Undertake Moderate Exercise

In the same way that dieting can become part of a vicious cycle of over and under eating, sedantary behaviour can be part of a vicious cycle of low perceived energy. Sedentary behaviour reduces cardiorespiratory fitness as one ages, leading reduced feelings of energy, and making exercise less likely. In the same way that patients may have attempted to use restrictive dieting to "control" their "bad" behaviours and weight, many will have a history of periods of excessive exercise. In their efforts to gain control and lose too much weight too quickly, they overdo excercise, causing pain and fatigue, which leads to a relapse in sedentary behaviour. The approach we advise involves a focus on increasing energy by gradual increase in exercise.

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.

Accepting a Healthy Weight

Health professionals should be concerned with optimising mental and physical health. Optimal physical health meaning regular, normaleating and moderate exercise which should lead to a lower weight and improvement in risk factors. If weight is lost slowly under these conditions it is less likely that the weight will be regained.

A "Healthy Weight" is that weight which can be achieved and maintained through this approach. We tell our patients that they can take control over their eating and their exercise, but that they cannot have direct control over their weight. The weight they achieve with a moderate life-style depends in part on genetic factor, their metabolism, the number of fat cells accrued in their youth and possibly on the effects of many years of dieting. Care must be taken to avoid the mentality that improved appearance through dramatic weight loss is a worthy goal. The social influence processes of the group are used to help people realise that they can be happy and loved without attaining a fantasy weight. If they cannot give up the fantasy of achieving a thin body, they will be forever engaged in a quixotic pursuit of an "ideal" weight.

Perspective

There is a growing anti-diet movement in the United States. The average participant in our weight loss studies for women has had at least three failure experiences with serious efforts to control weight with dieting on her own or through clinics. Although there is a great resistance to the idea of giving up dieting, most can be convinced to follow a non-diet approach as they know from their own experiences that diets have not been effective for them.

Adapted from "Nutrition Today", March/April 1993 and reproduced with permissions.