Kim* is an extremely attractive woman in her early thirties. She is married and has two small children. She also has a weight problem. As she puts it, "I take after my dad's side of the family. My mom and sister take after the other side. They are tiny and can eat anything they like. Dad and I gain weight if we just look at a cookie."
Over the years, Kim has tried every diet in the book: Weightwatchers, Jenny Craig, the Scarsdale, South Beach and McDougal systems - in short, everything she could find, she has tried. She has done colonics, fasts, and she has also tried not dieting. "I lose weight," she says, "and then I gain it back. And more."
In my experience there is almost always a rebound effect to heavy dieting - the more you restrict, the more likely you are to binge on all of the things that have been on your "do not eat" list. Another pitfall is the "I'll eat everything I love today, and then I'll go on a diet tomorrow." This, of course, is the story of the holidays for many of us.
But that doesn't mean you can't lose weight if you need and want to lose it.
I have found that for some clients going on a short diet can jump-start a healthy eating lifestyle. It gives them hope, makes them feel like they've got some control, and generally makes them feel better. But ultimately, I have found that the clients I work with who have lost weight and kept it off have learned to focus not on losing a certain number of pounds or reaching an ideal weight, but on finding an eating style that will last for the rest of their lives.
This may sound simple, but it's actually pretty complicated. Food is about nutrition, of course. But as we all know, it has all sorts of psychological and emotional meaning as well - and an eating style that works has over time has to take those meanings into account. (Susan Albers, an author with several terrific books and a wonderful blog on PT, is one of several other PT bloggers who writes about this). When I started working with people with eating disorders in the early 1980's, we thought we had found the underlying psychological reasons when we connected food with mother, and suggested that a binge could be an attempt to feel close to a distant mother, or to express anger or frustration towards a controlling or hurtful mother. But those interpretations, like many others that we made in those days, turned out to be way too simplistic.
Not only are the psychological factors behind binges more complex, but research has suggested that weight, like height and other physical characteristics, is at least partly determined by biology and genes. http://www.nature.com/nature/journal/v463/n7281/edsumm/e100204-10.html
Other research has shown links between depression, anxiety, and other difficult emotions and over-eating. http://www.nature.com/oby/journal/v11/n2/full/oby200331a.html In order to lose weight and keep it off, we have to be able to tolerate the discomfort of being hungry, of course; but we also have to be able to manage all of the other uncomfortable feelings that eating helps us fend off. And that is not a simple process, particularly because food also soothes and comforts us.
It's also complicated by the fact that most people do feel better when they lose weight. But as the weight starts to come off, the good feelings are sometimes replaced by other, less pleasant ones.
Shortly after Kim started therapy, she decided to limit her intake of fats and sweets, but at my suggestion she did not completely eliminate all of her favorite foods. By keeping those elements in her diet, she did not feel deprived and therefore did not suddenly find herself binging on those foods. Still, it was a slow process, with several periods of overeating and gaining weight again.
After a year she had lost nearly twenty pounds and seemed to have truly found a food plan that she could maintain for the rest of her life. But one day she came in and said she had started to overeat again. She could not figure out what had happened.
I asked her when she had noticed that she had started overeating. She said it had been going on for a few weeks. But, she said, she hadn't really gone back to old behaviors; it was just that she was eating more than she had been.
This was a positive sign. Overeating, for someone who has a pattern of using food for emotional reasons, is going to happen from time to time. The fact that she had noticed it and was bringing it into therapy was also important, since it meant that we could start to try to understand what might have triggered the behavior.
I encouraged Kim to talk about anything that was going on just before she started overeating. It took us several sessions, but eventually we realized that she started eating more after getting compliments about her weight loss. "I didn't like people looking at me. I felt vulnerable, exposed." Kim, like many heavy women, felt invisible with her extra padding. Although she wanted to feel more attractive, she had not realized that her invisibility was a sort of protection. Our next task was to figure out what she had needed to protect herself from. And this, too, was not a simple question to answer.
"I wasn't raped or molested as a kid," she told me, naming the first thing that many therapists start to ask about. "I didn't have any kind of trauma, other than feeling like a fat kid."
So what was going on? Over time, three themes began to emerge: Kim felt that as a slimmer person, people had higher expectations for her, and she worried that she could not possibly meet them; she also felt that she did not know herself anymore; and she feared that the people who had supported her as a heavy person would no longer be there for her.
Why had she suddenly become aware of these dangers? What had triggered the need for food again now? Unpacking the answers to these questions was a slow process, but here's the thing: just putting her feelings into words helped Kim manage them differently. And although handling feelings is not enough to on its own to make you lose weight, it can be a key to helping you keep it off.
What do you think? I would love to hear about your own experiences with this very difficult process. What has worked for you? What hasn't? Please let me know.
*Names and identifying information have been changed to protect the privacy of everyone