Watch Now – The Psychology of Appetite and Obesity

by | Apr 21, 2020 | COVID-19 Resources

Prof. Jason Halford from the UK, & Dr Patrick Ritz from France will be speaking on the Psychology of Appetite and Obesity, as the 1st in a series of Webinars on ‘Coping during Covid-19, hosted by EASO ECPO


Transcripts are auto generated, if you find an error, please let us know.

Welcome to everybody. Thank you so much for waiting as we get set up. It’s incredible for us at ECPO to welcome you along to our first webinar on coping during COVID-19 with obesity.

Next slide, please. Just to remind you all that we do have a question and answers function. We have got a lot of questions that have been sent in prior this webinar, which will be answered.

We will try to collate all the questions that come up during this session. If we don’t get to them, we will circulate them after. We will be sharing the slides and the webinar shortly after.

We encourage you to share it, especially with your patient community, and hopefully enjoy. Next slide, please. This is our agenda for today.

As you can see, myself, Vicky Mooney, we have Cherie Bryant, who will give us a piece on COVID and obesity, which is of paramount importance. I will address some patient concerns. We will move on with Professor Jason Halford on psychology of appetite and obesity, a presentation from Jason.

We will then have some comments and a review and remarks from Dr. Patrick Ritt. We have got a question and answer session for 20 minutes. Cherie will moderate this.

We will have some final remarks and closing. Next slide, please. As you can see, here are your moderators and speakers for today.

Dr. Patrick Ritt is from France. Professor Jason Halford from IAASO is from the UK. Cherie Bryant from IAASO in the UK.

Myself, I am in Lanzarote, Spain. Without that, I will move to the next slide and introduce Cherie Bryant. Cherie.

Hi there, everyone. Thank you so much for taking the time to join. I know it’s a difficult time for everyone.

So let’s talk about what COVID-19 is about. What are the symptoms? COVID-19 is a coronavirus, and coronaviruses are a family of viruses which can cause illness in humans and animals. COVID-19 was unknown before it broke out in Wuhan, China in December 2019.

And the most common symptoms, as I’m sure you’ve heard many times, are fever, tiredness, and dry cough. Some patients also have aches and pains, nasal congestion, sore throats, and diarrhea. The symptoms usually begin to be mild and gradually.

Some people, however, who become infected don’t develop symptoms and don’t feel unwell. Around 80% recover from the disease without needing special treatment, but one in six of everyone who does get the disease becomes seriously ill and develops some breathing difficulties. So who’s at higher risk and how do we prevent infection? Older people and those with underlying medical problems, including hypertension, cardiovascular disease, diabetes, and obesity, are more likely to develop serious illness and have serious complications.

People who develop fever and cough with difficulty breathing should urgently seek medical attention. People can catch COVID-19 from others who have the virus. The disease can spread through small droplets which are spread from the person who has COVID-19 who coughs or exhales.

Effective ways to protect yourself and others, as you know, I’m sure you’ve been talking about it in your countries, include frequent hand washing, covering your mouth with the bend of your elbow or Kleenex, and maintaining physical distancing. Government recommendations across Europe differ. Some suggest a distance of one meter apart and others recommend two meters.

So if you do have symptoms, what should you do? If you have obesity and you experience these hallmark symptoms, it’s important to continue taking your current prescribed medication and contact your doctor or local health authority. They’ll be able to advise you on what to do. And of course, the shortness of breath symptom is the one we all become concerned about.

Do remember that most people who who get COVID-19 will have a relatively mild illness, but since people living with obesity are at higher risk of complications, it’s important to take care and be alert to that symptom. IAASO urges people with obesity to take precautions to avoid infection. You can learn more on the IAASO website.

ECPO also has an excellent set of resources. We include here our links to an infographic on what you need to know. Please feel free to share this as well as individual country resources from every country in the IAASO community.

Thank you very much. Thank you, Cherie. Thank you so much.

So just moving on briefly before we speak with Jason and Patrick, one thing that ECPO has done here this week is we put the questionnaire out to the patient community to try to identify some of their concerns. Next slide, please, Cherie. And what we see here is we have obviously folks who have challenges, who have barriers, and have probably some misinformation.

So the evidence-based information in COVID-19 and obesity is of paramount importance to patients like myself. I’m a patient and the reason for this is that you know there’s so much misinformation around, you know, are we at higher risk? Are we at higher risk? Are we not at higher risk? And just to clarify that as patients living with obesity we may not be at higher risk of developing COVID-19. However, if we do contract it, we are at higher risk for more serious and severe symptoms and disease progression.

So I think it’s important that folks have actual information and leave some of the challenges that they’re facing. The impact obviously of social and physical distancing and Jason will approach hedonic eating and we’ll look later as well at mental health and motivation and other concerns. The questionnaire that we put out is not an academic survey, so this was purely to identify some concerns.

We did have just under 200 responses in a 24-hour period, predominantly from Western Europe and it was circulated by social media. Of those, 92% were folks who live with obesity and 8% were those who work with or care for somebody who has obesity. Next slide please, Shireen.

What are patients concerned about? So 73% of those who responded said they had concerns regarding obviously contracting COVID-19 and obviously like such a high number. Their mental health has also been affected in the current situation with 60% advising that they are struggling on a daily basis and their motivation levels are actually quite high. You can see here 61% said they’re struggling daily to motivate themselves and not only is their mental health affected, their motivation.

Next slide please, Shireen. We asked obviously with this being our first webinar about your eating patterns and behaviours. I know myself as a patient and I find I’m constantly hungry.

So as you can see here, only 19% of those who had responded are actually eating as normal. So we had a small word cloud kind of developed. If we just click along there and you’ll see some of the, I suppose the words that folks had advised, they’re struggling, they’re binge eating, they’re overeating and these are all the things that we want to address.

On that note, I’d like to introduce Professor Jason Halford to move us along. Thank you. Thank you Vicky and hello everybody.

My name is Jason Halford. I’m a psychologist from the University of Leeds and I’m going to be talking a little bit about appetite and obesity and also the implications of that when you’re self-isolating in this new situation that we all find ourselves in. But it’s very, very challenging when you’re trying to maintain your normal eating control strategies and trying to maintain your health.

So next slide. There are a number of components of appetite that when we look at people’s ability to exert control over their eating behaviour that we study. First of all, we ask what processes lead to eating.

Well, first of all, hunger, the drive to consume. Hunger is a very general thing but actually what is critically more important is wanting. The motivation to consume specific foods.

Often you experience those through cravings. Those cravings can be particularly acute when you’re denied those food sources or you’re trying to actively give them up. But also liking it, the pleasure elicited from food.

It’s that comfort also that comes from that pleasure as well which is important. Well, what should normally lead us to stop eating? Well, process of satiation within a meal. They’re critical.

The feedback you normally get through a meal and also the post-meal signals generated from the gut which should decrease hunger through the day. Those mechanisms don’t particularly function well and they function even worse as you get to higher levels of BMI. What’s the implications for this? Well, if you have weakened satiation and satiety, food is not filling you in the way that it should do and it’s not suppressing your appetite in the way it should do.

Also, if you’ve got a greater responsiveness to food cues and you could experience that through cravings, also just automatic orientations to those cues as well, then it means that your eating behaviour is being driven hedonically. Now, the ask then is that you’ve got weakened satiety and you’ve got overactivity in the reward section, it’s very difficult for the individual to what we call exert inhibitory control. That’s not weak-willedness, that’s actually the effort.

So it’s lots of efforts going in but actually that effort achieving is very, very difficult. So under normal circumstances when you’re living with obesity, because of the biology of obesity, you have impaired control of eating behaviour. Now, under the current circumstances, all the strategies that people living with obesity have been using to control their food intake have been robbed.

You’ve lost those strategies, those things that you’ve developed to help you manage day-to-day have been taken from you. Next slide. Now, as always with looking at obesity, the challenge is not just the biological weaknesses there which make it very difficult for people to exert the behavioural control that they want, there is also the food environment and that’s around the novelty of food, the numerous opportunities for convenient eating with little preparation, the increase of inexpensive energy drinks, foods and soft drinks, fats and sugars and unreasonably large portion sizes.

These are part of our whole food environment. Now, obviously our food environment has changed because we’re self-isolating and many of us are limited on the number of times we can go shopping, where we can go shopping and also what’s in the shops. I think there’s a lot of anxiety not only about eating but actual food availability and the quality of food available to us as well.

I think that adds to some of the emotional problems and challenges we face when trying to control our diet but also critically it has an impact in the home, on the home food environment as well. Next slide. Now, I just put this slide in because many of you may not be actively trying to engage in weight management but some people are and some people will be trying to diet through this period.

We know that dieting is difficult and dieting is difficult is because whatever your weight status, your biology actively resists this. Hormones called leptin and glp-1 drop and those are the hormones which help you maintain lower weight and hormones such as ghrelin increase. Ghrelin is a hunger hormone so you’re fighting again against biology which leads to increased appetite and increased preference for energy-dense foods, foods which are high in fat and sugar.

Now, if you go on to the eCPO or the EASO site we do have some basic tips on energy intake as well as energy expenditure as well. Now, some of you will be familiar with these tips but it is worth re-examining them in the context of the new situation you are because the strategies you based on those tips will be different at home. Next slide.

I think finally what I want to say is increased energy intake is an understandable response to the environmental and biological realities of living with obesity. It’s what you guys are living with, what you’re living with day to day. It’s particularly critical to understand under stressful times but there is a wider issue not just focusing on eating behaviour and appetite that I think we should think about.

Next slide. Now, there is a association between mental health and obesity, particularly depression. Obesity and being overweight increases the risk of depression and depression increases the risk for developing obesity.

When we track this we can track this bi-directional relationship right the way back into childhood and of course when we look at obesity and when we treat obesity and we talk about obesity we should always be very cognizant that we need to think about mental health and we need to think about the life course of somebody’s obesity journey or their journey with struggling with their body weight. Next slide. Now, we can see that in terms of the impact of life events and when we think about depression and we think about stress we think about events that could cause that and their lasting effects.

I mean some events can be positive ones such as marriage and pregnancy, others could be quite stressful such as depression, such as issues in the family, death, bereavement, divorce, issues around work and I think if we many of us as we can draw our weight histories we can see where these events impact on our weight profile. Now what’s critical in understanding this is these are stressors and it’s the way that we cope with the stressors which often impacts in terms of our eating behaviour and our ability to try and control our body weight. Next slide.

Now if we’re going to talk about impactful events and life-changing events I think we’re actually living in one that many of us will never live through the present unless you’ve lived through a world war will never live through again and we know that from the literature generally, back one, so we’re just waiting for Sri to go back a slide or two. So anyway I’ll carry on talking about this slide. What we know is that there is a big psychological impact of quarantine and one of the things is how do we mitigate that, how do we reduce it both in the medium term as in within quarantine and going into quarantine but also after we come out of quarantine as well and you have negative psychological effects including post-traumatic stress symptoms, confusion and anger and people are angry because they’re isolated, they’ve lost all their normal means of control.

I mean lots of feelings that we see around extremes, emotions, anger, frustration, psychosocial stresses and also to a certain degree interpersonal relations as well. I mean we love and like our family but we’re not quite equipped for this degree of proximity to them all the time. Now stressors include quarantine duration, infection fears and obviously given what we talked about in terms of obesity and covid they’re there, frustration, boredom we’ve talked about, inadequacy of supplies and that’s really been critical when we’ve seen the problems around food availability and trying to find healthy things, inadequate and reliable information, financial loss you know many people are out of work and thinking about how are they going to, what’s their financial future and I think critically also stigma.

Now the stigma of actually catching the disease and being somebody who is a covid case, there’s also stigma about being a beast and feeling that you’re an unnecessary burden to the healthcare system and I think you know that self-blame there whereas actually thinking that you have a valid need and right to have treatment and have protection and there’s also the stigma or all these memes which have gone around around becoming fat, oh yeah look at me I’m going to become fat of the covid and all these pictures of fat babies or fat animals people are sending around. So these are all the sorts of things going along and there will also be long lasting effects of this as well. I mean what’s my treatment journey going to be after I come out of this period of isolation, how am I going to access help and you know what have been the physical and mental consequences of this going forward once we come out of quarantine.

Next slide. Now when we talk about stress, mood, dietary restraint we know that stress and mood have an impact, a negative impact on our ability to control our eating behaviour and in this situation we’re experiencing a lot of stress and it’s having a deleterious effect to many of us on our mood. That affects the coping strategies that we employ to control our eating behaviour and we may flip from some of those more functional coping strategies, those coping strategies which just help us regulate our emotions and get us through the day and you know they don’t necessarily help us deal with the temptations in the normal way that we can do and they don’t necessarily help us deal with the consequences of lapses and that means a loss of dietary control, that means diminished feelings of self-efficacy and weight managed failure which again has a negative impact on mood and stress so we get into that negative cycle.

Next slide. Now I just want to say a little bit about temptations and lapses before I finish up. Now temptations are a sudden urge to break diet when you’re close to the brink and obviously there are appetite triggers for temptations, greater hunger, feelings of less fullness and there are also mood triggers as well, sadness, feelings of deprivation, stress and boredom, feeling less relaxed and feeling less feelings of being in control.

Interestingly they can happen particularly anywhere but when we talk about lapses, lapses have the same appetitive triggers, they have the same mood triggers but interesting look at the situation triggers, they’re by and large at home in the evenings at weekends and that’s the situation that we are all in at the moment. So we’re in a particularly vulnerable situation for lapses and we need to look at our usual coping mechanisms and look at the current situation in terms of reducing our exposure to temptations, not always easy when you’re confined, prevent them triggering lapses but also managing the consequences of lapses and realising lapses aren’t the end of the world and that you’re on a pathway here and looking for the support to help you with these coping strategies. Next slide.

Now EASO and ECPO have brought out some guidance on resilience and mental health and some of these are very basic things which you do normally following regular schedules, establishing objectives, keeping well informed, I mean that’s particularly important in the current crisis but remember don’t over immerse yourself in information, be careful where you get the information from because it can be very anxiety provoking. Again limiting caffeine with anxiety is probably quite wise and talking about prioritising activities to keep your mind active and using relaxation techniques are a way of combating anxiety as well but critically staying in contact, you know that self-isolation thing is a big issue and if you can rely on the supports of trusted friends or family but also support groups that is particularly useful as well. You can get the resource on the website and the links to further resources as well from that on the ECPO and EASO website.

Next slide. This is just because many of those tips were around anxiety, I just put this slide in from the UK National Health Service Every Mind Matters anxiety management tips and this just expands on some of the things we’ve talked about in terms of staying connected, maintaining healthy relationships, talking about your worries and getting support from others, working on schedules and feeling more prepared. I think number five is critical, looking after your body.

The exercise and the energy intake is not just about weight management and it’s not just about that, it’s about self-care and I think what we need to do is focus a lot more on self-care during the situation. Again stick to the facts as well and avoid some of the social media coverage of the current pandemic, finding things that you do which is enjoyable to find rewarding and focusing on the present rather than worrying about the future over things you can’t necessarily control at the moment is quite important and finally looking after your sleep as well. Quality sleep has a big impact on physical and mental health so getting enough sleep and maintaining regular patterns of sleep is important.

That again speaks to activities, anxiety, reducing things, reducing your screen time particularly before you go to bed as well. So finally increased intake is an understandable response to the environmental biological realities of living with obesity particularly during stressful times. The current situation is unprecedented and promotes a dramatic challenge to people living with obesity however there are opportunities to learn new skills and new strategies and gain access to new support networks which hopefully should help you see through this current period of time and hopefully we’ll be able to get to a point where we can work together with the patient community to address their needs coming out the other end of this quarantine period, this unprecedented period that we’re living through.

Thank you very much. Thank you Jason. I don’t hear Vicky on the line so I will introduce our colleague Professor Patrick Ritz who is professor of clinical nutrition in Toulouse and has spent his career working in obesity and eating disorders.

They have some very interesting programs there in the south of France. Dr. Ritz if you would share a few comments with us please about your work and how you’re managing there in France with the current crisis. Yes thank you.

First congratulations for putting together all this amount of information, reading the slides from Jason and especially the last one with the 10 tips. I feel like I’m going to translate it straight away and make it available for the patients. To be more serious we need to share the correct information and Jason has said so, Hsiu-Hui and Vicky have said so, so this is very very important that we get the most accurate information as possible.

In the south of France we are very lucky at the moment because there are very few patients that are suffering from this infection which is not the case in the north or the east of France where the number of patients has been very very important. So what we do here in Toulouse in the south of France at the moment is prevent people from coming to the hospital. It is a matter of preventing infection to go from one person to the other and we are only inviting the patients with a severe enough situation to come to the hospital and as far as possible use e-medicine, e-consultation, teleconsultation, video conferences to help people cope with a situation.

This is a tool that is important. We can get access to a nurse, a dietician, a psychologist, a medical doctor through these means. Then I’m lucky enough in my team to have dieticians and psychologists who are used to deal with all these matters of anxiety, depression, compulsions, binge eating and so on.

So at the moment we are very careful about it and we make ourselves available to the patients we know for phone conversations and so on and the psychologist that works with me, Aurélie, who is on the phone as well but unluckily speaks very little English. Aurélie has people on the phone every day and what she says is that it’s not only one call that is important, it’s also the fact that after one call Aurélie can call again the patients that need us. So one advice I would give to patients is if you feel uneasy, if you feel in need of help, try to find someone among your health system that is able to help.

Finally, my last comment goes to Jason because I think his presentation was really, really good and really clear. I think that now we are about to answer the questions. Is that the program? Thank you very much.

Thanks a lot, Patrick. Really appreciate it. So we do have some questions that have been shared already.

I will be happy to let Vicky say a few words. Absolutely. Thank you so much, Patrick and Jason.

I think particularly we have quite a number of attendees that are people who live with obesity and some of your remarks and obviously the presentation that’s delivered there really help us understand what is happening at the moment in our lives. I think one of the things that Jason mentioned there regarding the situation, one of the reasons that we may lack in our diet is we’re at home or we’re stuck in at the weekend or evening times. I might pick in the evenings.

I know myself, I’m terrible. I’m always hungry in the evenings. That is one of the reasons that we lack.

Unfortunately, we’re all stuck home now. There’s a lot of self-blame and a lot of, we’ve seen in the questionnaire of people saying they feel like they’re failures. They feel like they’re beating themselves up on their own mind, that they’re not doing good enough, that they’re constantly hungry.

I really appreciate that you address this and give us some insight into what is actually happening with ourselves. I think one thing that it was touched on that we will definitely approach in another webinar is this new wave of stigma. We’re seeing all of these memes and pictures pass around of somebody who has obesity.

It could be, heaven’s sake, it could be a picture of me. The tummy is hanging out and the average person saying, oh, this is so funny. This is how we’re all going to be.

No beach bodies this year. I think we’re going to face a whole new challenge coming out of this that we will have to address, of course. I really appreciate that.

I think, Patrick, you have a great view from what I believe you work with patients so closely. We really appreciate that. I’d like to hand over to Cherie for the questions and answers.

We did get quite a few in prior this. We can, I think, jump straight in, Cherie. Thank you, Vicky.

The first question is about a patient who has had bariatric surgery. The question is, I’ve had bariatric surgery and I initially lost a lot of weight. I’m finding my old behaviors creeping in.

I think they’re looking for some guidance here. Well, Patrick, if I answer, we know that there is a honeymoon after bariatric surgery, which lasts for 12 to 18 or 24 months, during which things are relatively easy. Then, after two years and a series of publications and scientific works in the US have well demonstrated that for 20 to 40% of people, weight increases again, not as much as it was before surgery, but there is an increase.

Every patient I know who has been operated is afraid of the first kilogram that is gained. Gaining weight after bariatric surgery is one of the issues. It is not because people do badly that it occurs.

It probably is something related to the behavior, physical activity, eating behavior, the conditions around us, the family conditions, the stress conditions and so on. What we believe today is that it is not the people’s fault. It is something that needs to be learned, how to improve our behaviors.

In this context of stress, I’m not surprised that people will gain weight. I would suggest that the tips that were given by Jason are very good to handle the difficulties that people have and that may lead to behaviors from before surgeries coming again. Thank you, Patrick.

Since I have you here, there’s another question from someone who’s had bariatric surgery and is concerned about their intake of vitamins. The question is, I had bariatric surgery. I’m really worried about my vitamins.

Should I be taking more than usual? Maybe that’s because of the stress. If I can’t get them, what should I do? It’s a good idea. Good question.

I think it’s a very, very good question. What I would say is, first, it all depends whether at the beginning of this period, there were deficiencies or not. If there were no deficiencies in vitamins, in iron, in copper or whatever, there is no reason today to imagine that the needs in vitamins, in iron are increased.

The usual treatment with vitamins should be enough. This is the first thing. If there were deficiencies before, then it’s another issue.

Maybe an advice from the dietician or from the medical doctor or from the surgeon that is working on your project is useful to know what to do if you are short of vitamins, if you need more or if you can follow the same path. As far as getting the vitamins is concerned, there are today through the internet some very reliable sources of vitamins. If someone happened to be short of vitamins, again, I would give advice to seek the doctor or surgeon advice to know about a reliable source of vitamins.

I think that would be my answer. Thank you, Patrick. I think that sounds very helpful.

I think there must also be support groups that have developed around and perhaps are even more active. I know for certain that ECPO has really pushed out more support groups than ever in country to help support people who are both living with obesity and going through this pandemic in quarantine. So I suspect that people are having these kinds of conversations in smaller groups all over Europe, all over the world.

Here’s the next question. Although I have been feeling okay before the pandemic, I can feel the depression coming back. I know the health service is overwhelmed.

What should I do? Jason, do you want to? Yeah, I will deal with that. If you are suffering from depression, you have the right for your depression to be treated. Certainly there are resources within healthcare systems which are not being utilised for COVID treatment, which can be used.

They’re still there and available. As Patrick mentioned, there are the psychologists within the group, psychiatrists operating. Many of the physicians have gone front of line to deal with COVID and many of the clinics have been disrupted because of that.

But there are mental health professionals within those teams who will be more than happy, in fact, would be able to come in and step in the breach. Moreover, there are other resources out there which you can engage with. You have the right for that treatment and I think it’s important that you get that treatment.

Although it’s difficult sometimes sharing this, I think the mutual support that people living with obesity can offer each other, which is being currently facilitated by ECPO, is very important as well. I think sharing worries, sharing concerns, sharing the way you are feeling is very important because depression is an isolating thing and you’re in an isolating situation. You’re not a burden and this needs to be dealt with.

Thank you, Jason. That’s a good answer. Here’s another question.

This is challenging. We are in a small apartment, but a busy household with two children. Quick and easy food is best for me, but I find myself snacking too much while making food for others.

I think probably everyone has this challenge during quarantine. It’s such an unusual time, isn’t it? Jason, do you want to speak to this? Yes, I’d be glad to, Cherie. I think we all hear you there.

I think for all of us trying to work, look after the family, look after children, school children as well, provides a lot of stress and strains. Now, doing planning and making a schedule is there to help you. It’s to help you plan and prepare and feel a little bit more in control.

It helps you bring in times where you’re eating, times when you can do some leisure activities, time where you can have some time on your own. Also, you can plan meal taking and meal preparation activities around that. Now, obviously, these things seem somewhat aspirational at times.

Then, when you don’t succeed on staying on your schedule, you beat yourself up about it. The schedule is there to support you. It’s not some militaristic rule that should govern your life.

If you don’t adhere to it 100%, that’s fine. Actually, sitting down and doing some planning and involving the family in that planning may be a good starting point. Just keep evaluating where you are, what worked, what didn’t work.

Remember, you’re not alone in this. Everybody’s going through this. Sharing issues with other people living with obesity and friends and family and having some discussion about this is also quite useful as well.

You’ll pretty soon realize that you’re not the only person who is trying to do everything the right way and lapsing a bit here and lapsing a bit there and then feeling incredibly guilty about it and then feeling a failure about it. You’re not. This stuff is difficult.

Thank you, Jason. That’s great advice. It also might be relevant for the next question, a longer question.

This is a person who’s living with both obesity and type 2 diabetes and is responding to the vulnerability to the potentially serious coronavirus consequences by staying indoors. He writes, I’m sometimes fearful about opening the windows and have this, I feel like I’m suffocating indoors and hand-washing, wiping everything down with and worry. This feeling leads me right into snacking.

I mean, this is classic anxiety, isn’t it? Really? And it goes back to what we were talking about earlier on in the presentation. Now, I think critically, it’s important that when you’re living with diabetes and living with obesity, you follow the advice that you’re given, but whether that advice should be extrapolated into further measures, I think you need to be careful about. I think it’s worth talking with your healthcare professionals about your current situation and how you’re reaching out and how it’s affecting your life.

I’m no expert on infectious medicine, but I think shutting yourself in and then feeling anxious and can’t breathe, I think you’re beginning to have anxiety and panic attacks and things like that, that could progress a little. So I think perhaps stepping back and reevaluating the situation and getting some like some input from friends, from family, from perhaps some healthcare practitioners, and look at resources around anxiety and anxiety management as well. So yes, we have to wash our hands, but not excessively.

Yes, we need to be careful about infection, but if the things that you’re doing are beginning to have an impact on your daily functioning in a detrimental way above and beyond living with obesity and diabetes in isolation, then you’re going to start having more and more problems. So I think it’s worth having reflection of what is being asked of you in terms of self-protection and self-isolation and in terms of what additionally you’re doing out of fear and anxiety and what actually is actually a reasonable response versus one which is driven out of fear and anxiety. And I think there perhaps taking, you know, taking, getting some support from friends and family and from professionals as well, it is quite, it would be quite a useful thing.

You will not be alone in this, by the way. Thank you, Jason. Shiree, it’s just Vicky here.

I just wanted to add some comments if you don’t mind as well. What you said there, Jason, I think is quite interesting because a lot of the time we see stigma and I suppose the comments that we don’t like coming from our family or loved ones who obviously have concern about us, but it’s very difficult to take the criticism or the comments on, wow, you’ve gained weight and that. And at this time that we’re in, things have changed so much that these are now the people that we now need the support from.

And I think something that you hit on there is very important and it’s the communication with your family and with the people that you’re living with and addressing some of the fears you have and letting them know how real they are. You know, I know a lot of my own kind of, I can beat myself up in my mind better than anybody else and, you know, verbalize, but I generally don’t share that with, you know, my fiance or my children because, you know, it’s private and I’m in fear really. But the more we communicate with these people, the more they will understand.

And I think that support is of paramount importance right now to many of the Haitian community. Thank you. That’s really helpful.

I also wonder whether Patrick, your psychologist colleague, might have some reflection on that too, because a lot of these questions really seemed focused around. They’re not tactical. They’re not, you know, what kind of, you know, what do I do if I can’t get access to my vitamins? They’re experiential and people are struggling.

It’s a difficult time. I’m just looking at this next question, which I can wrap into. I live alone.

I don’t have any of my usual life anchors, walking to the bus, going to work, interaction, eating lunch with others. My remote work has been curtailed. What can I do to help with the feeling of isolation and overeating? Any suggestions? Yes.

I think that this situation is difficult for every single person, more or less, but it is difficult. We have to acknowledge that. Every single positive input that enters your life is something useful.

I’ll just give you an example. Last Sunday was my wife’s birthday. Her daughters are living away in France and we managed to have a lunch all together through an application.

It was WhatsApp, I think, which she was very happy about because at some point there was something very pleasant for her birthday. It’s just one idea to fight against isolation. We have talked about community, speaking to others, and things like that, but we can do things with others.

We can play with others. We can play music with others. We can through this telephone application.

I think this is something to be looked after. What the psychologist working with me insisted on is how to deal with emotions. Emotions is something that we are not used to deal with.

We are easy with positive emotions, less easy with negative emotions, and very uneasy with fear. We used to say that in the Pyrenees, in the south of France, if you meet a bear, it is very obvious that you will have fear. What do you do about that? Well, strictly speaking, just now, I don’t know what to do.

This is what happens today with this infection. It is so unforeseen that many people have amazing unforeseen emotions. And what Aurelie says is, can you try to know, try to name, try to think about what these emotions are, and can you make sense about them? If you feel isolated, if it is something negative for you, what can you make sense of it? Can you call other people? Can you find a solution? Or is there a special reason now why it is like that? And can you find this reason? I’m not going to go into psychological evaluation and so on, but very easy things like that.

The other tool we can use is physical activity. And there are today on the internet many, many tutorials, little applications, little videos that will help you do very simple things. Not only the sports that athletes would do, but little exercises that help you do something during the day and probably fight against emotion and fear and anxiety.

There are also applications about mindfulness, controlling breath, and so on, which might be useful as far as anxiety is concerned on top of 10 tips that Jason gave. Yes, I think that’s the main issues, a few more issues. Thank you.

That’s really helpful, Patrick. I think just mentioning the word fear, which is something I never hear in the discourse around this pandemic, I hear about coping stress and anxiety, but fear is a very relevant word. And I have a question here, which is quite long and I’m going to try to summarize it.

I usually cook dinner, cook our family dinner. Now that we’re in lockdown, I have a partner who expects me to prepare all the meals. He is the main breadwinner.

So I am working, managing the kids with schoolwork, hand-washing, keeping them from fighting, doing my homework. This sounds like real life and managing food for everyone. Now I’m always in the kitchen.

I find myself angry and resentful, and I’m always around food. Any suggestions? Sorry, I’ve got to be on mute there. I think this is, there’s lots of things in here to unpack.

Well, first of all, obviously being in the kitchen is a real issue and the negative emotion is a real issue. And I think we know that psychosocial stresses are particularly associated with vulnerability to overeat and weight gain as well. And so this is quite a serious problem.

Now, if you can’t talk to your partner about the way that you’re feeling about this, then I think it’s worth reaching out to others just to, first of all, explore your feelings around this and articulate them. I think it’s also, if you are confined within home and working relationships and things have changed across the whole family, I think it’s worth sitting down and as a family and having a discussion about how things are going to work out better. And perhaps in that context, people can think about their contribution to the family situation as well.

It’s difficult and I’m not qualified to give advice on relationships. I don’t know the situation as well, but what I do know is you’re entitled to some self-care and you’re entitled to some time on your own to look after yourself. Excellent.

Thank you. Thank you, Jason. That’s great.

That’s a good answer. I think that’s going to be helpful. There’s another question about bariatric surgery.

So this is a person, I am waiting for bariatric surgery and I had to lose a lot of weight before being eligible for surgery. My operation has now been postponed and I’m worried that I may gain weight. I have lost in the program.

If I put it back on, will I lose my turn altogether? Any practical steps I can take? And actually, Patrick, please do speak to this and then I’ll turn it over to Vicky, because I’m sure she has some comments about this too. Yes. Thank you.

That’s a difficult question because in France, the resources for bariatric surgery are important. And therefore, this sort of losing the turn is not an issue in France. So that we don’t expect people to lose weight before they are operated.

If they do a good job, if they do not, it’s not always an issue. If they gain weight, it’s another issue, but if they don’t lose weight, it’s not an issue. So my advice would be, although I don’t know the situation, my advice would be, can you speak to the surgeon and try to negotiate something that is pertinent to the situation? If the surgeon can understand that stress and all what Jason explained can lead to dysregulation of appetite, eating behavior, and so on.

And if a surgeon can understand that the person has put on one or two kilograms, then maybe it’s easier for the surgeon to accept that this person needs to be operated. Just to add to this, this has actually been for our medical colleagues. This is a problem that they’re well aware of, and they are trying to work very hard with reimbursers who have these requirements to suggest that this requirement should be dropped.

So I think many in the medical profession who work with people living with obesity are well aware of this as a problem, are actively trying to advocate for changes in that rule, or at least some understanding of the application of that rule in terms of the consequences of the current pandemic and people coming out of that pandemic as well. So yes. And the other thing I would say is there are many, many people in this situation.

It’s a very commonly asked question. Thank you. Thank you, Jason.

We’re getting close to the end of our planned time. So why don’t we move along, and I’ll turn it over to Vicky, who will have some final remarks, and she may also be able to speak about that. Thank you.

Thank you so much, Cherie. It’s so appreciated. We are literally at the end of our webinar, and I want to thank Cherie, of course, who is a rock for us at eCPO, as we are a patient organization.

Jason and Patrick, thank you so much for your insights and input. And as this is our first webinar, I thought we’re finding our feet, and to have your professionalism, to have your experience, and to use your brains and your knowledge and wisdom has been tremendous for myself. I’ve learned things and reflected on things throughout this whole webinar experience that I didn’t really think about before, to be honest.

So thank you all. And to note, there has been some questions there regarding whether or we can share the slides, the recording afterwards, the images, people appreciated the images, and all of these will be available on the EASO and the eCPO website. So if you go to the eCPO website, you will see we have a number of images there of, I wouldn’t say happy people living with obesity, but there’s a lot of our team pictures and professional photos that are fantastic to use.

So feel free to use them. We will circulate all of this afterwards. And of course, there’s a lot of infographics and other presentations and resources that you can use also.

And this also showed that we are all in this together. You know, as Jason rightly said, and Patrick, you know, use aligned communication with your family, you know, get on WhatsApp and have those meetings with family and share your concerns because all of our support has been taken away as people who live with obesity. So utilize what we have.

And go back, you know, we’ve heard all this before that, hey, you know, if you put down on this food or exercise more, and we’ve heard all this, but let’s go back to and revisit everything that we have been told. And do our best. Do not beat ourselves up in our heads, right, in our minds.

Do not internally stigmatize yourself. By attending the seminar, or this webinar, you’re doing tremendous by sharing it with people that you love. It’s impossible in this day and age to not have somebody who lives with obesity in your life, whether it’s a colleague or a family member, or a friend.

So share the resources because there are people who literally will not speak out like many of us do. Thank you so much. Thank you, Jason.

Thank you, Patrick. Thank you to Patrick’s colleague who is with him. And thank you to Cherie.

And we will circulate all of this in time. Thank you, everybody. Thank you so much, everyone.

Thanks to all. Best wishes. We’ll see you on the next ECPO webinar.

Look forward to it. Thank you. Bye-bye, everybody.