db 620 PSYC

Cognitive-Behavioral Therapy for Problems With Binge Eating

1: Opening the Session

0 seconds DR. G. TERENCE WILSON

[00:00] DR. G. TERENCE WILSONSo, Pete I know you are here to talk about eating problems and maybe weight problems so let me ask you just to fill me in on what's going on.

10 seconds PETE

[00:10] PETEOkay I have dealt with food issues my whole life. It really became prominent in junior high and high school. DR. G. TERENCE WILSON: And just you are how old at the moment? PETE: I am 36.

25 seconds DR. G. TERENCE WILSON

[00:25] DR. G. TERENCE WILSONSo it goes back to high school?

30 seconds PETE

[00:30] PETEYeah, I was not a really, I wasn't one of the popular kids, I wasn't really one of the unpopular kids I just kind of was there and that made me kind of a target sometimes for being picked on and stuff like that and that was my way of dealing was to go home and eat large amounts after school. DR. G. TERENCE WILSON: So it was kind of comfort eating?

55 seconds PETE

[00:55] PETEYeah. DR. G. TERENCE WILSON: Eating with feelings kind of thing.

1 minute 0 seconds PETE

[01:00] PETEYeah or you know not having to think, just filling myself up and getting real tired from that and sleeping. That was always done pretty much alone. I wouldn't overeat as much at dinner or meals with other people because that was done when I had the house to myself. DR. G. TERENCE WILSON: Kind of anonymous? PETE: Yeah.

1 minute 25 seconds DR. G. TERENCE WILSON

[01:25] DR. G. TERENCE WILSONIf I may ask what's your current weight? PETE: About 275.

1 minute 30 seconds DR. G. TERENCE WILSON

[01:30] DR. G. TERENCE WILSONWhat's your height? PETE: Five ten.

1 minute 35 seconds DR. G. TERENCE WILSON

[01:35] DR. G. TERENCE WILSONAnd what's the highest your weight has ever been? PETE: 325.

1 minute 40 seconds DR. G. TERENCE WILSON

[01:40] DR. G. TERENCE WILSONWhen was that? PETE: It was probably about four years ago, four

1 minute 45 seconds PETE

[01:45] PETEand half years ago, I lost about 125 after that now I am on the upswing again.

1 minute 55 seconds DR. G. TERENCE WILSON

[01:55] DR. G. TERENCE WILSONSo the lowest then was about 200. PETE: As an adult about 200, yes.

2 minutes 0 seconds DR. G. TERENCE WILSON

[02:00] DR. G. TERENCE WILSONAnd what -- that's a lot of weight to have lost what that about was, were you on a program or it was just deliberate?

2 minutes 10 seconds PETE

[02:10] PETEI have done it before I had lost about 75 pounds in my early 20s, and my dad is a runner and he has never been pushy about that or anything but I finally got into running I started walking and then running and it became a kind of addictive and then once the exercise took over I started eating a little healthier, I didn't do any specific diets or anything I just ate less and little more made wise choices with food and then of course that weight all came back on and then this second time around I started walking, and then running, and then the food kind a became easier to control.

2 minutes 55 seconds DR. G. TERENCE WILSON

[02:55] DR. G. TERENCE WILSONAnd just going back to that so you lost 125 pounds and take me through what then happened, how did you then start going back up?

3 minutes 10 seconds PETE

[03:10] PETEPart of the weight loss was when I was dating the woman who soon became my wife and I you know you kind of want to show your best side so I was trying to be as good as possible that helped me lose the weight, and then we got comfortable with each other, and we both enjoy food and so I started eating again and exercising less, and at the time I was getting my master's and my teacher certificate, and I started becoming stressed about that, stressed about find a job and then I got job and the stress of course didn't end, it just got worse and so it was really easy to just say well, I deserve it I can go home and eat whatever I want. DR. G. TERENCE WILSON: Right, and I guess

3 minutes 55 seconds DR. G. TERENCE WILSON

[03:55] DR. G. TERENCE WILSONyou must have got pretty busy? PETE: Yes yeah. DR. G. TERENCE WILSON: And lots of thing to do. PETE: Much less time to exercise.

4 minutes 0 seconds DR. G. TERENCE WILSON

[04:00] DR. G. TERENCE WILSONRight, so it sounds then that the big change -- tell me if I have got this sequence right -- was you really started getting into exercise, walking and then running, that kind made it easier to eat in a healthy nutritious way.

4 minutes 20 seconds PETE

[04:20] PETEYeah. DR. G. TERENCE WILSON: And then when you stopped doing the exercise

4 minutes 25 seconds DR. G. TERENCE WILSON

[04:25] DR. G. TERENCE WILSONthen you started relying more on food as kind of a reward and to deal with stress.

4 minutes 30 seconds PETE

[04:30] PETEYeah. One of my things that seems to go hand in hand with this is depression and I have had had trouble with that in the past. I have been diagnosed with -- I mean one time I was diagnosed bipolar and that got sort of changed and it's just more of a general depression but I had been on medication for that, but I discovered that exercise and eating better really minimizes the symptoms of depression and...(crosstalk) DR. G. TERENCE WILSON: Okay let me

5 minutes 0 seconds DR. G. TERENCE WILSON

[05:00] DR. G. TERENCE WILSONcome back to that in a minute. PETE: Okay.

2: Family History & Medication

5 minutes 5 seconds DR. G. TERENCE WILSON

[05:05] DR. G. TERENCE WILSONBecause that sounds really important. How about family history of weight problems?

5 minutes 10 seconds PETE

[05:10] PETEMy Dad was a runner from the early 70s on when it was not even a fad and he has never had weight problem than I know of. My mother would say she has been on the big side, I don't really see it as much, but I know she loves food just as much as I do. And my dad sees food as fuel and my mother sees it more as well as food can be good and tasty and...(crosstalk)

5 minutes 45 seconds DR. G. TERENCE WILSON

[05:45] DR. G. TERENCE WILSONAnd which is same for you? PETE: Yes definitely.

5 minutes 50 seconds DR. G. TERENCE WILSON

[05:50] DR. G. TERENCE WILSONBrothers and sisters. PETE: I have one sister she is two years younger

5 minutes 55 seconds PETE

[05:55] PETEand she is kind of typical high school girl who thought she was big but she was not at all. And she got preoccupied with her weight for a while and now she is pretty good with it, she just she runs quite a bit. She is not that crazy about exercise but she likes to do it a little bit, but she has never been anywhere near obese or anything like that. DR. G. TERENCE WILSON: So it really sounds as though when you were into the exercise

6 minutes 25 seconds DR. G. TERENCE WILSON

[06:25] DR. G. TERENCE WILSONand running you enjoyed it and it really worked for you? PETE: Yes.

6 minutes 30 seconds DR. G. TERENCE WILSON

[06:30] DR. G. TERENCE WILSONIn terms not just of your eating but -- so now let us talk about the depression but it also lifted your mood and made you feel better? PETE: Definitely, exercise and movement really minimize

6 minutes 40 seconds PETE

[06:40] PETEthe symptoms, really get the endorphins or whatever is up there, the serotonin, moving in (inaudible).

6 minutes 50 seconds DR. G. TERENCE WILSON

[06:50] DR. G. TERENCE WILSONRight, and you think also eating in a healthy way might also have contributed to that.

6 minutes 55 seconds PETE

[06:55] PETEI think so, because my binge foods would make me so logy and bring me you know it is almost like drinking or something, it would have such a depressing effect.

7 minutes 5 seconds DR. G. TERENCE WILSON

[07:05] DR. G. TERENCE WILSONAre you currently taking any medication for depression?

7 minutes 10 seconds PETE

[07:10] PETENo. DR. G. TERENCE WILSON: Do you feel depressed or?

7 minutes 15 seconds PETE

[07:15] PETEYeah I still have it and I have the symptoms more and now that I am gaining weight again and not exercising it is becoming more of a problem.

7 minutes 25 seconds DR. G. TERENCE WILSON

[07:25] DR. G. TERENCE WILSONSo you were treated for it initially, was it initially that someone said that you are bipolar? PETE: Yeah. I had moved to Los Angeles

7 minutes 35 seconds PETE

[07:35] PETEin 1992. I had dropped out of college. I had been going to Northern for few semesters and just nothing clicked for me there. I did not want to keep going if I was not going to finish and I was living with my parents going from job to job and I finally decided to move out to Los Angeles and I kind of lost of all this weight, I was really -- it seemed kind a like manic behavior to me and Nirvana was a popular band at that time and there was this preoccupation with kids and teenagers being bipolar, and I guess when I went for a diagnosis, maybe the romanticism of being bipolar instead of just depressed kind of crept in and -- but after being on Wellbutrin and lithium and things like that, the doctor finally realized there was no real mania involved I think I had just been so...(crosstalk)

8 minutes 35 seconds DR. G. TERENCE WILSON

[08:35] DR. G. TERENCE WILSONYou did say they took you off lithium? PETE: Yeah. DR. G. TERENCE WILSON: And have you been on meds since that?

8 minutes 40 seconds PETE

[08:40] PETEI tried several things, Wellbutrin, Zoloft . . . DR. G. TERENCE WILSON: When was the last time you were on medication?

8 minutes 50 seconds PETE

[08:50] PETEIt has been probably nine years. I was never very happy with the side effects, and I talked to enough people that said maybe my symptoms weren't bad, if I would start exercising and dieting and generally that is right that if I just do that it is manageable.

9 minutes 20 seconds DR. G. TERENCE WILSON

[09:20] DR. G. TERENCE WILSONIs it today -- does it interfere with your work or does it interfere with doing things with the family at all?

9 minutes 30 seconds PETE

[09:30] PETEYeah, definitely, especially with work. There are days when I just feel like I cannot teach and I have nothing to offer these kids, and it just feels so hopeless and I have been through this enough times that I know it is really just an illusion and it's just sort of like looking at -- everything I look at seems negative and so of course my teaching would suffer. And I know if I make it through that I will feel good again the next day usually and especially if I don't go drown my sorrows and a big old Entenmann's cake or something.

3: Eating Habits

10 minutes 5 seconds DR. G. TERENCE WILSON

[10:05] DR. G. TERENCE WILSONRight. Tell me a bit about your eating habits. I have just spoken to your wife so I have some idea but let us start with you, can you give me, if there's such a thing, a typical weekday and then a typical weekend? Let's start with the weekday. PETE: The weekdays are the best.

10 minutes 25 seconds PETE

[10:25] PETEThere is a regimen to my day and I get up usually by 5 or 5:30. I get a little time to myself and I am in a pretty good state of mind, and I'll just eat a bowl of cereal, usually something high in fiber, something pretty healthy, a little bit of cottage cheese or some kind of protein and a piece of fruit, and I feel great about that and I say this is going to be the day, I am going just keep this up. And lunch is controlled because I bring sack lunch to school and I eat in my classroom while the kids are getting their lunch, and that is pretty easy to do. I can't go anywhere to get anything. DR. G. TERENCE WILSON: That's a great start, breakfast and then lunch.

11 minutes 5 seconds PETE

[11:05] PETEYeah, and then I get home and especially if I have the house to myself, if she is out shopping or she is still at school or something than I will start to forage and look around the kitchen for stuff, and sometimes I'll binge.

11 minutes 20 seconds DR. G. TERENCE WILSON

[11:20] DR. G. TERENCE WILSONAnd that's sort of like the old pattern right, when you got home from school and you were by yourself?

11 minutes 25 seconds PETE

[11:25] PETEIt is exactly, and I'll make several sandwiches or whatever I can find.

11 minutes 30 seconds DR. G. TERENCE WILSON

[11:30] DR. G. TERENCE WILSONSo if I've got this right it's not because you are hungry or so on but the opportunity is there, you are by yourself it's kind of part of the old pattern. And does it help to kind of like numb out or not think of any of the problems that you might have had at school or work related?

11 minutes 50 seconds PETE

[11:50] PETEYeah, yeah and even if it's not a stress thing even if I had a good day at school and I am feeling really good, if feeling like a great teacher or something, it's just then I want to multiply that feeling of goodness and celebrate and just -- I mean food to me is like the big bright spot on the horizon at all times.

12 minutes 10 seconds DR. G. TERENCE WILSON

[12:10] DR. G. TERENCE WILSONYeah, that could also be a reward that I really killed them today, I really did well, and so on and so it's kind of a treat for me then.

12 minutes 15 seconds PETE

[12:15] PETEYeah, definitely. DR. G. TERENCE WILSON: You used the word binge, so if we think

12 minutes 20 seconds DR. G. TERENCE WILSON

[12:20] DR. G. TERENCE WILSONbinge as like this unusually large amount of food, we have this loss of control where you feel that you just can't resist starting to eat if once you start eating you can't stop. That's when it tends to happen when you've come back from work and you are by yourself? PETE: Yeah,

12 minutes 40 seconds PETE

[12:40] PETEgenerally almost always by myself. My wife likes to joke I won't eat sugar in front of her and it's kind of true. Usually when I am around people I feel so self-conscious about my eating habits and I won't binge at all. DR. G. TERENCE WILSON: And of course it's not uncommon that,

12 minutes 55 seconds DR. G. TERENCE WILSON

[12:55] DR. G. TERENCE WILSONhow often then would you say you binge on an average week? PETE: Probably three to four times

13 minutes 5 seconds PETE

[13:05] PETEa week. Sometimes it will be weeks, you know a whole week, where I won't binge at all, those are kind of rare, but usually three to four times.

13 minutes 15 seconds DR. G. TERENCE WILSON

[13:15] DR. G. TERENCE WILSONAnd any particular binge foods? You mentioned sugar.

13 minutes 20 seconds PETE

[13:20] PETEExcuse me, I do like sugar a lot and anything with like meat and cheese, sandwiches. If I don't have meat or cheese around I'll do peanut butter and jellies, bread, carbs.

13 minutes 40 seconds DR. G. TERENCE WILSON

[13:40] DR. G. TERENCE WILSONAnd so basically you feel good during a binge and then just take me through the sequence -- after the binge.

13 minutes 50 seconds PETE

[13:50] PETEYeah, I'll feel kind of guilty starting it and then I get a little taste and I just feel really good and really high about it, and I generally will keep eating until I've run out of good stuff that I can find and -- or when I start to just feel really almost too full. DR. G. TERENCE WILSON: And then?

14 minutes 15 seconds PETE

[14:15] PETEAnd then I feel really guilty and I think, why did I do that?

14 minutes 20 seconds DR. G. TERENCE WILSON

[14:20] DR. G. TERENCE WILSONHow could I have done this again, what do I do? PETE: Yeah. DR. G. TERENCE WILSON: And then do you really get down on yourself and get very self-critical? PETE: Yeah, yeah, and I feel like

14 minutes 30 seconds PETE

[14:30] PETEI can't accomplish anything then and I just -- I'll lay down, and it's not even a nice relaxation laying down, it's just cause I am feeling physically sick and then mentally I am just being really mean to myself.

14 minutes 45 seconds DR. G. TERENCE WILSON

[14:45] DR. G. TERENCE WILSONYou're really beating yourself up. Give me a little idea of that dialogue that voice that's going on at that point. What are you saying to yourself? PETE: Yeah, I always mess this up, I can never

14 minutes 55 seconds PETE

[14:55] PETEyou know lose the weight again, I am doomed to do this all the time and you know start feeding into other areas of my life. I will think oh my God and now I am going to be huffing and puffing in front of my kids, well I am not a very good teacher.

15 minutes 10 seconds DR. G. TERENCE WILSON

[15:10] DR. G. TERENCE WILSONRight, so I can't do this and now it spreads to other areas of your life and so it sounds as though before you know where you are you are kind of this hopeless incompetent person?

15 minutes 20 seconds PETE

[15:20] PETEDefinitely. DR. G. TERENCE WILSON: That's tough.

15 minutes 25 seconds DR. G. TERENCE WILSON

[15:25] DR. G. TERENCE WILSONOther than the exercise and running times when you have been into that, have you found that anything else that you have done or tried has helped? PETE: One of my

15 minutes 40 seconds PETE

[15:40] PETEquick relaxation techniques is any kind of puzzles whether they are word puzzles or jigsaw puzzles. I like things that are solvable and sort of convergent that you can just, you know, they have a solution you know you will get to them and if you just plug away you will get there. In fact in between classes at school sometimes if I am feeling stressed, I will play Freecell or Solitaire, things like that on the computer and...(crosstalk) DR. G. TERENCE WILSON: What do you teach by the way?

16 minutes 10 seconds PETE

[16:10] PETESpeech and English at the high school level.

16 minutes 15 seconds DR. G. TERENCE WILSON

[16:15] DR. G. TERENCE WILSONSo there are some things that you could turn to that, I don't want to say it would be a substitute but that kind of could be incompatible with bingeing?

16 minutes 25 seconds PETE

[16:25] PETEDefinitely, yeah.

16 minutes 30 seconds DR. G. TERENCE WILSON

[16:30] DR. G. TERENCE WILSONWhen you get self-critical and you start really beating yourself up, are you critical of your actual body, of how you look and do you avoid things because of that? Do you start thinking of things like, well I put on all this weight, I do not deserve to go out or go to this function or do stuff like that?

17 minutes 0 seconds PETE

[17:00] PETEI feel yeah I feel very uncomfortable. I can't stand being around mirrors let alone other people, and I just you know, I hate the way my clothes feel on me I feel like I got nothing to wear out anyway and that all makes me look fat.

17 minutes 20 seconds DR. G. TERENCE WILSON

[17:20] DR. G. TERENCE WILSONYou weigh yourself?

17 minutes 25 seconds PETE

[17:25] PETENot often. I'll go a week or two without weighing myself. Now when and my wife are being more conscious, I'll try to weigh myself every couple of days. Especially if I have been good I like to see the numbers go down. DR. G. TERENCE WILSON: Right, right,.

17 minutes 45 seconds DR. G. TERENCE WILSON

[17:45] DR. G. TERENCE WILSONSo you might weigh yourself more than once a day when say you are on a roll and you are doing well?

17 minutes 50 seconds PETE

[17:50] PETENo, that to me is kind of, I have read enough I know that's kind of obsessive. And that you fixate on the number and not the feeling. DR. G. TERENCE WILSON: Good, yeah good for you.

18 minutes 0 seconds DR. G. TERENCE WILSON

[18:00] DR. G. TERENCE WILSONThat is the experience. You have a scale at home? PETE: Yeah.

18 minutes 5 seconds DR. G. TERENCE WILSON

[18:05] DR. G. TERENCE WILSONSo it's one of those things when things are going good or going okay then it is one of the thing that works as well, because you pay attention to that, and you are paying attention to what you are eating. And then if things aren't going so well you sort of go on to another pattern of not doing it and so. Any other ways in which you have been self-critical plays into causing problems in life?

18 minutes 35 seconds PETE

[18:35] PETEI think I am afraid to get involved in anything. For example, at school, the speech team coach has been after me to be one of the assistant coaches, and I just feel like oh, I am going to mess it up, I don't know anything about this speech team, and I don't want to have to learn a whole new thing because I'm probably not going be very good at it and then I am just going to disappoint him, and there is lots of thing like that, or I feel like maybe I could get involved in after school stuff and then I think no I don't I can take on anything else I can barely handle the teaching.

19 minutes 15 seconds DR. G. TERENCE WILSON

[19:15] DR. G. TERENCE WILSONRight, are you conflicted about that? I mean are there times when you think, yeah maybe I could do this all, maybe I should do it? PETE: Yeah, when I am feeling pretty good about myself

19 minutes 25 seconds PETE

[19:25] PETEI think you know I have been around kids that I get along with and they you know hey Mr. Stapleton, you got to come out and coach us do this do that and I feel okay I do know what I am doing. I mean I was always a good student at least after high school and after my first try at college, I had always gotten awards and high A's, perfect A's and then I kind of forget that sometimes. DR. G. TERENCE WILSON: In fact you just anticipated what I

19 minutes 55 seconds DR. G. TERENCE WILSON

[19:55] DR. G. TERENCE WILSONwas going to ask you next which was you've told me that you get really down on yourself about weight and maybe not taking care of yourself and that kind of spreads to other areas of your life, so some of the things, tell me some of the things that you do that you do well, that give you a sense of accomplishment, of competence?

20 minutes 20 seconds PETE

[20:20] PETEWell, the first one is kind of silly, but I love to clean, I love organizing, I love to, you know, sometimes after my binges I will get up and just start cleaning the house and it feels really good and you can look around and say, oh look what I did today. DR. G. TERENCE WILSON: No, I mean that doesn't have to be some huge thing,

20 minutes 40 seconds DR. G. TERENCE WILSON

[20:40] DR. G. TERENCE WILSONit's just some activity that gives you some sense, hey I'm doing something, I'm getting something done, a sense of accomplishment.

20 minutes 45 seconds PETE

[20:45] PETEExactly, and also writing. I have been joking around with my students lately because I'm teaching a research paper now, but I remember how much writing this research papers were awful in high school, but sometime after high school I started just writing on my own and I got pretty good at it, and by the time I went back to college my professor started pulling me aside and remarking on my writing ability, and I submitted papers and won awards and I published a couple times, but I don't do it. I don't do it now that I'm not in school and I kind of regret that.

21 minutes 20 seconds DR. G. TERENCE WILSON

[21:20] DR. G. TERENCE WILSONEven the way you're saying that now has this very sort of modest if not dismissive tone. I mean, so I'm hearing a professor pulls you aside, which is not an everyday occurrence, and you write various papers and you win awards. Sounds like something of a big deal I mean --

21 minutes 45 seconds PETE

[21:45] PETEI guess it is. I don't know it's, I don't know I'm not real good at giving myself credit, I feel like if I'm good at it then it is probably not that important.

21 minutes 55 seconds DR. G. TERENCE WILSON

[21:55] DR. G. TERENCE WILSONYeah, well, I should be able to do that and then sounds as if, but you focus a lot of attention on some of the things you think you're not good at and you do not miss an opportunity to beat yourself up and --?

22 minutes 10 seconds PETE

[22:10] PETEYeah, I kind of tend to look at everybody else and think they're good at useful things and if I'm good at it it's probably not that useful or anything. DR. G. TERENCE WILSON: Let's come back and that's an important point that I've noted down,

22 minutes 25 seconds DR. G. TERENCE WILSON

[22:25] DR. G. TERENCE WILSONlet's come to back to that at the end here. Anything about eating or weight that I haven't asked about that we should talk about?

22 minutes 35 seconds PETE

[22:35] PETEI don't think so.

4: Advantages & Disadvantages

22 minutes 40 seconds DR. G. TERENCE WILSON

[22:40] DR. G. TERENCE WILSONThe question I often ask people is if you were thinking about making a change -- so let's assume at this point we're talking about you sort of recommitting yourself to make an effort to eat in a healthy, moderate way which would be good for health, energy, probably for your mood as well. There are some obvious advantages to doing that. How about any disadvantages to making that commitment to doing it?

23 minutes 15 seconds PETE

[23:15] PETEI feel like, you know, I'm giving up food as a friend. DR. G. TERENCE WILSON: Right, no, this is why I'm asking it because

23 minutes 25 seconds DR. G. TERENCE WILSON

[23:25] DR. G. TERENCE WILSONthere is this kind of balance of sometimes competing interests and outcomes, which is -- I find important to kind of think through and so on to really get a feeling, so -- okay so I'm going to note these down and then we'll elaborate on them. So one is giving up something that -- the sense is that I'm given up something I really enjoy like an old friend, okay.

23 minutes 50 seconds PETE

[23:50] PETEYeah. I probably one of the big ones is failing. I'm afraid that I won't be able to do it and -- I mean, I get worried when I'm eating like this that I'm out of control and I can't control myself, but then sometimes I think well if I don't try then I don't have to feel like that.

24 minutes 10 seconds DR. G. TERENCE WILSON

[24:10] DR. G. TERENCE WILSONRight, so there is a fear that, well, I did it once before, but that maybe I don't have an -- if I really tried I couldn't do it. PETE: Yeah.

24 minutes 20 seconds DR. G. TERENCE WILSON

[24:20] DR. G. TERENCE WILSONAnd that would be a scary prospect, okay. PETE: Those would be the two main ones

24 minutes 25 seconds PETE

[24:25] PETE, I think. DR. G. TERENCE WILSON: Well, I think you are pretty insightful about these things,

24 minutes 30 seconds DR. G. TERENCE WILSON

[24:30] DR. G. TERENCE WILSONand those are real issues. So in terms of this balancing act, if you were to -- let's take those seriously, those are real considerations, and balance them against the advantages, let's just go over some of advantages again. If you were to cut out the binges, eat in a more healthy fashion, what would be the real advantages to you?

25 minutes 0 seconds PETE

[25:00] PETEWell, clothes fitting, it would be kind of a small one, but it would feel good, I wouldn't feel like I'm going to have to go buy yet another set of fat clothes. Feeling physically fit, and I think the most important one is my mood just -- and even if I can't control everything just feeling like I have some control over my emotions and my mental health.

25 minutes 30 seconds DR. G. TERENCE WILSON

[25:30] DR. G. TERENCE WILSONHow about your health in general? Cholesterol level? Do you get your health checked, do you...(crosstalk) PETE: Actually, just a few weeks ago

25 minutes 40 seconds PETE

[25:40] PETEand it was I think 20 or 30 points too high and so -- my doctor had actually put me on a high blood pressure medication, so to get off of all that would be nice.

25 minutes 55 seconds DR. G. TERENCE WILSON

[25:55] DR. G. TERENCE WILSONIs you doctor saying you should lose weight in order to deal with this or not? PETE: He didn't

26 minutes 0 seconds PETE

[26:00] PETE-- he is not a very talkative guy, but I think I inferred that from what he was... DR. G. TERENCE WILSON: No problem with blood sugar or diabetes?

26 minutes 10 seconds PETE

[26:10] PETENo, and I've always been worried about that and every time I've gone for a physical, I've had them check that, and I haven't been prediabetic or anything, so but I think if I continue to do this I think it would just be a matter of time.

26 minutes 25 seconds DR. G. TERENCE WILSON

[26:25] DR. G. TERENCE WILSONAnd you've got health in there, so -- mood, which is a big one, health, which is big, but on a day- to-day basis feeling comfortable in what you are wearing and being able to do it, that is certainly not unimportant. So if you kind of stack up the advantages and disadvantages, where do you think you come down?

26 minutes 50 seconds PETE

[26:50] PETEThe advantages win out easily. DR. G. TERENCE WILSON: Really, gut-level feeling that you really

26 minutes 55 seconds DR. G. TERENCE WILSON

[26:55] DR. G. TERENCE WILSONbelieve that -- ? PETE: Oh yeah, and I have had the success with it before

27 minutes 0 seconds PETE

[27:00] PETEand I remember what it feels like to just to not get so depressed all the time and that is a real concrete feeling, it's a good thing.

27 minutes 10 seconds DR. G. TERENCE WILSON

[27:10] DR. G. TERENCE WILSONYeah. You mentioned as one of the disadvantages, potential disadvantage, of giving up something that's really important to you and that you really like, food, or this sense of an old friend, so let me ask you this: If you were to go back to more healthy eating pattern where you didn't binge, would that necessarily mean that you would be denying yourself the old friend?

27 minutes 50 seconds DR. G. TERENCE WILSON

[27:50] DR. G. TERENCE WILSONSo I'm not clear, is it, is it the bingeing that was -- that you are kind of a little unhappy about letting go or is it certain types of food? PETE: I don't feel like I would have to give up any

28 minutes 5 seconds PETE

[28:05] PETEcertain type of food. In fact my success before, I didn't give up sugar, I didn't give up cheeseburgers, I didn't give up having some beers, but I just -- it was all in moderation. What scares me is that missing that feeling of just being able to go to like say a buffet and just really, really pig out, and there is -- even if it's twisted there is some satisfaction in that.

28 minutes 35 seconds DR. G. TERENCE WILSON

[28:35] DR. G. TERENCE WILSONSure and I understand that, but let's say I had spoken to you right in the middle of the time you were doing really well where you were eating in moderation and so on and if we could sort of re-run this conversation back and I said to you, Pete, tell me, are you really missing something here or is this good? Is this still satisfying just from the food point of view? You're not, now you still allow yourself food that you like you are not getting rid of or trying to avoid all sorts of food, do you really miss binging at this point, what do you think you would say? PETE: No, I don't miss it all.

29 minutes 15 seconds DR. G. TERENCE WILSON

[29:15] DR. G. TERENCE WILSONYeah, I think that's -- that would be the case, and in fact I think you're ahead of the game because anyone in nutrition or weight loss I think these days, if you look at the evidence, would say to somebody the best way, the healthiest way to do this is basically to do what you did, eat in moderation. Don't deny yourself all the food that you love because let's face it, unless you are a saint you are not going to -- sooner or later you're going to say I just got to have that cheeseburger. PETE: Yeah. DR. G. TERENCE WILSON: But if you can do it in moderation you are not really denying yourself being able to eat well, and why not? If you like food -- some people like food more than not, I think it's important that you still enjoy it, but, a big but, in moderation, and if you can do that then it's good for health, it's good for the pattern. And I think the key thing is then you'll find as you sounds that you have done before that there is kind of no need to binge, that in my experience of bingeing usually comes in when eating habits become kind of disorganized when you skip meals, like skipping a breakfast or going too long without eating anything, and then you start eating something-- let's say you have breakfast and then you don't have anything until about 4:30, by that time you are getting hungry and then you might eat something you like then it's pretty hard to stop.

30 minutes 45 seconds PETE

[30:45] PETETo stop, yeah. DR. G. TERENCE WILSON: Whereas if you had lunch in between, it gives you more structure, more control.

30 minutes 50 seconds DR. G. TERENCE WILSON

[30:50] DR. G. TERENCE WILSONThat's really the way and it's a very effective way to rid of binge eating, that -- healthy eating is moderation. Its regular, so you should have breakfast, lunch, dinner, and with a planned snack or more than one planned snack in the afternoon. PETE: That would really help me especially if I

31 minutes 10 seconds PETE

[31:10] PETEhad something right before I came home, even just an apple or something, then I come home and I'm not quite as hungry. DR. G. TERENCE WILSON: Yeah, I wrote that down that's --we call that a high-risk situation

31 minutes 20 seconds DR. G. TERENCE WILSON

[31:20] DR. G. TERENCE WILSONof you coming home, you are by yourself, you are probably a little tired, you are coming down from a hard day's work, and it's pretty tempting. It is like a classic high-risk situation for people having eating problems, and it makes sense because that food is very tempting at that point, so one of the strategies would be to try to plan ahead of time to do that. PETE: Yeah

31 minutes 45 seconds DR. G. TERENCE WILSON

[31:45] DR. G. TERENCE WILSONBut again I think you've got exactly the right idea about what it would take in terms of the changes you would need to make that would knock out the disadvantage of losing this old friend, and that leaves us here the one disadvantage of fear of failing. And it's possible that of course that you could try this and it would not work.

32 minutes 10 seconds PETE

[32:10] PETEIt's happened hundreds of times before. DR. G. TERENCE WILSON: But you have also got some experience

32 minutes 15 seconds DR. G. TERENCE WILSON

[32:15] DR. G. TERENCE WILSONwith it working and really making a big difference. So here are some of the thoughts that I would have about this that it sounds really important to make some of these changes, to make a commitment, and there are no quick fixes, and we talk about lifestyle change on a day-to-day basis, and it's kind of got to be long term. Dealing with weight issues is a chronic problem.

32 minutes 50 seconds DR. G. TERENCE WILSON

[32:50] DR. G. TERENCE WILSONYou can't just, you know it is not like having some kind of bacterial infection and then having an antibiotic and bang, it's gone. It's more something like if you had hypertension, your blood pressure is high. Basically, your doctor has probably told you, you have to keep taking the antihypertensive pills. Well, weight problems are kind of chronic too, so you have to stay after them. But in order to do it on a day-to-day basis, you need to make lifestyle changes that really fit for you in your lifestyle, so moderation works, don't deny yourself the pleasure of eating.

33 minutes 30 seconds DR. G. TERENCE WILSON

[33:30] DR. G. TERENCE WILSONYou don't want to feel guilty about eating all the food because that has not helped you right? PETE: No. DR. G. TERENCE WILSON: If anything it makes things worse? PETE: Yeah.

33 minutes 40 seconds DR. G. TERENCE WILSON

[33:40] DR. G. TERENCE WILSONOur experience is, if somebody starts beating himself up about being overweight, it is usually a trigger to eating more, so that's not helpful. PETE: It's a cycle.

5: Psychoeducation

33 minutes 50 seconds DR. G. TERENCE WILSON

[33:50] DR. G. TERENCE WILSONSo I think if you could -- as I mentioned to your wife as well -- if you could find some program -- I think you need some help, with a program that helps provide some structure and helps provide some support -- it's all about motivation, right. You're knowledgeable, in fact you're pretty insightful, you know yourself, you know what has worked for you, what hasn't worked for you, and if you could get back -- and you've really done it the right way of exercise and physical activity, which is great for your health, and then that kicks in improving your eating, and then the big one , I think, improving mood so that you would not need to go on antidepressant meds etc.

34 minutes 35 seconds DR. G. TERENCE WILSON

[34:35] DR. G. TERENCE WILSONThat would be a great way of looking after yourself but also benefiting your family. PETE: Yeah. DR. G. TERENCE WILSON: These are almost exactly the words I used with your wife and that...(crosstalk) PETE: Might help if we're both doing it at the same time.

34 minutes 50 seconds DR. G. TERENCE WILSON

[34:50] DR. G. TERENCE WILSONI think that would be great because if you're not, it's tough if one person's doing it and the other person isn't, then it's easy for one of you to say oh well, forget it, it's too busy; but if the two of you can be sort of helpful, help each other, but also maybe look into the possibility of finding some kind of structured program that really provides some of the support and structure because I think you know yourself because you are insightful, you know some of the things that sort of have worked for you and so it's a question of doing it and getting the support and to keep doing it. Big problem about weight loss is once you've done it successfully, is keeping it going.

35 minutes 40 seconds PETE

[35:40] PETEYeah, I would swore it would never come back on and then of course I've done it twice now, so -- DR. G. TERENCE WILSON: Well, I mean it's really a big problem and the answer is

35 minutes 50 seconds DR. G. TERENCE WILSON

[35:50] DR. G. TERENCE WILSONit's because it's very difficult and the last thing that I wanted to sort of convey to you in doing this is to try to be less critical. Now, in a sense it sounds way too easy to say that, but I think working on that and saying to yourself does this really help me, my kind of beating myself up? and then try to look at the evidence. Probably doesn't, if it makes things worse, if it gets you avoiding stuff that you might be very good at like doing stuff at school which some of kids have encouraged you to do. PETE: Yeah.

36 minutes 30 seconds DR. G. TERENCE WILSON

[36:30] DR. G. TERENCE WILSONI think you might be depriving yourself of something you would be good at, something you would enjoy, so part of it is saying I have got to be kinder to myself, taking care of myself is not sort of trashing myself even if I binge. It's one thing to say well, I wish I hadn't done that and I've got to try to do something different, but you're going way beyond that, you are then saying, well, I'm doing it again I'm hopeless and in fact the more I think about it I'm kind of hopeless at everything and it's like a downward spiral. Do you think you could think of like interrupting that downward spiral?

37 minutes 10 seconds PETE

[37:10] PETEYeah, I could. DR. G. TERENCE WILSON: I think you could.

37 minutes 15 seconds PETE

[37:15] PETEI think could find ways or just kind of make myself get up and...(crosstalk) DR. G. TERENCE WILSON: You know what's a good thing at times to say okay

37 minutes 20 seconds DR. G. TERENCE WILSON

[37:20] DR. G. TERENCE WILSONhere comes that thought again that I know where this is going, I'm beginning to start to getting critical, been there, done that, can I do something? Think of that is kind of a cue for action, do something else, get up, do something active, and physical activity really seems to work for you, big time.

37 minutes 40 seconds PETE

[37:40] PETESometimes I've gotten up and just kind of walked around the school. We have a very big school.

37 minutes 45 seconds DR. G. TERENCE WILSON

[37:45] DR. G. TERENCE WILSONGreat idea. PETE: And it does change and -- DR. G. TERENCE WILSON: It's the activity, it is -- change is good. I mean the worst thing is kind of just sitting there and you start introspecting and then one thought leads to the next, and it is kind of like a downward spiral, so anything you can do whether it's getting up, literally getting up physically or switching to something, doing a puzzle, doing something else, but interrupting that cycle. Because you know it and you see you got to read the early warning signs, and all of this is not just to benefit you, but it's going to benefit your family as well. PETE: It will make me easy to live with.

38 minutes 25 seconds DR. G. TERENCE WILSON

[38:25] DR. G. TERENCE WILSONWell, you're not, put at this way, you are not being selfish by taking care of yourself. You are actually, this is good for you and it will be good for the people around you. So I hope that you can find some program around that's feasible, and then, you know, you've gone through what we did quickly tonight but that might be worth revisiting about these disadvantages and advantages of making the change, and without me leading you at all I think you spelled out pretty much that there are lot of advantages that outweigh -- PETE: Yeah. DR. G. TERENCE WILSON: The problems and it's important to keep that in mind. I hope you find it, I think you can do it and be good. PETE: Well, thank you. I appreciate the help. DR. G. TERENCE WILSON: Thank you.