Tag: apfeldorfer

Gérard Apfeldorfer: “Eating is not a restorative act anymore but a source of anxiety”

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It’s been a while since I last mentioned Zermati, mindfulness and all the things that have helped me stop considering food as my best enemy. I’ve stopped the therapy three years ago now. I’ve been stable for three years, fluctuating sometimes by two or three kilos, without it  being a source of absolute anxiety, without old obsessions relapse, promising myself I would fast for three days, banishing chocolate for life or daily lashing on the mode “I’m just a cow with no willpower”. I’m not going to lie to you, I’m not happy when my trousers get too tight and I’m still terrified by idea of putting on again one day that weight I’ve lost. But this thought is rather far, it doesn’t obsess me like before and doesn’t prevent me from going to the restaurant, enjoying a homemade cake or a finger diner. In short, I’m not sure I’m “cured”, but let’s say remission has lasted long enough for me to be relatively serene.

Now that this little preamble is finished, I thought it could be interesting to share with you Gérard Apfeldorfer’s point of view. He is a psychiatrist and a psychotherapist, and Jean-Philippe Zermati’s associate. At the occasion of the GROS’ congress this week, he gave me an interview in which he reminds us the basic principles of the method he and Zermati have established. Be aware that, next Saturday, there will be a session open to the public. The theme will be “Mangez en faim[1]” and you can attend for free, register here. Knowing that it takes place in Cordeliers faculty of medicine, a place dear to my heart since it’s where my brother presented his thesis. A wonderful place with lots of history, if I weren’t myself on a business trip this week I would have gone for sure. I never have enough of listening to GROS’ speeches, as they turned my life upside down…

I leave the floor to Gérard Apfeldorfer…

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Kindly remind us what the GROS’ objectives are.

Gérard Apfeldorfer: The research group on obesity and overweight is an organization registered as a non-profit association in accordance with the French law passed in 1901 created fourteen year ago. The initial objective was essentially to gather health professionals who were dealing with obesity issues. We had in common being fed up with diets, which we considered as toxic and ineffective. The idea was to explain that weight issues don’t come only under dietetics. Originally, we were rather marginal. Little by little, numerous scientific studies that were showing mid and long term ineffectiveness of diets and their nuisances, namely ascending yoyo effect, eating disorders, self-esteem loss and depression, have ended up convincing the medical world, or least recognized specialist. So now the troop agrees with us! The association evolved in parallel developing alternative method to provide care for obesity and associated eating disorders. Now, we have something to offer.

Kindly sum up the method advocated by GROS. Do you have a way to prove its effectiveness?

Gérard Apfeldorfer: I think it must be made very clear that today there is no method that guarantee lasting weight loss. Research of all kind, genetic, neuro-hormonal, on intestinal microbiota, for example, are in progress but we can’t expect anything immediately. There is no miracle pill! The medical corps is globally resourceless, when the weight loss demand has never been so high. In this context, we have worked on an approach that allows us to help people differently, keeping in mind that we can’t promise results in every instance and that “success” of the therapy requires patients’ involvement, acceptance of spread over time work.

Our method is based on three lines.

The first one is about eating behavior and hunger and satiety sensations identification. These sensations are often totally disturbed by repeated diets and the cognitive restriction they’ve led to. In other words, by always controlling themselves, overweight people have absolutely no idea if they are hungry, what they feel like and when they must stop eating. Forcing yourself to follow dietary rules is contrary to the organism’ physiologic functioning. Several exercises enable our patients to start listening to their eating sensations, to stop demonizing food, including the most calorific, to discover their body’s wisdom as soon as they listen to it instead of brutalizing it. Often, they confess feeling liberated.

Second line, emotions. Eating doesn’t fulfill only physiological needs, but helps, also, with calming emotions, whether it is anxiety, boredom, anger, etc. This is part of cognitive behavioral psychotherapy. We use tools like cognitive therapy and mindfulness, which are very effective and powerful. The idea is not to fight emotions, they are part of us, but learn to accept them without them triggering desires to eat.

Finally, the third line is body. Overweight people often have a very negative perception of their body. It is the target enemy, the one that doesn’t want to obey or function as it should. It results in an internal fight between yourself and your body. Often it ends in an unconscious will to not feel this body, leaving it as still as possible. When you don’t move you don’t “feel” your body. To help with reconciliation, we use, here too, mindfulness techniques like “body scan”, that consist in visualizing each part of your body, to experience this body from within and really inhabit it. Then we encourage patients to start moving again, not with a weight loss purpose (sport doesn’t make you lose weight, at best it helps stabilizing your weight) but in order to be “gentle” with their body. I’m used to comparing this with a pet dog, which, if it always stays in a flat, becomes sad. If you take it to the park, plays with it in the open air, it is happy. The body needs this too. It can imply a bit of efforts, especially in the beginning, but without pointless suffering. The principle being that positive sensations prevail over everything else. It can also be achieved through massages, yoga, tai-chi, very soft exercises.

Is this method the one you use on Linecoaching, which you’ve created with Doctor Jean-Philippe Zermati? Do you have enough perspective to evaluate the results of this online method?

Gérard Apfeldorfer: Yes, on Linecoaching we use the same principles as in our doctor’s rooms. We have started a study together with two hospitals to try to analyse the results, but it’s still too early to draw conclusions. What we notice on Linecoaching is that people who take part in forums are more involved and show a real increase in well-being. Whether for face to face therapy or on Linecoaching, once again, this method requires patient’s involvement, it is not a recipe where the latter is made irresponsible.

Can we really expect personalized care from an online therapy?

Gérard Apfeldorfer: Yes! Studies show that online therapies are equal to similar therapies directly with a professional. Members of Linecoaching receive support from coaches, by email or on the phone. Jean-Philippe Zermati and I often organize chats to answer questions. Being able to participate in many online discussions on forums helps a lot as well. On these forums, people who went through the program already can support and advise newbies. The objective is to promote exchanges and dialogue to fight against the isolation overweight people can feel.

GROS’ yearly conference’s theme is ‘fears’ this year. What are these fears, how do they have an effect on weight and eating behavior?

Gérard Apfeldorfer: We indeed wanted to discuss the different fears that interact with our eating behaviors. They are more and more intense and numerous. There’s the fear to put on weight, of course, which results in general in weight gain, because it triggers restriction mechanisms that themselves result in compulsions. There is the fear to lack, very real for overweight people who anticipate and eat while they are not hungry. There’s finally the fear to eat incorrectly which leads to orthorexia (being obsessed by eating healthy), more present with people consulting nutritionists than in the rest of the population, but it is a widespread trend. We are afraid of poisoning ourselves, afraid of the effect our food choices will have in twenty or thirty years on our organism. Eating is not a restorative act anymore but a source of anxiety.

Is this fear justified, according to you?

Gérard Apfeldorfer : One thing is certain, it is less dangerous to eat now than one century ago, when intoxication risk was high because of toxic additives, dangerous cooking method, bad food conservation or bacteria that are almost inexistent today. I think that behind all current precautions, there’s this belief of being able to fight aging, even death, by only eating ultra healthy food. It’s a slightly useless youth quest, especially when it turns into obsession, and it wastes our present to protect us from the future.

Edit: I might not be very available this week, I’ll be in Lyon from tomorrow for a conference. Generally, it has been a bit crazy lately with work, it explains the slow pace on these pages, I sincerely hope it will slow down!

 

[1] TN: the literal meaning is “Eat with hunger” but it’s also a play on word with “Manger enfin” which sounds the same when pronounced and can mean “Eat at last” or “Finally eat”.

When Zermati et Apfeldorfer settle old scores with Dukan

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No doubt you didn’t miss it but doctors Zermati and Apfeldorfer finally settle old scores with Dukan. Not on a ring, no, but in a small book “Mensonges, régime Dukan et balivernes”[1], which I’ve personally found exhilarating, as it manages to expose the ridiculous – and nevertheless terrifying – aspect of the protein diet pope’s views.

Exhilarating also from the sharp style and some turns of phrase that, I have to admit, made me snigger (I’m a budding sniggerer, it must be said, the one who was systematically caught during class for giggling at jokes from funnier than me). Authors should take the credit for it, but Dukan too, whose words, quoted and dissected in the essay are themselves a huge joke. In which we learn that for example one solution to extra kilos but more globally to ill being lies in taking “for life” what “simply is a treat”: the much vaunted three table spoons of oat bran. Obransly!

In which we discover too that Dukan advises beauty industry to “take part in developing the awareness around overweight’s devastating role in the beauty equation, in the thickening of facial features, in eyes expression, etc.” , that he plans to create a “mac-du”, “big mac double” with …bran patties inside, what else… without mentioning “his future international cooking school to fight excess weight”, or a “French anti-overweight cooking Academy”. Bran it on, once again…

I could talk about it in length as some part also moved me – the book is funny through its irony but doesn’t forget to be serious nevertheless – when I’m now familiarized with the two authors’ theories.

Moved me because it appears rather quickly that, beyond Dukan’s cosmic and imperialist delirium, his method is based on stigmatization of people he calls himself “fat”. I hadn’t read his writings and I guessed he often crossed the red line, I didn’t think he played that cruelly with the essence of a fat person: his or her low self-esteem. In their work, Jean-Philippe Zermati and Gérard Apfeldorfer apply themselves to demonstrating this but also to rehabilitating the honor of overweight people.

I could talk about it in length but I’ve preferred asking doctor Zermati to answer a few questions, so, after this long preamble, here are his answers.

  • Why this book now, why did you go for Dukan as a subject 

The number of patients completely destroyed by Dukan’s method we see every day with Gérard Apfeldorfer made us react.  We are not talking anymore today about an epiphenomenon, but about millions of followers, as he states himself. All these castaways have devastated us, we couldn’t keep quiet.

  • So you decided to bury yourself in his work, to understand the phenomenon?

Exactly. Actually, I had never read his writings. I knew his method, I had heard him on TV, but had never immersed myself in his books. And there, what we discovered stupefied us. More than his precepts to slim down, it’s his philosophy that is terrifying. Not only does that man want to get rid of our fat, he wants in all modesty to save France, and then conquer the whole planet. On the premise that “fat people” are so because they react to their emotions with food – an observation that we share – what does he suggest? Nothing less than eradicating misfortune. As crazy as it gets, a dream for a smooth and purified society, with no emotions and occupied by beautiful and happy people because they are slim. A philosophy that bring to mind one of a guru, even the darkest hours of history…

  • What is, according to you, the most dangerous in Dukan’s diet?

The real danger lies in long terms destruction of eating sensations with, at the end, difficulties to treat eating disorders. Above all, with his permanent stigmatization of overweight people, whom he describes as “dehumanized”, Dukan ends up wiping out all their self-esteem. He has understood very well that the main anxiety of his patients is to be rejected. He plays with this feeling of exclusion by promising to make them more beautiful and thus more loveable. And during a first phase, he indeed makes them slim down. While warning them that if they don’t follow his principles literally, they’ll gain again.

  •    And that it will entirely be their fault…

Of course! It’s the funding principles of his theory and of diets in general. The patient has slimmed down? It’s thanks to the practitioner. He puts on weight again? It’s because he is a loser with no willpower. It’s magical and wonderful because it works every time.

  • Do you have good hopes to be heard and that these practices end?

I believe there’s currently a realization from health practitioners that diets are inefficient. The ANSES report published in 2010 denouncing the iniquity of diets has been a real trigger, even if it wasn’t a revelation for us who’ve been working for 15 years on alternative methods. But there again, there are misunderstandings. Many wanted to see in this report a comparison between good and bad diets. Yet what this report wants to question, it’s the actual concept of diets. Admittedly, we are able to differentiate Dukan’s purification delirium from the lighter Weight Watcher method for example, but it’s wrong to think that Weight Watcher is not a diet.

We sketch in our work a few trails that are the funding principles of our method: self-listening, respect of eating sensations and work on emotions. There are solutions. But they imply that you accept this initial postulate: everybody has a set point and this set point can’t be changed.  The objective of our therapy is to somehow get back to this set point, not to display a spectacular weight loss, even if this happens sometimes, when the patient is just way higher than his or her set point.

Edit: doctors Zermati and Apfeldorfer have put online a petition against diets. Feel free to sign it if you agree with this position. You can also leave your feedback on the site. Besides, you can find the two practitioners on Linecoaching. Very interesting articles are published there, starting with this one (it’s also a portal with paying online therapy).


[1] TN: “Lies, Dukan diet and nonsense”