpoint theory suggests that you will have be patient and diligent to ride out the plateau as your body adjusts and you may have to live at the plateau weight for months before you can begin to lose again.

Professionally Supported Strategies

The second level of help enlists the support of peers whereby those with similar issues come together either in person (groups) or online to garner helpful hints, compare trial and error methods, and enlist motivational support. The third level of help involves seeking the advice of allied health professionals who possess specific training in the biology or psychology of weight management such as dieticians, nutritionists, occupational therapists, and health psychologists. The highest level of help is when medical advice is sought and the outcome may be that diet pills are prescribed or bariatric surgery performed. Increasingly, research shows that the best chance of success is from a multidisciplinary team of allied health service providers who have specific bariatric training and this now seems to be the safest method and most effective method to chose. There are problems inherent in each level of help. Self help books may be written using too much professional or scientific jargon or may contain only a few chapters of information with over half the book full of recipes. And while there is much research evidence to support the use of peer support programs for a variety of health conditions; anecdotal evidence of weight loss programs describe how some tyrannical programs mandate humiliation to control behaviour as they forced people to weigh in front of their peers, and berated members for failing to lose. In one group the person who did not lose had to wear a pig mask. This practice is unconscionable, and there is no place for such degrading treatment in a civilized society. Even professional led treatment has its limitations. The old way of thinking was just to consult a dietician with the underlying assumption that all you need to do is tell someone the correct way to eat and ‘voila’ – problem solved. Unfortunately, many seek the quick fix and turn to diet pills as a first strategy thereby artificially altering their feeling of hunger. There are two major problems with this: it assumes that people overeat because they are hungry and if you take away hunger you take away the impetus to eat.

Choosing your Help

Every weight management strategy must begin with a psychosocial assessment to explore the cause of your body size and weight – be it genetic, medical, or lifestyle; include a weight management history of what worked, when, and why and what didn’t and why; and identify problem areas which would lead you to use food as a coping strategy. The key to success is finding a way of living which allows you to find balance in matching your food intake to your natural activity levels in relation to your genetics, your health status, and your lifestyle. There are many reasons to eat, and self soothing with comfort foods, habit, celebration, or duty surely rank as high as hunger – even more so I believe. Secondly, it appears more likely that many people misinterpret anxiety as