Much of our experience has come through the treatment of type-2 diabetic patients suffering from obesity . More than 80% of our type-2 diabetic patients are overweight, very often due to dietary behavior of a binge-eating disorder. The usual nutritional approach is insufficient, since even ideal teaching of dietary knowledge, and the fat contents of foods does not bring about a lasting loss of weight. Even multiplying the number of practical teaching exercises on food management, shopping habits, slimming recipes, etc., only brings a very slight improvement in long-term results. The cognitive-behavioral approach has allowed us to make a great step forward in our interdisciplinary approach and to maintain behavioral changes in the long term [12, 24, 25].
The cognitive-behavioral approach is above all interested in the mechanisms behind the triggers of binges and emotions, as well as automatic negative thoughts (I'm no good, ugly, incapable). The final step of what is called a functional analysis (fig. 4) of a binge episode consists of helping patients to find their own strategies and evaluate the positive consequences arising from them.
The functional analysis (fig. 4) of a food binge allows patients to break the vicious circle. For example: frustration at work (trigger) associated with anger (emotion) and negative thought, such as 'I'm silly to let myself be
insulted', will induce a binge disorder as usual strategy: 'I get stuck into food as soon as I get home'. Finally, the consequences of this vicious circle are weight gain, bad glycemic control, a lot of guilt, and even more frustration.
By analyzing the flow from trigger to consequence, patients will gain a better understanding of the underlying mechanisms involved. They will move progressively from a vicious circle into a virtuous circle (fig. 5). For example, frustration at work will be reduced by patients learning to be more assertive, to say no politely, to step back, to express their emotions, etc. Expressed emotions will grow less painful and thoughts will become less negative. Meanwhile, replacement strategies for binges will be found which will become both rewarding and pleasurable. As a result, food binges will decrease in number. Finally, the consequences for quality of life and biological results will become more tangible and increasingly felt by the patient.
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