Some dieters find themselves developing binge eating patterns (Polivy and Herman 1985). In studies of patients presented for obesity treatment up to half are found to ave frequent eating binges. Binges are often precipitated by negative emotions, while the act of overeating seems to relieve the emotional symptoms. Bingers report feeling out of control and experience guilt and self loathing because of their self-perceived gluttony. As a result, binges are often followed by periods of increased dietary restraint and even fasting. The pattern is thus set for many patients in whom dieting may merely exacerbate an unbalanced relationship with food.

WEIGHT MANAGEMENT WITHOUT DIETING. In designing our approach to weight management (Foreyt and Goodrick 1992) we started with the assumption that a health professional should use treatments that have the best potential for healing the damage caused by years of dieting failure, perceived lack of self-control and social isolation often associated with being overweight. We felt a conservative-approach that could also optimise physical health, would include motivational techniques to help the patient develop a regular exercise habit.

The non-dieting approach to weight management that we are researching involves four componenents, which are applied in the following order:

1. Development of therapist and peer support.
2. Cessation of dieting and normalisation of eating patterns.
3. Gradual increase in exercise.
4. Acceptance of whatever weight is achieved with normal eating and exercise habits.

This approach is suitable for overweight individuals who have been frustrated by their attempts to control weight. The same principles apply to individuals who purge by vomiting or abuse laxitives, but treatment of bulemics may require more intense therapy and medical consultations.

Therapist and Peer Support

Because our culture idolises thinness and ostracises people of the basis of fatness, many overweight individuals grow up socially isolated with deficiencies in social skills. The struggle alone to become thin so that they will become acceptable and loved. However, failure at dieting only adds to feelings of self hatred and increased feelings of isolation. The way out of the cycle is to learn to develop loving relationships, first with oneself and then with others. The task of the therapist and therapy group members is to provide an environment in which self-acceptance can be developed independent of perceptions about appearance and in which social skills can be improved. The group forms an artificial world of acceptance and understanding, two commodities which are in scant supply for the overweight in the real world.

In these groups the message is that the overweight persons should not blame themselves for failure to achieve a lower weight. The metaphor used is that dieting is like trying to breathe throught a straw, eventually a person must give up and gasp for air. There is no guilt or blame associated with inability to sustain breathing through a straw; likewise, the lack of eating control caused by dieting is seen as a natural physiological response, not a character flaw. Peers who have experienced the same failures can be helpful in convincing others to rethink the self-depreciating thoughts that have been ingrained into many overweight individuals over years of perceived inadequacy.

This approach is suitable for overweight individuals who have been frustrated by their attempts to control weight. The same principles apply to individuals who purge by vomiting or abuse laxitives, but treatment of bulemics may require more intense therapy and medical consultations.

Normalising Eating Patterns

Participants are directed to eat three meals and a couple of snacks a day of whatever they want in order to get out of the habit of restrictive dieting. An important component of the plan is reteaching the subjects how to recognise true hunger as distinguished from cravings. Chronic dieters have often learned to ignore hunger. True hunger is the feeling of emptiness felt in the gut, while cravings involve the urge to eat something usually in response to an environmental or emotional trigger. These triggers could be as simple as the sight of food or as deep-seated as emotions stemming from buried childhood trauma. With a history of dieting many develop lists of "forbidden" foods and generally have much anxiety about succumbing to temptation. Some seem to feel that because they are overweight any eating is unaccetable behaviour. A relaxed attitude about all foods seems to be needed before qualatitive changes are made in eating patterns. If the anxiety is not alleviated a return to self-imposed restrictive dieting may occur.

Many binge eaters have a tendency to restrict their eating during the day, typically skipping breakfast and eating little at lunch or dinner. Binges usually occure in the early or late evening, which result in a lack of appetite in the morning; breakfast is missed, thus helping to repeat the cycle. Many of the participants in our study are amazed that they do not want to binge eat after eating a normal breakfast, lunch and dinner.