Mardi 25 juillet 2017

The GROS position and statements versus dietetic cacophony

Intervention de Bernard Waysfeld, colloque IREMAS, 2007

Summary                                                                              

« Diet » has a two-sided meaning, both in French and in English:

¨     one’s eating behaviour in a therapeutic perspective

¨     a conference, a meeting or a convention.

On which side, then, can the cacophony take place? Among those who eat or among those who talk?

Our group does not claim to uphold Hippocrates’ recommendation that one’s first medicine shall be one’s food. Our aim is to help patients who suffer from their behaviour and their excess body weight, all the while endeavouring to prevent the rising prevalence of obesity. In this respect, we contest the recommendations of the PNNS 1 and 2 ((Nutritional and Health National Program) , which draw no distinction between informing and educating. In so doing, these recommendations bypass the individual’s system of regulation, favour cognitive restriction and dissonance and furthermore, deprive our eating//alimentary behaviour of any symbolism or imagination.

We are living in full dietetic cacophony. Food no longer fits within the famous trilogy of energy, physical satisfaction and the symbolic life, a trilogy that ensured the individual with the satisfaction of his needs and his inclusion within the realm of pleasure and the spiritual domain.

Science, the media, and the feminist revolution have intervened and entirely upset the trilogy, leaving the eater very distressed. (Waysfeld, 1999)

Key Words :     Dietetic  cacophony, Cognitive restraint, Nutritional education

We are living in full dietetic cacophony. Food no longer fits within the famous trilogy of energy, physical satisfaction and the symbolic life, a trilogy that ensured the individual with the satisfaction of his needs and his inclusion within the realm of pleasure and the spiritual domain.

Science, the media, and the feminist revolution have intervened and entirely upset the trilogy, leaving the eater very distressed. (Waysfeld, 1999)

THE  DIETETIC CACOPHONY

During the last fifty years, food found itself ensnared in networks of varying significance, from the simple act of eating.

The different representations of food: (Poire,1998)

-       In the 50s and 60s, food remained foremost the source of energy that our body needed. It was the era of "food equals energy," and one needed not count calories yet.

-       A decade later, under the influence of feminism and the cult of thinness, food found itself implicitly involved in body-shaping and becoming thin. The rise of androgyny drove women to the fashion of wearing pants and to hiding their natural curves. They believed, and the medical profession did not disconfirm, that one could freely decide her body shape and weight. That is, that the criterion of "weight", a criterion infinitely unreliable in completely normal individuals, decided the consumption patterns of many young women. Fortunately, the body is not like modeling clay, and body weight remains remarkably stable in the long term Waysfeld, 2007), regardless of diets we inflict upon it (Waysfeld, 1998).

-       Then from the 80s and 90s, it has been the era of health food an its relationship to the cult of the body. Everyone endorsed the precept of Hippocrates "your diet will be your first medicine." Food became in the language of Aesop, «  the best and the worst of things », and a multiplication of recommendations and more diets obscure more and more the ability to comply with the individual signals of hunger and satiation.

Alimentation and  Thinness

1.     Which food may cause weight gain ?

The phenomenon is not new but it has become exceptional in the last decade: there are indeed foods that cause weight gain and others not! Moreover, attending outpatients ask us more and more often the question: "Doctor, what can I eat to lose weight? ! "- And indeed many foods and beverages are sold for" slimming "(pineapple, green tea, etc.).

The distribution of food is also being demonstrated not beliefs. In order to lose weight, "eat breakfast like a king, lunch like a prince and dinner like a beggar." Again, no serious study has confirmed such aphorisms and allegations.

2.     The nutrients are depending on  fashions.

If we consider the banned or dangerous nutrients, we observe an irrational evolution: carbohydrates are convicted in the sixties by the Atkins diet, name of his inventor; Lipids are the object of all evils because of an energy density more than twice as high (with equal weight, of course) than carbohydrates or protein; even proteins, for a long time spared, but too early used in feeding babies, are said to promote obesity later. So no nutrient escapes our wisdom, criticism and distrust. But a turnaround situation occurred in the past two decades: Carbohydrates are no longer said to put on weight and will be restored as sport-food and especially as preventive in  eating disorders (according to Wurtman’s theory which considers the importance of the antidepressant effect of them for serotonine synthesis, 1986); a minimum of protein is needed to fight the rise of vegetarianism  at risk of iron deficiency  among many young women; as to the fat, essential constituents of our cell membranes and our nervous system, a minimum flow must be maintained - despite the lipophobic atmosphere and balance between alpha linolenic- linoleic needs to be better respected (Ailhaud, 2007).

3.     The "healthy" food

In french, the phoneme healthy refers to three different meanings: healthy,  saint and breast ! (though in English, the pun is not working). Nevertheless, we succeeded in an era characterized by the quest for "healthy" foods:

Is the food we consume safe? Since we do not know its origin, the question arises: What do we eat? And the lack of response leads us to the precautionary principle and to the search for a traceability.

-       Our time is marked by the dismantling of meals, by the need to consume permanently palatable food, which also refers to the symbolic search for breast feeding, a kind of regressive childish feeding food  which is on the continuous way , in the manner of fetal nutrition.

-       Finally, we lack "saint " food .Without going as far as the Eucharist or Cacherout, we can not be satisfied "to eat for living." The food is part of a friendly and spiritual dimension, which, if not met, leads to eating disorders. The food, separated from its symbolic and spiritual environment becomes inedible and even dangerous. In the end, our eater no longer knows how to eat healthy. Devoted to our time, he will, like the surrounding society, stigmatize foods. The easiest way is to establish two categories: good and poor. The poor are often the best as they leave an imprint on our  taste buds as on the hypothalamus, conditioned for thousands of years to select the most substantial foods ." The poor are obviously those that cause the most fun, the most"reward", and which generally provide at least 3-400 kcal per 100 grams. Thus, one can define a route frequently found: some subjects are prone to become fat because of a”permissive genetic”. Immersed in an environment where food is permanently available (Western countries, countries with rapid increase in their socio-economic change as the countries of Eastern Europe) and thus multiplying the "food-contacts", they will alternate weight gain and control dieting, meet the yoyo syndrom (or weight cycling), and being at a high level of cognitive restriction. At this stage, any negative emotion, anxiety, sadness, anger beyond their regulatory mechanisms will scramble their sensory dashboard and lead to eating disorders in a vicious cycle that is naturally chronically maintained. After a few months of this gloomy yoyo, overweight is likely to become irreversible because of the multiplication of adipocytes and the raise of the level of  set point.

A SPECIAL TIME

We belong to an era and a bulimic civilization. We want everything immediately, whether our business, our consumption, our pleasure.

That time could have, through the means of communication, provided more emotional satisfaction, and yet leaves anyone hungry. The Other is only virtually present; The infusion of images to which we are subjected blocks our imagination. Our children have never had so much activity and they never have so much dreaded boredom. These hyperactive and hyper-stimulated children often end up saying no to their mother (or mother figure) and  beyond,  to food, sometimes in an orthorexic attitude, sacrificing quantitative to qualitative.

Many of them have not been able to establish self-stimulation process, a prelude to the imaginary world. The over presence of objects prevents the symbolic thinking and fosters intolerance to frustration, bypassing the time of the lack and the desire (Waysfeld B. 2003).

The force-feeding suppresses the lack indeed, the desire and therefore this lack of "missing" urges us to look elsewhere objects of addiction from which we could be dependent, this dependence allowing in turn, the lack to enter the field of desire. Thus, so many diseases appear without true  drug addiction: anorexia, binge eating , but also pathological gambling, compulsive shopping, and so on.

 cognitive restraint

In front of this abundance of items including food, having to face the rise of obesity and the cult of thinness, man, in an attitude of resistance (and perhaps in a saving burst  for survival ) has undertaken to restrain himself. Initial work on cognitive restraint were introduced by Herman and Polivy in 1975, two Canadian searchers who had already distinguished the restricted obese from the unrestricted ones. The first results show the first-differences and particularly the tendency to be driven by «  external cues «   among restricted obese.

Although controversial, this theory has continued and our association has strengthened the position of those authors. For the GROS, cognitive restraint is not just to restrain oneself from eating or  to eat with the intention to lose weight. Merely to "control" or be imposed from outside a system or a way of eating that appears to be rational, scientific, rather than relevant to our feelings, or our needs, is already cognitive restraint. (Apfeldorfer, Zermati 2001).

In recent years some authors have attempted to propose a flexible restriction, softer than conventional. In terms of diet, a modest reduction of our daily caloric intake is always possible. In terms of mind control, it is clear that our feelings are disqualified, regardless of the type of restriction and this is the main point.

As for the cognitive restraint itself, it evolves in two stages: a first stage in which a person relies on its willingness to "inhibit" her eating behavior; The person eats in accordance with the rules and will therefore tend to eat more allowed food (greens, for example) and less forbidden foods (fatty and sugary foods in particular). It is indirectly what is suggested by the National Nutrition Health Program, advising to eat five fruits and vegetables a day, which is experienced by the majority of our contemporaries as a form of "filling". At the end, often through a festive and friendly atmosphere with  sometimes alcohol abuse, the person  overlaps its"inhibitions" and this is the starting point for eating disorders, craving and particularly binge eating. These disorders appear under the sign of urgency and coercion, still brimming the will of the subject. They are similar to general behavior of addiction even if the food itself is clearly not an object of addiction. At the same time, they overtake or close  anxiety, irritability and depression resulting from the cognitive restraint and achieve to a state of pseudo- depressive state driving the subject to the alimentary deliquency.

The GROS position

This position is most developed in the book of G. Apfeldorfer and P. Zermati, "La dictature des régimes", published in 2006 . It is true that this position is more adjusted, however,  to overweight subjects than to the general population.

Some remarks are first described in terms of observation:

1.     To be more oneself  avoids eating too much : this is the famous dualism between having and being. Our society seems to produce more and more narcissistic psychological organisations including depression and focusing on the all-immediately. So is made a bulimic society where everyone is looking to get more in order to compensate an identity failure. Personal achievement in our post-modern societies cannot be bought. So we devour books, the world, our friends; We fall in the workoholic addiction when it is not simply alcoholic or, at last, in the burn-out syndrome.

One can eat differently if only living differently. One should be a ble to:

-       Make a break (during the work, the leisure time),

-       Listen to one’s body and move

-       Rest  his mind to review his feelings, his emotions in order to  identify them, accept them, integrate them.

2.     Refuse to be a scapegoat and take upon oneself:

Fat people are the perfect scapegoats of a guilty society which is ashamed to consume as much. As such, they are discriminated, stigmatized, discredited, in all areas of life  . One must be aware that stigmatisation of the obese subject is a serious injustice - especially if we know one does not decide his body weight ; the Ayatollah who say "eat less and move more," behind the rationality of this sentence , simply do not know what they are talking about.

3.     Facing stigmatization :

Agreeing to be observed in public places, as everyone looks at the others, is not always an easy task. One can see large, plump, stunted, bald - others who have big ears or an asymmetrical face -you can see the brown, blond, buxom or flat-chested .

The family is also a place of great danger. Under the guise of good intentions, those who love you are sometimes planting daggers in your back. They continue to believe that you do not know you are fat, and that you should make a diet by reducing your intake and choosing better foods.

The medical profession itself, often placed in the front line, is responsible for sigmatization. Many doctors react to every obese asking for any symptom as if the weight reduction was a panacea .

Moreover, the stigmatization of the obese leads to the stigmatization of foods: in the streets, nobody will look at a thin person eating quietly a sandwich, but if he is fat!

Thus, the fat person is induced to restrain itself and eliminate fatty foods and sugar – with the risk of overeat these forbidden foods !

Eat less ... is a negative message stigmatizing and false, which leads in the end to weight gain.

Eating according to his hunger is  not a stigmatizing message and what’s more, is fair.

4.     To promote information and nutritional education

-       Nutritional information relates to the content of food (protein, carbohydrates, fat and micronutrients).

-       Food information deals with the nature and origin of food.

-       Nutritional education provides the key to use the information if food is no more inscribed in the medical field. Indeed, the "supporter of nutritionally correct will have to reconsider its models, its standards and its claims to knowledge" (Le Barzic, 2006) .

Nutritional information based on statistical data, can not take into account  real needs, individual characteristics. The excess of information increases the confusion.

-       Concerning outpatients looking for a special weight loss, prevention measures consist mainly to:

  • Ÿ    to make less dramatic weight problems
  • Ÿ  allow without guilt  any type of food
  • Ÿ  advise to listen to our feelings and emotions, even about food.

Finally, we could quote one of the conclusions of the excellent book by Gerard Apfeldorfer and Jean-Philippe Zermati who wrote after the manner of Martin Luther King: "Let's have a dream. Information campaigns diet would be replaced by campaigns promoting the eating well, the thousand pleasures of meal,  complete and meaningful dishes, and it is obvious, sharing food and conviviality. We would advise everyone to take its time to eat, listen carefully to their appetites to consume suitable quantities at any given time.

One can imagine slogans like:

  • "To sleep, you need a good bed; to eat, you need a good meal. "
  • "With whom will you have the pleasure to eat today? "
  • "Eating sad is often eating too much. "
  • "The more you eat quickly, the more you eat . "
  • "Are you hungry for a sandwich, or for a half-sandwich? For a dish or a half-dish? When one is no longer hungry, why finish? "

Being in touch with oneself, its body, its feelings about food, its body emotions; Make choices that fill, bring comfort, confidence; one should not be in the all-or-nothing, should not obey to the approximate science of food that states are trying to impose through rules that are (and will provide) more deleterious than usefulness since they target the general population, since they combine health and overweight (like population and most doctors elsewhere); not to be in the ever more, give place to the symbol, that is to say what connects us to others and to our past, to our personal history, our future and our posterity.

That is what food should enable because it is at the core of every human culture.

References :

Waysfeld B,  L’Univers de l’aliment, Science et Vie hors série, Septembre 1999, 6-13.

Poire A., Hock P. Communication à Dietecom, Paris 1998.

Waysfeld B, Le poids, Obésité, Dictionnaire du Corps, (sous la direction de M. Marzano), 665-669 ; 745-748, PUF 2007.

Waysfeld B, Les échecs du traitement de l’obésité (en collaboration avec Anne Laurent

Jaccard). Encycl. Méd. Chir. (Elsevier, Paris) AKOS Encyclopédie Pratique de Médecine, 3-0790, 1998.

Wurtman JJ, Wurtman R, Carbohydrate craving, obesity and brain serotonin, Appetite, 1986;7 : 99-103

Ailhaud G.,Massiera F, Weill P. et al, Temporal changes in dietary fats: role of n-6 polyunsaturated fatty acids in excessive adipose tissue development and relationship to obesity, prog lipid res 2006 May,45(3) :205-236

Waysfeld B, Le Poids et le Moi, Edition Armand Colin, 2003(new edition 2014)

Waysfeld B, la peur de grossir, psychonutrition des troubes alimentaires, Paris, Armand Colin 2013

Herman CP., Polivy J. , Anxiety, restraint, and eating behavior.

J Abnorm Psychol. 1975 Dec;84(6):66-72.

Apfeldorfer G, Zermati JP, Cognitive restraint in obesity. History of ideas, clinical description, Presse Med 2001 Nov 3;30(32):1575-80.

Apfeldorfer G., Zermati JP, La dictature des régimes, attention !, Edition Odile Jacob 2006

Le Barzic M, Le plaisir oral est-il nutritionnellement correct ? Colloque de l’IFN du 12 décembre 2006.

  • Dernière mise à jour: 14/07/16 17:25
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