By Janis Rosenberg, Ph. D.
Losing weight is one of the hardest goals to achieve. As a psychologist
who has worked with weight and food issues with clients and as woman who
has battled extra pounds myself, I have studied this issue and watched the
popular culture and fad diets move through many different incarnations. I
also work with individuals who have more severe eating disorders, either
restricting or bingeing and purging.
There are many reasons for
food addiction and overweight. Some are chemical and some are emotional.
In my years of helping those with eating problems, I’ve learned
that to successfully recover, blocks in both the physical and the psychological
realms need to be understood and resolved.
There is an epidemic of overeating and obesity
in the United States and now we are hearing this is becoming truer in
other Western countries. It’s estimated that 65% of Americans are overweight or obese. Some
wonder, with cheap and easy calorie loaded fast food, with the sedentary
lifestyle that is especially problematic to children, why everyone isn’t
fat. Half of our children are overweight because television and video games
have replaced family time. Parents are afraid to let their children play
outdoors. Prevention Magazine quoted a study that says it only takes 100
calories (one cookie) over your allotted amount of calories per day to
gain 10 pounds in a year. Even if you aren’t compulsively overeating,
weight can creep on as we get older unless some serious
changes in lifestyle are embraced.
Most people who are overweight have a strong desire
to lose weight, to be healthier, more fit, and more attractive. We get
discouraged for several reasons: it’s not easy; it hasn’t worked in the past; we feel
like failures; we have too much to lose. We give up our belief in ourselves
to be able to do it. We have no hope that we can stay on the diet or maintain
a healthy eating pattern. We have tried several diets and many don’t
work. This helpless mode comes about because people give up hope after many
failures, since failure brings about more shame. Shame is a very potent emotion
and we want avoid it, so we give up trying.
Group support helps to create hope and seeing
others succeed creates a feeling of possibility. In my groups for compulsive
found that people can take in valuable feedback from another group member
more readily than they can take it in from me, since other food addicts
get it and are also working on how to succeed.
There are different categories to describe a troubled relationship
with food. There is the category of eating disorders, anorexia or bulimia,
which are serious issues and need to be addressed with psychotherapeutic
treatment, since they can be life threatening. These disorders, the obsession
with food, body image and the compulsive need to restrict or binge and
purge, are painful and destructive, both for individuals and families.
It’s important to understand
the physical or chemical reasons that make it hard to lose weight.
Dr. Michel Mazouz, a Los Angeles physician who has been successful in
helping many patients lose weight, explains Metabolic Disorder as follows:
Metabolic syndrome is a complication
of being overweight that makes it more difficult to lose weight. Insulin,
the hormone that stores sugar, takes blood sugar from the blood and delivers
it to the cell. Before diabetes develops, insulin doesn’t work well. The body compensates by overproducing
what isn’t working well. The body overproduces insulin, which creates
more hunger and craving of sugars and carbohydrates. Sugars and carbohydrates
are harder to metabolize and may be stored into fat.
High levels of insulin in the body need to be treated. One fourth
to one third of people in United States have metabolic disorder, due to
obesity. There are greater cardiovascular risks if you have metabolic disorder.
Cardiovascular damage starts five years before diabetes shows up. Dr. Mazouz
treats this with Glucophage, a diabetes medication, to regenerate the insulin
so the body will stop overproducing it. With more level insulin levels,
the body will crave less of the insulin producing sugars that would be
stored into fat.
Those who have a metabolic
disorder have a harder time losing weight. The main symptom patients
can feel with metabolic syndrome is that eating refined carbohydrates
leads to more hunger. It’s a vicious circle.
You eat carbs or sugars and you create more insulin and an hour later,
your blood sugar drops and the brain craves more.
Dr. Mazouz describes the medical characteristics of a patient with
Metabolic Syndrome, or Insulin Sufficiency or Syndrome X.
Metabolic syndrome is defined by a constellation of measurable
characteristics that diagnose the syndrome:
- A waist size over 40 inches for men and over 35 inches
- Blood pressure over 135 systolic or 85 diastolic.
- Fasting blood sugar over 105, cholesterol over 200 or
a low ratio of LDL and HDL.
Dr. Mazouz prescribes a low carbohydrate, high protein diet, but
with some carbohydrates in the early part of the day. He also prescribes
L-carnitine, which stimulates fat burning in the cell and Chromium GTF,
which helps insulin regain potency. He offers appetite suppressants for
the weight loss phase, but it is not mandatory to take these, since the
high protein diet usually reduces cravings. Exercise, which must be a part
of the program, improves insulin performance.
Once you start losing weight, your insulin goes down and you have
less craving. The goal is to increase lean muscle, which will reduce body
The goal of a food plan is
to feel satiated, that is, being able to forget about eating for 3 or
4 hours at a time. Certainly food choice is important. Letting go of
the sugar/ carbs that stimulate the cravings and eating more satisfying
protein and vegetables seems to be the most effective way for most patients.
important for you to find a food plan you can fall into without it being
a strain, or without being hungry.
It’s important to have smaller goals so you don’t
get overwhelmed. Even a little loss goes a long way.
If you lose only five pounds, you decrease your cardiovascular risk by ten
percent. With a ten pound weight loss, you decrease your risk of developing
osteoarthritis by fifty percent.
If you lose ten percent of your starting
weight (say 20 lbs. if you are at 200 lbs.), you gain a great deal of the
In his article, “Change or Die” in
Fast Company Magazine, (May, 2005) Alan Deutshman talks about how we
fight change, even in a health crisis.
Severe heart disease is among the most serious
of personal crises, and even that doesn’t motivate people to adult healthy lifestyles—at
least not nearly enough. Two years after cornonary-artery bypass surgery,
9% of patients have not changed their lifestyle, said Dr. Edward Miller,
the dean of Johns Hopkins Medical School. Nor does giving people accurate
analyses and factual information about their situations. What works? Why,
in general, is change so incredibly difficult for people? What is it about
how our brains are wired that resists change so tenaciously? Why do we
fight even what we know to be in our own vital interests?
Dean Ornish, who motivates heart patients
to make radical change, believes you have to appeal to people’s emotions, to reframe their
ideas of themselves. Fear isn’t as good a motivator as positive emotions.
If I believe I can have joy, I’m more likely to change. He also found
that radical, sweeping, comprehensive changes are often easier for people
than small, incremental ones. “People need to make big changes to
get immediate rewards, whether in health, weight loss or gains in physical
ability. Then they see that the changes are worth it. It’s a paradox,
that big changes are easier for people to make than small ones. Patients
often stop taking a cholesterol-lowering drug, he says, because they don’t
actually see the changes or feel better.” (p.60)
Dr. Mazouz believes that eating to lose weight
is different from eating a healthy balanced diet. He believes that if
the body has less carbohydrates, it will use the fat stores more quickly.
It isn’t about calories,
in his opinion. In Weight Watchers, you can eat what you want, as long
as it’s under a certain amount ohf points or calories . Weight loss
is slow, which can be discouraging for some. Others like the freedom to
eat carbohydrates and can manage the portion control and like the stimulation
of the meetings and group support.
Group support helps a lot. I’ve found
that people can hear something from another group member and take it
in more than they can from an individual therapist. In my group, one
member was able to stop throwing up after many years, when others expressed
concern for her health.
Come out as an overeater and talk about it. One group member can
model for another. One member made a firm decision not to be hard on herself
and this helped the others do the same.
In a group you feel like you’re not the only one. One member
says it’s the only place she can tell the truth.
So what happens when people give up the soothing fix that food
Many patients then have to experience the feelings they
have repressed with food and being with a good therapist who is skilled in
eating issues can help. Often rageful feelings about not having needs met
in childhood, or childhood trauma or sexual abuse can finally be processed,
once the feelings can be experienced in safety with another human. Others
feel they are coming out of hiding and waking up to the life they have been
avoiding with food.
Prochaska et. al says you can master the
problem and still feel that the change isn’t yours. “As the new behavior takes hold,
a new self-image, one that feels consistent with the healthier behavior,
gradually develops.” (p. 276)
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