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Learning not to eat

In Mind
Written by  Annelotte Huiskes Wednesday, 04 February 2015 13:50

Imagine: you adore chocolate. White, dark, filled with caramel, whatever. You only have to see it or smell it and you’re sold. And you rarely stick to just the one bonbon – no, you eat the whole box in one go. Chances are, you’re also overweight. This irresistible urge, the overpowering desire to overeat, is much more prevalent in obese people than in thin people. The good news is that, with the help of a psychologist, you can ‘unlearn’ this uncontrollable eating behaviour. The bad news is that it’s not yet clear whether you’ll also lose weight.

Anita Jansen, professor of Experimental Clinical Psychology and specialist in obesity, has spent years studying the learning mechanisms that underlie people’s eating behaviour. In 2011 she received a prestigious Vici grant for her research. “Obesity is mainly a behaviour problem: obese people don’t always have their eating behaviour under control”, she says. “Yet, it’s usually still seen as a medical problem. The GP or dietician will tell you to change your diet and do more exercise, or get a gastric bypass as a last resort. The psychologist plays no real role in this process, yet we’re the ones specialised in behaviour. We know better than anyone how hard it is to change ingrained behaviour patterns. You need more than just advice; you need knowledge about the underlying cognitive processes associated with eating behaviour. And that is precisely what we’re investigating.”

Addiction
This month Jansen and her colleague Sandra Mulkens will publish an i-book for therapists who work with obese people. Using the psychological treatment plan described in the book, they can help clients to manage their tendency to overeat. “It’s a form of valorisation of our research.”

The treatment is based on the cognitive behavioural therapy approach already used for eating disorders and addiction. So is obesity an eating addiction? “There are many similarities between alcohol or drug addiction and obesity, certainly when you look at the mechanism of loss of control. Obese people feel that they ‘must’ eat, just as alcoholics think they ‘must’ drink. They learn to analyse these sorts of expectations and to take the edge off them by doing certain exercises.”

Control
These treatment techniques are described in the book and demonstrated in video recordings of real therapy sessions. One important technique is ‘cue exposure’. “The idea is that certain situations – that is, cues – encourage overeating. In the underlying, ingrained pattern, that cue represents loss of control. Ultimately, you want to help obese people to learn to control their eating behaviour through frequent exposure to these cues. So the therapist places something the client loves to eat within easy reach. Chocolate, for example. He can smell it, touch it, anything but eat it. If you practice this enough, the client notices that the urge to eat decreases, and his ability to withstand this urge increases. One step further is an exercise where clients are asked to throw away all their chocolate. Often they find that really hard. The aim behind all these exercises is to teach clients a different association: cue is control, so I don’t eat. Developing this second association takes a lot of time and you have to keep on practising until you lessen the power of the ingrained idea ‘I have no control’”.

Top sport
So this therapy can help to tackle derailed eating behaviour – but will you also lose weight? “We assume that if people eat in a more controlled way, they’ll also eat less and thus lose weight. But if you need to lose something like 60 kilos, you have to eat even less. To lose one kilo per week you have to cut your daily calorie intake by 1000 calories. In that sense losing weight is top sport, and you’re asking that of people who don’t have that kind of talent. Top sport requires a great deal of self-control, which is precisely what these people struggle with. We try to increase this self-control through the therapy. If you don’t do that, you’re fighting a losing battle. Research shows that fewer than 10% of people manage to keep weight off once they’ve lost it.”

Work in progress
Learning not to eat is not, then, a self-help book with a quick and easy solution for weight loss. That said, “I’ve long had plans to write a book for laypeople on the psychology of obesity, and why it’s so hard to change eating behaviour”, says Jansen. “It would have tips you don’t find in the usual diet and nutrition books, because they pay next to no attention to the psychological problems involved. Science is a slow process. After years of research we now know more about uncontrolled eating, but we haven’t yet studied on a large scale whether our intervention also really helps people to lose weight. A lot more years of study are needed for that and, in particular, there needs to be the money for it. But you only get a Vici like this once. It’s all work in progress. A global problem like obesity is not something my research group can solve in five years. We’ve developed a great deal of insight and a number of interventions to tackle problems, and as far as I’m concerned that’s already a lot. After all, if we came up with the one and only solution, we’d deserve a Nobel Prize, right?”

  
Anita Jansen (1960) has been professor of Psychology at Maastricht University since 1999. Together with her ‘eating group’, she studies eating behaviour, eating disorders and obesity in the broadest sense: from brain activity and cognitive processes to behaviour patterns and healthcare interventions. In 2011 she received a prestigious Vici grant for her research on obesity.

The i-book Learning not to eat: A manual for therapistsis available via Apple’s i-books store. A web version is also available

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