I am a principal and the Professional Training Coordinator at ACORN Food Dependency Recovery Service, a treatment and training program based in

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2 I am a principal and the Professional Training Coordinator at ACORN Food Dependency Recovery Service, a treatment and training program based in Sarasota, Florida. I have written and published several books, chapters and articles in the field of food addiction. I have no other relationships with commercial organizations of any kind to disclose.

3 I am in favor of bariatric surgery. It saves lives and alleviates pain. I have worked professionally with over 4,000 late stage food addicts since 1988, and there have been cases where I recommended surgery in addition to food addiction treatment with positive outcomes. About ten years ago, I started seeing an increasing number of clients who had bariatric surgery, couldn t stop overeating, and regained most of the weight they had lost. They did food addiction recovery work, lost the weight again and are either still losing or maintaining a healthy weight loss.

4 BEFORE lbs lbs BEFORE AFTER

5 In 2007, I started writing an open letter to surgeons about my experience with food addicted patients who regained weight. In talking with surgeons and reading the literature, I found that as many as 30% of surgery patients either did not lose weight, or became newly addicted to alcohol or drugs in the first year or two following surgery. New research confirms this. I wrote a book and started looking for a bariatric surgery practice interested in developing a food addiction track. I have yet to find one, though discussions with UMass may lead to such an effort here, if we can manage the logistics of distance. One practice in Nashville said they thought everything I said was true but they couldn't figure out how to get paid for the food addiction work.

6 Prescreen every patient for food addiction For those testing positive, do a thorough diagnosis and develop an expanded bariatric treatment plan that incorporates treatment of food addiction Educate all bariatric surgery patients about the need to properly prepare for their surgery if they are among those who turn out to have advanced food addiction Offer Twelve Step resources and opportunities to detoxify Develop special post surgical aftercare for those who are food addicted linked to Twelve Step support Send those who still cannot stop overeating to treatment, e.g. outpatient addiction recovery group, one-week residential workshop, or residential treatment

7 NORMAL EATER (with obesity) EMOTIONAL EATER (eating disorder) FOOD ADDICT (chemical dependency) The problem is physical: Weight The solution is physical: Medically approved diet Moderate exercise Support for eating, exercise and lifestyle change What works: Willpower (less calories in, more calories out) The problem is physical and mentalemotional: Binge eating, restricting, and/or purging over feelings Unresolved trauma And possibly weight (sometimes overweight and sometimes underweight) The solution is mental-emotional and physical: Develop skills to cope with feelings other than with restricting, purging and bingeing Resolve past emotional trauma and irrational thinking (heal trauma) Same as for Normal Eater What works: Moderate Eating (challenge irrational thinking, resolve prior trauma) The problem is physical, mentalemotional and spiritual: Physical craving (false starving) Mental obsession (false thinking) Self-will run riot (false self) And often trauma and weight The solution is physical mentalemotional and spiritual: Abstinence from binge foods and abusive eating behaviors Rigorous honesty about all thoughts and feelings A disciplined spiritual program, e.g. The Twelve Steps All those for Normal & Emotional Eaters What works: Surrender [complete commitment to battling a chronic condition] (no addictive foods, ask for help, work a spiritual program)

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9 Case studies 1,2,3 are from Werdell, Bariatric Surgery and Food Addiction Case study 4 is from a client of the surgery practice of Dr. Lowe mentioned in the book Food Addicts in Recovery Anonymous. All individuals in the case studies are given a different name and disguised to keep their anonymity.

10 Food Addiction: Progression and Recommended Actions Disease Stage Recommended Actions Pre-Disease No sign of abnormal eating or reactions to specific foods. If no dependency or pathology develops, this stage will continue through the person s entire life. Early Stage Problems with weight management, cycles of weight gain followed by dieting, weight loss, and weight gain again. (Occasional binge eating on sugar, excess fat, or volume could be early-stage food addiction or a normal eater making unhealthy choices.) Middle Stage Frequent binge eating and grazing. Purging or severe restriction may begin. Rationalizing before eating, guilt afterward. Could be advancing food addiction or emotional problem eater with a psychologically based eating disorder. Prevention Education about food addiction. Ongoing checks for signs of chemical dependency. Moderation in eating, especially commonly addictive foods, e.g., sugar, caffeine, excess fat, alcohol, drugs. Detox and Abstinence Identify addictive foods. Eliminate binge and trigger foods. Move through detoxification. This often seems extreme if negative consequences are not yet severe. This can be the beginning of addictive denial. Twelve Step Group/Counselor Participation in a food-related Twelve Step program, e.g., Overeaters Anonymous, and/or work with a food addictions counselor. Assistance with addressing blocks to physical abstinence, especially denial. Develop feeling skills, resolve trauma.

11 Late Stage Serious consequences from overeating morbid obesity, Type II diabetes, chronic depression and/or spiritual disillusionment, and eating anyway. Food no longer provides comfort, escape, oblivion, etc. Loss of control, increasing tolerance Final Stage More Structure and Support Participation in a highly structured Twelve Step program, e.g., Food Addicts in Recovery Anonymous, Compulsive Eaters Anonymous HOW. Outpatient treatment and/or workshops such as those offered by ACORN. Abstinence as a spiritual path. Primary Inpatient or Residential Treatment Severe consequences hospitalization for heart attacks, suicide attempts, lost jobs or inability to work, ruined relationships, treatment and/or intestinal surgery followed by relapse, housebound or confined to nursing homes. Given the lack of any hospital-based inpatient treatment for food addiction, alternatives include Turning Point of Tampa, Milestones in Recovery, Shades of Hope, ACORN s year-long Living in Abstinence program. This is sometimes insufficient. DEATH

12 PO Box Sarasota, FL PO Box Sarasota, FL