Therapy for living well

THERAPY FOR LIVING WELL

Tahirah Samuels, LMSW

“At some point we all get stuck. We stay where we feel comfortable and forget what it was we really wanted to accomplish with our life. We find ourselves just going through the motions of day to day life, while hoping for an experience that will shake us out of our rut and make us feel fully alive again – where we would live each day with more satisfaction, health, success, joy, love and excitement.” ~Megan Thorpe

http://www.youtube.com/watch?v=b_qYKCc9m0A

Defining Overweight and Obesity

Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems.

Definitions for Adults

For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the "body mass index" (BMI). BMI is used because, for most people, it correlates with their amount of body fat.

•An adult who has a BMI between 25 and 29.9 is considered overweight.•An adult who has a BMI of 30 or higher is considered obese.

Height Weight Range BMI Considered

5' 9"

124 lbs or less Below 18.5 Underweight125 lbs to 168

lbs 18.5 to 24.9 Healthy weight

169 lbs to 202 lbs 25.0 to 29.9 Overweight

203 lbs or more 30 or higher Obese

BMI is just one indicator of potential health risks associated with being overweight or obese. Two other predictors:• The individual's waist circumference (because abdominal fat is a

predictor of risk for obesity-related diseases).• Other risk factors the individual has for diseases and conditions

associated with obesity (for example, high blood pressure or physical inactivity).

Obesity is common, serious and costly

More than one-third of U.S. adults (35.7%) are obese.

The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight.

Research has shown that as weight increases to reach the levels referred to as "overweight" and "obesity,"* the risks for the following conditions also increases: Coronary heart disease Type 2 diabetes Cancers (endometrial, breast, and colon) Hypertension (high blood pressure) Dyslipidemia (for example, high total cholesterol or

high levels of triglycerides) Stroke Liver and Gallbladder disease Sleep apnea and respiratory problems Osteoarthritis (a degeneration of cartilage and its

underlying bone within a joint) Gynecological problems (abnormal menses,

infertility)

Obesity affects some groups more than others

Non-Hispanic blacks have the highest age-adjusted rates of obesity (49.5%) compared with Mexican Americans (40.4%), all Hispanics (39.1%) and non-Hispanic whites (34.3%)

Being overweight is generally caused by the intake of more calories than are expended by the body. Factors that may contribute to this imbalance include: Alcoholism Eating disorders (such as binge eating) Genetic predisposition Hormonal imbalances (e.g. hypothyroidism) Insufficient or poor-quality sleep Limited physical exercise and sedentary lifestyle Poor nutrition Metabolic disorders, which could be caused by repeated

attempts to lose weight by weight cycling Overeating Psychotropic medication (e.g. olanzapine) Smoking cessation and other stimulant withdrawal Stress

Factors, con’tThe variety of factors that play a role in obesity make it a complex health issue to address.

Behavior and environment play a large role causing people to be overweight and obese. These are the greatest areas for prevention and treatment actions.

Areas of life affected by obesity

Relationships – social and intimate

Occupational

Mental and Emotional Well-being

Relational

The impact that obesity has on your relationship with your spouse, colleagues, boss, friends, and even your children is huge.

Relational, con’tThe connection between self esteem and being overweight and its effect on relationships has been much studied. It is very hard on your self esteem to be heavy when the rest of the world, or so it seems, is skinny or lean. We are bombarded every day by images of celebrities in magazines and on TV, and most of them are quite svelte and beautiful. While big can be beautiful, or so some of the ads or songs say, it does not always feel beautiful.

Children

Overweight children are more like to face bullying and isolation among their peers. Even though school officials continue to crack down on bullying and preach acceptance, children and teens can still be incredibly cruel. Often, overweight students are targeted and face open hostility and social rejection.

Occupational You nailed a phone interview for a new job. But once you meet your

prospective boss in person, things go downhill quickly. Either your meeting is cut short or you’re abruptly told the position has been filled.

The scenario is an all-too-familiar one for a number of overweight people who have experienced weight-based discrimination in the workforce. While many victims of the bias have suspected their appearance has been hurting their careers.

Weight-based discrimination consistently affects every aspect of employment, from hiring to firing, promotions, pay allocation, career counseling and discipline.

The bias appears to be most prominent during the hiring process, when an employer knows a potential employee the least and therefore is most likely to be influenced by stereotypes (such as fat people are lazy).

Occupational con’t In 2004, Charles Baum, of Middle Tennessee State University,

also reported in the journal Health Economics that obesity could lower a woman’s annual earnings by as much as 6.2% and a man’s by as much as 2.3%.

Employers, of course, are concerned about obesity in the workplace because of the associated price tag. Obese employees cost U.S. private companies an estimated $45 billion annually in medical expenditures and work loss.

The damning stats don’t stop there. Between 1997 and 2004, obese workers filed twice the number of workers’ compensation claims, had seven times the medical costs and lost 13 times the days of work from work injury or illness compared with other employees - Duke University Medical

Until companies stop worrying about health care costs, more laws are passed or society’s anti-fat sentiment fades, the discrimination is bound to continue.

Obesity and self-esteem - The vicious circle

Another point to remember is that obesity and self-esteem can become a vicious circle, where obesity creates low self esteem and visa versa.

When you have low self esteem you eat to make up for it and so you add on weight, this deals a further blow to your already low self-esteem and it takes on the form of a vicious circle.

Your body image is the way you see yourself in the mirror. It can have a large impact on your self-esteem , as what you see may not always reflect reality.

Depression The relationship between obesity and depression

has always been a contentious issue. Mood states like depression are known to be associated with. Recent research suggests the relationship between depression and obesity is actually a two-way street. Obesity seems to lead to depression and depression seems to lead to obesity.

It remains unclear as to the exact relationship between obesity and depression. For people with depression obesity appears to follow as a long-term consequence. Body dissatisfaction and low-esteem are also factors that can lead to depression.

Anxiety According to research, it is not the obesity itself

causing the depression, anxiety or other mood disorders, it is the impact of obesity on physical and emotional well being that affected mental health.

Research studies continue to show a correlation between anxiety and obesity, however, there is conflicting data over whether obesity contributes to anxiety problems or anxiety contributes to obesity.

Anxiety disorder can affect anyone, regardless of age, race, shape or size. However, there are researches that are pointing towards a connection between obesity and mental health problems.

While some studies say that people who are obese tend to develop panic attacks and other mental health related problems, there are others who say that it really is the other way round.

There are studies that indicate people who have mental health problems tend to become obese -

The rationale is simple; people who are undergoing depression or mental disorders do not feel good about themselves. They tend to be less physically active, and overeat. Therefore, they will be the least motivated to work out, or make a trip to the gym. They tend not to be focused on their physical health, thus making them prone to grow obese.

The debate of whether it was the egg or chicken that came first can go on and on, but there is growing evidence that reveal the link between treatments for anxiety and obesity.

Although it is true that certain medications for mood disorders have a link to obesity (due to side effects), but it does not mean a person should discontinue medications prescribed by a doctor.

Strategies to combat obesity

Diet Exercise Surgery Religion/Spirituality Medication Behavioral Therapy

Fad Diets Recommendations that promise a quick fix Dire warnings of dangers from a single product or regimen Claims that sound too good to be true Simplistic conclusions drawn from a complex study Recommendations based on a single study Dramatic statements that are refuted by reputable scientific

organizations Lists of “good” and “bad” foods Recommendations made to help sell a product Recommendations based on studies published without review

by other researchers Recommendations from studies that ignore differences among

individuals or groups Eliminated one or more of the five food groups

Fad DietsCabbage Soup DietThe cabbage soup diet is the king of all fad diets. Popular, Nutritional Decent, and Fairly Easy.

South Beach DietNaming Your Diet After A Place Where Skinny People Vacation...Brilliant.

Lemonade DietAlso Called A Master Cleanse - For The Strong Of Spirit and Weak of Mind.

The 1 Day DietIf You Know You Will Quit After 1 Day, Go With This One And Be A Success!

The 3 Day DietIf You Think You Can Last For 3 Days, Here Is The Diet Plan For You.

7 Day All You Can Eat DietSeven Days of Weird Portions of Strange Foods. How Can It NOT Work?

HCG DietThis diet has exploded in popularity in 2009, but is it a legitimate way to lose weight or should the HCG diet be considered an unhealthy fad?

The Hollywood DietIf You Want To Drink Juice Instead of Eating, This Fad Diet Is For You.

Fat Loss 4 Idiots

This diet is supposed to be so simple that anyone can lose weight.

Exercise Plans Videos Equipment Personal Trainers Gym memberships Yoga

Weight loss surgerySleeve GastrectomyWhat is it? This is another form of restrictive weight loss surgery. In the operation, about 75% of the stomach is removed. What remains of the stomach is a narrow tube or sleeve, which connects to the intestines.

The Pros. For people who are very obese or sick, standard gastric bypass or biliopancreatic diversion may be too risky. A sleeve gastrectomy is a simpler operation that allows them a lower-risk way to lose weight. The Cons. Unlike gastric banding procedures, a sleeve gastrectomy is irreversible. Most importantly, since it's relatively new, the long-term benefits and risks are still being evaluated.The Risks. Typical surgical risks include infection, leaking of the sleeve, and blood clots.

Gastric Bypass Surgery What is it? Gastric bypass is the most common type of weight loss surgery. It combines both restrictive

and malabsorptive approaches. It can be done as either a minimally invasive or open surgery.

In the operation, the surgeon divides the stomach into two parts, sealing off the upper section from the lower. The surgeon then connects the upper stomach directly to the lower section of the small intestine. Essentially, the surgeon is creating a shortcut for the food, bypassing a section of the stomach and the small intestine. Skipping these parts of the digestive tract means that fewer calories get absorbed into the body.

The Pros. Weight loss tends to be swift and dramatic. About 50% of it happens in the first six months. It may continue for up to two years after the operation. Because of the rapid weight loss, health conditions affected by obesity – such as diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, heartburn, and other conditions -- often improve quickly. You'll probably also feel a dramatic improvement in your quality of life.

The Cons. By design, surgeries like this impair the body's ability to absorb food. While that can cause rapid weight loss, it also puts you at risk of serious nutritional deficiencies. The loss of calcium and iron could lead to osteoporosis and anemia. You'll have to be very careful with your diet -- and take supplements -- for the rest of your life.

The Risks. Because these weight loss surgeries are more complicated, the risks are higher. The risk of death from these procedures is low -- about 1% -- but they are more dangerous than gastric banding. Infection and blood clots are risks, as they are with most surgeries. Gastric bypass also increases the risk of hernias, which can develop later and may need further surgery to fix. Also, a side effect of rapid weight loss can be the formation of gallstones.

Biliopancreatic DiversionWhat is it? This is essentially a more drastic version of a gastric bypass, in which part of the stomach -- as much as 70% -- is removed, and even more of the small intestine is bypassed.

The Pros. Biliopancreatic diversion can result in even greater and faster weight loss than a gastric bypass. Studies show an average long-term loss of 70% to 80% of excess weight. Although much of the stomach is removed, the remainder is still larger than the pouches formed during gastric bypass or banding procedures. So you may actually be able to eat larger meals with this surgery than with others.

The Cons. Biliopancreatic diversion is less common than gastric bypass. One of the reasons is that the risk of nutritional deficiencies is much more serious. It also poses many of the same risks as gastric bypass, including dumping syndrome.

The Risks. This is one of the most complicated and high-risk weight loss surgeries. According to National Institutes of Health, the risk of death from the duodenal switch ranges between 2.5% and 5%. As with gastric bypass, this surgery poses a fairly high risk of hernia, which will need further surgery to correct. However, this risk is lower when the procedure is done laparoscopically.

Laparoscopic adjustable gastric banding

In the adjustable laparoscopic gastric banding procedure, a band containing an inflatable balloon is placed around the upper part of the stomach and fixed in place. This creates a small stomach pouch above the band with a very narrow opening to the rest of the stomach.

A port is then placed under the skin of the abdomen. A tube connects the port to the band. By injecting or removing fluid through the port, the balloon can be inflated or deflated to adjust the size of the band. Gastric banding restricts the amount of food that your stomach can hold, so you feel full sooner, but it doesn't reduce the absorption of calories and nutrients.

Putting a Spiritual Spin on Weight Loss

The easy-to-use 50-day format of "Spiritual Secrets to Weight Loss" emphasizes both the physical and spiritual aspects of weight loss and encourages positive health habits and long-term lifestyle changes. “The secrets to permanent weight loss lie in understanding the power of God.” –Kara Davis, author of Spiritual Secrets To Weight Loss: A 50-Day Renewal of the Mind, Body, and Spirit

Spiritual Diets… Buddhist Diet the Hallelujah Diet, the Bible Diet Body by God

These spiritual diets use the mind and the spirit to stay on track and transform all parts of existence, not just the way the body looks and feels.

Meditation and hypnosis have also been used.

Meditation

Meditation is a relaxation technique that helps the body and mind disconnect from everyday stress and concerns. The more important issues in a person's life can be examined and dealt with from a clear perspective.

Individuals with weight loss goals can incorporate relaxation practices into their daily schedule to address whatever issues are affecting their ability to lose weight. Reasons for overeating vary according to the individual's life circumstances. Stress, boredom or comfort are all possible reasons why a person turns to food.

Interesting… One of the most powerful ways of doing this is to act "as if." Act as if

you have already manifested and created the body and weight loss you want. Act like the thin person you want be!

Acting “as if” creates a powerful energy shift. Your actions will begin to align with your new intentions because it creates a positive expectation of success. You cannot succeed without this!

To lose weight successfully you must also know and feel in your heart that you can lose the weight. You must see yourself as capable of achieving your goal. You must decide that you can win this particular game.

This is what separates the winners and the losers in life. The winners expect to succeed, therefore they do. They have optimism. If you think you can, you can. If you think you can’t, you’re right.

One of the best ways to act “as if” and create positive expectation, or optimism, is through the practice of gratitude, the use of affirmations or positive self-talk, and the power of visualization. - Catherine Taylor, Weight loss “Master.”

Medications for weight loss

Prescription meds, appetite suppressants (Phentermine)

Non prescription meds (Fenphedra) Herbal cleanses (teas) Laxatives Injections (B12)

Behavioral Therapy Mainstream cognitive behavioral therapy assumes that

changing maladaptive thinking leads to change in affect and behavior, but recent variants emphasize changes in one's relationship to maladaptive thinking rather than changes in thinking itself. Therapists use CBT to help individuals challenge their patterns and beliefs and replace "errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing" with "more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior" or to take a more open, mindful, and aware posture toward them so as to diminish their impact.

CBT helps individuals replace "maladaptive… coping skills, cognitions, emotions and behaviors with more adaptive ones", by challenging an individual's way of thinking and the way that he/she reacts to certain habits or behaviors.

Therapy for Wellness

Overall Wellness Occupational health: Includes work that is

meaningful, and vacation Social health: Includes community, social

environment, and family Emotional health: Includes positive and optimistic

feelings about life and oneself Spiritual health: Includes spiritual values and beliefs Physical health: Includes physical activity and health Mental Health: Includes symptoms of depression,

suicidal ideations, attempts, and self harming behaviors.

When is overall wellness therapy needed?

I am ready to create more balance in my life. I am ready to improve my personal or business relationships. I am ready to make real and positive changes in my life. I am ready to find and live my life's purpose. I am ready and willing to overcome self-limiting beliefs and

behavior. I am ready to create plans and take action to achieve my

goals. I am ready to achieve a sense of fulfillment at work and in my

life. I am ready for more fun and enjoyment in my life. I'd like to work less and make more money. I can benefit from someone who will help me to stay on track.

Focus Relationships and Intimacy Stress Management and Balance Spirituality and Personal Growth Entrepreneurial and Small Business Development Career Planning and Development Motivation and Time Management Creativity for Artists, Writers, Musicians and

Performers Finances and Budgeting Health, Aging, Lifestyle and Self-Care Family and Parenting

Health coachingAlso referred to as wellness coaching, is a process that facilitates healthy, sustainable behavior change by challenging a client to listen to their inner wisdom, identify their values, and transform their goals into action. Health coaching draws on the principles of positive psychology and the practices of motivational interviewing and goal setting.[1][2] The terms “health coaching” and “wellness coaching” are used interchangeably.

Coaching and Psychotherapy

Coaching and psychotherapy both are rooted in person-centered psychology. Today many therapists are now coaching or have practices where they concurrently are practicing both disciplines. Both coaching and psychotherapy take place in

individual and group sessions. Both are catalyst for change driven by the desire of

the client for improved health. Both use similar methods of inquiry. A clear difference between psychotherapy and coaching is therapy focuses on a problem while coaching focuses on the solution, driven by client’s inner strength and wisdom.

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