Martha thinks that this time, she's ready to really lose weight. I think she's not quite there yet.
One of my favorite ways of looking at people's readiness to change is known formally as the Transtheoretical Model of Change, known more commonly as the Stages of Change model. It was initially developed by psychologists James Prochaska and Carlo DiClemente, who wanted to understand the processes of change in psychotherapy, regardless of theoretical framework. The beauty of their model is that it applies to how people change, more generally. The model is good science-including the fact that it makes intuitive sense and is easy to understand. That also means that it can be readily used in practice, whether psychotherapy, coaching, or everyday application. I love it. (Recommendation: read Prochaska, Norcross, and DiClemente's Changing for Good.)

In brief, Stage 1 is Pre-Contemplation, aka denial. Other people may think you have a problem, but you're just fine, thank you. When you can acknowledge that something's going on, but you're pretty ambivalent about whether and what to do, you're in Stage 2, Contemplation. In Stage 3, Preparation, you try out the change. Seesaw-like though, you are likely to revert back to your prior ways of behaving. We think of Stage 4, Action, as what change really is: I was doing X before, now I'm doing Q. But as you can see, there's a whole lot of...yes, preparation...that comes before one is fully committed.

And then, Stage 5, Maintenance, is the point at which you have been committed to change and have been consistently doing the change for at least 6 months.

Martha? I've only known her a few months, and she tries, she really does. In that time, her weight has fluctuated by about 5 pounds: lost, re-gained, lost, re-gained. Her behaviors-the things that will actually get her weight to change (most notably, what she eats, how much she eats, and how much she exercises)-have fluctuated as well.

Martha has only recently begun to pay attention to the moments when she turns a metaphorical light switch "on" (I'm paying attention to what I'm doing) and "off" (all the rationales, new possible diet methods, spending sprees, emotional roller coasters, and I'm-just-not-going-to-think-about-its). When she can keep that light on with more consistency, she will have moved into Action-and truly start losing weight.

Elizabeth weighs, perhaps, the same as Martha-but she's come a long way, especially in the past four years. She has persisted; she has actually lost weight-75 pounds, as a matter of fact-with a lot of help from Weight Watchers. In Stage Theory, she is in Maintenance (of weight loss behaviors, not of weight loss: she still has another 20 or so to go).

I've only recently met her; what we've embarked on is the complex challenge of appreciating a new identity. She is "between selves."

Elizabeth grew up fat, teased, disliked, last-picked. She rarely dated, had few friends. The TV set and food were her companions. Now, she is in the process of letting those "companions" go...but who is she now? Who is she becoming?

She has always interacted with the world as-her term-Fat Girl. She sways from side to side as she walks-as if that non-existent 75 pounds still surrounded her. She's still baffled when she goes into a clothing store and can head for regular sizes. Intelligent, articulate, emotionally warm, she doesn't know what interests her. She's shy about meeting people. She is no longer Fat Girl...but she's not yet fully "Liz," the person she is becoming. (Her new moniker reflects, in the length of the name, her shift from large to small.) She is between selves.

How can she figure out what she's interested in and who she might want to meet? She may start by doing some web searches and finding some online groups, to get accustomed to her new "voice" with people who don't know her size one way or another; they're going to connect to her because of her self. She may soon become adventuresome: She may check out www.meetup.com for some group that sparks her interest. I've suggested some books to her: classics, like Susie Orbach's Fat is a Feminist Issue, and Marcia Hutchinson's Transforming Body Image. A colleague suggested Geneen Roth's new book, Women Food and God.

Finally, there's Bethany. She and I have worked together, off and on, for many years. Like Martha, she dieted and her weight bounced around. She stopped drinking...and then binge drank, yet again. Now two years fully sober and one year into systematic weight loss, Bethany knows how to keep the metaphoric light on. She and I reflect on weight and alcohol-as well as the meaning of life.
It would be so tempting, sometimes, to just flick that switch. Not to have to do all this work. Bethany persists. She appreciates yet further the layers of emotional protection that weight and alcohol afforded her for so long. She tears up as she recognizes the essential loneliness each of us needs to confront and acknowledge.

As she peels away the layers of fat and the miasma of alcohol, Bethany says, "I am finding my edges." Her process of self-definition and self-discovery, although challenging, is also exhilarating.