There is no way at present to distinguish between individuals who will or will not develop an eating disorder subsequent to dieting. There is also no way to identify who will or will not be damaged by repeated weight cycling. It is uncertain whether some people will need constant support and monitoring to maintain fat loss. It may be that a different approach needs to be taken for people with a food dependence from the traditional approaches used in behavioural and self-management practice.
A further model for eating disorders has been proposed with reference to obesity and non-purging bulimia, which suggests that repeated cycles of dieting and regaining weight lead to food dependence.” Dependence is defined as ‘the failure to stop using a substance that is deleterious to health and where use results in short term mood alteration’. In this model, food (specifically those foods which are reserved for bingeing episodes) becomes a psychoactive substance. In common with other psychoactive addictions it has the following characteristics:
• food is used in larger amounts, or for longer periods than the person intended
• there is a persistent desire or effort to cut down or control intakes
• there are ‘withdrawal’ symptoms—cravings, anxiety, tension, depression—when the food is not available.
Obese and bulimic clients frequently report bingeing in response to stress, frustration, rejection or other negative emotional states, and it seems likely that both uncontrolled eating and the kinds of food used (high carbohydrate/fat) act synergistically to lower the internal arousal state. Few of these clients are able to activate behavioural self-management techniques at these times.
This presents the fat loss counsellor with a major dilemma; on the one hand is the desire to encourage healthy weight loss, but on the other is the concern about encouraging restrictive eating disorders. Unless the counsellor turns away a client, leaving them at the mercy of someone less scrupulous, they have a responsibility to be helpful, and above all, to do no harm. The following are some guidelines for counsellors, based on this ‘do-no-harm’ principle:
Myth-information. Tai Chi, the ancient Chinese art of movement, is a form of relaxation which may, indirectly, have an effect on nervous eating and thereby improve body fat levels. The physical component of Tai Chi alone, however, is not sufficient to create a significant energy deficit.
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Carbohydrate is a part of food. Starch is a carbohydrate, so too are sugars and certain types of fibre. Starches are nature’s reserves created by energy from the sun, carbon dioxide and water. The building block of starch is glucose, a single sugar.
The simplest form of carbohydrate is a single sugar molecule. Chemically, this sugar molecule is known as a monosaccharide (mono meaning one, saccharide meaning sweet). Glucose is a single sugar molecule which occurs in foods and is the most common source of fuel for the cells of the human body.
If two sugar molecules are joined together, the result is a di-saccharide (di meaning two). Sucrose, or common table sugar, is a disaccharide.
Starches are long chains of sugar molecules joined together like the beads in a string of pearls. They are called polysaccharides (poly meaning many). Starches are not sweet to taste.
Dietary fibres also have a complex structure, containing many different sorts of sugar molecules. They are different from starches and sugars in that they are not broken down by human digestive enzymes. Fibre reaches the large intestine without change. Once there, bacteria begin to ferment and break down the fibres.
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You may say, “I already suffer enough pain. What good can it do to inflict more pain?” I have asked you to go along with me in these ideas, and I must ask you to go along with me in this. Yes, you are suffering pain. In suffering pain in the way that you do, you are having an experience of suffering uncontrolled pain, pain that you can do nothing about. Perhaps it is better to say that your mind is having an experience of pain which it can do nothing about. Now, what I want to do is to give your mind a different kind of experience—an experience of pain which it can do something about, of pain which it can control. This new experience will give your mind a basis from which to work. In this first experiment it does not matter if the pain is very slight. The thing that matters is the new experience of the mind in being able to control it.
Inflicting Pain on Oneself-There is no doubt that these exercises in pain would be easier if I were there to inflict the painful stimulus on you for the first time, rather than you having to do it to yourself. But if you will just make a start, you will find that you can do it quite easily.
Instead of inflicting pain on the patient, I sometimes do it to myself while the patient is watching, and then ask him to do it to himself. So now, although I am not there with you, you can let yourself feel that I have just done it, quite easily and naturally. I was completely relaxed. There was nothing complicated about it. Now it is your turn.
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Dark signs—grey to dark wisps, clouds or lines—also testify to an under-function or weakness of the affected sexual organs. Small black points, or grey-black indented marks, are signs for sclerosis, i.e. enlargement. These signs are especially found in the area for prostate gland.
Iris signs in conditions of the female sexual organs: One finds:
i. Ovary: right iris 35′ and left iris 25′—in the third major zone,
ii. Uterus: right iris 25′—in the second major zone,
iii. Vagina: right iris 25′-28′—in the third major zone.
The ovaries, as with the testicles in man, have close connections with the fore-brain. In case of inflammation-signs in the area for ovary (white signs), one often finds similar signs in the opposite brain area. The same may occur with the dark signs of under-activity, where we often find the so-called Brain-Ovary line. The appearance of this line always indicates disturbance of the sex life with effects upon the cerebrum and mind. Patients with such signs are depressed and oppressed.
In this connection, one should refer to the hypotrophic state and deficient development of the internal and external sex organs in both sexes. This condition may be presumed when one finds a patient with short flat finger-nails. In such cases, the deficient development of the ovary affects the nerve life of the fore-brain, giving rise to the following symptoms:
Frontal headache, giddiness, disturbance from exposure to the sun, travel sickness, sense of pressure from headwear, bitten finger-nails and enuresis in children.
All these symptoms can be confirmed, either singly or in association, in persons with flat short finger-nails. Short nails frequently recede behind the fingertips, especially when they are continuously bitten off or torn off. This is pathological, and no child should be punished for the condition. Headaches cease after the menopause. Furthermore, it is found with especially small nails that there are small dimunitive nipples with deficient lactation in childbirth. On the other hand, nature makes up for these deficiencies by giving an easy normal digestion, so that these persons are seldom thin. Usually, they are of a simple homely disposition, a probable consequence of the influenced cerebral function.
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PRESSURE GROUP TACTICS
You and your friends may well have worked out that a change of school policy would help a lot of you cope more easily with the difficult business of being a woman and a schoolgirl at the same time. You might want to persuade the Head to allow you to wear trousers, for example, or to permit you to stay inside in the warm at break and lunchtimes; to opt out of games or to convert an unused space into a rest room or a sick bay; or to persuade the staff to give you a week’s notice of homework so that you can plan your lives. One or two of you may have made tentative approaches about it and been turned down, so you could be thinking of forming a pressure group. If you are, remember that there are rules to the game and you are more likely to succeed if you follow them.
Start by involving as many of your parents as you can. Parents are far more influential than they realize. Then try to involve the seniors as well. Half the girls in the fifth form have far more impact than two lone second formers. Assume that the Head and his/her staff will agree with what you say and be sympathetic. Most of them will be, eventually, and those who aren’t will find it more difficult to refuse you if you approach them confidently and politely and obviously expecting a favourable answer. If you are thinking of a petition, take great care with the wording. Get parents to help you. And if you are using a spokeswoman, make sure you send her to plead for you at the right time in her month. Last but not least, try not to look too fierce! A smile gets results much quicker than a scowl. Good luck!
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This second exercise is easier than the first because it doesn’t require any furniture. All you need is some music. It’s a sort of dance step, but when you first experiment with it, it’s a good idea to dispense with the music and take each movement slowly until you’ve got the hang of it. Start by standing with your feet slightly apart. If you hold your right hand lightly across the front of your belly and rest your left hand in the small of your back you’ll be able to feel your pelvis rocking once you begin.
The pelvic rock consists of two swinging movements, one forward and one backwards. Imagine you’re a kangaroo with a solid tail resting on the floor behind you. Swing that tail
forward and between your legs until it’s resting on the floor in front of you. You’ll find the movements will make you want to bend your knees slightly. So bend them. Now sweep your tail back again until it’s lying on the floor behind you, where it was when you began. Your knees will probably straighten of their own accord as you lift, but if they don’t, straighten them anyway.
Take your time over these two movements and concentrate as much on what’s happening between your hands as what’s happening to your knees and your imagined ‘tail’ and your legs. As you swing the tail forward, you’ll feel the muscles down the front of your belly lift and tense. When you swing your tail back, it will be the muscles in the small of your back that will be doing the work, and yeu’ll probably feel a certain amount of tension down the front of your thighs too. Of course, these muscles should be working. Their action will be doing you good. But don’t let any of the other muscles in your body come out in sympathy. Check that you’re not tensing your bottom or those valuable muscles in your pelvic floor. Keep your shoulders relaxed and don’t frown, no matter how hard you’re concentrating. This is one exercise that really should be done with a smile on your face.
Once you get the hang of it, you’ll find it’s fun, and it won’t be long before you’re dancing to music. Start with fairly slow tunes and progress until you find the rhythm that’s right and comfortable for you. The choice of music is up to you, whether you use reggae records (the beat is perfect!) or something quieter—I know someone who does a lovely slow rock to Mendelssohn’s Overture to A Midsummer Night’s Dream. This is an exercise you can do at odd moments when you happen to be on your feet. Try it half-way through the washing up. But not in public, please, or you’ll cause a stampede. It’s very sexy.
One final word in his section and that’s about constipation. Lots of women suffer from constipation at period time and of course an overloaded bowel makes all those dragging pains worse. Both these exercises should help to get a sluggish system moving, particularly if you can make time to do them in the morning, quite soon after breakfast.
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Signs and symptoms
A urinary tract infection may produce either no symptoms at all (silent UTI), or any combination of the following: urgency or frequency of urination; painful urination; dribbling of urine; bedwetting; daytime incontinence (inability to control urination); foul-smelling, cloudy, or bloody urine; fever; abdominal or back pain; vomiting; chronic diarrhea; or redness of the external genitals. If the infection is untreated, the symptoms generally disappear in a few days of weeks, but often return later.
The diagnosis of UTI depends upon a careful physical examination, plus urine tests. In boys, the diagnosis involves a search for an obstruction in the urinary tract. In girls, the search for an obstruction is undertaken only after two or three bouts of UTI or one bout with an infection that is resistant to treatment. In an infant, whether boy or girl, investigation for the underlying cause is always undertaken immediately.
Home care
Any attempt at home treatment is potentially dangerous and may result in a low-grade, destructive infection with no outward symptoms.
• A urinary tract infection, particularly one of a series of infections, commonly produces fever, but few or no other symptoms; the doctor’s physical examination reveals nothing unusual.
• To obtain a urine specimen for analysis or culture, cleanse the genitals and collect the portion at the midpoint of urination. In this way, the urine sample will not be contaminated.
Medical treatment
Your doctor will conduct a complete physical examination, including taking your child’s blood pressure and ordering urine tests. If the urine specimen shows an infection, the doctor will put the child on antibiotics for ten to 14 days. Urine samples will be retested during and after the course of antibiotics.
After your child has recovered from a urinary tract infection, your doctor may recommend X rays to determine if there is a physical abnormality. Sometimes, further X rays and direct examination of the urethra and bladder are necessary. To treat recurrent UTIs that are not due to obstruction, your doctor may prescribe the use of antibiotics constantly or on and off for months or years. To correct an obstruction, your doctor may perform surgery.
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The following instructions are provided to help other people responsible for your child and a copy should be given to the school teacher and anyone else who is going to be responsible for him at times when he could have a hypo reaction.
Diabetes
With modern treatment a child with diabetes can live in perfect health with few restrictions of activities.
Treatment relies on daily injections of insulin, a carefully regulated diet, plenty of exercise and regular medical supervision. It is important that the child has his meals (including between meal snacks) on time, and it is usually desirable for him to have extra food or sugar before very vigorous sport, such as swimming or lengthy physical training. Beyond this he should lead as normal a life as possible and no differentiation should be made between him and other children. A child usually feels self-conscious about his diabetes and it is better not to draw undue attention to his condition. Discipline or punishment should not be different for a diabetic child except that he must not have delays in his meals, including morning and afternoon snacks.
Mealtimes for a person with diabetes can be adjusted to fit in with school routine. A child with diabetes should normally have her snacks at recess and lunch with the other children.
If the school does alter recess or lunch times, it will be helpful to warn the parents, as some adjustment in the diet or insulin may be necessary.
Even with a careful regimen, a child may have a reaction to his insulin – the so called hypoglycemic reaction or ‘hypo’. These instructions have been prepared as a guide for teachers and others if they should be responsible for a child during such a reaction.
Hypo reactions
A hypo reaction refers to the behaviour of a child when there is an over-effect of insulin.
Any unusual behaviour in a child known to have diabetes and having insulin, and who previously appeared to be normal, is most probably an insulin reaction, and treatment should be given for it at once. A child may have a different type of reaction on different occasions.
Early stages: (one or more signs may occur at the same time)
1. Unusual lack of concentration, and later listlessness or drowsiness
2. Pallor in a child who previously had a normal skin colour
3. Sweating which may not be appropriate to the weather
4. Undue stubbornness
5. Unusual difficulty in reading and perhaps in speech
6. Readiness to cry for no real reason
7. Headache
Very rarely, if appropriate treatment is not given, a reaction may become more severe.
Later stages: (most children never experience these signs, particularly if treatment for the early stages is prompt)
1. Inco-ordination of movements and unsteady gait
2. Twitching of face or limbs
3. Vomiting
4. Convulsion
5. Unconsciousness
The child may complain of any of the following: hunger, ‘jitters’, numbness and tingling of tongue and lips, double vision, headache, faintness, or sleepiness.
Time of reaction: Each type of insulin acts differently but most reactions in children occur in the hour before the meal time is due. They may occur during or after strenuous exercise.
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Some particular event may motivate us to do something. At another time we may do the same thing from quite different motivation. Just now, when you were looking at TV, were you doing so for entertainment, for enlightenment or simply as an escape?
The housewife has got her husband off to work, and the children off to school. It was all a bit of a rush. And the little one has been complaining of a pain in his tummy. ‘I suppose it was his nerves. But it could be something else.’ She is stressed. Makes a cup of tea, turns on the TV just to help her settle out of it. Her thoughts are taken away from the little one’s tummy, and her husband being in such a rush that there was no kiss goodbye. In a little while her stress is reduced, and she gets on with the chores of housework.
So in this way TV becomes an effective and rather harmless means of relieving minor stress. Her husband comes home. He is stressed by the problems of the day. She wants to discuss household events; she needs to talk to relieve the emotional isolation of being alone in the house. But because of his own tension, he immediately turns on the TV. His tension is reduced and hers rises! Of course, the real answer to this situation lies in the fact that the simple ‘being with’ of man and woman reduces the tension of both parties.
The danger is that TV can become the major stress-reducing mechanism for all and sundry in the household. Anyone who feels a little tense or restless from minor stress turns on the TV. It does not matter what the programme is, it is only the distraction that is wanted. This kind of escape from stress becomes socially destructive from the time that is wasted. If the individual can learn simple, biologically effective ways of managing stress, he is free to use this wasted time in productive leisure that will improve the quality of his life.
The individual may become aware that he is in fact hooked on TV in just the same way as others are hooked on alcohol, drugs or tranquillizers. This awareness itself may be quite upsetting, and will compound with other factors to increase still further the stress situation.
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«Do men get silly as they get older? He is drinking too much. Not much. But enough to be too much. We go to a party. He gobbles up two or three whiskies as soon as he can get them. Then wanders off. Flirts with the younger women. Some of them are flattered. After all, he is a distinguished man. But I am sure some of them would like to give him the slip, and talk with men of their own age. I am just left to my own devices. I don’t like it. Feel embarrassed. Spoke to him about it. All he said was, “You are all right. You can talk to people”, and left it at that. But it is not all that easy for a woman. Besides, I am basically a shy person. I think people notice that the evening goes by and he hardly says a word to me.
‘It’s really the drink. If we go where there is not much drink we stay together, and I quite enjoy it, but he feels it rather a bore.
‘Worse than this, I am frightened he will be caught driving with too high a blood alcohol level. That would be awful for a man in his position. »
She needs to enlist the help of one of his friends. Someone of equal professional status, who can speak to him as man to man on an equal footing.
When we warn someone who is acting foolishly, we want to warn them in areas which are socially acceptable for discussion. In this case his friend should warn him about the dangers of drinking and driving, but should leave the effect of his drinking on his wife alone, as it is much more difficult to tolerate advice in this other area. The effect of the advice, if it is heeded, covers both areas.
It is much better for the advice to be given by a third party, rather than the woman herself. If she gives it, there is a likelihood that it will cause further tension between them.
There is another point. In dealing with stress situations, counseling and the giving of advice is usually not much help, because the type of understanding needed to be effective is something deeper and more biologically significant than the logical understanding of our intellect. But in this case, the consequences of drinking and driving are so simple, and so well acknowledged, that direct counseling may well be effective.
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