Caring about our future

Health is Beautiful

Obesity is growing, and more and more children are falling prey to this social disease.  Why have we not seen this before?  Why now?  Is it as a result of the bountiful post-war period, or a shift towards more sedentary life-styles?  Is it the symptom of addiction to highly flavoured, brightly coloured fast foods?  Is it all of these things, or is there something else? 

I believe it is all of these things but with a subtle difference - namely, the underlying association of food with comfort, warmth, love and rewards, and an ever increasing need for these things in our society.  As far as I can tell, there has never been a period in history where life-styles have been so easy and yet morale has been so low.  As a therapist, the causes of the morbid obesity that I have treated have all, without exception, had their roots in low self-worth. 

We already know that the inclusion of flavour enhancers such as Monosodium Glutamate, sugar substitutes such as Aspartame, along with the preservatives and other additives, in our food, is affecting behaviour and moods.  The brightly packaged, highly flavoured snacks have moved from being regarded as occasional treats, due to their original scarcity, to everyday expectations, creating a feeling of deprivation if we can’t have them.  Gradually the nation has seduced itself into a mass desire for unnatural food products – perhaps even a dependence?  Why?

Here’s one simple explanation:

As newly born infants, we, as a species, are completely dependent for everything – we have a built in mechanism to alert those around us to our needs – we cry – to be cleaned, to be fed, and to have any other basic needs attended to.  The time when we are most comfortable is when we are being fed – we are held close, cuddled, our tummies our filled so the pain of hunger is assuaged and we are warm and satisfied.  We are also in control of our environment and feel ‘replete’.  This association with food is reinforced throughout our very early development.  It should be no surprise then that we easily fall into the behaviour of seeking out food later in life when we are in need of those feelings of comfort – whatever the reason.  The ‘sugar-rush’ experienced with sweet foods makes these prime candidates for ‘comfort-eating’.

The statistics are staggering:

‘The number of people who are obese is rising.  About 1.2 billion people in the world are overweight and at least 300 million of them are obese, even though obesity is one of the 10 most preventable health risks, according to the world Health Organisation.  In the United States, more than 97 million adults – that’s more than half – are overweight and almost one in five adults is obese.  Among teenagers and kids 6 years and older, more than 15% are overweight – that’s more than three times the number of young people who were overweight in the 1970’s.  At least 300,000 deaths every year in the United States can be linked to obesity.’ http://www.kidshealth.org/teen/food_fitness/dieting/obesity.html

The incidence of childhood obesity has risen to such a degree that various remedial procedures have been adopted, some of which are extremely invasive:

‘Operations: A number of operations have been devised over the years and modifications have been made. This diversity is one complicating factor when trying to analyse the evidence. Criteria for acceptance or rejection for operation vary. Another problem is that the surgery is just one of many components of the management plan. A PubMed search for "bariatric surgery systematic review" yielded over 100 references published in 2005 alone. It is valid to ask why the world needs so many systematic reviews and the answer would seem to lie in the interpretation of the data.

Surgical procedures can be divided into categories:

•       Malabsorptive surgery bypasses parts of the gastrointestinal tract to limit the absorption of food.

•       Restrictive surgery reduces the size of the stomach so the feeling of fullness occurs with less food.

Malabsorptive procedures include jejunoileal bypass, gastric bypass and biliopancreatic diversion, while restrictive procedures include gastroplasty and gastric banding. There is an increasing trend towards using laparoscopic rather than open techniques.

•       Endoscopic placement of something in the stomach. This tends to be a shorter procedure, requiring sedation rather than general anaesthesia.’ http://www.patient.co.uk/showdoc/40025123/

Other procedures involve medication such as appetite suppressants, diuretics and so on:

‘There is no evidence of the effectiveness of orlistat, sibutramine, and rimonabant in the long-term treatment of obesity. Bariatric surgery is more effective than non-surgical treatment for long-term weight loss and control of some co-morbid conditions, particularly diabetes, in severely obese patients. However bariatric procedures differ widely in terms of long-term effectiveness and safety and important gaps in scientific knowledge exist in this field. Risks can be high. A volume-outcome relationship has been described for most bariatric procedures including gastric banding. There is no evidence that gastric banding has a better risk/benefit ratio than the current standard Roux-en-Y. Long-term residential care of severely obese children (on average, one school-year) is effective in the short-term, but is very expensive, might have some disadvantages (less family involvement), and no data exist to assess its long-term effectiveness.’ http://nhscrd.york.ac.uk/online/hta/20060812.htm

For those who have no problem with over-eating or with maintaining a healthy body weight, the problem has a simple remedy – just reduce the amount you eat.  So why is it not that easy?

I believe it is because the issue is not about the food, but about low self-worth and low self-esteem – feeling of no value, unwanted, unattractive, and unable to achieve.  If these things are true, then how have we managed to create a population of people who feel inadequate, and what can we do about it? 

Perhaps the following should be part of our national curriculum:

* caring about people and caring for people,

* learning about what our bodies need to keep us healthy

* learning parenting skills way before we are able to become parents,

* respecting each other,

* focussing on our strengths rather than our weaknesses, and

* fostering a culture where everyone can achieve ie skills for employment opportunities

* ensuring that everyone feels a valued member of society.

Surely, prevention is better than cure?

What does Quality of Life mean to you?

‘Real Progress cannot be measured by money alone.  We must ensure that economic growth contributes to our quality of life, rather than degrading it.’

Rt Hon Tony Blair MP

Foreword to A Better Quality of Life, the UK's first Sustainable Development Strategy (1999)

What does quality of life mean to you?

Can you list the criteria that need to be addressed in order that your happiness and well-being are satisfied on a daily basis and in the long term?

This could prove to be quite a complex exercise - certainly- I, or we, cannot define your personal needs and desires for you, only you can do that! 

Most people have difficulty in making a categorical list - often our priorities change from moment to moment as life evolves and we are faced with different challenges - so what may suit us today, may not tomorrow, or next year.

At MindSight we have created an online interactive process that enables you to log your personal preferences/idiosyncrasies/needs that will enhance your quality of life - without having to adhere to someone else's definition of what makes you happy.

The following is a quote from Daunt's definition of Quality of Life:

The concept of independence is a self-defined one which varies from person to person.  Of such a good quality of life we were able to identify these components:

Autonomy: the freedom to choose a preferred way of life

Independence

the opportunity to make one's own practical decisions; encouragement not to be over dependent in everyday matters

integration; acceptance by society as a fellow citizen and member of the community, with full political as well as social rights; freedom from marginalisation

respect; recognition of the value of one's identity and role, and of one's contribution to the lives of others

ownership; the possibility to keep one's own personal possessions and retain control over one's finances

social involvement and communication; access to a range of useful and interesting occupation, of educational experiences and cultural, leisure and self-help activities; enouragement and support in undertaking these; availability of an accessible environment, including transport

privacy

tranquillity; freedom from noise and disruption; continuity of place and environment"  Daunt, 1992, page 175

Where Daunt has defined quality of life criteria for people with disabilities, we would now replace 'integration' with 'inclusion', but broadly these definitions still provide good guidance and apply to each of us.

When one tries to interpret these guidelines, discrepancies in the practical implementation emerge, due to the subjective interpretation of the criteria.  The concept of independence varies from person to person, and autonomy and inclusion are dynamic, not static, processes.  We continuously act and react, evolving and developing, adapting or modifying our beliefs and our attitudes with experiential learning.  So then, what exactly does the Rt Hon Tony Blair mean when he talks about economic growth contributing to our quality of life, rather than degrading it?  What criteria is he using to measure these effects?

At present it is extremely problematical to illustrate the enhancement of a person's quality of life with anything other than observable measures.  For instance, with good housing, healthy diet, sufficient income to sustain a good standard of living, healthcare, access to amenities - and so on.  But what about the more subtle influences - feeling valued, being loved, or needed?  What about the differences between us - one man's meat being another's poison? 

I would like us to help clarify what each of us regards as criteria against which our quality of lives may be measured.  I cannot do this alone without it becoming too subjective.  Therefore, I am asking for collaboration to create as comprehensive a list as possible. 

If you would like to help in this process please visit the website:

http://www.dawnheather.com

We are currently seeing the results of quality of life imbalances in the high levels of stress that are affecting the nation's health and economy!

Autism, AS and Hypnotherapy

Autism Spectrum Disorders (ASDs) and Clinical Hypnosis

There is a distinct absence of hypnotherapy courses that acknowledge Autism Spectrum Disorders (ASDs), and in particular High Functioning Autism (HFA), and Asperger Syndrome (AS).  And yet there is a strong possibility that any therapist may be faced with patients who may have a diagnosis of HFA or AS, but, more importantly, they are very likely to be faced with patients who may be borderline cases, with no diagnoses at all.  The responsibility to recognise obvious traits rests with the therapist.  In addition, many of the hypnotherapeutic techniques would be contra-indicated, which places both patient and therapist at risk of failure. 

Prevalence
The current prevalence rate of ASDs ranges from 91:10000 (Wing & Potter 1999) (across the age ranges and including subtle traits), to 1:85 children in education (PACE ).  This amounts to more than 1% of the population. 

Economy
In 2000, the costs for the care provision in the UK for people with Autism Spectrum Disorders were estimated at £1 billion per year.  The additional lifetime costs for one person with autism and associated learning disabilities was estimated at £2.4 million, while for people with High Functioning Autism (HFA) or Asperger’s syndrome (AS) additional lifetime costs were £0.5 million. ( Knapp & Jarbrink, 2000).

Symptoms
In general, people with Asperger syndrome and Autistic Spectrum Disorders (ASDs) see the world differently.  All social interaction is affected, and for those higher functioning individuals who are aware of their difficulties, the consequences include heightened anxieties, stress, depression and often suicidal tendencies.

The heterogeneity of this population has, historically, made it extremely difficult to generalise support procedures. In this sense, the nature of hypnotherapy, where the structure is therapist led, but the content is patient led, lends itself very readily to the customised practice that is so desperately needed for these individuals. Hypnotherapy can be used as a tool for empowerment and enablement to manage anxiety levels and thereby facilitate learning.  Please note that this is not a cure or treatment for ASDs.

The Essex Institute for professional training in clinical hypnosis is pioneering the first training modules in ASD and hypnotherapy in April 2007.

If you are interested in our training module please email: dawn@dawnheather.com 
http://www.dawnheather.com

Refs:

Barnard, J. et al (2002), Autism in Schools: Crisis or Challenge? NAS: London.

Howlin, P., (1997) ‘Autism: preparing for adulthood’.  London: Routledge.

Knapp, M., & Jarbrink, K., (2001)  ‘Cost of Autism in the UK’.  London: Mental Health Foundation.

Internet Refs:

PACE (2005) http://www.pace.org/

Wing, L., Potter, D., (1999)
http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=364&a=2618

Poisoning childhood? what happens next

The number of documentaries and the amount of media coverage aimed at the incidence of morbid obesity in children and adults in UK today, have risen significantly.  There is also an increase in the prevalence of childhood depression.  Add to this the practice of including surgical procedures, as everyday items, to our shopping lists, and the picture becomes frightening.

'Patrick Holford, a psychologist and nutritionist, who heads the Food for the Brain Foundation, believes swift action is needed to help children. "There is absolutely no question that there is a profound link between children, their poor performance and a poor diet,"  he said.' (BBC News)

I would go so far as to add that this also has a profound impact on their career development and their own future parenting skills. 

When we also take into consideration that the government has invested billions into researching stress in the workplace - due to the amount of lost hours and the resultant financial implications this has on the economy - then a pattern starts to emerge.  Of course, it is likely that addressing some of the issues in working environments will go some way towards alleviating some of the current mental 'unwellness', but my belief is that the problems start long before leaving school.  Unless there is a multi-disciplinary approach towards both physical and mental health and well-being, starting early in childhood, then we will fast become a nation of depressive invalids.

Geoff Mulgan's comments on the 'mis-match between education and the needs of the UK service economy' illustrate another source of conflicting pressures resulting in anxiety and depression for the young adult population.   

Children's writers Philip Pullman and Jacqueline Wilson, and scientist Baroness Greenfield recently signed a letter to the Daily Telegraph warning that: "poor diet, restricting exercise, putting children in "academic straitjackets", and dressing them like "mini adults" will "restrict their creativity and enrichment".

Going on to add that:

"Our society rightly takes great pains to protect children from physical harm, but seems to have lost sight of their emotional and social needs.  However, it's now clear that the mental health of an unacceptable number of children is being unnecessarily compromised, and that this is almost certainly a key factor in the rise of substance abuse, violence and self-harm amongst our young people."  (BBC news)

So why is there this upsurge of support for surgical procedures, removal of dignity and, in some cases, abusive practices, all aimed at supposedly helping people to lose weight, to change their image, and implying that they will instantly lead fulfilling lives?  Why is the emotional side of these issues being overlooked or ignored?  And why is little attention being paid to the long term effects of some of these popularised procedures?

There are examples of heroic attempts to address some of these issues, for example, Jamie Oliver is proactively promoting the message of healthy eating, and I applaud his efforts, but what happens when the promotional vehicle itself implicitly criticises the parenting skills of the very people who need to be on board, to support and implement the necessary lifestyle changes? 

Perhaps we need an additional less obtrusive method that is non-confrontational and yet educational to help us avoid leaving a legacy of doom for future generations?