Very low-energy diets. These are often available through clinics, where the diet supervisor (usually someone untrained in nutrition) provides some monitoring designed by a medical practitioner. These diets usually provide a formula feed of less than 800kcal/day, which is less than the usual range needed for the resting metabolic rates of most adults. The physiological effects of these diets are less than for fasting, but still carry risks and require medical supervision. The low-carbohydrate content of the formula stimulates the production of ketones which are thought to be responsible for the appetite suppression experienced. The hunger is intense upon reinstating carbohydrate in the diet. These diets should only be administered to morbidly obese people fulfilling strict selection criteria and within the context of a long term management plan.

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Some of the best work in this field has come from eating disorder specialists at the University of Toronto. They recently conducted an important piece of research comparing the effectiveness of different treatments in reducing the symptoms of bulimia. Amazingly enough, they found that for the healthiest 40 percent of the bulimia patients, educational therapy-in the form of a short lecture course-was as effective as a much longer treatment involving individual cognitive-behavioral therapy. The lecture course gave information about bulimia as well as self-care strategies to help the patients learn how to return to normal eating habits. The findings of this research suggest that it makes sense to begin treating bulimia patients with educational therapy and reserve costly, time-consuming individual therapy for those who don’t get better after learning the facts about their disease.

I can think of few other illnesses in which there can be such a dramatic therapeutic response after taking the simple step of learning the facts. In the next few pages, let’s review some of these facts as they might be covered in a course of educational therapy.

Our society keeps turning up the pressure to be thin. As a result many women resort to severe dieting. Our bodies, however, operate under biological rules. Each of us has a certain predetermined weight range-the set point range-that our bodies fight to maintain. For many people, this range is higher than what society says is the “ideal standard” for beauty.

Excessive or constant dieting robs the body of the food it needs to maintain the weight it prefers. The body then turns up the volume on the “hunger” signals. The result: bingeing.

Some people then try to undo the damage by purging, which leads to a vicious cycle. The woman binges with less guilt, since she knows purging will protect her from gaining weight. And she binges because it’s easier to vomit with a full stomach. Purging also keeps the body in a constant state of semi-starvation and dehydration. The cycle leads to anxiety and depression, which the woman then attempts to relieve through further eating.

After prolonged disruption, a person’s body may lose its ability to control eating. A woman must then relearn what it means to feel hungry, how to eat properly, and when to stop eating. She also has to learn to feel comfortable and not feel anxious when her body returns to its natural set point weight range.

But how does she know what that range is? In other words, what should her “goal,” or target weight, be? That’s something educational therapy can show her. First, the weight should be such that she can maintain it easily. She should be able to stay at that weight without resorting to extreme dieting, which as we have seen promotes bingeing. Secondly, the goal should be an individualized weight, not one derived from statistical charts.

Actually, the best goal is really a “no-goal.” By that I mean the woman should stop thinking in terms of weights and numbers and concentrate instead on learning better habits. Through psycho-education, she learns how to eat reasonably, exercise regularly, and develop ways of coping with stressful feelings without using food as self-medication.

Reaching this no-goal, however, usually occurs at the end of therapy. There are lots of steps in between, some of which involve setting up concrete objectives and working to achieve them. For example, an anorexic needs to know how much weight she has to regain. Her target should be neither too high nor too low, and should be a range rather than a precise number. As a rule, I ask patients to reach roughly 90 percent of the stable highest weight they had prior to the onset of their disorder. Each patient is different, but many find they can reverse starvation and maintain a reasonable weight without subsequently feeling the urge to binge and purge.

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In 1992, Jeanann was a 22-year-old college graduate about to embark on a career in university public affairs. At 5 foot 2 and 200 pounds—she gained about 20 pounds in each of her last 3 years of college—she wondered whether she would be able to meet the demands of her new job. “Being overweight made everyday activities so much more tiring than they used to be,” she explains. “I made up my mind to slim down.”

Armed with information from the university library, Jeanann began trimming the fat from her diet and walking on a daily basis. She planned her walks for first thing in the morning so she’d be certain to fit them into her schedule. The trouble was that she had a hard time getting up early. At 4:45 A.M., all she wanted to do was snooze.

At about that time, Jeanann happened to be reading What It Takes to Be Number One, a book by legendary football coach Vince Lombardi. She was struck by one particular passage, in which Lom-bardi wrote, “Winning is not a sometime thing; it’s an all-the-time thing.”

His words provided the motivation that Jeanann needed. “I understood that to succeed at weight loss, I had to win every little battle along the way—including my morning skirmishes with my alarm clock,” she says. “I had to think like a winner to be a winner.”

From that point on, Jeanann had a new morning ritual. Rather than hiding her head under her pillow to block out her alarm clock’s ring, she repeated to herself Lombardi’s words. And then she asked herself, “Do I really want to be fat?” That got her out of bed and into her running shoes.

It also kept her weight-loss program on track. “After all, a winner doesn’t give up when she’s halfway to the finish line,” Jeanann says. Within a year, she got rid of all 85 unwanted pounds. She has maintained her weight at a healthy 115 pounds ever since.

WINNING ACTION

Give yourself a pep talk. All of us have moments when we need a little extra push to help us stick with our weight-loss programs. At times like these, having some sort of personal slogan can help. Think of a quotation, a song lyric, or a prayer that gives you inspiration and strength. If you can’t come up with one, create your own affirmation. For example, “My body is getting stronger, slimmer, and healthier every day.” You can repeat your slogan to yourself whenever you need to, or you can make it part of a daily ritual, as Jeanann did. It can help you get over the bumps on the road to weight-loss success.

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