The “W” Words

Usually, when a word is abbreviated to only its first letter, it’s a curse word. “Watchful” and “waiting” are not generally considered to be vulgar expletives, but in this context, they might as well be.

Every year, it becomes more obvious that, in the struggle against epidemic obesity, “watchful waiting” is not a strategy likely to prevail. It has become obvious that the earlier someone enters the “overweight” category, the more time they are liable to spend there. The more years a person remains overweight, the more likely they are to occupy that demographic throughout life.

Watchfulness alone is not such a bad thing. We could, in fact, use more of it — for instance, when it comes to keeping an eye on the outrageous claims made by the food industry publicists whenever they think they can get away with it. Also, it has long been felt that elementary school meals could benefit from a little more scrutiny. Maybe, without violating any basic American principles, we could still find a way to minimize the devastating effects that result from the overabundance of fast food outlets.

Some very well-informed experts tell us that 80% to 90% of childhood obesity cases persist into adulthood — even when the person makes some efforts toward positive lifestyle changes.

Apparent progress plus disappointment

There has, over the past couple of decades, been a sort of overall gold-rush tendency to take childhood obesity more seriously, characterized by flashy but soon-forgotten headlines, and sporadically causing alarm in the anti-drug and anti-surgery factions. Meanwhile, deep and interesting work goes on more quietly in the background, for instance, on an identifying characteristic called the phenotype, which is made up of the combination of influences exerted by heredity plus environment.

For instance, as Tatyana Meshcheryakova, who is one of the writers on this blog, points out, Dr. Andres Acosta describes four categories of obesity phenotypes that can guide treatment recommendations:

Hungry Gut (HG). Patients experience rapid gastric emptying and feel hungry shortly after meals.

Hungry Brain. Individuals have impaired satiety and tend to overeat during meals.

Emotional Hunger. Emotional or hedonic eating behaviors dominate.

Slow Burn. Patients have a sluggish metabolism and burn fewer calories.

As the French say, “Vive la différence!” This research team discovered that when lifestyle interventions specifically tailored for each phenotype were applied and adhered to, “patients lost more weight and had greater metabolic improvement.” Better yet, Dr. Acosta’s lab “has developed a genetic test to predict the best responders to GLP-1 RAs, showing promise in identifying individuals who might benefit most.” Here, as in so many life situations, precision targeting works better than random stabs.

There is a limit

Subtlety is overrated, so let’s go right ahead and reveal the takeaway embedded in this post. Namely, in the catalogue of human frailties, another highly overrated item is the illusion of “watchful waiting,” a dodge that all too often is a coverup for a copout. We cherish a vague notion of doing something about a situation at a certain point in time, like when summer vacation starts.

Or when school is back in session… Or when that ongoing plumbing crisis is finally solved… Or after Melissa’s birthday, when she turns 14 and we can plan a serious talk…

“Watchful waiting” is a useful technique only in a limited number of situations, and any adult who finds themselves indulging/engaging in it too often, just might be deluded. This is worth considering. Sure, get a professional opinion. But Mom or Dad, don’t kid yourself.

Don’t fall for your own propaganda. If you have noticed that Junior tends to occasionally collapse a chair into a pile of splintered wood, more than likely, others have noticed it too. Maybe even Junior, who might be confused and ashamed and wishing for some kind of help, without knowing how to ask.

Bottom line: Watchful waiting is nowhere near as useful as active intervention.

Your responses and feedback are welcome!

Source: “Unlock your unique weight loss plan,” HelloAlpha.com, undated
Image by vandesart/Pixabay

What Does It Take to Change?

Opinions have been quietly changing about two possible treatments for childhood obesity that, up until recently, have pretty much been viewed as undesirable, and even dreaded. The most volatile reputation belongs to medication, specifically to the glucagon-like peptide-1 receptor agonists, also known as GLP-1 RAs. With this particular type of drug, it seems that the biggest percentage of conversation centers on two demographics: menopausal women and teens of either sex.

So far, the risks for teens seem mostly financial, promising to lock them into a lifelong “deal with the devil” whose hefty price will no doubt become increasingly unaffordable. Pharmaceutical products are not famous for any tendency to become less costly over time. Federal aid for medical expenses is drying up fast. Still, more parents will choose to spring for the GLP-1 subscriptions, even if it means raiding the college fund.

Inevitably, additional cases will go on record showing that these drugs can cause problems that are presently unclear or unsuspected. Even someone who is not the wagering sort can confidently bet on that.

And then, the knife

At some point, this will probably lead to an increase in the other dreaded outcome, bariatric surgery for teens, and even for children. Following that, history is expected to repeat itself and reveal still more reasons why the surgical option can also cause regrettable yet unfixable lifelong difficulties. We already know enough about that subject to be quite wary. Still, some doctors and parents will inevitably choose surgery as a prospect less odious than other possible grim outcomes.

What sort of problem could occur?

As previously discussed, harmful eating habits might result from our own past emotional upsets and psychological traumas. Registered dietitian and nutritionist Carly Zimmer reminds parents that good eating habits need support from the environment, and alerts us to some of the signs that this area has developed problems.

She teaches that weight loss medication is only a partial answer, because it either must continue throughout life, or else the subject needs to develop an entire brand new repertoire of habits around food and eating. Sadly, the most elemental fact about life is that it can change. A person may not always have the means to procure the GLP-1 meds.

An audacious proposal

In any case, the probability is strong that some day, the consumer will need to learn to live without the drug… so why not start now? If it is just a matter of developing new habits, why do people have such a hard time with the concept and the execution? The mind might recognize that change needs to take place, but how does this translate into action? If it is a mental/emotional health issue, how do we address that?

(To be continued…)

Your responses and feedback are welcome!

Image by geralt/Pixabay

Goodbye to 2025, and Try This

The facetious advice in the picture on this page has been seen millions of times online and is impossible to trace back to its source. But let’s lift a glass of sugar-free fizzy soda and drink to the health of its author. Yes, going forward into the new year, humans will continue to fight against our own best interests. Sooner or later (perhaps in 2026!) more of us will come to see the truth of another anonymous quotation:

You can fool some of the people all of the time, and fool all of the people some of the time, but — ultimately, eventually, inevitably — you can’t fool yourself.

This blog has pointed out many of the societal costs of obesity, so for the end of December, it gathers a little bouquet of talking points from the past year and the past few years, and some things to look out for in the coming months.

There are problems we don’t want to see our kids, or any kids, have to face in the upcoming year or any year subsequent to this one. In other words, let’s poke and prod ourselves to do something about looming obstacles and stop putting off the unpleasant tasks. To stall is to invite consequences that quickly outgrow the unpleasant stage and morph into real-life nightmares.

Interview with an expert

“Watchful Waiting Not Recommended For Childhood Obesity” is the title of a very recent piece by Tim Ditman, and let’s have a peek at what the expert he interviews has to say about the subject.

The American Academy of Pediatrics (AAP) has been taking a second look at some of its guidelines and softening its attitude toward surgery and medication. Some parents became nervous about venturing beyond the traditional guardrails of diet and exercise, and this is understandable.

Too often in life, the urge to “Do something!” becomes diverted or misapplied. The only thing worse than neglecting a problem is approaching it with the wrong tool. Maybe the error even lies in the mental construct of attack. Maybe “address” or “examine” is a better approach. So we do not want to start out with a misstep. When aiming for a compass bearing, even a single degree of error can lead to far, far from the intended destination.

One thing is for sure:

The AAP says waiting and hoping things get better is not a good choice.

Up until about age 12, sure, stick with the traditional methods, but beyond that age, “diet plus exercise” is not a sufficient prescription. The AAP is talking about, among other remedies, “in-person, family-based behavioral health treatment” for three months to a year. After passing that 12-year mark, the organization says, let’s start thinking about a pharmaceutical approach; and after the 13th birthday, in many cases surgery should not be arbitrarily ruled out.

Registered dietitian-nutritionist Carly Zimmer feels empathy for the difficulties that children face. Their lives are saturated with “activity” that involves mainly sitting on their ever-enlarging behinds, watching screens that glorify and strenuously recommend eating all the wrong stuff, and plenty of it. Yet and still, very often the food is not the enemy — the mind is.

Zimmer says,

Often our eating habits stem from events in our past, trauma or emotions. A mental health professional can dive into those topics and help establish a healthy relationship with food.

This is what needs to happen, not an eternal relationship with weight-loss meds acting as a band-aid, because a band-aid is glued to a person only to be replaced. That is why they are sold by the package. Commitment to a lifetime of regular injections of a very expensive drug is not a solution; not a win or a cure, or any other positive description of an outcome. It is a very poor alternative to what is ultimately possible, and many professionals are deeply committed to never settling for less.

Zimmer offers suggestions which, yes, have been heard before. That isn’t the point. If a concept has value, it is worth hearing a thousand times — until someone whose health hangs in the balance actually absorbs it. For parents, Zimmer suggests a technique that begins by adding, not subtracting. Go ahead and give the kid the same old cereal for breakfast, but offer fresh fruit, too. Maybe at some point, this particular individual will become more interested in the fruit and abandon the cereal.

Be the grownups

Get used to the idea that sometimes a child will be hungrier than other times, and don’t make a big thing out of it if they occasionally consume what you think is too much or too little. And forget that tired old “Join the clean plate club!” nonsense. Please do not set a heap of food in front of a kid. Let them start with a small serving of the fattening stuff, and maybe they will surprise you by scarfing down all the green beans.

Don’t let yourself be discouraged. You can place the same food in front of a child 20 times, only to see it scorned; and then, one day, they will eat it. When the child eventually caves and admits the stuff isn’t so bad after all, refrain from sarcasm. And now, Zimmer gives advice worth gold: “Don’t make exercise a chore.”

Parents, if there is some physical, active, calorie-burning activity your child enjoys, embrace it. Please. Find where the kid can go skateboarding or swimming, or learn gymnastics or Jiu-Jitsu, or whatever sort of exercise they can get behind. Please give them a chance to try an activity before committing to it. Make the time, find the money (it will probably not cost as much, ultimately, as weight-loss drugs or surgery), and figure out how to retain this as a major part of life, for as long as the child is into it. The rewards will be vast.

Your responses and feedback are welcome!

Source: “Watchful Waiting Not Recommended For Childhood Obesity,” RiverBender.com, 10/13/25
Image by JillWellington/Pixabay

Additional Complicated Angles of Weight

All the behaviors that combine to define an eating disorder are just maladaptive coping strategies, writes Brittney Williams of Fairhaven Treatment Center. According to Internal Family Systems (IFS) theory, the inner “exiles” who perform those behaviors do not need to be banished, only freed of their painful burdens:

The goal of coming to see eating disorders as a “part” similar to the rest of an individual’s various “parts” gives a chance for them to be seen, heard, understood, and transformed.

In other words, the concept here is to own the eating disorder and the ghostly entities that inhabit you, because to admit in the first place that they exist is the only way to tame them.

“Parts work,” as pioneered by Dr. Richard Schwartz, is claimed to be effective not only with eating issues but with “many mental disorders.” According to this worldview, for a person to contain several beings is not a pathology but the natural order of things. Rather than suffer banishment, the multiple entities within should all be consulted and regarded, because if given the chance, they can and will prove helpful. In other words,

The foundation of this model offers a beneficial framework for clinicians to approach clients’ eating disorder behavior from an internal relational perspective rather than as maladaptive behaviors.

To shun the “parts” only nudges them into extreme “look at me” behavior, so it is much more helpful to grant them respectful attention. Trying to ignore them will not accomplish anything anyway, so you might as well give them a chance to be heard. The “parts” all want to help, and they are not going anywhere, so the smart thing to do is get to know them and understand what they bring to the table.

The downside

This all sounds very inspiring, but apparently it can go plenty wrong. Often, good intentions are not enough. IFS is sometimes paired with intuitive eating, “a non-diet approach to food intake that involves listening to your body’s hunger and satiety cues and eating accordingly… [Y]ou can eat what you want and when you want, as long as you are tuning into your body’s signals.”

Success depends on interoception, “the ability to perceive physical sensations that arise from within your body. Intuitive eating relies on interoception since you must be attuned to your hunger and fullness in order to give your body the fuel it needs.” It is all too easy to imagine how readily this philosophy could jump the track.

In one way, the IFS worldview is very positive, in assuming that your healthy self is tucked away in there somewhere — you just have to locate and connect with it. But matters are not always quite so simple. In group therapy, listening to the wrong person can be a problem. Artificial Intelligence entities, no matter how cleverly created, can be wrong. The “parts” of a person, the “managers” and “firefighters” who are meant to fix things, can be mistaken. They can give bad and even dangerous advice.

One aspect of relatability is in the bag already. Thanks to technology, AI can be engineered to speak in a voice so convincing that perfectly sane people are swindled into sending their life savings to bail their grandchildren out of jail.

So, why shouldn’t an equally convincing fake entity succeed in helping a person feel worthy and capable of making enormous life changes and losing 100 pounds? Or, if the human in need of therapy is a child, wouldn’t it be theoretically possible to dispose of breath and heartbeat entirely, and let AI help the kids adopt, painlessly, a lifestyle through which they would never become overweight in the first place?

Caution is advised

With self-protective clarity, a young teen in therapy might recognize that he or she has an absolutely terrible parent. (If they didn’t already know it.) Still, the knowledge does not imply a recommendation to murder that parent. This is where professionals really must possess skill, in the realm of helping patients transform pain and anger into positive outcomes. Sadly, that result is not always achieved.

How bad can it be? Of course, a response that triggers binge eating is apt to have quite different results from a response that triggers homicidal tendencies. Does a therapist ever fear setting off a murder or a suicide? Even worse, intentional harm of this kind has been done on purpose.

According to investigators, government agencies in the Sixties were involved in influencing some very bad people to become even worse, and earn public disapproval that would have political consequences. Basically, there is good brainwashing and bad brainwashing, and caution is advisable.

IFS has run into some trouble in this area. As its popularity grew, some families were inevitably shattered when false memories convinced patients that their parents had abused or tried to kill them. Rachel Corbett wrote about this in detail, explaining that thorough and comprehensive training is vital, especially when dealing with vulnerable people who are at a life juncture when they really could use some family support.

Your responses and feedback are welcome!

Source: “The IFS Model With Eating Disorders: ED is Just a Part of You,” EatingDisorderHope.com, 10/11/23
Source: “Eating Disorders and the Internal Family Systems Model,” EatingDisorderHope.com, 10/19/20
Source: “Using internal family systems with intuitive eating to enhance eating disorder recovery,” WithinHealth.com, undated
Source: “Grandparent Scams Take Advantage of Your Love for Your Family,” AARP.org, 02/13/25
Source: “The Therapy That Can Break You,” TheCut.com, 10/30/25
Image by GDJ/Pixabay

Some Complicated Angles of Weight

Although styles of therapy differ, it is widely accepted that the root of all psychological malfunction is pain. In the animal kingdom, the amoeba is about as simple a creature as can be. And yet, even the humble amoeba knows to avoid pain, and somehow recognizes the appropriate moment to flee from a molecule of poison.

In that respect, people are very much like amoebae, but have more freedom of choice in their reactions. Amoebae probably can’t even fight. Their choice of displacement activity is quite limited.

Now, what about the entities that facilitate the healing of pain? Psychologists, for instance — do they absolutely need to be human?

As we have discussed, one aspect of psychological therapy has developed quite rapidly and noticeably into an overwhelming issue. Can excellent results be achieved with less, or even zero, human interaction? Can human connection be adapted and reconceptualized into something equally curative, by perfecting the ability of Artificial Intellligence to imitate high-quality connection?

It’s not that surprising

One might ask, why shouldn’t this be the case? Look, for instance, at books. They are made from common materials, and from symbols that are very different from human speech or breath. Furthermore, vast numbers of humans have been and still are unable to read books — and yet the influence that books have exerted on many of us (for better or worse) throughout the ages is a true marvel.

An important aspect of convincing relatability is in the bag already. Thanks to technology, AI can be engineered to swindle people out of their life savings by speaking in a voice so relatable that a perfectly sane adult will think it’s their grandkid, in desperate need of bail money. Compared to such an accomplishment, the ability to sound like the world’s most empathic therapist is no big deal.

One thought leads inevitably to another

So, why shouldn’t an equally convincing fake entity succeed in helping a person feel worthy and capable of making enormous life changes and losing 100 pounds? Or, if the human in need of therapy is a child wouldn’t it be theoretically possible to dispose of breath and heartbeat entirely, and let AI help the kids adopt, painlessly, a lifestyle through which they would never become overweight in the first place?

How much actual personal contact between patient and therapist is actually optimal? Can a group of other people with similar problems serve the personal-connection need just as well?

Maybe so. Millions of group therapy participants will attest that to go through the self-discovery experience with a cohort of similarly affected others can be incredibly helpful. For many, it has been vital to associate with others who are on the same basic journey, but a little bit ahead.

As Alcoholics Anonymous and similar groups have demonstrated, we also benefit from hanging out with people who travel a little way behind us so we can take our well-deserved turn as experienced encouragers of others on the same path.

(To be continued…)

Image by dbutlerdidit/Pixabay

So, relax. Eat cake.

Not long ago, we mentioned the experience of Kris, who totally recognized how much her emotional health depended on feeling so massively immovable that she could not be knocked down and rendered helplessly vulnerable. (To state it more theatrically, and sadly, she could absolutely never be “swept off her feet,” either, which was all according to plan).

As we have seen, Richard C. Schwartz and (unrelated) Mark Schwartz spent a decade refining the philosophies and practices of Internal Family Systems, stressing “the importance of working with the eating disordered part of self that encapsulates the trauma of the past.” The materials written for the public explained that, in contrast to other existing treatment facilities, Castlewood helped clients to heal the pain beneath their eating disorders “rather than just manage the symptoms.” They got in touch with their “parts” — the various inner beings known as Exiles, Managers, Firefighters, and other types.

When worlds collide

It seems unfair that even people who grow enough to accept and follow advice will still mess up so badly in choosing which advice to adopt. When taking action, it is also important to do the least possible harm. Listening to the wrong person and/or the lousy advice can be a problem at home, in group therapy, and basically whenever someone sets out to claim agency.

We could say that Kris had an inner advisor who advocated staying massively overweight for the sake of safety. And to all intents and purposes, it worked. But here is the problem. A “part,” be it manager, exile, firefighter, or whatever, could be mistaken in its opinion, and might be a wrong-headed advisor, just like a regular human. Real people and “parts” can all be mistaken, and so might people with degrees and headlines. And so might AI.

Important note: When a counselor helps a patient to identify the decent protective impulses that drive the parts called “firefighter” or “manager,” this is for identification purposes only, and does not imply endorsement or recommendation. To provide meaningful service, the professional really needs to have a handle on what’s what.

Today’s illustration features a slogan that has been seen, with creative variations, many times over the years, but to track and credit the original author would probably be impossible. Our most recent post asked if it is possible to facilitate the healing process without the participation of any actual second human.

And why not?

Well, why shouldn’t this be the case? It has already happened. Look, for instance, at books. They are made from common materials and from symbols that are very different from human speech or breath. Furthermore, vast numbers of humans have been and still are unable to read books — and yet the influence that books have exerted on humanity (for better or worse) is a true marvel.

Now, the real world connection, in-the-flesh, in the same space-time — how much of that is the minimum amount needed; the “necessary but not sufficient condition” that would be required to cause an effect? Is it the same in every case, and if not, then how do we tell the difference and decide how to proceed?

Okay, how about not very much?

One aspect of that psychological challenge has developed quite rapidly and noticeably into an overwhelming issue. Can excellent results be achieved with minimal human interaction, or even none at all? If the ability of AI to imitate high-quality connections could be perfected, then what? Well, first of all, forget all that, because it doesn’t meet the criterion of being human.

But what if AI works anyway? What if it learns to function incredibly well? Then, could human connectivity catch up and be similarly effective? Could human connection be adapted and re-conceptualized into something equally therapeutic?

Some people will always insist that AI is not human: end of story. Likely, there will always be others who insist that, of course, AI is drenched in humanity because people conceived and created it, and trained it on the works of thousands of unpaid creators, and so forth. Most likely, it is too soon to know.

Your responses and feedback are welcome!

Source: “The Therapy That Can Break You,” TheCut.com, 10/30/25
Image by Iffany/Pixabay

How Much Connection?

How often does it happen that a perfectly valid therapeutic approach fails, although there may be nothing wrong with that approach whatsoever? Maybe, for example, an outside force exerts a negative influence on the relationship between a therapist and the person being counseled. Among adults, an insecure partner, especially one who lives with the patient, can sabotage weight-loss efforts with ease.

In a far different setting, on the conceptual level, there may be difficulties, like those that can occur in the implementation of Internal Family Systems (IFS) theory. This modality is said to be designed for patients 18 and older, and may seem to have only a slight connection with childhood obesity — at the moment.

But if our current offspring emerge from their teens still carrying extra weight, the popularity of IFS guarantees that they will run into it sooner or later. It claims to be very successful in dealing with weight-control issues centering around either substance addiction (to food itself), or behavioral addiction (to the process of eating). IFS raises questions that may seem to stray far afield, but which provide glimpses into areas of human psychology that are quite different from jogging for miles, juggling calories, or judging portion sizes.

Human frailty never ends

In the Sixties, group therapy became popular and helped scads of people with various problems. There was a lot less obesity in those days, but for some folks, it was their main difficulty. For them, and many other types of help-seekers, there were side effects.

What if, during every group therapy session, a patient was fantasizing… “I’ll lose so much weight, and at our anniversary parties, I’ll tell the story of how we met because I couldn’t fit into my jeans, but my doctor fell in love with me. And he/she will playfully pinch my bottom, and all our friends will laugh and laugh…”

This is a tempting road to explore, because in the hearts and minds of most psychological counseling participants, to win the approbation of the therapist is golden. It is a powerful drive, and the possibility exists for a patient of any age or sexual orientation to develop very strong, situationally inappropriate feelings toward their therapist.

Another question

How heavy an effect does this need for approval, validation, and love exert in already-established obesity prevention programs? Everyone who enters therapy might not visualize an engagement ring, but plenty of us like to believe that we are the favorite patient, the one whose astonishing improvement makes it all worthwhile, not like those ordinary schlubs our therapist merely tolerates.

How does it tend to work out, for instance, in IFS, where the therapist has a chance to become acquainted with not just one aspect of the help-seeker, but with an entire cast of interior characters, each one of them whispering into the patient’s ear whenever they feel like it?

The future is now

All of this brings up a much bigger and potentially more dreadful problem that gains ground daily. Never mind being the favorite patient. Do we really, really need our psychological maladies to be addressed by a human intelligence or consciousness, at all? Or, for therapy to succeed, can a mere simulacrum do the trick? If we truly require a certain amount of human attachment in this context, how can the most useful amount of it, along with the correct amount of intellectual and emotional content, be achieved and maintained?

A human connection, whether through office visits or online counseling sessions, can affect a patient at any age, though with varying manifestations. In the case of weight-related problems, the relationship involves ideas and emotions about the body, and this additional dimension can be tricky.

What happens when human practitioners are replaced by chat robots and artificial intelligence? How has that method succeeded so far? In light of recent news reports about teenagers persuaded to commit suicide by human-imitating AI programs, the very existence of such an abomination is terrifying. (On the other hand, the issue becomes more complicated when, for instance, we learn that AI counseling may be of great help in preventing suicide among military veterans.)

Two views

Getting back to Internal Family Systems, here are two pertinent quotations from an article by Rachel Corbett, who conveys some of Richard Schwartz’s ideas about how the method that he originated (and developed at Castlewood Treatment Center) “is really the opposite of fragmenting people.” Corbett writes,

Clients come into treatment with their parts already intact — like a bulb of garlic, rather than the layers of an onion, he has said — “It’s not like I’m creating them.” Instead, IFS therapists work on “rounding up all those outlying parts and bringing them back home.”

Corbett views it all from another angle (and more about that is coming up next time). She cautions:

Most of Castlewood’s methods, starting with its use of IFS and the focus on trauma, contradict the prevailing playbook for treating eating disorders. Dredging up harrowing memories can overwhelm already fragile psyches and may lead to self-harm, substance abuse, or other unhealthy coping behaviors.

Your responses and feedback are welcome!

Source: “The Therapy That Can Break You,” The Cut, 10/30/25
Image by ThomasWolter/Pixabay

Listening to Internal Advice

It is worth mentioning here that many people, even in the healing professions, tend to discount emotional pain, as if it were a mere inconvenience or even a whim that someone can simply choose to shrug off. There seems to be a “Just say no to emotional pain” school of thought that tends not to work out well in everyday life. Really, the only people who “get” how crippling emotional pain can be are those whose lives are impoverished by it.

This might be why some practitioners obviously see great value in a basic Internal Family Systems concept, which is:

[D]isordered eating behaviors are not the problem themselves but rather attempts by protective parts to manage deeper emotional pain.

The internal beings called “parts” are also sometimes known as sub-personalities, thoughts, ideas, internal dialogue, feelings, sensations, symptoms, behaviors, defense mechanisms, maladaptive coping strategies, or even spirits.

The crowd

Among the inner multitude, one category of respondent, known as a “manager,” wants to protect the host and might be interested in setting up some rules. Also, those might be counterproductive rules that will wind up creating even more pain in the end. A manager sees a problem and proposes a solution, and strives to make something happen, even if it isn’t the optimal thing. Still, the managerial parts probably tend to have more common sense than those even more proactive parts that leap into the fray — known as “firefighters.”

Firefighters operate under a different set of criteria. They suit up, grab high-pressure hoses, mount ladders, and rush in to try and save the day. Their mission is to stop the immediate threat of psychic violence and destruction, even if it entails physical violence and destruction. Their priority is to end the inner pain, right now. The impulsive firefighters can be like enthusiastic amateurs who mean well, but do a sloppy job. If the only way forward is to tear down the museum-quality ancestral drapes to smother the fire with, a reactive guardian will do it.

Or that over-amped protector might pull some stunt like a spending spree, an unwise date, self-harm, violence, or even suicide. More likely, to terminate the current discomfort, this misguided volunteer might send the person on an eating binge. Sure, that is a variety of self-harm, but it smothers the present, in-your-face pain.

Thanks a lot

A binge is harmful enough, but there are, in fact, other shades and nuances of damage that must be written off as the inevitable consequence of avoiding immediate pain. Conversely, but for the same purpose of escaping today’s pain, tomorrow’s opportunity to heal might be put at risk by purging. If things continue badly, the firefighter’s next suggestion might be to exercise compulsively, or to try some nice numbing opiate.

Of course, all of this activity, however misguided or futile, takes place to protect the Exiles, the “parts” who are like ossified copies of the person at crucial stages when shattering life events took place. They broke off and live like hungry ghosts, unable to reconcile the horrible experiences they went through with a desire to keep on living, and yet unable to give up life as long as the tough old meat body is still hanging in there.

So, why not punish that animated corpse in some way, like the way that is so easily available in almost every society on Earth these days — by piling on the bulk until life becomes undesirable, and is sustainable only at a very high cost in daily pain?

Your responses and feedback are welcome!

Source: “Internal Family Systems and Eating Disorders: A Compassionate Approach to Recovery,” BalancedAwakening.com, undated
Source: “The IFS Model With Eating Disorders: ED is Just a Part of You,” EatingDisorderHope.com, undated
Image by cottonbro studio/Pexels

Parts and More Parts and IFS

Many professionals have explained and elaborated on the theories, called Internal Family Systems (IFS), of Dr. Richard Schwartz. It’s all about the “parts” — or inner beings — that inhabit psychologically troubled people. In what is perhaps a vain attempt to understand why these childhood-obesity-related teachings have caught on in such a big way, we consult yet another explainer, this time, writer Tess Brieva.

Overall, there seems to be a consensus that the various parts all aim to do the same job in different ways. That main task is to help the patient figure out, “Why am I doing this to myself?” Or perhaps, “Why are we doing this to ourselves?” Bottom line is, they all, in their unique ways, struggle to ultimately blend together into a single, healthy being.

One problem is, some of the parts are misguided, and every effort they make to avoid causing pain to the “exile” parts will only cause new problems. A “firefighter,” for instance, being an emergency first responder, might recommend an obvious cure that will distract and comfort the human host quickly, but alas, only temporarily. Brieva writes,

A binge-eating part might believe it’s helping by offering temporary comfort from emotional pain, while a restrictive eating part may believe it’s creating safety through control.

Then — just like small children when Mommy and Daddy fight — the “exile” parts experience even more fear, loneliness, shame, separation, and other negative emotions. Their problems are compounded, and another cycle of attempted compensation begins.

“It’s above my pay grade”

This author characterizes the “manager” parts as proactive, and anxious to avoid such obstacles as, for instance, painful emotions. Sadly, those efforts to dodge suffering only generate more problems, like, for instance, unreasonable rules and unachievable standards. It all gets to be just one big dysfunctional merry-go-round, with every part clueless about how to make the darn thing grind to a halt so everybody can get a grip.

Apparently, the basic goal of Internal Family Systems is to rope all those confused yet earnestly striving inner beings onto the “same page.” Or at least, singing from the same hymnal. Brieva explains what stands in the way of that peaceful resolution:

In eating disorders, managers and firefighters are usually polarized, creating inner conflict and a sense of confusion, turmoil, or stagnation. Protector parts in these extreme roles often lead to yo-yo dieting, restrict-binge cycles, and other unstable patterns.

Nobody wants to live with a bunch of different voices yammering away inside their head, and IFS makes a valiant effort to carve a new path to a better way. As the author explains,

IFS encourages individuals to explore the underlying intentions of their parts and uncover the deeper wounds driving those behaviors. Healing becomes possible when all parts are welcomed, listened to, and guided by the Self toward new ways of being.

Then, she clarifies that listening to and understanding the different internal parts, and their various plans for correcting the situation, does not imply approval. The therapist “does not necessarily condone or support this behavior,” because obviously some of the protective plans made by firefighters and managers are anti-social, self-harming, or otherwise counterproductive.

While the intentions are good, the methods may just cause more trouble, and this is what all the inner parts, it is hoped, will understand, and then figure out more effective methods for their healing process. It’s like a club where some members misbehave, but nobody gets kicked out, because the goal is to convert them into team members, who will then help to bring those other slackers into line.

Your responses and feedback are welcome!

Source: “Internal Family Systems and Eating Disorders: A Compassionate Approach to Recovery,” BalancedAwakening.com, undated
Image by kirill_makes_pics/Pixabay

The Problematic Core of Internal Family Systems

Obviously, aspects of Internal Family Systems (IFS) might prove elusive or difficult to grasp. Why are patients with eating disorders said to be exceptionally difficult to treat? Why do so many sources mention the particular suitability of IFS to treat eating disorders? And yet, why do some experts consider it an unsafe form of psychotherapy?

If the popular Internal Family Systems philosophy is quite possibly dangerous, or even simply misguided, inconsequential, or otherwise unworthy of attention, why devote so many words to it? Because it cannot be ignored. The number of adherents and practitioners is startling. This may be because, despite sounding perhaps unlikely, some of the basic notions are either familiar enough to be comfortable with, or unfamiliar enough to be intriguing.

Although the tenets are controversial, they are by no means original. For example, we noted how, several decades ago, the popularity of a particular book was able to dramatically increase public awareness of multiple personality disorder. Once the existence of a new malady is confirmed, the day inevitably comes when the public will “take that ball and run with it,” as the saying goes.

Age of Aquarius

Along came the Sixties, when huge numbers of young (and not-young) Americans tuned in to ancient ideas, and turned on to new ones. Our society has entertained some interesting notions and practices. Although Richard C. Schwartz did not suggest this, a case could even be made that the additional inner beings he posited might originate from previous existences.

Each “part” is like you, because they all are you, and yet each brings to the table its own concerns, talents, and traumas. Over thousands of years, millions of humans have accepted the concept of reincarnation. It would not be difficult to interpret those voices as echoes from one’s own successive physical presences on Earth.

We see how people might be persuaded that each human contains a whole crowd of entities, all with different and important roles. Even if we are unable to prove it with science, most of us have experienced the feeling of not being ourselves, as if another driver had metaphorically taken the wheel and steered us to a bad place. Still, it is a matter for concern that large numbers of professionals have climbed on board with the multiple personality premise, a theory that is, after all, not amenable to proof.

Not uncomfortable yet?

Strong objections have been voiced regarding a corollary of IFS dogma that many experts do not accept, or at least have limited enthusiasm for. This is the idea that most early-life trauma has to do with sex. For decades, that carnal connection was mostly associated with Freud. It is not difficult to see why, even within the professional realm, it might draw negative attention.

As journalist Rachel Corbett discovered, some therapists, reviewers, and patients have embraced (maybe too enthusiastically) the apparently extensive connection between eating/food issues and early sexual trauma. Patients tend to want to please their therapists, and when multiple interior beings are proposed, are perhaps too eager to find those “parts” within themselves.

Especially when the patients or clients are minors, emphasizing this view of things can attract unfavorable attention. Regardless of how severe the problem is, or even how logically obvious it might appear that some type of sexually-oriented trauma could be the root of it, no practicing therapist wants a lawsuit involving an underage individual.

Your responses and feedback are welcome!

Source: “Internal Family Systems and Eating Disorders: A Compassionate Approach to Recovery,” BalancedAwakening.com, 12/01/25
Image by SHVETS production/Pexels

FAQs and Media Requests: Click here…

Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources