Session 2: Addressing Strict Dieting and Establishing Flexible Eating

CONTENT

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1) Welcome, Review of Treatment Map, and Agenda-Setting (approx. 5 mins)

 

Questions to ask client:

• How are you feeling after session one?

• Did you leave the session feeling unsure or ambivalent?

• Did you have any questions?

• What was one thing you took from session one?

• Have you thought much about the formulation we created or your SMART goals?

• Normalise concerns and ambivalence.

   

• Topics today: (1) link between dieting and MD + (2) addressing strict dieting rules and fear foods + (3) establishing flexible eating.

 

 

2) Dieting and Restrictive Eating (approx. 10 mins)

 

Eating (along with exercise) is one of the core behaviours through which one can change their body composition.

 

Questions to ask client:

• What comes to mind when you think of dieting?

   

Dieting – having strict rules about food (often involving restriction) that increases preoccupation with food (i.e., we want what we cannot have).

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• Dieting can come in a number of forms, including:

  (1) delaying eating (i.e., intermittent fasting) + (2) avoiding certain foods (e.g., takeaway foods + foods low in protein + being on a carnivore diet) + (3) having strict rules about food intake (e.g., I must consume 200g of protein or eat less than 2,500 calories in a given day).

   

Questions to ask client:

• How do you think dieting is related to MD?

   

• Dieting (restrictive eating behaviours) maintains MD through:

  (1) increasing preoccupation with food + (2) reducing opportunities for social interactions which increases our reliance on exercise/diet/shape.

 

 

3) Calorie/Protein Tracking (approx. 10 mins)

Most people with MD track their calories and weigh their food in a meticulous fashion, with a particular emphasis on meeting protein targets (e.g., 200g of protein per day).

 

Questions to ask client:

• What are the benefits of counting calories and protein?

• What are some downsides of counting calories and protein when it comes to MD?

 

• Potential downsides:

  (1) food intake become mechanical and inflexible + (2) increases preoccupation with food/eating/shape + (3) food becomes a means to an end (rather than a social/pleasurable experience) + (4) creates stress about needing to stick within calorie/macro targets + (5) creates a binary view of eating as ‘good’ (within calorie targets) or ‘bad’ (outside of calorie targets).

 

 

4) Developing Flexible Eating (approx. 10 mins)

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Questions to ask participant:

• What is flexible eating?

• What is inflexible eating?

• What are some benefits of adopting a more flexible eating approach?

• What are the potential downsides?

   

• Flexible eating has several benefits:

(1) allows us to eat from multiple food groups and reduce diet imbalances + (2) reduces stress about needing to eat at specific times + (3) reduces preoccupation with food/eating/shape + (4) increases opportunities for social interactions + (5) reduces stress related to eating.

 

Questions to ask participant:

• What would it look like for you to eat more flexibly over the next week?

 

 

5) Behavioural Experiments to Address Food Avoidance and/or Dietary Rules (approx. 25 mins)

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Addressing food avoidance

• Write down all avoided foods (i.e., fear foods) or avoided situations (e.g., eating out in public) - examples might be junk food + ordering takeaway food + eating foods that are low in protein or protein amount is unknown.

• Sort foods into three categories:

  (1) minor fear foods/situations + (2) moderate fear foods/situations + (3) major fear foods/situations.
   

• Create a plan to introduce fear foods/situations over the next few weeks, beginning with minor fear foods/situations and working up to major fear foods/situations.

• Plan a behavioural experiment to tackle 1-2 specific fear foods/situations over the next week, focusing on feared outcomes (i.e., predictions) and how to measure if those predictions come true (e.g., progress photos + weight measurement).

   

  Challenging dietary rules

• Write down all known dietary rules - examples might be needing to count calories and eat within specific calorie/protein targets + needing to consume a protein shake after exercising + not eating before/after a certain period + needing to eat meals prepared at home + eating every 2-3 hours.

• Order those rules from most confronting to challenge to least confronting to challenge.

   

• Create a plan to challenge one or more of those dietary rules over the next week, beginning with the least confronting and working up to the most confronting rule.

• Plan a behavioural experiment to tackle 1-2 specific dietary rules over the next week, focusing on feared outcomes (i.e., predictions) and how to measure if those predictions come true (e.g., progress photos + weight measurement).

 

 

6) Setting Goals/Homework

• Carry out behavioural experiment(s) to challenge fear foods/situations and/or dietary rules.

• Implement suggested activities to eat more flexibly over the next week.