The first step is to determine during the assessment process whether any or all of the following “road blocks” to weight loss are present.
There are 7 reasons for the very substantial difficulty most people experience in attempting to maintain any diet and lifestyle changes to lose weight and keep it off.
An individual with chronic weight loss failure will suffer with most of the following problems which in aggregate, always prevent weight loss, or give rise to further weight gain. Percentages (%) are shown to indicate what we have proven regarding the prevalence of these problems in individuals suffering with severe obesity = BMI 40+ .
Problems with Mood (88%):
Depression, Generalized Anxiety, Social anxiety, mood swings/mood instability, Seasonal Affective Disorder, Bipolar disorder, OCD, etc. .
Chronic daytime sleepiness (65%):
Often rated by using The Epworth Sleepiness Scale, where a rating of 8 or higher indicates sufficient tiredness to stop any weight loss.Many individuals are more tired than they realize and there are many reasons for this. (sleep time inadequate-less than 9 hr., sleep that is disturbed- restless legs syndrome, periodic limb movement disorder, sleep apnoea, upper airways resistance syndrome, etc.)
Chronic pain ( 60%) :
pain that is persistent and rated on average as a 3 or more out of 10 on a standardized pain scale.Ex. A visual analog scale allows you to mark with an “x” , where you rate your average daily pain level: 0 ———— 10. 0 = no pain, and 10 = pain as bad as you can possibly imagine. Pain often accompanies various injuries, conditions such as Osteoarthritis in joints and spine, Rheumatoid arthritis, Migraine-recurrent /chronic, Spinal stenosis, Plantar fasciitis, Fibromyalgia, and so forth.
Chronic indigestion ( 60%):
Symptoms are frequent acid reflux, heartburn, “queasy stomach”, loss of appetite in the first 2 hr. after waking , frequently bloated feeling, abdominal cramps, irregular bowel function, episodic constipation and diarrhoea ( Irritable bowel syndrome) inflammatory bowel diseases, etc.
Disorders of Impulse Regulation, Working Memory and Attention:
The hallmark of these disorders is that they all significantly interfere frequently or always with a persons’ capacity to stay self-directed or “on track” for any reasonable length of time.
There are too many symptoms to list but these examples are included: excessive distractibility, poor time management, impulsivity in many areas of daily living (ex. eating, shopping, gambling), obsessional preoccupations ( ex. cravings that cannot be ignored and which lead to binge eating).Binge Eating Disorder ( 25%), Bulimia nervosa ( 15%), Night-time Eating Syndrome ( 10%), and Attention Deficit Hyperactivity Disorder ( 32-41%).
Circadian misalignment ( affects most individuals) :
where an individual has ever changing bed- time and wake times, or habitually stays up late and arises after too few hours of sleep and whilst it is still dark.An example would be in those working certain shifts, and in those with variants of insomnia, chronic pain, mood disturbances, etc.
Chronic sitting (most individuals qualify):
Being sedentary whilst seated or lying for many hours daily whilst being intensely visually stimulated.The human brain has never been as intensely stimulated as is now the case, whilst the level of activity of the physical body has been so restricted. There are serious consequence of inactivity in the midst of intense visual stimulation including elevated stress hormone levels in the bloodstream, elevated blood pressure, anxiety, depression, and feelings of stress, agitation, and dissatisfaction. Food is often used to soothe these states.