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We need to tackle obesity by getting inside patients' heads

Our conventional approaches to obesity just aren't working, says Dr Natheera Indrasenan. It's time to give NLP a try

Our conventional approaches to obesity just aren't working, says Dr Natheera Indrasenan. It's time to give NLP a try

How often have you heard an overweight patient say 'I don't eat a thing doctor, but I can't lose weight'? Often they have tried diet after diet, been referred to the dietician and still stubbornly keep weight on.

Today one person in four is obese, putting a growing burden on the NHS. Studies show the proportion of patients who successfully lose weight on diets can be as low as 9%. Of those who do, about three-quarters regain weight within a year.

So it seems conventional approaches just aren't working. If you do what you always did, you get what you've always got. It is time to consider alternative approaches, and I would suggest psychological techniques. Eliciting and directing patients' motivation, through neurolinguistic programming, can drive weight loss.

It's all a bit like my experience with tax returns. I always used to get fined for getting mine in late. As soon as the form arrived a voice reminded me how bad I am at accounts. I would imagine the process of completing the return as overwhelming.

I put it off, again and again, until I was fined, forced to do it, and realised the actual task was far easier than I had imagined.

The task was easy. The problem arose from my own internal representation of the task, the internal state it created and the resulting behaviour. Essentially, all human behaviour is determined by the internal state, which in turn is determined by our internal representation of external events.

For an obese patient, a call to lose weight can produce similar results to the tax forms landing on my doormat. It may conjure up an internal representation - images and feelings - that is overwhelmingly negative. This produces a stressful internal state that discourages people from doing what they know they should.

Core values

NLP is about identifying whether our reactively created internal representation is producing the desired internal state and behaviour. If not, we use techniques to change the internal representation to one that creates the desired results. As a GP, I have successfully used NLP for the past eight years. The key is to understand that patients don't have to continue running the same old programme. Everyone can create an internal representation that brings the action or outcome we want.

These days I create a large colourful image of the tax return in its envelope, completed and ready to go, which gives me a sense of achievement. My internal state is positive and I can't wait to get the job done.

For obese patients the goal is to help them create an internal representation that is motivating and to practise doing so regularly. We all have subconscious filters, including values and beliefs, that determine our internal representation. These may be the reason patients overeat.

All of us have core values - the subconscious motivating drivers behind our action or inaction - such as sense of achievement, challenge, freedom, control, security, recognition, comfort and love. We hold them in a hierarchy depending on their importance to us, and feel driven to take action when our principal values are being engaged with. But we are not consciously aware of them, so we behave in accordance with them without realising why.

One patient may be motivated to lose weight by a sense of achievement (their top core value). Another may be subconsciously driven to stay overweight because it gives them comfort. When patients say 'yes but…' or 'a part of me wants to go to the gym but another doesn't', there may be a conflict of internal values. This leads to self-sabotage: 'I don't know why I don't do it.' Their top values could be comfort and sense of achievement - and there is a conflict between them. These conflicts can be resolved at the subconscious level using NLP techniques.

Subconscious beliefs

Beliefs, determined by our life experience, also act as subconscious filters that create statements about who we think we are. We may not be consciously aware of them but subconsciously we will behave in a way that maintains their integrity.

Patients who subconsciously believe 'I can never lose weight' or 'it's wasteful to leave food on the plate' will find themselves unable to diet. Like values, beliefs can be changed at the subconscious level to support desired outcomes.

Internal self-image is also a powerful filter determining whether a patient will take action or not. I recently spoke to a lady who had lost five stone, yet had a constant fear she would put it back on. She told me she saw herself as a fat person. Part of her wanted to maintain the integrity of her self-image by driving her to behave in a way consistent with being fat.

Often I see patients who comfort eat, maybe when bored or lonely - food is cheaper and more easily obtained than alcohol or other addictive substances.

The subconscious mind learns, in a Pavlovian way, an association between certain foods and feeling good. NLP offers techniques that teach the subconscious mind to undo this association, so they can take or leave foods like chocolate and crisps rather than being controlled by them. We also teach them to create 'anchors' that deliver good feelings when they need them.

Paul McKenna, who teaches overweight people how to lose weight using these techniques, highlights an interesting study showing that when people eat consciously, slowly and with full awareness, they eat less. Overweight people think about food all day, except when they are eating, when they go into a trance and fail to heed the fullness signal.

Similarly, people eat more when they are watching TV. He has demonstrated the importance of this trance-like state by blindfolding a group of people who were ravenous and giving them a full breakfast. None of them could finish their breakfast because they ate more slowly and became aware of the feeling of fullness, rather than overriding it.

Patients know they need to lose weight to be happier and healthier, yet with diet after diet they try, and fail. Like someone with arachnophobia who knows logically there is nothing to be afraid of, their subconscious drives determine their response - and this is where changes need to be made.

NLP offers a way to do this that is potentially very powerful. With a challenge as intransigent as obesity, it is an approach well worth consideration.

Dr Natheera Indrasenan is a GP in Enfield, north London, and NLP master trainer


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